Health Revolution. Maria Borelius

      I’m working on a book that I’ve been thinking about for a long time.

      I once had a brother who died. My handsome, mischievous, idolised brother got sick in his twenties and was diagnosed with schizophrenia, a grim psychiatric diagnosis. In 1986, I lost him in a fire in a Stockholm apartment. Through a contractor project I’ve done for Karolinska Institutet, I’ve begun to think a lot about the stigmatisation of mental illness.

      Now I’ve decided to write a book that illuminates and looks into the taboo around mental health problems. This also involves dealing with the taboo within myself, the shame that I’ve felt – because mental health problems are looked at differently than physical disease. Aside from the sorrow, there’s this damned feeling of shame that rests over both the afflicted and their loved ones. And that makes us doubly ashamed. We’re ashamed because people we love have a shameful illness, and then we’re ashamed because we’re ashamed.

      I root around eagerly in everything that’s connected to this issue. I talk to researchers, read and interview lots of people with different illnesses, as well as doctors and nurses.

      While I’m looking through the latest research, a new branch emerges. It has a very long name: psychoneuroimmunology. It’s the study of how mental illness can arise in the brain, and how it’s linked to– here it is again – inflammation. Hmm . . .

      In other words, on the one hand there’s a connection between immune defence and inflammation, and on the other hand, a connection to brain health? Fascinated, I look more closely into this connection.

      We’ve already mentioned all the foot soldiers that are sent out by the immune system. Among them are the cytokines, triggered by inflammation to show up in huge numbers – something called a cytokine storm. This storm, like a swarm of bees, starts up the body’s defence system in the form of the so-called B and T lymphocytes. But the cytokines also talk directly to the brain.

      Let’s say that again. The immune system and the brain talk to each other.

      This is a new piece of knowledge, a new puzzle piece. I investigate further.

      The American researcher Robert Dantzer did the pioneering work that showed that the cytokines triggered by inflammation also affect the brain’s signalling substances: dopamine, serotonin and noradrenaline. Since these substances directly affect how we feel, physically and mentally, cytokines can change how we feel in emotional terms.

      When you have a high inflammation level, the cytokines decrease the levels of dopamine, noradrenaline and serotonin. You get a feeling of illness, like when you’re coming down with something. You feel low, tired, withdrawn. And when the inflammation decreases, the number of cytokines also decreases, and the signalling substances can flow again at a normal level in the synapses of the brain.

      I add this to what we now know about signalling substances, highly simplified. Balanced dopamine levels provide more energy and self-confidence. Balanced serotonin levels lead to more calm and less anxiety. Balanced noradrenaline levels lead to increased alertness.

      That’s exactly the change that I’ve felt in myself. This is interesting . . .

      Not only does this train of thought offer new possibilities for understanding how mental illness begins, but perhaps it might also account for my new, brighter mood. A signal sent directly from my decreased inflammation level up to my brain might actually be affecting my mood. Has the new diet rearranged my brain chemistry?

      I have to keep digging.

      Researchers can demonstrate a connection between the degree of inflammation and depression, as well as between the degree of inflammation and the risk of suicide.

      Suicide is today the most common cause of death among young men. One of the explanations is that there are too few resources available in the scandalously downsized psychiatric acute care centres. The doctors are forced to make a brutal selection among all the people who are seeking help, asking themselves terrible questions like ‘Who is actively likely to commit suicide? Who can we consider to be managing adequately at home, in spite of their depression?’ They are forced to look for those patients who have the highest risk for suicide and send home the rest even if they are feeling unwell.

      Since the price of making the wrong judgement call is so incredibly high, people have looked for more objective markers, something that can be measured, instead of simply asking the patient questions. As most people who have known someone who committed suicide realise, a person who really wants to commit suicide will hide it.

      At Lund University, the researcher Lena Brundin found that in people with depression, the will to commit suicide was directly linked to the degree of inflammatory markers in the blood. Not only that, but the degree of violence used in the suicide could also be correlated with the degree of inflammation.

      In autumn 2017, new research was presented in London, where scientists from the University of Cambridge argued that there is a ‘very robust link between inflammation and depressive symptoms.’ Professor Ed Bullmore, chief of psychiatric staff, pointed to the fact that people who have just received vaccinations and people who take inflammatory medicines get depressed more often. The teams are now thinking of depression as a physical illness that might be treatable with anti-inflammatory measures.

      It turns out that 30 per cent of people who suffer from inflammatory diseases like rheumatism are also depressed, making that group four times more likely to develop depression than the general population.

      Schizophrenia has also turned out to have connections to inflammation, in research carried out at the Karolinska University Hospital by the psychoneuroimmunologist Sophie Erhardt, a pioneering scientist I had the privilege of meeting when we both became involved in the Swedish Psychiatry Foundation’s work. The same goes for bipolar illness.

      It’s clear that cytokines are linked to poorer mental health for people, and cytokines are produced when there is inflammation.

      I’m now hearing more and more researchers say that there’s a real connection between immune defence and the mind. Might these mental illnesses actually be immunological diseases? Which one is the chicken and which is the egg?

      More and more doctors are coming to radical conclusions.

      ‘Our old model of care, where we make a distinction between body and mind, is completely outdated, where psychiatric care is provided by psychiatric specialists and physical care by doctors and nurses who specialise in the body. We have to begin to educate people within healthcare who can bridge this gap – between immune defence and the nervous system,’ thunders Professor Robert Lechler, chairman of the British Academy of Medical Sciences, in an interview in the Daily Telegraph.

      Everything is connected, and the link is inflammation.

      This is the very front line of research. I’m standing right at this front line and probing it as I’m writing this book, and I see the inflammation trail grow red hot again. I have to dig deeper, even though it’s sometimes tough going – very tough.

      I have the twenty-five-year-old grief of a big sister simmering away inside. It’s been shut up in a closet with the door bolted shut and marked with a sign saying ‘Open at your own risk!’ In that closet lives the grief I feel for not being able to save my brother. It sometimes feels like I’ve gone straight down into a black hole while I’m working on this book. I also encounter the sorrow and anxiety of the people I interview, people who have been stricken with serious illnesses and sometimes met with little understanding from the outside world; who feel alone and vulnerable even though they’re fighting with such courage. It touches me at my very core, since I understand them all too well.

      But then I notice something. The afflicted and their families say almost exactly the same thing: when