Mental Health and Mental Illness Basics Part 1: Risk and Protective Factors

Talking about mental health and mental illness Fundamentals Part one. So there's obviously two parts to this, and this is based on the Surgeon General's report on mental health. In this presentation, we're going to explore the neuroscience of mental health, how mental illness manifests itself. We'll learn about the prevalence and epidemiology and the costs of mental illness a little bit. We're not going to go into that a lot because it's, you know, not all that interesting. We'll explore the biological, psychosocial, and individual risk factors for mental illness and review the differences between correlation and causation in order to determine consequences. So let's start with the neuroscience of mental health. And one of the things that, you know, it's really important to remember is that a lot of our feelings, our emotions, our ability to think and perceive things occurs in the brain. And, you know, so if your brain is not healthy and happy, then it's going to be hard to feel healthy and happy and concentrate and do all that stuff. So, you know, we want to focus on this. And I'm not going to get deep into the details with the diagrams of the axons and the dendrites and all that, because, you know, that's really technical. And we're just going to hit the highlights today. The working of the brain depends on nerve cells being able to communicate with each other. Well, that makes sense. Now, there are two different things that impact that Structural and nutritional is kind of how I categorized it. Structural means, you know, if a neuron gets damaged in some way, if it gets burned up, if it gets injured in a traumatic brain injury, something like that, it could cause a problem with the neurons communicating with one another. Nutritional is when the neurons have the nutritional components necessary to make the neurotransmitters and to secrete them into the synaptic space. Each neuron makes over a thousand connections. So one neuron is really important. And we have, like, billions of neurons in our brain. So it's important to recognize that each one has over a thousand connections. One of the cool things to recognize, though, is also the fact that, well, it has 1,000 connections. Since there are billions of neurons, if one goes a little wonky, then there is a workaround, which is why a lot of people with traumatic brain injury are able to, or after stroke, can redevelop a lot of the skills and things that they had, if not all of them, before that brain injury. Now, the frontal lobe is involved with our motor behavior. It's involved with how we physically react to Situations. The prefrontal cortex, which, you know, you can kind of think of as your forehead, is responsible for planning and integrating cognitive and emotional streams of information, which is a really fancy way of saying it takes how we're thinking about something and helps us figure out how we feel about it. So if we're thinking about something as scary, then we're going to have an emotional reaction, which is fear, and it's going to synthesize those two things together. If we're thinking of something as exhilarating, then it's going to synthesize that, too. So, you know, the example I usually give is roller coasters. I'm terrified of roller coasters. Some people love them. We can look at the same exact roller coaster and have two very different emotional reactions based on our cognitions, our thoughts about the roller coasters. The other thing that's important to remember in neuroscience is the brain continues to develop until you're about 25. That impulse control area is still developing until about 25. So we want to make sure that in this development process, the brain has all of the abilities, through good sleep and adequate care and good nutrition and all that stuff to develop as fully as possible. They found that a lot of the brain injury that occurs as a result of chronic stress, trauma, and substance use is actually significantly worse in people who experience those things before the age of 25, because the brain's still developing. So that just throws a monkey wrench into the works. So, you know, we do want to look at the timing of some of these stressors in addition to just the stressors themselves. So electrical signals from the neuron are converted into chemicals called neurotransmitters. So neuron, the sending neuron basically secretes neurotransmitters into the space between neuron number one and neuron number two. The neurotransmitters are released from the sending neuron into the space, and they attach, like a key into a lock called a receptor on the receiving neuron. So the receiving neuron passes on that. That signal, and it's kind of like that game you used to play when you were a kid, telephone. You know, everybody would pass along the message. Well, if there's a breakdown in the system, if there's not enough neurotransmitter, the wrong neurotransmitter goes through. Then you know there's going to be a breakdown in the system and how people feel, think, or react. The more receptors that are stimulated, the more intense the reaction. If a little bit of neurotransmitter is secreted and only two or three receptors are stimulated, that's going to be a pretty low reaction. If 50 or 60 neuro receptors are stimulated, that's going to be a more intense reaction. So, for example, when somebody takes cocaine, you know, that is an excitatory drug that we take. It secretes the excitatory neurotransmitters like glutamate into that synaptic cleft. So then the receptors, it's just flooded and that just floods into the receiving neuron and it finds every single lock that's available. So the person gets this, like, supercharge of excitement. The excitatory neurotransmitters include norepinephrine and glutamate. And this is really pretty overly simplistic because most neurotransmitters are involved in a lot of things. And we have other videos on the All CEU's education channel@allce.com YouTube about neurotransmitters and neurobiology. So you can get into the depths of that a little bit more if you want to. Inhibitory or calming neurotransmitters include gaba, which is our main calming neurotransmitter, and to some extent, serotonin. And we hear a lot about serotonin in terms of it being an antidepressant. It is also an anti anxiety neurotransmitter. Serotonin also is responsible for a lot of other things, including libido and appetite and pain perception and heart rate. It has 14 at least different functions in the body. Other neurotransmitters that we hear about a lot include dopamine. And dopamine has at least five functions. It is our pleasure chemical. So if we secrete a lot of dopamine, it's going to tell us, do that again. It helps us concentrate and learn, and it motivates us. So dopamine is really important. Acetylcholine, you know, that's another one of those neurotransmitters. It's more involved in schizophrenia. Endorphins are our natural opiates, so we have those going in there. And endorphins help us not feel pain as much and feel a little bit happier. And Substance P is one that we're learning about now and, you know, we've just started to learn about over the past 20 years. But it is responsible in part for pain regulation, anxiety regulation, and stress management. Neurotransmitter availability is impacted by the presence of other neurotransmitters and Hormones, and I'm going to show you a couple diagrams in a couple of minutes. But neurotransmitters, if there is cortisol in the system, which is a hormone, that is our stress chemical, and our stress chemical is telling our body, fight, flee, protect yourself. So it is going to basically shut down or reduce the availability of things like GABA and serotonin, because the body is trying to fight or flee the presence of certain hormones. If you have not enough estrogen or not enough testosterone, it impacts the availability of serotonin. So everything is interconnected. We can't just say, you know, we want to increase serotonin. We need to look at what's causing serotonin to be low or what's causing GABA or dopamine to be low. The other thing that impacts the strength of the neurotransmitter is the quality and quantity of it. So if you're not eating a good diet, and I'm not talking about being a super nutrition freak, I'm just talking about getting some basic proteins in there and some vitamins. If you're not eating a quality diet, your body can't make the neurotransmitters, they can't make the neurotransmitters, it can't secrete the neurotransmitters. So you're not going to feel as much. You're going to feel flat blah, or you're only going to feel or really feel intensely. The neurotransmitters that your body does have. The building blocks to make vitamins and minerals help break down amino acids, which are proteins to make neurotransmitters. And again, I'm going to show you a diagram in a second. So it's important to understand that you can't just have crap, you know, crap in produces crap out. So we want to make sure that you're getting something relatively healthy. But without proper nutrition and adequate stress management, remember, we want to keep that cortisol from disrupting the whole system. The neurons will not be able to function effectively. So we need to make sure that the neurons are not disrupted by too much stress and too much cortisol, and that they have the building blocks to make the new neurotransmitters that will help us feel happy and calm. So here's the first diagram, and this is how serotonin and melatonin are made. Tryptophan is a protein that we eat, and it's available in, you know, most any food. So it's not like it's Hard to get tryptophan. But tryptophan requires iron, Magnesium, calcium, vitamin B6, and folic acid to be converted or broken down into something called 5htp, which is a precursor of serotonin. Okay, so we have five htp. That's kind of like, you know, raw fuel. It still has to be distilled down to make the stuff that we put in our car. So 5 HTP has to have vitamin C, vitamin B6, zinc and magnesium in order to be broken down to make serotonin. Okay, so now we have serotonin. And serotonin is responsible for, like I said, a lot of things like libido, appetite, sleep, pain perception, as well as depression and anxiety and other things. So if you don't have enough serotonin, you may have gut and heart problems, you may have sleep problems, cravings for carbohydrates, alcohol and other certain drugs, and fibromyalgia and other pain conditions. When your serotonin level is low, your pain tolerance is lower. The other thing with serotonin is it is broken down to make melatonin, and melatonin is our sleep hormone. So if you don't have enough serotonin, you're probably not going to be sleeping well, which puts you in a state of stress. Your body says you're exhausted, you don't have the energy to go. You're kind of the weak lion in the pride, and you're going to be the one that's going to be killed first. So you need to be alert. And our body operates on a very primitive survival mechanism or thought process like that. So when you're stressed, your HPA axis, your hypothalamic pituitary adrenal axis, or your threat response system, because that's a lot easier to say, gets activated. So when you're under stress because you're in pain, you're injured, you're sick, or, or you're just stressed out, the brain tells the body to release cortisol, which is your stress hormone, and adrenaline, which is your get up and go hormone. All right, sounds like a good plan. If you're under stress, you need to get stuff done. So these things cause the release of glucose, which is blood sugar. That's great. Gives you the energy to get the stuff done. It suppresses sex hormones because right now you're under stress. It is not the time to be procreating. It's the time to be protecting your own self. And it also suppresses serotonin. It suppresses serotonin because you are under stress right now, your body perceives a threat of some sort. So it doesn't want you relaxing, it doesn't want you chilling out. It wants you activated. So it suppresses serotonin, which can be a calming neurochemical. So what does all that do? Well, that means that you have very little libido. And when your serotonin is suppressed, your anxiety can go up and your depression can go up. You don't have as much melatonin, so you're not getting as much sleep. So you're going to start to feel fatigued, and you may start feeling more irritable. Well, when you're fatigued and feeling irritable, then that generally leads back and intensifies the body's threat response. So you get in this negative cycle here, and you have to figure out how to break it. So all of these things play together that it's really important to recognize. You can't just pluck out one thing and go, oh, let's just increase this, and everything will be fine. That may not be it. In a lot of my other classes, I talk about making a good marinara sauce. When you're making a good marinara sauce, you have basil, parsley, oregano, garlic, onion, fennel. You have lots of different spices. And if you taste it and it tastes a little bit off, it doesn't just mean, let's just add some more oregano, because oregano may enhance the flavor of a couple other spices in there. So then those spices are too strong, and you've got to play them down. So it's a gentle balancing act between all of the spices in the marinara sauce, just like it's a balancing act between all the neurotransmitters in the brain. So when people's brains are not functioning optimally, when they don't have adequate neurotransmitters, they may start to feel depressed, anxious, angry, or they may start experiencing something more severe, such as psychosis or dementia. So let's talk about. How does mental illness manifest? This is really important. A lot of times people think of mental illness at its late stages, and if we pick up on the signs of mental illness, and I really hate the term mental illness because it's so pathologizing, but if we pick up on the signs of depression and anxiety and that kind of stuff early, then we can prevent it from causing ripples of problems. So what does it look like? Think about when you're anxious. You know, you may have rapid heart rate, you may have muscle tension, you may feel lightheaded Those are all stress reactions. Those are all cortisol and adrenaline reactions that result when your body perceives stress of some sort. And it can lead to anger, it can lead to anxiety. Just kind of depends on whether you choose to fight or flee the situation. But these are signs that you know you're not happy. Fatigue is common. It can be common in anxiety when you're anxious for so long, at a certain point, your body goes, I can't win this fight. So it stops devoting as much energy to that when you're anxious for too long. Remember, on that last slide, when you're anxious, your body is not letting you get good quality sleep. It's kind of like a soldier sleeping in a foxhole. You may doze off, but it's not going to be good quality sleep because you got all that cortisol running through your system. So eventually you're going to get fatigued, if nothing else, just from lack of quality sleep. You may have appetite changes. Some people have no appetite at all. You know, food just makes them sick. Other people start craving carbohydrates and things like that. Remember when on that last slide, if you don't have enough serotonin, you may start having cravings for carbohydrates, alcohol, and certain drugs. Well, when you're under stress, your body is suppressing serotonin. So guess what? You may start craving carbohydrates especially. You may have dysregulation of mood. And I've never really liked that term, but it means you have excessive anxiety or fear or excessive irritability or anger or depression. And what's excessive is what starts being problematic for you or what lasts for more than, you know, a couple of days. We all experience these emotions when something happens. We can feel anxious or angry, or when we lose something important, we can feel depressed. And those are normal emotions. I don't want you to get the idea that we don't want to feel those things, because we do. We want to feel the full range of emotions, though. So when it becomes too much, when it starts interfering with your relationships and your motivation and your work and all that other stuff, then we need to start taking a look at it. Cognitive dysfunction is another thing that can be an example of mental illness if you start having difficulty with memory or concentration. Now, norepinephrine and dopamine are two of your neurotransmitters that are involved with memory and concentration. And when people get anxious, when they get depressed, or when they start having other problem mental health problems, Memory and concentration are some of the first things to go. So you do want to pay attention. After a baby, for example, I had what I called mommy brain. For the first year, I wasn't sleeping as much as I would have liked to, and I would walk into a room and couldn't remember what I walked in there for. You know, I was 28. It wasn't like I was, you know, 68 or 78 and. But the difficulty with memory and concentration was more because of my fatigue and that system not working as efficiently as it could. Other things like deficiency of thiamine can cause alcohol related dementia, which can make it difficulty for people to remember or concentrate or function in daily life. And finally, disturbances of thought and perception, such as hallucinations, thinking you see, hear, taste, or feel something that's really not there, and delusions. And those are like delusions of grandeur. You think you are God, or you think you're the president or whatever, or you can have delusions of persecution where you think spies are chasing you. So there are a lot of disturbances of thought and perception. But to most people that hear those, they're going, yeah, I'm not thinking. So. But to the person who is experiencing those disturbances of thought and perception, they make perfect sense. So you can't rationalize with somebody who's having hallucinations or delusions. You just need to accept that they're in a different space right now. These are all things we want to be on the lookout for in ourselves too. Think about when you start getting burned out at work or you start getting to a point where you might be depressed, that's the time you want to intervene. What symptoms do you have? You know, I know I tend to get a lot of muscle tension. My neck hurts a lot, I'm fatigued, I crave carbohydrates. You know, I know I'm going down a bad road. If I continue doing what I'm doing and I don't step back and say what needs to change. So anxiety is one of those mood disorders that we talk about and a lot of people have. When you experience something that triggers the fight or flight response, you can either feel anxiety, which is the flight response, it says, get me the heck out of here, or the fight response, which is saying, either I can't get out of here so I need to protect myself, or I am going to conquer this threat. Either one is in response to a threat. Obsessive compulsive disorder, panic disorder, and phobias all kind of fall under this anxiety umbrella. One thing that's interesting about obsessive compulsive disorder is it has components of anxious emotions. So it has an emotional component, obsessional thinking, so it has a cognitive component and behavioral compulsions. When people have ocd, they start getting very, very worried and very, very anxious that something bad is going to happen if they don't do something. And in order to make those thoughts go away, they have to do that like check the door or check the stove. And that helps them feel a little bit calmer for a short period of time. So let's talk a little bit about how common are mental illnesses or mood disorders. According to the CDC and the surgeon general, about 20% of the U.S. struggles with a mental illness in any given year. And this is true for adults and children. Think of 20% doesn't sound too bad. But when you think of it in terms of numbers, that means one in five people. So look around your office, look around your church, look around your own household. If you've got more than five people in the household, there's a chance that one of those people may experience mental illness in this 12 month period. That's a lot. And that doesn't mean 20% of the population over here will ever experience it. That means in one year. So those 20 may experience it in 2017, and then, you know, 5% of them get better and then another 5% experience it in 2018. So a lot of people are going to be touched by mental illness at some point in their life. In 1996, over $100 billion was spent as a direct cost of mental illness in the U.S. now, direct cost relates to hospitalizations, medical treatment, those sorts of things. Indirect costs are costs such as employers who lost productivity from employees. It's estimated that greater than 45% of people will experience an addiction in their lifetime. Now, I'm not necessarily talking to drugs or alcohol. You know, it can be sex addiction, it can be smoking, it can be food issues, or it can be alcohol or drugs. There are a lot of different addiction or addictive behaviors out there. But it's estimated that nearly half of people will experience one in their lifetime. So we need to be aware of that because it doesn't matter what kind it is. It negatively impacts the person's life. That by definition, for it to be an addiction, it has to negatively impact the person in two or more areas of their life. So while that sounds kind of all depressing, what do we know? Well, we know that there are risk and protective factors, and those factors can be in the Individual, they can be in the person's biology or they can be in the psychosocial realm, which kind of encompasses their environment, their friends and all that other stuff. Well, that's great. So there's all these risk and protective factors. So why don't we know what causes it? Well, because we've never been able to find a one to one causation where we can say if this happens, then this person is definitely going to develop an addiction or become depressed. We have a lot of information out there and we're going to talk about these risk and protective factors in a few minutes. But it's important to recognize that correlation means, you know, it's more likely if the person has, you know, certain genetic characteristics like a family history of depression and they're exposed to trauma when they're a child, then they have a stronger chance of developing depression or ptsd. It doesn't mean it will happen. There is, you know, a lot of variation there. So causation, we don't know. Correlation, we're quite sure of. Causes of health and disease are generally viewed as a product of the interplay or interaction between biological, psychological and sociocultural factors. According to the biopsychosocial model, one factor by itself may not weigh in very heavily, but the combination of factors are exponentially additive. Which means you may have a genetic predisposition, but if you've got a great environment when you're growing up and you've got good self esteem and you take care of yourself, that genetic predisposition may not ever show itself. But if you have a genetic predisposition, an unhealthy environment, and you know, you have low self esteem, for example, all of those things together may add up to finally cause that problem to express itself. Mental disorders arise in part from defects not in single genes, but multiple genes. So they found a lot of physical problems that have occurred as a result in defects in a single gene. So they can look on the, on the DNA and they can go, that one, you know, that's a problem. Mental disorders, we haven't found a causation, we haven't found a gene that we can say if the person has this gene, they're going to develop depression. We've also haven't found a correlation, a strong correlation where we can say if they have that one gene, then there's a strong chance they'll develop depression. There are multiple genes that have to be interacting. Mental illness appears to result from the interaction of those multiple genes that confer risk. So a person may have genes to have a more irritable or fussy temperament as a child, and in addition to a genetic predisposition or a genetic inheritance of certain genes related to depression. So there's a lot of stuff that goes in there. One thing that's good to know is that no gene is equivalent to fate for mental illness. So we're not going to look at the DNA and go, you're definitely going to develop schizophrenia or you're definitely going to develop depression. We can't say that there are modifiable environmental risk factors which can become targets for prevention efforts. And we're going to talk about those in a couple slides. Even with a high level of heritability such as schizophrenia, it's essential to point out that environmental factors such as environment, nutrition and healthcare access play a significant role in the severity and course of the disorder. Again, not everybody who inherits a gene for a mental health disorder like schizophrenia that does tend to have high heritability will necessarily develop it. If they have a really good environment. Infectious agents can penetrate into the brain where they can cause mental disorders. So this is one of those risk factors that is generally modifiable. We do want to protect ourselves from as many viruses and infectious agents as possible. Some examples include HIV associated dementia, which happens because the immune cells in HIV get, you know, messed up and they're called macrophages and they indirectly call cause the death of nearby neurons because they release toxins as they're trying to destroy the virus and other things. So it's kind of the byproduct, kind of like the gas, or not the gas, but the. What am I thinking of? The exhaust that comes out of our car. The byproduct is what's killing these nearby neurons. Herpes simplex, encephalitis. Sometimes when people get herpes, it can migrate to their brain and cause their brain to swell measles. Encephalomyelitis can cause the brain to swell rabies, encephalitis. You know, all of these obviously are penetrating into the brain and causing physiological disruption in the neurons in the brain. And there's also a new classification of obsessive compulsive disorder called pandas, or pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, which basically means the kid got strep and the strep went to the brain. The strep infection somehow manages to attack a part of the brain called the basal ganglia, which results in OCD, or obsessive compulsive disorder. Symptoms, so what can we do? And I said we were going to talk about risk factors, but I changed my mind. And we're going to talk about protective factors. Adequate prenatal care. Let's make sure when the fetus is in there, it's getting everything it needs and it's not exposed to things like alcohol, drugs or viruses, including toxoplasmosis that can potentially cause brain injury. Adequate medical care. Once the child is out of the womb, we need to make sure that they are not exposed to those viruses and if they have a head injury, they get treatment, etc. And this is true for adults too. You know, any of a lot of these things can happen when you're adults. Herpes simplex encephalitis or HIV associated dementia. You know, we can get herpes, we can get hiv, or if you're not vaccinated, even measles when you are older. And it can cause brain damage and poor hygiene and health practices. You know, wash your hands so you're not getting those potential harmful agents in your body. Get enough sleep and eat enough good nutritious foods so your brain can do its job. We need to keep the brain healthy and those are the ways to protect yourself. Biologically psychosocial protective factors. Now I'm going to start out with young children because they're unique. Young children need attachments to responsive caregivers. So it's really important that they have a caregiver or several caregivers that are responsive and comforting and all that kind of stuff that goes a long way to the development of trust and self esteem and self efficacy. You can learn more about that in our videos on child development. And they need to have consistency in rules and parental supervision so they need to understand the environment and feel like they've got some control in what's going on. Now for all people from infants through elderly, we need a safe, nurturing, somewhat stimulating environment. Safe from physical harm, safe from emotional harm. It needs to be nurturing. So we have friends, we have family, we have people that care about us and stimulating enough to kind of keep our brain working because if you don't use it, you lose it. And they've done a lot of studies that have found in the elderly population, those people who stay more cognitively engaged and more physically engaged tend to have fewer signs of dementia and cognitive decline. We want to protect everybody from abuse and neglect. Not only does that hurt self esteem and mood and produce a lot of anxiety and stress, but it can cause physical damage to the brain. We want to protect people from abandonment and life stress. Now life stress happens, but we do want to try to mitigate that as much as possible and protect them from feelings of abandonment so they always have, hopefully somebody they can rely on. We want to protect people from being in a household with a member that has a mental illness or substance use disorder. When you're in a household with somebody with depression, it can be exhausting, it can be depressing, it can be frustrating, it can be a lot of unhappy type emotions. So we do want to make sure that if you're living with somebody with mental illness or substance use disorder, you have support outside of the home. And household conflict and family dysfunction increases everybody's stress. So we do want to make sure that we're addressing that. We want to make sure people have consistent support, positive peer relationships, school and work success, and some sort of a sense of control over their environment. For individuals, we want to look at, you know, what things may contribute. Well, you can't really control whether you were a full term or a premature birth that just happened. But that is one of those individual characteristics. If a child is born premature, you know, all of the stuff didn't finish linking up before they were born. And the more premature they are, the more likely they are to have difficulties which can lead to developmental delays. So it's important that this person receives early intervention for developmental delays which may be genetic because of down syndrome or something else or illness related. Children who have lots of ear infections often have developmental delays which can cause them to struggle in school and in peer relationships. And it's been linked to to increases in depression and anxiety. And prematurity is also in there. It's not really an illness or genetic, but we do want to make sure that early intervention is available. Physical disabilities, people need early intervention and children can be born with them, but they can also be acquired at any stage in your life. And when people lose the ability to function in some way, if they lose their sight or lose the use of an arm or whatever it is, it has a significant impact on their sense of self. It also results in a period of grieving and some anger and some other stuff that we need to help people work through or people need to work through it. But it's important that people recognize if I develop a disability or if my child is born with a disability, you know, we're going to have to figure out how that person can learn to accept and embrace that disability. As, you know, being differently abled, comorbid mental health issues. We want to look for Them. Sometimes a child may be born with, you know, mental health issues and start showing signs of depression or anxiety or OCD or ADHD at a very young age. It's not super common, but the earlier we catch it, the earlier we can provide intervention and prevent it from having a ripple effect on their development. Temperament, you know, everybody has different preferences for the types of environment they like to be in. If people are aware of their temperament, then they can put themselves in environments that are in line with what they prefer. For example, you know, extroverts tend to be like to be around a lot of people. They draw energy from other people, whereas introverts don't. And my daughter is an introvert and we'll go to martial arts or she'll go to a picnic or something and she'll come home and she's like, okay, two hours of extroverting was plenty for me today. And she will just want to go to her room and draw or you know, sit on the couch and veg for a little while because it's draining for her, but she recognizes that. So if she has to go into a situation that adds a little bit of stress, she recognizes it and then takes care of herself before and after. So knowing your temperament doesn't mean you can always be in your preferred environment, but it means you know what's going to be stressful. So you can save up energy leading into it and you can take care of yourself afterwards, which helps prevent exhaustion, frustration, depression, anxiety. A high self esteem is great because it means you feel good. You're not relying on somebody else to tell you you're okay. So developing a high self esteem in children is awesome, but if it didn't happen when you were a kid, no harm, no fat. Well, a little bit of harm, but it's not irreparable. People can develop their self esteem as adults and getting adequate nutrition and sleep again so the body can do what it needs to do. Those are all things the individual can do to protect themselves. So mental health is largely impacted by the functioning of the brain and the learning experiences of the person. So remember I referred to the roller coaster? You know, I look at a roller coaster and I'm terrified. Somebody else looks at a roller coaster, they think, wow, that's really awesome. I'd love to do that. I look at a dog running towards me barking and I'm like, oh sweet puppy. Somebody else may look at a dog running towards them, barking and carrying on and be like, that dog's gonna eat me. So it's all based on our learning experiences that we process. And then our brain figures out how we're supposed to respond, either with a calm response or a stress response. Damage to the brain itself or problems in neurotransmitter functioning can lead to mental illness. If certain parts of the brain get damaged irreparably, especially large parts, not just a single neuron, people can experience more apathy, depression, anxiety, or impulse control issues. Biological protection includes proper prenatal care and avoidance of viruses and substances which can harm the fetus or your own brain, harm your brain, such as HIV or hepatitis or herpes. Psychosocial protection includes ensuring a safe, supportive environment and the development of healthy coping skills. This can happen at any age. We all need a safe, supportive environment. And you know, most of us could use a little help with our coping skills once in a while because life will sometimes throw us more than we can handle, and that's when we grow. Individual protection includes good health behaviors, development of self esteem, and this is an ongoing process. We should, even as adults, we should be working on ensuring that we're developing our self esteem and we feel good about ourselves. Understanding one's temperament and needs, and receiving early intervention for any traumas, developmental delays or disabilities. So again, early intervention doesn't necessarily just mean childhood. It can be, you know, if there was a trauma, you were in a car accident, and you know, it was a traumatic experience. Getting early intervention for that can be vital to preventing the development of ptsd. Does it mean that everybody who experiences a trauma has to go to counseling? No, it's important for that person to check in and say, what resources do I have, what do I need? And can I manage this on my, on my own? But they provide early intervention for themselves, and if they realize they need more help than they've got available personally, then they can reach out for counseling. Other videos that relate to this are on YouTube. Remember I said you go to allceus.com YouTube and I have three different playlists. One's on self esteem development, one's on child development, and one's on infant toddler development. All of those can be useful. We also have videos on depression and PTSD and other things if you're interested. All right, well, thank you for joining me today and I will see you on Thursday.