, who heads up the at the University of Cambridge, has just published her first book, (Penguin). She explains how novel treatments, and a new emphasis on our sense of our body’s internal states, could transform mental health.
Liz Else: You have packed in some surprises in your book. Let’s start with what the title means.
Camilla Nord: I see mental health as a kind of homeostasis, as a balance, a very active state. It’s a way of coping with the changes in our external environment and inside our bodies. In both cases, our mental health is constructing a view of the world that is an attempt at balance.
Advertisement
Is the body undervalued in mental health research?
One key message in the book is that bodily processes have a profound influence on our mental health, but they are often disregarded or oversimplified. Interoception, the sense of the internal state of our body, is so important because it provides a lens on those processes: it can give you specific information about the sense of your heart speeding, or general information like feeling nauseous. It’s such a key filter through which we feel all our bodily processes. I think it is likely to play a role in mental health.
Many of the most influential experiments on interoception are about the heart because there are close ties between the beating of the heart and emotions. But the gut is another important source of interoceptive information, and some researchers think it may play a central role in mental health.
Why?
Your stomach contracts at a very slow rhythm, but when you feel nauseous, it contracts at an irregular rhythm. My lab ran a where we showed people disgusting images, which are very hard to look at. We gave some participants domperidone, an anti-nausea drug, which “normalises” the gut. Those who received the drug avoided the images less. What this means for mental health conditions is unexplored so far.
My lab ran a study where we showed people disgusting images, which are very hard to look at
Are you planning to explore it?
I’m planning to research pathological disgust. Many people with post-traumatic stress disorder have fear-related PTSD, but some have disgust-related PTSD. This is very difficult to treat because exposure therapy (which is very effective for fear) doesn’t work. I’d like to see if domperidone improves exposure therapy for people experiencing pathological disgust.
This is a very targeted way of tackling mental health. Are there other tools you value?
Computational psychiatry, the application of mathematics to mental health, is exciting because it helps us define precisely the differences in the behaviours and thoughts of people with different mental health conditions, and how treatments affect those conditions.
Is this part of a shift towards an evidence-based approach?
One of the ultimate goals is to move away from a diagnostic framework based on people in a room voting on what makes a psychiatric condition. There needs to be empirical evidence about where we draw the lines between conditions – something that has held us back from new treatments. How can we expect the same treatment to reduce depression in two people with totally different symptoms? This is a very difficult prospect, but we need to be looking for common mechanisms that cut across what we now think of as diagnoses, and tailoring treatments.
What if the therapies don’t work?
Even very effective psychological therapies may work in 50 or 60 per cent of people, but there are variations in how well. And if we can better understand techniques like, say, cognitive distancing, we can ask what can we add to help it along. Suppose before a cognitive behavioural therapy session, someone could take a particular drug that let them engage better with that session.
That sounds radical.
Right now, someone might be on long-term medication and receive therapy. In my lab, we’re interested in flipping that and asking, what if someone doesn’t need to take a drug every day, but a drug would help them with a particular therapy session or a particular therapy? Or maybe people could get “homework”, doing something that’s difficult for you and then reporting back to your therapist.
Maybe that experience could be made more powerful if it was combined with a biological augmentation. One of the most effective is psychedelic therapy, including MDMA and psilocybin.
Will this personalised approach be expensive?
Think about an MRI scan. A good one costs ÂŁ500. But what if you could use it to predict if someone is better taking antidepressants or receiving CBT? A personalised framework, maybe involving more investment at the start, would save money in the long run.
One study I like shows that exercising for more than a couple of days a week could make you less happy
Is there is a “mentally healthy” lifestyle?
When people think about the science, they think about a particular brain chemical they’ve heard is different in mental health [conditions]. But they don’t think their own lifestyle might have biological effects on their mental health: obvious things like exercise, sleep and diet have effects on your biology and thus mental health.
What about exercise?
One I like shows exercising for a couple of days a week is associated with better well-being, but beyond that it could make you less happy. That tells us even something that seems beneficial has individual components. One friend said, isn’t it unusual that even though I really like exercise, I don’t think it’s for everyone? I thought, no, that’s the point: you shouldn’t extrapolate from your own or someone else’s experience.
The ancients’ prescription was “everything in moderation”. Are you looking back at that?
I probably am. One thing that inspired me when I wrote the book was a contrariness against the idea that everything fun is bad for you. I thought, that’s so wrong. I even write about the positive mental health effects of alcohol, some recreational drugs, aspects of diet like sugar – and a late night out.
