Man is the only rational being, but what happens when a person loses the power to reason? Mental illnesses can have countless names and forms, but ordinary people usually include all of them in the basket that is called madness. “Madness is nothing. There are psychopathies, schizophrenias, depressions...” explains Dr. Koldo Callado. “Beyond that, every patient is a world; as a medical axiom says, there are no depressions, but depressed patients. We try to classify them into groups: depressive, schizophrenic... but within each group there are many types. Although the symptomatology is similar and falls into this group, each patient has its own characteristics.” In its latest

report, the World Health Organization (WHO) states that by 2020, the most serious health problem facing rich countries will be mental illness. Today, there are about 450 million mental patients in the world, almost 9% of all human beings. Of these, 121 million suffer from depression and about 50 million suffer from schizophrenia. The society has a distorted image of mental illness, according to Callado. “The media propagates stereotypes: the schizophrenic is a mentally ill murderer and the person who is sad for a week has depression.” However, this ignorance has a clear cause; psychiatric research has been lagging far behind other areas of medical research. Over the past ten years, there has been significant progress in this area.

One of these advances is the Bank of Brains of Bilbao. The only one in the Spanish State and the most recent of the nine in the world. Two years ago, the Spanish Ministry of Health created the CIBER network to promote collaboration between leading scientific research centres. In this Network of Biomedical Research, the CIBER-SAM began to be in charge of the investigation of mental illnesses, and the realization of a brain bank was considered essential. “Among the twenty best research groups in the state, we were selected to manage the bank because we have been working with brains for twenty years,” explains Callado. But the Biobank of Bilbao is not ready yet, “we are discussing how we will manage the bank. It should be noted that not all brain samples will be in the same place; some will be stored in Barcelona, others in Madrid, others here...”.

The pharmacological approach

According to the Biscayan doctor, the Bank will be ready by 2011, while research will continue in the same way as before: “On the one hand, we investigate what doesn’t work in the diseased brain, and once we know it, we try to get the drug it needs to repair the missing protein or the malfunctioning enzyme. This is the basis of the pharmacological approach.” Twelve people work with Callado in the neuro-psycho-pharmacology group at the Leioa campus of the UPV/EHU. They have about 900 brain samples from former patients with schizophrenia, bipolar disease, and/or depression. Many of them committed suicide.

Wanting to give life the tragic end of it is not only the result of the vicissitudes of everyday life. DNA can provide important information about whether a person is at risk for depression. “It’s clear that the neuro-psychiatric diseases we learn have a genetic component,” says Callado. Some people have a higher genetic risk of suffering from a mental illness, for example, if an ancestor has had a mental illness; this does not guarantee that they will suffer, it just means that they are at a higher risk. How smokers are at higher risk for lung cancer, even if they don’t always develop it.

In addition to the genetic component, the environment in which we live also plays a role in mental illness, especially stress. Depression can also be caused by common life events such as the couple leaving you, the death of a relative... But whatever the cause, those who are genetically at risk will always be closer to the disease.

In the case of schizophrenia, Callado explains the hypothesis that newborn children and/or those who are still in the mother's womb can develop the disease by contact with a virus, increasing the incidence in those who also have a genetic risk here. The causes of bipolar disease, on the other hand, are not yet known, but genetic, biochemical and environmental factors are known to play a role.

Bipolar disease, or bipolar disorder, is very difficult to diagnose because it is a cyclic disease. Also known as manic-depressive disorder, it is characterized by the emotional circumstances of the patient. The depressive phase of the disease is quite well known, but the manic period still raises many questions, David A. Kahn, Ph.D., Columbia University, USA Treatment of Bipolar Disorder: As he explained in his book A Guide for Patients and Families. He says that people who suffer from this disease can spend eight years until they are properly diagnosed, and the problem is that 6% of them end up committing suicide, Kay R. According to Dr. Jamison's data.

Mental illness and suicide, unfortunately, often go hand in hand, but not all diseases that affect the brain are the same. “On the one hand we have neurological disorders and on the other we have mental illnesses,” Callado explains. “Although everyone’s corpus is the brain, Alzheimer’s and/or Parkinson’s are very different diseases, such as schizophrenia and bipolar disorder. The first two are neurological conditions that are caused by very clear biological problems: in the case of Parkinson’s some neurons disappear and in a brain with Alzheimer’s you can see clear lesions under the microscope.”

The limits of the microscope

In the case of mental illnesses, there are also, in most cases, disorders in neuro-transmitters, but these do not leave clear physical evidence. “With a microscope we can’t see if a brain has schizophrenia or depression,” says Callado, “that’s why we have to rely on symptomatology to make the diagnosis.” While the patient is alive, a doctor must determine whether or not the person has a mental illness; and there are special tests developed for this purpose. Blood tests do not reveal anything about these diseases, as they leave no clear physical trace.

This is why the Biobank of Bilbao is so important, because the brains will be accompanied by clinical diagnoses. Not everything in mental illnesses is purely chemical, although the organic component is vitally important. “Before we die, the medical records of these patients will give us a lot of clues about the behaviors of these poor brains.” Studies have shown that there

are organic defects in the brains of most patients, but many of them have enough with psychotherapy, such as leaving a depression behind. Although Callado works to find a drug that will improve the lives of patients, he complains that sometimes the patient is medicated too quickly: “In the United States, unfortunately, they give pills directly to those who are sad, which is not correct.” But you don’t have to go that far, because in the Basque Country there is an annual increase in sales of anxiolytics. However, it is not only the professionals' responsibility for the excessive tendency towards drugs. Enrique Echeburúa, Professor of Psychology at the UPV/EHU, believes that we are psycho-pathologizing everyday life. In his recent interview with the newspaper El País, Echeburúa explains the social position: “We have lost the ability to cope with suffering. To cope with the bad times of life, such as when a family member dies, today we are looking for the quickest solution: a pill to leave

the pain behind.” Mental illnesses do not understand social or economic situations. With the standard of living you have, your brain can slip without warning you. In the same article in El País, the psychiatrist from Madrid, Antonio Espino, condemns the stress caused by the lifestyle we lead: “The current organization of work overwhelms people, and this pressure causes serious anxiety and depression.” In the same vein as Echeburúa, Espino adds that we should not resort to pills to end this problem, “this is a situation that we are suffering all over the world and it is politicians, businessmen and trade unions that must work to calm this situation.” They are not exaggerations of Espino’s words, because every year the number of casualties caused by depression and stress increases. According to WHO data, depression will be the second leading cause of sick leave by 2020. “These diseases are increasing because we live in a society with too much stress,” says Koldo Callado.

At the mercy of the game and drugs

Behind the Bilbao Brain Bank, together with Callado, are professors Javier Meana and José Vicente Lafuente. They also carry out research on dependencies in their working groups. When asked about the difference between drug and gambling addictions, Callado explains that they are basically the same: In the brain, a similar procedure occurs, which is called a repair system. This system is designed to ensure the behaviors essential for the maintenance of the species: eating, drinking and having sex. But there are other substances that activate this system: cocaine, heroin, alcohol... and there are other behaviors such as sex, such as gambling, that stimulate this center. Therefore, the neurological basis for the generation of addiction is similar.

In the case of addictions there is also a genetic risk: “There are people who take cocaine once and have no other problems, but there are people who can’t stop taking cocaine twice,” says Collado. It is very difficult to learn how to control addiction, practically impossible. “The definition of addiction is uncontrollable behavior. The fact that a person goes from being a hobby to an addiction means that he has lost control.”

The scientists in charge of the Biobank of Bilbao have already begun to receive the recognition they deserve. After many years between microscopes and test tubes, the prestigious journal Nature published its findings on schizophrenia last February. And soon they will be patenting a protein that can be useful for the treatment of the disease, in collaboration with the Basque biotechnology company Progenika.