As social workers, we are concerned with modifying possible negative environmental stressors of our client’s lives and facilitating growth. We use a biopsychosocial approach because we believe that the biological, psychological and social are all important to understanding what makes a person and the challenges they may face. Specifically, regarding the biological aspect, there has been significant advances, led by developments in brain imaging, in neuroscience over the past 25 years (Ray, 2018). Epigenetics and psychoneuroimmunology are growing fields within neuroscience that are building on our understanding of the important role that physiology plays in human development over the lifespan (Yorke & Begere, 2018). Clinical social workers can diagnose clients by observing behaviors and then consulting the DSM 5 but it is important to know what is happening in the brain at the same time.
Although advances like brain imaging cannot yet diagnose an individual, it gives us insight into the nature of mental illness. If social workers are to be effective in providing services to their clients, it is imperative that social workers have knowledge and understanding of the way a person’s biological makeup interacts with their environment and the implications it has on their health and mental health. Having this knowledge helps social workers identify appropriate interventions, increases ability to work with an interdisciplinary team, and helps inform us about social justice. To demonstrate the importance, I will first provide a summary of relevant neurological functions, define epigenetics and why it is important in thinking about various disorders, how epigenetics applies to social justice and policy, and then define psychoneuroimmunology and explain its implications for social work.
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Evident in the curriculum of the course Human Behavior III is the importance of neuroscience in social work. Ray (2018) writes, “Mental disorders are brain disorders. Further, those physiological processes involved in physical disorders such as the immune system, the turning on and off of genes, and the chemical processes of the body are also equally involved in mental disorders” (p. 3). Current techniques in brain imaging like electroencephalography (EEG), magnetoencephalography (MEG), positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) allow us to examine changes in the brain.
Neurotransmitters are also important in the discussion of neuroscience and mental disorders. Neurotransmitters are defined as “Chemicals released into the synaptic space that are involved in increasing or decreasing the likelihood for action potentials to be produced; they also maintain the communication across the synapse. Their presence or lack is related to psychological disorders” (Ray, 2018, p. 46). The chemical messengers affect a range of physiological functions. Important to treating mental disorders with medication is understanding that neurotransmitters have different functions, “…first is glutamate and GABA that mediate communication between neurons, opioid peptides in the pain system that influence the communication of information. The third group includes those neurotransmitters such as diapine, adrenaline, noradrenaline, and serotonin that influence the activity of large populations of neurons” (Ray, 2018, p. 46).
Epigenetics is defined as the “study of the mostly environmental factors that turn genes on and off and are passed onto the next generation” by the process of tagging. (Ray, 2018 p. 66). This means that genes can be modified by the social environment. As the study of epigenetics is progressing, there has been important research findings on how stress and trauma affect neurological development (Ray, 2018). Significant to understanding the effect of epigenetics is understanding how the brain processes stress. When a person experiences threat, there is a complex system of interactions in the hypothalamic-pituitary-adrenal (HPA) axis. Glucocorticoids and adrenaline hormones are released, and this causes a faster heart rate and higher blood pressure to deliver blood to the muscles, indicating a flight or fight response. Once the threat is seemingly gone, the body returns to homeostasis (Combs-Orme, 2012). Understanding this process is paramount to understanding what happens next. When someone is faced with constant stress, this process happens repeatedly without a chance to return to homeostasis. Combs-Orme (2012) explain that “The physiological effects of stress continue for long periods of time, resulting in high blood pressure, rapid heartbeat, and the other physiological adaptations that are damaging and result in disease….” (p. 26). Ray (2018) notes that this overactivity in the HPA axis is linked to depression, suppression of immune system and hippocampus reduction associated with psychosis.
Combs-Orme (2012) state “The stress response system begins to develop during gestation in interaction with the mother’s own HPA axis. It is believed that the bath of chemicals resulting from the mother’s chronic stress may result in up-regulation of the baby’s own stress response system, resulting in higher baseline levels of stress hormones and a high level of reactivity…The infant’s stress system continues to develop in the first year of life, however, and a calm, nurturing environment can reduce some or all of the effects of high stress during gestation. In cases in which the mother’s stress continues after the baby’s birth, however, as in cases of poverty or domestic violence, for example, this remediation does not occur, and the infant may become even more reactive (p. 26) Despite the exposure to stress and trauma that may be experienced in utero, there are still opportunities to alleviate the effects by experiencing a less stressful environment.
Advances in neuroscience is relevant to treatment of mental disorders. When a client has been trying various therapies and medications to treat their disorder but has not experienced any relief of their symptoms, they may become frustrated and hopeless. Social workers, usually focused on the environment, may be more prone to understanding the time that is needed to relieve symptoms through talk therapy. This might lead them to ignore other options. For example, electroconvulsive therapy (ECT) has shown to be helpful for clients with depression that have not shown improvement with medication or psychotherapy. It is important for social workers to be aware of possible treatment options.
As in the case of other disorders, understanding the neurobiology of anxiety disorders help inform social workers of treatment options. Ray (2018) writes, “With the discovery of functional networks in the brain, psychopathology can be mapped in terms of which cortical networks differ from normal functioning” (p. 281). It has been found that anxious people have reduced Gamma-aminobutyric Acid (GABA) and therefore lese inhibition to threat responses (Ray, 2018). Anxiety is associated with overactivity in the salience network, which detects errors and conflicts that might call for cognitive control. It is also associated with underactivity in both the executive network, which implements increased cognitive control and the default network, which does self-inspection, future planning and emotional regulation (Ray, 2018). Panic disorder is when there are recurrent sudden panic attacks, involving feelings of apprehension, anxiety, and fear (Ray, 2018). While anxiety is integrated in the forebrain, panic is organized in the midbrain. It is also important to note that while stress releases cortisol and involves the HPA Axis, cortisol is not released in panic attacks. Regarding treatment, research shows that CBT with antidepressants are most effective in relieving symptoms.
Epigenetics is also relevant to social work because it sheds light on the need for social justice. Writing about the importance of epigenetics in social work, Combs-Orme (2013) explains that “DNA does not predict destiny, it rather assembles a set of potentials to be activated (or not) by experience and the environment” and concludes “that poverty is the number one threat to the expression of genetic potential” (p. 27). Further, Combs-Orme (2013) states that “insights on epigénesis suggest that poor and minority children are not inherently inferior, damned by inferior genetics and condemned to poor health and low achievement” (p. 28). These insights on epigenetics Lupien et al. (2009) explain that “In children facing early adversity, forms of environmental enrichment, such as support from a family member, enriched daycare or school environment or social support from members of the community, could induce a similar heterotypic reorganization of synaptic development or changes in gene expression that could lead to resilience later in life” (p. 442). If social workers understand the very real, scientific effects that physiological mechanisms have on the development of health and mental health over one’s lifespan, they can better advocate for policies and programs that aim to provide these forms of environmental enrichment described by Lupien et al. (2009).
Psychoneuroimmunology studies psychological connections to the immune system (Ray, 2018) and is a growing field in neuroscience research. Recently, a man living in Japan with schizophrenia was cured of his symptoms after he underwent a bone marrow transplant due to having acute myeloid leukemia. Velasquez-Manoff (2018) posits that this phenomenon posits that the man’s immune system was influencing his psychiatric symptoms. Additionally, Velasquez-Manoff (2018) points to another case where a woman’s psychiatric symptoms were also relieved after experiencing a severe infection with a high fever. Velasquez-Manoff (2018) state, “The bigger question is this: If so many syndromes can produce schizophrenia-like symptoms, should we examine more closely the entity we call schizophrenia? These findings are significant because it questions the objectivity of how mental disorders like schizophrenia have been pathologized as well as “suggests that targeting immune function may improve mental health outcomes” (Velasquez-Manoff, 2018).
In conclusion, due to recent advances in neuroscience by way of brain imaging, there has been a rise in study of epigenetics and psychoneuroimmunology. These advances have shed light on the ways in which development is affected by an interaction of genes and the environment. Epigenetics addresses the nature vs. nurture debate by showing that one is not more influential than the other, but instead, they are constantly interacting with each other over the lifespan. By looking at the physiological mechanisms through which stress, anxiety, and schizophrenia are manifested, it has been demonstrated that having an understanding of advances in neuroscience is critical to the social work profession It has implications on how we understand the experience of our client, the interventions we suggests, and highlights a call to social justice that will minimize the effects of adverse physiological phenomena. The rise of epigenetics has shown that health disparities are more of a result of social and environment rather than a biological cause. Having a deeper understanding of the biological aspect of the biopsychosocial approach only strengthens social workers ability to treat, advocate, and assist clients effectively.