There has been a furor lately in the psychiatric community and among psychiatric patients about the causes of depression and other mental disorders, as well as the appropriate treatment and the appropriate name for them. Among the issues are whether neurotransmitters in the brain cause these illnesses and whether biopharmaceuticals will help relieve them.
One of the main arguments against the neurotransmitter theory is that we do not really know whether depressed persons (most of the arguments use depressed persons as the easiest example) really have lower levels of seratonin, norepinephrine, or other brain chemicals than the general population. What is known is that increasing the amount (or decreasing the deficiency) of those chemicals helps many people recover from their condition, at least partly.
No, seratonin et al. are not “magic bullets” for depression. They don’t work for everyone. They can become less effective as time goes on. And no one quite knows how they work. But in many cases, including mine, they were the first – and at the time only – thing that helped. The explanation was sufficient for me, even when my doctors added new drugs to the “cocktail.” Advances in biochemistry, ya know.
Now, however, various scientists, psychiatrists, patients, and reporters talk about “debunking” the biochemical theory. Instead, they say, depression and other disorders are caused by traumatic events and stressors that change the way our brains react to stimuli – that the environment influences the brain in ways that lead to psychiatric illness.
But, it seems to me, we have a chicken-and-egg question going on here. Am I more susceptible to depression (or bipolar) because of the traumas and stresses in my life (especially my youth)? Or has my brain chemistry made me more susceptible to the traumas and stresses?
How, anyway, are we going to prove either theory?
Part of the difficulty seems to me to be the backlash against the pharmaceutical industry, which has surely done some sketchy things of late. Biopharmacy and drug treatment of various illnesses have become less popular as people question whether we really know what’s going on in the brain and whether we really know what those chemicals do.
Psychiatry itself follows the arc of a pendulum. At one time psychotherapy – the “talking cure” – was all that it had to offer. Later, with the advent of Haldol and Thorazine and Prozac and their cousins, it seemed that physical causes were more likely to be responsible for mental illness than unresolved childhood issues. This threatened to put psychotherapists out of business.
(I have always been helped by talk therapy, whether or not I was medicated for bipolar disorder. It has helped me through crises, taught me about healthy coping mechanisms, provided a reality check on my feelings, and so much more. I would never have made it as far as I have without both pharmaceutical help and psychotherapy.)
Now the biochemical theories are questioned and psychotherapy is in the ascendance again. Rather than treating our brains, we are to be treating our memories, uncovering the traumas that are said to have made epigenetic changes in our brains that manifest as depression, anxiety, or whatever. (I don’t think schizophrenia is included. There are just too many factors tying schizophrenia to genetics and the brain.)
It’s true that I had traumas in my young life, though never to the extent that many others experience. Were they brain-changing events? I wouldn’t have thought so. I took biopharmaceuticals and they helped. Was I mistaken about the causation (post hoc ergo propter hoc)?
If all this dissension leads to better ways to help sufferers of mental illness, then good. Plain and simple. But if it causes patients to abandon treatments that are working for them, I am less sanguine. In our pill-shaming, homeopathic culture, it just may be possible that the pendulum has not swung as far as all that. I’m not giving up my psychiatric drugs based on a theory, when they have helped me so much. And need I point out that the “latest” treatments for depression and bipolar also target the brain and not the traumas they may have endured? Ketamine, ECT, and TMS all affect the brain directly.
Also, let us consider that part of the objection to the “chemical imbalance” theory is the idea that it more likely promotes stigma to say a person has a “brain illness” than a “psychosocial difficulty.” That’s all well and wonderful, but I would argue that it calls for more education rather than a change in how we treat. “Neurodiversity” may be a less stigma-laden term, but so far it shows little sign of catching on outside the ASD community. (Ask the person-on-the-street what “neurodiversity” means. Then ask what “mental illness” means. Neither answer will be helpful.)
If this remains a debate about what we should call mental illness, then I suppose there is little harm done. But if it affects the way we treat mental illness, that’s another matter entirely.