Chemical Imbalance — A Mythical Diagnosis
I looked at her, better dressed than most of the folks at the clinic where she was seen, with an open mouth. I had to take a few extra minutes to figure out what I was going to say next. In case you have not guessed, that is pretty far from my usual state.
“I have a chemical imbalance,” she said. She looked a little like Sharon Osbourne, hip and trendy but expensively dressed. ”He gave me some medicines that really helped, like Xanax and Ativan, and either of those would be just fine.”
I freely admit that psychiatric diagnosis and treatment have a long way to go to meet either the organic precision of the surgical specialties or the subjective enthusiasm of the non-prescribing mental health professionals, such as psychologists or psychotherapists. But there are practitioners out there who are either so indifferent or so pressured that they rattle off words without meaning and give prescriptions that hinder more than help.
There is absolutely, positively, no such thing as a “chemical imbalance” that can be corrected by prescription medication. Despite some inventive and touching attempts at animal research, there is no single congenital lack of, for example, Prozac, or any material the production of which has been induced by Prozac.
One of the first hypotheses for the reason for depression was something called the “neurotransmitter” hypothesis. Maybe one single neurotransmitter is lacking.
Well, a lack of any neurotransmitter, if we limit ourselves to just one, brings about all kinds of biological problems that have little to with psychological symptoms. For the catecholamines, we would be talking a descended blood pressure and cold extremities and a lot of things.
In other words, this “chemical imbalance” thing does not fit any data. It has been, for many years, a way to destigmatize a profession that has suffered at least as much from stigma as it has from a lack of knowledge of the most pristine sort — Knowledge of what makes what happen and why.
My brother of blessed memory was diagnosed, mostly by me and later by others, as having Asperger’s Syndrome. He was told that he had a chemical imbalance. He told me that actually, the doctor said that more to my mother than my brother, the supposed victim of said imbalnce. Mother was told this “fact,” quite precisely, by a psychiatrist chosen by my father. My father had simple criteria for chosing this type of professional — He must have matriculated at Harvard.
Furthermore, the psychiatrist had been a man of some public renown , which carried a lot of weight with my parents. I later met this medical paragon and considered him an idiot at best. He could have been the model for Frank Burns of “MASH.”
Mother wanted to know “what do I tell other people who ask what Harry has got?” My mother of blessed memory was not much of a social person. As a matter of fact, her social interactions were largely defined by — if not limited to — her answer to this sort of useless question. I still remember her smug satisfaction at telling people Harry had a “chemical imbalance,” which seemed to absolve everyone of blame and was an expression she found unusually effective at shutting people up.
It was well over a hundred years that Camillo Golgi started staining cells of the central nervous system and discovered only a relatively small amount of them actually stained. Their biochemical differences, both intrinsically and in terms of the substances released as droplets between them, are not yet a resolved question by any means. Delicate assays may measure single enzymes or substrates, but the only people who make me more angry than those who diagnose a “chemical imbalance” are those who purport to “balance” great complements of neurotransmitters and thus make people normal, healthy, and well.
How can you balance something if you cannot show how and where it is imbalanced in the first place?
You can claim that you know how to balance it, and convince people they feel better. This is the territory of foreign doctors, many of whom live in Mexico. Much in the same manner as King Arthur’s knights seeking the Holy Grail, I’ve toured many such clinics in Tijuana — always openly, professing my desire to learn and usually being disappointed in what I find.
There is a small possibility that you can overwhelm the system, giving it enough wonderfully nutritive products that can cross its blood brain barrier that the problem solves itself through the infinite wisdom of God or Universe or whatever you want to call it. This could explain the wonderful results obtained with products like the ones I often use — such as EmPowerPlus and Total Amino Solutions.
This is not as far-fetched as it sounds. It is certainly several steps above throwing a mess at the wall and seeing what sticks. If you fill the body with the basic building blocks it needs for healthy functioning (i.e. nutrition) the body has the wisdom to sort things out and put them to use where they will do the most good. Anything not used is eliminated — no harm done.
NO science can explain a chemical imbalance that gets better with Xanax.
“Those are words,” I told her gently. ”They don’t explain what is going on in your brain.” She was shocked. She could not accept the fact her previous psychiatrist had given her pleasant words without meaning. It took a lot of gentle talk. ”Your body does NOT have any kind of a congenital lack of Xanax,” I told her. ”He gave you an addictive drug, and now you are asking me for more of it…”
I had to assure her that I would give her at least a little bit. After all, you have to be stupider than me to cut somebody off an addictive drug cold turkey.
I was patient — patient beyond words. I have been patient. I saw her for a couple of months until leaving the facility where I had seen her.
In those few months, I recommended to her a few things that anybody could do. I told her to keep a diary of her anxiety — Why she got anxious, and when.
No, we are not all bags of chemicals. We have reasons for our anxieties. Whether genetic or environmental, they are reasons. In her case, there had been a fairly toxic relationship. Even if she did not want to go to specific counseling for that — and she certainly did not — she would not have admitted the problem if I had not made her keep a journal.
The journal is the cheapest and most useful part of my business, and yet I have never met anybody who uses this technique other than me.
I recommended some books to read about relationships. She started talking, a little. I never talked her into “formal” psychotherapy. She said she would consider a religious counselor. They come in all kinds of shapes and sizes, and unfortunately, varying skill levels. She was going to at least get a referral from a clergyperson she trusted. I could not ask for more.
I did not have very much time to work on the taper off Xanax, as she was on a fairly high dose, but we did at least get started. Benzodiazepines (the family of drugs to which Xanax belongs) are drugs that do concern me greatly. Getting a patient off them is a highly individualized process. There is a risk of seizure, and with higher doses, there may even be a risk of death.
I cannot believe how many people suffer from chronic addiction to these medications. They are central nervous system depressors and can even cause depressive symptoms — not to mention a slowed psychomotor response that could cause, for example, an automobile accident. So to stay alive and well, you need to have a physician supervising this.
If you want ideas of what can be done, The most rational folks known to me have been those working with protocols established by Professor Heather Ashton, who ran the downtown London benzodiazepine withdrawal clinic for a really long time. This series of protocols can be printed out and put under the nose of the most recalcitrant of doctors.
Last I heard she was willing to listen, progressing, happier with her life.
Do not listen to doctors who give you “catch phrases.” Do not believe that doctors know things they cannot explain. Do not accept easy answers for complicated problems.
My mother of blessed memory had an education that did not go beyond high school. She told me that if I could not explain what I was doing and why in a way simple enough for her to understand it, then I simply did not really know what I was doing.
She was right