Useless Phase For Today: “Chemical Imbalance”

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I recently had a patient who walked in to see me wearing a vintage Dior suit. I complimented her, of course, as I think that an ideal way to dress. She presented as powerful, and in control of her life.

She looked me straight in the eye, as if she were delivering me a deep and secret truth.

“Maybe it will make things easier if I tell you my last psychiatrist told me my problems were from a chemical imbalance in my brain.”

I smiled and thanked her, but this often repeated phrase is perhaps the most useless thing a psychiatrist could say.

There are lots and lots of chemicals in the brain. More precisely, there are lots and lots of “neurotransmitters” in the brain — chemicals that carry messages from one brain cell to the next. Anything that one could call a “mental illness” has had several of them implicated as parts of a cause for it at one time or another.

As of this moment, we are incapable of “micromanaging” them in a brain.

Although neuroimaging has advanced mightily, direct clinical applications are still limited.  Research has shown over the past 20 years or so that seeing mental illness as biological seems to have increased, not decreased, the “stigma” associated with mental health care. It may actually be helping to keep people away from mental health care.

The truth of the matter is, the more I look for some kind of traumas behind mental health conditions the more I find them. I even wonder if they are, simply, universal.

Perhaps, in the longer view, we need to spend our resources teaching allegedly-normal people to deal with allegedly-normal trauma.

It seems to me that as society becomes more easily violent, the phenomenon we call “mental illness” can only increase. The avoidance of treatment because of “stigmatization” can only increase.  It is not untrue, to say that I treat “misery for a living.

We have to find a more human way for psychiatrists to treat psychiatric patients.

My head is percolating on this. Stay tuned.

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