Reducing the Brain, Ignoring the Soul

  1. Reducing the Brain, Ignoring the Soul
    Grace E. Jackson, MD
    December 5, 2002
    There are at least five problems with the chemical imbalance model of mental disease:

    1) the model ignores the reality that there has never been a consistently reproducible biological marker, to substantiate the levels of normal or abnormal neurotransmitters in the human nervous system
    2) the model fails to respect the enormous complexity of neurotransmission in the human brain:

    a) there are over five kinds of dopamine receptors which have been characterized to date, and even the best researchers know nothing about the D5 subtype
    b) there are five separate kinds of cholinergic receptors

    c) there are fifteen different kinds of serotonin receptors

    d) neuroscientists do not yet understand the relationship between neuroreceptor density, sensitivity, or neurotransmitter turnover

    3) the model fails to consider the fact that many of the neurochemicals which are presumed to be the basis of "mental disease" are, in fact, broadly distributed throughout the body. This fact casts doubt about our conceptualization of "brain tissue" (perhaps it is not limited to the cranial vault) and also raises questions about the reliability of serum or urine tests, as those assays may be capturing levels which reflect non-brain locations of neurotransmitter activity:
    a) over 90% of the serotonin in the human body is made by the enterochromaffin cells of the stomach and small intestine, rather than the raphe nucleus of the midbrain and pons
    b) a broad variety of cells in the human body possess receptors for many of the neurotransmitters, including white blood cells and platelets

    4) the model fails to acknowledge the impossibility of measuring discrete events in the human brain, due to the speed of neurotransmission; and due to the relative bulk of our measuring devices, relative to the size and complexity of each synapse
    5) the model fails to acknowledge the impossibility of explaining the brain in reductionistic terms. That is to say, the organic whole may so far exceed the sum of the component parts, that science will never be able to fully explain the workings of this magnificent system. Part of the problem here is that the brain is never capable of being studied in a vacuum - the system is forever open, due to the conscious, and unconscious, processes of the subject who is being observed. Part of the problem, too, arises from the phenomenon of diaschisis, or non-local effects, through which changes in one part of the brain reflect, and then precipitate, complex cascades of events in multiple locations throughout the nervous system. Thus, it is impossible to speak of serotonin or dopamine without analyzing the interactions of all complex chemicals, peptides, and amino acids upon each other, but far too little research has occurred to study the gestalt of these intercommunications.
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  3. by   finness
    so, should they stop treating depression with chemicals or should they just treat more carefully? thoughts, opinions? sorry if this has become a topic of mild fascination. i do not want to hijack the board!
  4. by   laughingfairy
    I do not believe that we should stop chemically treating depression.

    Here are my reasons

    1) medicine has a long history of effectively treating some ailments without a true understanding of the underlying disease process for a very long time.
    True during the trial and error stage crazy things have been done, based on totally incorrect hypothesis, but some times it worked and we were able to learn in a backwards way, having found one solution and then identifying the true problem.

    2) I believe as time goes on we will find out that depression and anxiety are not "mental illnesses" that they are biological illnesses of great complexity and that the fear of many that we will medicate people just to make every one happy will be found to be incorrect. As we get better at medicating and the drugs themselves get better, incapacitating illness such as GAD and Major depressive disorder, post partem depression will be cured. But we will be able to leave the person able to experiance emotions of both great joy and great sadness. Just not to the point where the person is no longer able to function.

    3) I also believe that this research will show us that many of the "somatic" complaints are actually linked to the same neurotransmitters involved with depression and anxiety.. As you pointed out these neurotransmitters occur through out the body. You specifically mentioned the production of seratonin. How many times now are we finding medications for GI disorders that a few years ago would have been called somatic? Or the person would be told that they have emotional problems etc. (please see the discussion on the use of paxil for IBS on another thread)

    Overall I believe that the gains outway the risks, that are technology is advancing rapidly and that quality of life will be improved for many.
  5. by   finness
    i tend to agree with you. i think where science made its gravest errors in letting pharmaceutical companies coin the term "chemical imbalance" to sell a few billion dollars worth of "happy" pills. true--we may only have an imprecise understanding of neurotransmitters and their effects on the body--but hey, what we do know is that drug therapy does work for many, many people. so why toss our artificially engineered contentment out the window? i think the medical community needs to admit when they're wrong and move on. cheers and thanks for your thoughts!
    Last edit by finness on Jul 26, '04
  6. by   laughingfairy
    As someone who has suffered from major depression most of my life, I don't even think of them as happy pills. I think of them as my functional pills.

    I was first dx with depression when I was 9.

    I have been on so many different meds as they became available. Some worked a little, some did nothing, but the more recent drugs are definetly better. So I believe that we are making progress.
  7. by   lsyorke
    I wonder how many people would sign up to take a drug if they knew that we have no idea why it works??? Trial and error just isn't good enough for me. Especially when trial and error can result in death!! The clinical trials related to antidepressants are so tainted that they can no longer be considered reliable indicators of outcome.
    If your willing to take a drug and see what it does, more power to you, but the public deserves full disclosure of the fact that these drugs can have powerful, devastating side effects and protracted withdrawal.

    If had been told that my son could exhibit suicidal ideation,aggression,increased anxiety, death obsession and a withdrawal that could cause him to experience nausea,vomiting, electrial "zaps", dizziness,diarrhea,increased suicidal risk, You can be assured that he never would have been put on that drug.

    We are all responsible for our decisions, but we have a right to all the information available to make that decision.
  8. by   laughingfairy
    Quote from lsyorke
    I wonder how many people would sign up to take a drug if they knew that we have no idea why it works??? Trial and error just isn't good enough for me. Especially when trial and error can result in death!! The clinical trials related to antidepressants are so tainted that they can no longer be considered reliable indicators of outcome. ..
    We are all responsible for our decisions, but we have a right to all the information available to make that decision.
    Absolutly...I just know the difference in me...imagine being12 years old and unable to sleep for 36 hours because it caused you that much anxiety and because you were so depressed.

    Imagine remembering being 6 years old and thinking when you saw your pet die that death was a good idea...

    My first memories of childhood are of overwhelming sadness and just wishing the ground would open and swallow me.

    I'm talking about for me personally those side effects are nothing compared to what I lived with day to day.

    I believe that antidepressents are too quickly perscribed with out the counseling and othe coping mechanisms taught.

    However I don't believe that they should be thrown out the window.
  9. by   lsyorke
    Laughing Fairy, Dont' get me wrong I don't deny that depression exists as evidenced by your situation. But to a large portion of the population these drugs are being handed out to people who have very identifiable reasons to be depressed ie, grieving,major life change etc.. They're told to take this pill for a year and then you'll be OK. Its realized to late for them that the withdrawal process can be more painful than the original reason for going on the drug and the reason they went on is still not dealt with.

    Mental illness is a very real thing, but to look at the numbers of people on antidepressants its staggering. We as a society look for the quick fix and don't take the time to learn about ourselves.
  10. by   finness
    thanks, laughing fairy! i was being slightly sardonic when i called them "happy" pills. i too, have reaped the benefits of antidepressants. to you and i, who truly need them, they are functional pills--to pharmaceutical companies and silly pdocs who prescribe them willy-nilly, they are merely "happy" pills...and quite profitable ones at that! lysorke brings up a good point. when is trial and error good enough? only after every last intervention, but as lysorke, testifies, i believe it too often doesn't work that way--especially in juveniles. there is certainly a huge difference between transient depression in pre/teens that are already inclined toward volatility, and chronic, major depression in adults. so why are they treated the same? i get the feeling a lot of this has to do with the vulnerability of the diagnostic process. are we too quick to say chemical imbalance?
  11. by   danu3
    My understanding and observations are that non pdoc hand out these "happy" pills also. Guess trying something like CBT before trying meds takes too long. Guess it is part of our "instant" and "quick fixes" culture.

    I don't know if there are any studies, but it would be interesting in actually see how many who are on antidepressent who actually meet the DSM IV criteria for depression or bipoloar disorders. My intuitive guess is that there are probably lots of people who would not meet the criteria.

  12. by   zenman
    Quote from lsyorke
    I wonder how many people would sign up to take a drug if they knew that we have no idea why it works???
    If you look in the PDR you will see many drugs in this category!
  13. by   lsyorke
    But tack on the buried side effect of suicidal ideation and protracted withdrawal and that minimally positive effect takes on all new meaning.The original indication for use of an antidepressant was depression due to low Seratonin levels. Just how do we know if we have low seratonin levels? No one can answer that. Now we have "social anxiety disorder",premenstrual dysmorphic syndrome, etc.. Just where did these diagnosis' come from?? The marketing departments of the pharmaceutical companies!
    Once again, I do believe there is true mental illness out there. I also believe that millions of people have bought into the hype of "take a pill and feel wonderful".The, now publicly known , suppression of clinical trial data by drug companies shows that financial gain is the motivator. When you read that the target of one such study is "To effectively manage the dessimination of this data in order to minimize any potential negative commercial impact". That doesn't sound like they have the patients best interest at heart.
  14. by   rached
    I'm nurse-liason for a psychiatrist, and do medication management for our patients once they have been stabilized. The bulk of our suburban practice is comprised of anxiety disorders (ocd being primary), bipolar disorders (mostly depressives), and to a lesser degree schizophrenia and other chronic thought disorders.

    When patients initially come to us, it is usually because they or their families are desperate for help, and their situations are acute and intolerable. While CBT and other forms of talk therapy certainly have their legitimate and useful place in the treatment of mental/emotional illness......what these folks are looking for is NOT referral to a therapist, but relief from pain, and the sooner the better. Who can blame them? We can go on all day decrying that yes, we're a culture used to the "instant fix" but I think that psychotropic drug therapy gets a bum rap, frankly. Every single day I witness what I consider to be near-miracles primarily due to psych drugs; can't argue with that.

    And yes, we do strongly encourage traditional talk therapy for every patient for whom it's appropriate. Generally speaking, that's most of them, once they're stabilized.