I would like to tell a little fictional* story about Abe as part of a thought experiment. Abe has been visiting a particular doctor every couple of weeks for two years. Every single time he comes in he is shaky, nervous, fatigued, and unhappy. The doctor performs tests on his brain and body to determine the cause. The results are always the same. He finds a marked overabundance of adrenaleen (a fictional hormone and neurotransmitter roughly equivalent to epinephrine) to be present in Abe’s brain. The doctor concludes that Abe’s unpleasant symptoms are the result of an excess of adrenaleen in his system, and that an induced change of brain chemistry is the only answer. The doctor prescribes medication called Prozak that will alter the balance of adrenaleen in Abe’s brain, something complicated having to do with re-uptake and other things Abe doesn’t understand that well. Abe doesn’t care about the details, though, he just wants to feel better.
Reflect on my little story about Abe. It sounds pretty typical, actually, a lot like what is going on in psychological health today, except for some fictional alterations. It is standard and accepted that drugs are the best solution to such mental-physical health problems. The solution that Abe’s doctor invents seems totally logical and irrefutable. Clearly the chicken came before the egg.
However, let us re-examine Abe’s story with some new information about his situation. Abe is actually a prisoner of war being held in a concentration camp. The doctor that he visits is employed there to see to the health of prisoners. Abe is frequently threatened with violence, and without warning he is sporadically tortured. He is in constant fear of unprovoked pain or even death.
In light of these insights, a rather different picture of Abe’s health conditions is painted. The unconscious fight-or-flight response in his system that he is constantly subjected to causes adrenaleen to be produced and build up to excess. He is fatigued and shaky because of his body always being on the edge of panic, always releasing adrenaleen into the bloodstream until he is saturated with it. He is nervous and unhappy because he is always subject to violence and obviously has very poor quality of life.
So the doctor got it backwards. The cause of his affliction is not excess adrenaleen; adrenaleen is produced in excess because of his affliction. It’s the complete reverse! His symptoms are exaggerated by the presence of adrenaleen in his body, but the ultimate cause is not some innate problem with brain chemistry. The imbalance in his brain is caused by his situation; his situation is not caused by an imbalance in his brain. Thus, to solve his problems one has to remove him from these fearful situations, not prescribe drugs. Only if he was absolutely unable to alter his situation but wanted to reduce his suffering would one prescribe drugs to help him cope.
I offer this thought experiment as a way to raise questions about current treatment practices in modern medicine. Issues of causality can be very relevant to understanding the body’s disorders. Sometimes people forget the old “chicken or the egg” enigma and assume that problems start with biology and then manifest mentally. In the case of depression, to cite a common example, one must ask, did my irregular brain chemistry cause me to get depressed or did getting depressed cause my irregular brain chemistry?
After all, emotions and mental states cause different chemicals to be cascaded through the brain. We could take a newly wed couple to the doctor and after all the relevant brain tests the doctors would conclude, “yes, I can see by the functioning of XYZ neurotransmitters that these two patients are quite happy.” Or we could take two children whose parents just died in a car crash to the doctor and, after the tests, the doctor would say, “oh yes, I can see right there in the lab results that these two have problems with their brain chemistry that ought to cause them to be depressed. We’d better prescribe antidepressants!” How much thought is given to the possibility that it is a person’s mental habits, their subconscious thoughts, that most influence their mood and their current brain chemistry? Over time, the brain can “get used to” regularities in its functioning and adapt to make those regularities even easier. If you practice speaking in a different language, the brain will make using those neurons even easier over time so that it becomes more and more natural. If you always get angry when you go to work every day, the brain may fall into a neurological pattern of quickly and regularly exhibiting the effects of anger. If negative thoughts become part of your brain’s routine or you habituate negative responses to stimuli, those negative emotions maybe become rutted into your physical brain structure and alter your brain chemistry, thus making it more and more difficult to escape and find happiness.
Of course, I know scientists aren’t stupid and so I trust that experiment has shown the efficacy of and need for medicated neurochemicals such as SSRI’s. However, how much of the time does the solution lie in changes of thought patterns, in conscious shift, rather than drugs? In some cases (not all, of course), could SSRI’s and the like be analogous to giving someone throat lozenges when they have strep throat? The analogy is that throat lozenges may help relieve some of the symptoms but it does not address the actual and ultimate cause of strep throat: the bacteria streptococcus must be eradicated either by the immune system or antibiotics. You can buy throat lozenges for the rest of your life, or you can extirpate the problem.
It is very easy to seek some medicated solution to a health problem, physical or mental, but some consideration needs to be given as to what the best solution actually may be. The ultimate cause for the health condition must be ascertained before decisions of how to fix it are made. It is important for doctors, patients, science, and society in general to pursue this because there could be a large incentive for some sections of the medical industry to ignore alternative treatments—eg., the pharmaceutical companies.
My limited understanding is as follows. The pharmaceutical companies are not interested in health or the well-being of patients. They are not non-profit. To the contrary, the are only interested in profit. If it was legal to sell drugs laced with other addictive drugs to cause patients to need to continue drug treatment even after being cured, they would do so. If they could cause an increase in the rates of cancers and diseases requiring drugs, they would. If they could get away with threatening you or your family if you refused to buy their products, they would. It’s just business for them, like any group of companies in control of a life-dependent commodity. Thank goodness for laws.
Since the pharmaceuticals and other for-profit divisions of medicine can attain so much economic value (and, consequently, power) they could, and would, inflict very serious impediment to attempts to progress medical science. For this reason, some restructuring of medicine needs to take place. I am not an expert, but it is not difficult to foresee huge problems with the current order. How to fix these things is another issue entirely.
*(The events are fictional, the characters are fictional, and the science is fictional!)
>>Please check out this column by Lawrence Weathers on causes and treatments of ADHD. He also takes into account the chicken and the egg argument.