If chemicals don’t work, why do we get drunk?
This morning’s story ‘A case against antidepressants’ caught my attention. Seemingly endorsed by the University of Auckland and packed with statistics and opinions, it makes the point that we’re over prescribing anti-depressants, which may well be true. But on the way, it argues against the prevailing theory that mental illness is often underpinned by chemical imbalance.
I completely disagree.
As a person living with mental illness I’m chronically dependent on chemicals (1g lithium, daily) to keep my brain in balance. I’ve been taking it for almost 20 years since I was sectioned, diagnosed and pretty much force-fed my first dose. And I’m lucky. Since my first exposure to lithium I’ve only ever been mildly unwell when I’ve been careless (or experimental) with my chemicals.
Chemicals work brilliantly. For me.
Maybe not everyone. But that’s the point.
There are no silver bullets in mental illness. Some people respond to chemicals. Some don’t. Some can set and forget a chemical regime. Others can’t. Some people may be situationally depressed and are better off with talk therapies. Others are different. And whatever the situation, it’s a careful understanding of the patient and a hard-fought journey back to balance.
Suggesting that chemicals are ineffective is inaccurate. Worse still, it’s dangerous.
The biggest challenge for me (and so many people I chat with) is adherence to the chemicals that keep my brain in balance. There have been many times in my journey that an article like this would reinforce my natural bias and rebellious streak to say “stuff the drugs, let’s chat”. That doesn’t work for me. I’ve tried it.
Of course, this is just one person’s experience. But remove the obvious bias from the researchers’ perspective and they could find thousands of similar stories.
And while we’re talking bias, let’s challenge a couple of assumptions. The article argues that between 1991 and 2016 the number of New Zealanders with disability payments for mental illness had quadrupled. This is a serious concern. But aside from the fact that the New Zealand population increased by almost 35% in that time, what else has changed?
Is it a response to a growing sense of helplessness in society as a result of inequality? Maybe. Is it a response to an increasingly commoditised primary health system where people expect to be diagnosed and fixed within one 15 minute appointment? Maybe. Is it a function of the being self-diagnosed by Dr Google before either knowingly or unknowingly throwing bias into the diagnostic process? Maybe.
Is it that finally we are acknowledging the reality of mental illness and actively helping more people who were struggling all along? Hopefully. And maybe.
Instead of considering different theories, the researchers draw a straight line between the growth of mental illness and the ineffectiveness of chemicals. And even though there’s every chance that for some people that might be the case, it’s certainly not the case for everyone. And positioning it that way is both wrong and dangerous.
Do we have a mental health crisis in New Zealand? You bet we do. Should we do more to help solve it? You bet we should. Is there merit in biased and loosely founded arguments that discredit established therapies while pushing an alternative viewpoint. Never.
And looping back to the start, just to pick up the point about chemicals and balance; most of us have had first-hand experience of the way chemicals can change your brain and behaviour. It’s why you do stupid stuff when you’re drunk.