The Chemical Balance Myth

I recently read the August 7, 2017 Time cover story "The Anti Antidepressant." It talks of possible "new" innovations in psychopharmacology. It's hardly new Ketamine, MDMA, and other medications have been researched in the past. Often street (ab)use, led to discontinuing the research in medications like this.
This latest article does a fine job of describing the (Western) understanding of depression. It also does a poor job of updating the understanding that's come in the last 40 years. The brain in "chemical imbalance" model of understanding and treating depression was outdated by the time it was used to help portray to clients the usefulness of SSRI in treatment. It's not that it's totally incorrect -- it's incomplete. The latest Time article does at least note that the latest understanding acknowledges the likelihood that depression is perhaps a dozen plus conditions. It still, however, perpetuates the perspective that depression lives solely in the brain.

Depression may be demonstrated through low serotonin, dopamine, or other neurotransmitters. Recent researchers, though, see a multidimensional, physiological syndromes that explain the depressive experience. There is a shift in how the anatomical areas of the brain metabolize and send impulses (a neurological and circuit based disease.) Not only do certain genes show links to depression, but whether those genes have been turned on or off in a person's lifetime (a genetic and epigenetic disease.) The genes con
trol how hormones are replicated and how sensitive our body is to these hormones (an endocrine disease.) These hormonal interactions inflame our tissues - a disease of inflammation. These are all parts of depression - it is not only seen in the brain, not only felt in the brain.
Depression impacts our sleep, appetite and metabolism, our sense of energy, our ability to concentrate. It impacts relationships in the family and in the community - a person's participation in the call and response of human connection.
I hope that clinicians find one more effective treatment of depression. I regularly tell my clients and colleagues (with a touch of facetiousness) "No business is good business." My sense of this comes with the belief that counseling is only one vehicle to address depression. Often, it's the job of therapist to connect people to more meaningful interventions, more resolute solutions to managing mood: Healthy relationships, healthy lifestyles, communities, friends, exercise, greater sense of connection to the world and to people, a sense of meaning, a remembrance of one's fortitude and internal resources. Because depression does not simply live in the brain. Treatment can start in the brain, in relationships, and in physiology. It does not end there.

You Can Always Ask, They Can Always Say 'No'

There's a list of recommended exercises I pull from when working on assertiveness with clients. It comes from Dr. Linehan's DBT Manual - the Interpersonal Effectiveness chapter. It's a whole list of ways to make requests of people in settings that are generally safe. For some (including myself), a portion of the exercises can feel like a real challenge. 



There's two suggestions that didn't make the list, but other clients and group members have recommended. (I have since found them in other material.) One of those suggestions is asking a sales associate to open a display case for you without buying an item. I regularly picture the scene from Wayne's World in which the sales person in the guitar shop reluctantly obliges. BUT the salesperson draws the line at the first few notes of "Stairway." And, he ultimately asks Wayne to put the guitar back in the case. (Yes, I realize Wayne then purchases said guitar.) When building assertiveness, it helps to recognize that other people we make requests of have some responsibility in setting their own limits and refusing or rebuffing. If they don't want to hold resentment, it's their responsibility to keep to a line or say "No." Most people let us know gently and politely that we're putting them out or crossing a line.

Another suggestion brought up has been sending food back when dining at a restaurant (even if it is exactly what you asked for.) This tends to get a debate going in DBT skills groups I've led. In session, it often gets a strong pushback, as well. I'm all for the "social experiment" for a good cause -- restoring a person's voice and recognition of one's own worth. It excited me to read this article. "Why sending something back at a restaurant is perfectly fine — and how to do it right" Seattle Times Yes, it still does not bring up the issues of the legitimacy of the "social experiment"/exposure therapy in a restaurant setting. It does, however, show that a dish may still be sent back while by all measure it's a fine plate -- it comes down to personal taste.