One of our family mottoes is, “If you can’t make your own neurotransmitters, store-bought is fine.” However, there is a society-wide excess of assuming neurotransmitter dysfunction when mental health issues might be much more psychological or even situational. This brings up another family motto as told by my granny: “Drugs aren’t gonna help if the real problem is that you’re surrounded by a******s.” (Forgive her French, but she was French.) I appreciate Granny’s perspective – and sometimes it is definitely true – but there are often times when a person has been exposed to toxic, abusive, stressful, or traumatic situations for so long that a round or two of psychoactive medications along with some lifestyle changes and psychotherapy (I use the term broadly throughout here to refer to any form of engagement-based therapy) is precisely the remedy.
My personal philosophy on the topic of medications and psychological disorders is this: there is no mental illness or disorder that can be solved by medication alone, and by that I mean that while there are a great number of disorders that require medication, medication should never be the only remedy or recovery protocol. Many situations can be addressed by psychotherapy alone, but medication should be approached for most scenarios as the element that helps the psychotherapy or supportive system work.
Specific Scenario Exploration: ADHD
Let’s consider one of the most heavily medicated but under-supported conditions: ADHD.
As a person with autism and ADHD at the head of a family full of other autistics with ADHD (with also a liberal smattering of social anxiety, generalized anxiety disorder, major depressive disorder, OCD, and other neuro-spicness), I’ve found that medication for this condition is only up to 60% of the solution (Brown et al., 2019); the rest must be material support. That means producing calendars, establishing routines, using bullet journals, setting alarms, using only clear containers, and labeling everything – all of which works to varying degrees depending on the person, but none of it works until there’s a little extra neurotransmitter support to make it work.
The structure and support must be a major feature of the treatment for ADHD. Without the medication, all the planners and alarms in the world will never make any kind of lasting impact. However, if good structure is established while someone is on good medication support, then the structure has a reasonable chance of being sustained without medication. The caveat/emphasis on this must be that the medication actually has to be effective, which means acknowledging the variation of ADHD being experienced (inattentive presentation, emotionally dysregulated, or combination (Luo et al., 2019; Reimherr et al., 2020; Salvi et al., 2019)) and applying the correct remedy (Cortese et al., 2018).
Second Scenario Exploration: Depression
Stress and trauma materially impact the brain, and the greater the stress and trauma, the more profound that impact (Borodovitsyna et al., 2018; Ford-Gilboe et al., 2023). This is an axiomatic understanding that begs the correlate that not all brains are the exact same at baseline and some are more or less susceptible to the impacts of stress and trauma. Neurodiversities are a key deviation to be considered (Amos et al., 2019; Haruvi-Lamdan et al., 2020; Homberg & Jagiellowicz, 2022), especially in light of the higher susceptibility to serotonin toxicity for even low-dose SSRI monotherapy for some autistics (Madan et al., 2023) – which is something I personally have experienced.
Even among allistic populations, stress and trauma can create vastly different neurological effects, which is why SSRIs are only effective for a comparatively small portion of the population, particularly when not supported by psychotherapy. Moreover, the assumption that serotonin is the exclusive or even primary neurotransmitter involved in depression was based on a guess without truly compelling scientific support (Ang et al., 2022; Cowen, 2008; Möller & Falkai, 2023).
Back Up, and a Hypothesis: Why do we even have a medical-only psychological treatment culture?
I feel there has been a massive failing in the mental health industry with its deep devotion to trying to solve psychological issues mainly with medication, and I feel there are specific dimensions that have created this phenomenon. I suspect that the foundation of medication-first culture can be traced back to the popularity of mechanistic behaviorism: if you can just figure out the right conditioning or chemical, you can make humans do whatever you want! This is the attitude proposed and promulgated by John B. Watson, Ivar Lovaas, and their ilk (Gondra, 2014; Harris, 1981; Lovaas, 1987; Rekers & Lovaas, 1974; Watson, 1913; Watson & Rayner, 1920) during a time when psychology and social science were still trying to decide what model should be used for the human psyche.
The problem is that humans are not mechanistic, and all experimentation that was based on that mechanistic model proved that model false. (I touched on this briefly in a previous discussion discussing Skinner’s fundamental behaviorism versus Watson’s version where history demonstrated that Watson’s method was destructive and self-defeating while Skinner’s compassionate functional behaviorism produced success and positive outcomes (Swain, 2024).)
This desire to simplify humanity and its collective psychological state makes sense in a way: trying to solve problems like “what makes us sad” and “why can’t we perform consistently” with a mechanistic approach fits with the industrial paradigm of the era. Alas, humans are strange and messy and inconsistent, and industrialism has only been the dominant system for a small fraction of our existence, thus it cannot adequately explain that human messiness.
A drive to understand the neurological is important, and developing medications and remedies for neurological conditions is absolutely critical, but the industrial/mechanistic behaviorist influence on the mental health system has forcefully neglected investigations into subjective experiences. The industrial paradigm demands that all things should be easily quantifiable and consistent, but this lack of focus on the subjective (or perhaps an excessive focus on the objective) ignores exploration of the complexity of the mental and emotional worlds that would render sense from the seeming chaos of neurobiology.
The Future of Medications and Drug Therapies
The greatest weakness we have observed in the pursuit of grander and more effective pharmaceutical accomplishment is an apparent disinterest in discovering why individuals respond to medications in different ways, and this applies to discrete variation among populations and also the larger problem of homogeneity in development environments, especially in regards to gender (Bailey, 2023; Clayton & Tannenbaum, 2016; Nunes et al., 2014; Sandberg & Umans, 2015). As we discover more about natural diversity, it is my hope that we will be able to differentiate more completely what medications will provide the most support for mental health issues, and perhaps also understand that how people respond to given medications can help us understand more completely how neurology works.
References
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