Chemical Balancing Act, Part Four

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The Perfect Drug

Many years ago, I posed a question to myself to help me understand my contribution to mental health. The question was this: If the perfect drug to treat mental illness were to be developed, what would be its effects? This idea was the basis for my short story, The Grand Inquisitor Revisited.

A number of thoughts converged to create this story. At first, I wondered what the parable The Grand Inquisitor from Dostoevsky’s Brothers Karamazov would look like if it occurred in a modern context. The original tale, really a rant from brother Ivan, presumably told during the 19th Century when the story was written was set during the Spanish Inquisition. It was to dramatize how the truly Holy, Jesus, would not be accepted given people’s real world needs how they would fall short of Jesus’s hopes for their spiritual potential. This makes no sense without a fundamental faith and questioning of the Christian religion.

I am not a Christian and I am not from either time period to which the story refers, but I do understand the human issues that the story addresses. I quickly realized that, even among the religious, beliefs have shifted. There is so much that is no longer seen as challenging to survival that was a threat to life then, like the expectation that there would be food to eat. This is not to say that everyone has equal access to food today, but our expectations of being fed if we are unable to provide for ourselves is quite different.

Now, we appeal to the government for sustenance or to food banks. Back then, they appealed to God or else they begged. People then, like some people now, do both, but not with the same reliance because there are agencies to fill the need. So expectations around access to food are different. What seems to drive most people in our society today is an expectation of being able to provide for one’s self, but also to provide for one’s own comfort, including comfort for the mind. At the time of Dostoevsky’s writing, comfort of body and mind were likely inseparable and, therefore, it would make sense that providing for the body would take precedence over providing for the mind. Mental illness, as such, existed back then as many of his characters would inform you, but they cannot be understood outside the context of their survival needs.

So, I imagined, nowadays with food being more readily available, we have the freedom to lock horns with our mental health demons without being fettered. And in this context, I present Dr. Osterreich, a self-fashioned biochemist, who invents the perfect drug for mental health. It will not only cure mental illness, but will perfect a mind, any mind, that might otherwise be flawed. It will not only restore, but create the perfect chemical balancing. His only problem is that he needs to have a subject on which to test it. This is how our particular Inquisitor finds our homeless schizophrenic, who believes he is Jesus. It is a similar drama to Dostoevsky’s, with similar characters, but with a modern set of assumptions about what one can and should expect as a person living in the modern world.

Where it concerns mental health, what do we know? Really our notion of health, whether mental or physical, is based on our wish for an absence of discomfort. We want to at least not trouble ourselves with unwanted thoughts or feelings. And, if we have them, we want to calm them or get rid of them as soon as possible. It is these thoughts about our thoughts and feelings that drive us to doctors to relieve symptoms. Some parents who observe their children’s symptoms that seem unusual to them might have a similar response. But ask the person, ask the parent, ask the doctor treating, ask Dr. Osterreich what can we expect as an outcome of treatment? It is a reasonable question that is not often asked, almost as if the treatment is its own reward.

But, what do the chemicals do? It used to be advertising would tell you to trust your doctor and, if people wanted a particular treatment they would ask their physician. Today, they tell us what the medication is intended to treat and, if a particular med has suicide as a potential sideeffect, the ad is considered fair warning. Now that the patient is informed of benefits and potential side effects, the patient is in a position to advocate with the doctor, even without the training to consider appropriateness or weigh benefit against outcome. Now, we have drug companies positioned between the patient and doctor, influencing the decision of both and, in some cases, offering perks to the doctor to prescribe.

In this context, some will say and people have said, “Just give me a pill to have this feeling go away.” That’s the general idea. There are plenty of practitioners out there who would be happy to oblige the willing patient. Then, there is the interface between a patient who reports symptoms to help the treater and the treater who takes the report at face value without further investigation. This is a frequent occurrence, too. There is also the doc who matches the patient’s symptoms to the diagnostic manual (DSM5 nowadays), taking in the reported symptoms as evidence without considering other possible explanations. I consider this a checklist approach that most frequently appears when a patient tells a doctor, “I have mood swings.” “We have a treatment for that (and a diagnosis).” You now have Bipolar Disorder. Congratulations!

And if there are side effects, these too can be treated with medications. If there are more side effects from the combination of medications, these too can be treated with medications. While somewhere in the middle, there is the mind of a patient who becomes more concerned about physical symptoms associated with side effects than they were concerned about their mood in the first place.

There needs to be a separation between the demand for relief from symptoms that may be a product of culture, the possibility of misidentifying true symptoms, and the monetary rewards for treating, whether or not the treatment is incorrect. The truth is, in both the real world and in the world of my Dr. Osterreich, nothing is preordained and outcomes may not follow the rule book exactly, a rule book that doesn’t exist.

First trust yourself, then if need be trust your doctor. Never, never trust what they tell you on TV. It seems silly to day but, the TV doesn’t know you, neither do the drug companies that write the ads. Without training, there is no way anyone can interpret or anticipate the results of a treatment. Even less so, if the person treating doesn’t take sufficient time to get to know you and your symptoms.

(“Feel better?” a doctor may ask in the second session. “Why, yes, yes, I do.” And it sometimes happens that by the third or fourth session symptoms are worse. What do you do then?)

For those who wonder. Yes, I am licensed in a state that allows psychologists to prescribe psych meds with training. But, no, I am not licensed to prescribe and, as of this writing, have no intention to train to do so. I will work with physicians who prescribe psych meds, but, frankly, I continue to be fascinated by the process of treating the mind in whatever state of balance or imbalance it presents itself. The problems of being human in the world, such as it is, remain interesting to me. In my therapy, I try to focus on that. I call it psychsurvival.