Friday, June 07, 2013
Onward to the murky swamps of the DSM
Since it turns out that Eric Holder and James Clapper already know all about my pathetic social life (and BTW, Glenn Greenwald says there is more to come), I might as well fess up here. I was bummed out a while back by a relationship that didn't work out, and I'm still kinda bummed out. I don't happen to want to talk to a professional counselor about it, but somebody else might. Do I have a disease? What if I stay sad for a really long time? Do I have a disease after six weeks, or six months? Do I have to be more than a certain amount sad? What difference does it make what you call it?
As you may recall, drug companies used to run ads claiming that depression was caused by a deficit of a specific neurotransmitter, serotonin; and that their pills fixed it by increasing the amount of serotonin in your brain. One of them even had a little cartoon showing serotonin ostensibly flowing between brain cells and their pill keeping it from being reabsorbed, whereupon the person got happy.
This was total, unmitigated bullshit. People diagnosed with depression have the same amount of serotonin in their cerebrospinal fluid as everybody else; and most people with depression don't respond to anti-depressants at all. (Absolutely true. At best 15% of people show a clinically meaningful response. The rest just get the side effects.)
The brain is not a bag of chemicals, and our moods, thoughts and feelings do not correspond to some overall level of one or any combination of chemicals. The brain generates the mind in all its states through highly complex processes -- networks of excitation flowing among millions of neurons to produce each and every phenomenon of consciousness. Once we have ruled out the gross abnormalities of structure or biology I discussed earlier, we are left with states that are only arbitrarily classifiable and which nobody understands very much about.
It would be nice to have a pill that could stop us from being sad. Actually, they used to prescribe amphetamines, which do work. You could ask Lenny Bruce but, uh, he's dead. It would also be nice if we could take pills so we wouldn't be shy, wouldn't be anxious, wouldn't get angry. Well, there are pills that have these effects to some extent, but it's usually a very bad idea to take them for very long. The reason is that our shyness and anxiety and anger are not caused by a deficiency of a chemical, and if you do pump in a lot of some chemical that changes how your brain works, the effects are going to be a whole lot more than the specific one you're looking for.
In fact, there are occasions on which it is very wise to be anxious, or shy, or angry. Evolution has equipped us with these states because they sometimes can save our lives, or benefit our kin. And people's personalities and capacities vary enormously, which is also a good thing for society and makes life more interesting.
Alas, we sometimes make unwise choices, or get locked into emotional states that are unpleasant or counterproductive. Some people behave in a self-defeating way consistently, or are frequently obnoxious to others. It can get so bad sometimes that we want to get help. Here's where psychiatrists come in. They want to be thought of as real doctors, so they need to be treating diseases, and they need to have pills to do it with. And so we get official names for mood disorders and personality disorders. But these are not real entities. They are pareidoilia, an "illusion or misperception involving a vague or obscure stimulus being perceived as something clear and distinct," like Jesus appearing on toast.