Let us put the final nail in the coffin of the neurotransmitter myth of big Pharma and the APA. The idea that psychiatric issues come from some quantitative soup of neurotransmitters in the synapses of the brain is completely wrong.
My daughter Lily was at a party at a friend’s house. The friend had two black cats that Lily knew quite well. Everybody was outside in the backyard for a barbecue. Lily’s cell phone rang, and she went over to a far corner of the property for privacy and to get better reception. While she was talking, she spied one of the black cats in the bushes. She kneeled down, stretched out her hand and signaled the cat to come to her. It approached her. As it came out from under the bushes, she noticed a white patch of fur on the cat’s head that continued right down its back and onto its tail. My daughter felt a sudden wave of fear without immediately knowing why. Then it hit her—skunk! With her heart beating fast, she turned and walked slowly away without getting sprayed.
Lily had been living in kitty world, one of her favorite worlds. Being partially preoccupied on the phone, she experienced “cat.” The skunk, possibly rabid, did not behave like a wild animal. It came to her, much like a cat. The white stripe of fur was the visual trigger that didn’t fit with a black cat. Lily remained in the kitty drama for a few moments before the discordant information registered. When the white stripe took on the meaning of skunk and its skunk-story meaning, she had a fear reaction. Then she fled. Notice that her fear reaction actually preceded her conscious recognition.
This wasn’t just a correction of cat to skunk. It was a drama shift from kitty world to skunk world. From her immersion in kitty world, Lily was tender, warm, and maternal. Oxytocin and vasopressin were secreted from her hypothalamus, generating a feeling of love, tenderness, and warmth. Her autonomic nervous system created this mood state in the context of reading safety, trust, and love from her internal kitty world, triggered by seeing a cat.
When she saw the telltale white stripe, she shifted from kitty drama to skunk drama. In skunk world, she went in the other direction—into fight or flight. She went into a state of fear and, in this case, flight from danger. Her hypothalamus was stimulated to start the fight/flight response, secreting corticotrophin-releasing hormone and stimulating the sympathetic nervous system. Her autonomic nervous system, through the vagus nerve, stimulated an increased heart rate. In concert with other brain nuclei, it stimulated the adrenals to secrete cortisol. This went back to the hippocampus and amygdala, the feeling centers. Her fight-or-flight response, with all its necessary aggression, followed. These reactions were regulated by neurotransmitters, particularly serotonin.
Here’s the important point: both of Lily’s responses—the tender response and the fight-or-flight response—followed from the meaning of two separate brain plays (kitty world and skunk world). The biochemical, hormonal, neurological processes were not the progenitor of her responses. They merely were the mechanisms that mediated and made manifest her response. Her response to reality was through a top-down processed story that was generated by her cortical mappings. The meaning from perceived sensory data was purely through an activated cortical play. This then determined the biological, biochemical, neurological, hormonal, muscle, thinking, and feeling responses that followed. It was a specific cortical story that determined her state of mind-body.
Neither animal was a stand-alone fact, independent of story. Each elicited a limbic-cortical drama—one for cat, one for skunk. The state of feeling response was consonant with the meaning of the internal story of each animal. Lily has a long history of kitty love. Her internal story of cats elicited the feeling states that comprise this story. The meaning of white stripe was skunk story—danger from overpowering olfactory assault. It is the top-down cortical story that determined the biochemical, hormonal, and neurological responses. Each story reflected the mapping. The state of feeling and action response followed from the internal story of persona, plot, and feeling relatedness.
Yes there are neurotransmitters in the brain. There are thought to be a hundred, with ten of them doing the lion’s share of the work. Between two neurons there is a synapse, a gap of .02 microns. Neurotransmitters generate a chemical neurotransmission between neurons. This is a mechanical linkage that functionally glues a sequence of neurons together. It is what allows a nerve impulse to create memory maps of our experience. It is the emotional memories mapped though our limbic system that coalesce into our very plays of consciousness. When our plays of consciousness are sufficiently infused with love, they foster our authentic being and loving relatedness. When we are subject to trauma, deprivation and abuse, our plays are infused with sadomasochistic aggression. This is so with our original play, as well as traumatic experience all the way through development. All problematic plays result from trauma and are mediated by serotonin. However, serotonin does not create symptoms, the sadomasochistic play does.
Lily’s kitty and skunk worlds are relatively simple stories with an uncomplicated plot. How does this compare to the more central and powerful dramas, like problematic plays of consciousness – when the primary story of an internal play is a relationship of cruelty between two personas. This drama becomes the prism through which one experiences the world. When the drama is sadomasochistic, it is not grounded in a loving engagement between a loving ‘other’ and one’s lovable Authentic Being (which would be analogous to Lily and the kitty). The currency of an ongoing sadomasochistic play is a fighting sadistic aggression between the two personas (analogous to Lily and the skunk). The characterological story is deeply held. It is not a momentary enactment, like a skunk scare. Consequently, the fight of sadomasochism in one’s cortical world is a continuous steady state of war. There is an endless internal rage between two personas. [See – “How did Captain Hook get into Eddie’s Closet?”]
There are two essential points to keep in mind: First, one’s literal internal play is invisibly and constantly in operation inside of us. And second, it is this actual story that determines what is activated in the brain-body circuits. Fighting anger between personas consumes serotonin. On an ongoing basis, the neurotransmitter serotonin feeds the fight throughout the salient regions of the brain where these characters are mapped, particularly the feeling centers—the amygdala and the hippocampus. The inner drama, as an ongoing and enduring play, is sucking up serotonin on an ongoing basis.
Here’s the way it works: As a neurotransmitter, serotonin regulates aggression in the mapped neuronal circuits. Aggression is not a dirty word. All of our functioning in daily life uses healthy aggression. Assertiveness and self-protection—our capacity for fight-or-flight—are necessary aggression that utilizes serotonin. However, the ongoing sadomasochistic war in one’s cortex between the other persona and the self persona is of a different order than the regular and routine aggression of daily life. It is sadistic aggression. This constant state of fighting, from the sadomasochistic play, is constantly feeding on and overtaxing the serotonin supply.
When a personality is subject to a steady state of war, at some point the supply of serotonin will cross a threshold and become insufficient. This is purely in the context of a sadomasochistic play of ongoing fighting created by abuse and deprivation, i.e., trauma. At this point psychiatric symptoms are generated. Serotonin depletion is not the cause of psychiatric conditions; it is merely a mediator. The problematic play is the thing. Serotonin is specifically employed in the extensive mappings of ‘self’ and ‘other’ engaged in sadistic aggression. This is what is stored in the specific memory loops. This is where the fighting can’t be sustained. It isn’t some general pool of ‘not enough serotonin’.
People come to a therapist because they are suffering, due to the pain created by their symptoms. A psychiatric symptom is the signal that the sadomasochism of the cortical drama has crossed the threshold into serotonin depletion. Symptoms are the consequence of a diminished supply, like a fighting army whose supply lines have been cut off. Replenishing the serotonin allows the warring parties to fight on, which escalates and fosters the pernicious internal war. Symptoms comprise the built-in crisis of problematic characterological worlds. “Crisis” in Chinese ideograms is drawn as the intersection of danger and opportunity. The patient’s crisis provides an opportunity to address the real issue. The real issue is the problematic characterological play. Therapy is about dismantling the internal war and the recovery of the authentic self and the ability to love.
Psychotherapy is not about the signal that something is wrong, but about the something that is wrong. The real work of therapy is with the characterological world, the Authentic Being, and relatedness. In actuality, symptom relief is not so difficult, and never needs drugs. Character is the heart of the matter. Symptoms signify two things: First, that the characterological world has actually been in an unsustainable state of internal war, and second, it is the signal that the play has broken down. In the context of an ongoing problematic internal play, it is not a question of if but only when the system will get overtaxed. A characterological world with problematic fault lines will break down in characteristic ways.
If I am an auto mechanic, and you bring your car to me because the engine is overheating due to a cracked radiator, I can give your car symptom relief by feeding the radiator more fluid. This fix might work in the short run, but the structural problem has not been addressed. Just feeding the radiator will not fix the problem but will actually make it worse. There will be more leaks and more overheating due to the extra water, that will damage the engine even more. As the auto mechanic, I had better understand the organization of the engine in order to address the real problem—a cracked radiator—and how and why that happened. I need to understand the real issues and not mask them.
Sadomasochistic aggression is the primary manifestation of problematic characterological reality. It is the ongoing war between two internal personas. Sadistic anger is the currency and intoxicant of sadomasochistic relating. Anger is not a feeling or impulse that exists on its own. The anger is enacted between the two deeply held personas in the characterological play. Problematic plays are composed of these fighting personas, living on a projection screen imposed on reality. The aggression, in all its overt and subtle forms—whether a physical beating, sexual abuse, resentment, envy, simple disdain, or self-criticism—is an enactment between these two personas.
In the absence of love between two Authentic Beings, pain becomes the problematic solution to utter aloneness and emptiness. Hurting or being hurt and its accompanying anger gives the sensation of pseudo-vitality. Because pain feels real, one always becomes attached to this substitute relatedness. But it is a substitute that can never really work, and so the sensation gradually ceases to be effective and there has to be a constant escalation of attack to create the sensation of being alive. Built into this enactment is that the aggression will continue to increase. The sadistic judge will punish the bad attackee but cannot be satiated. Feeding the internal fight with extra serotonin escalates the war and generates a greater hunger for more and more serotonin.
When a patient feels psychiatric symptoms, it is analogous to putting your hand on a hot stove. You receive a pain signal, which signifies harm. The temperature triggers a pain response that travels up your afferent nerves. You send an impulse down your efferent nerves to your muscles to get your hand out of there. I could treat this problem by injecting a drug to numb the pain nerves of your hand. The upside to this solution is that it would take you out of pain and make you feel better. The downside is that you would keep your hand on the hot stove, feeling no pain. This solution would foster the pernicious situation and escalate the damage to your hand resulting in a bad burn. This is exactly how antidepressants operate.
By pouring more serotonin (radiator fluid) into the synapses, one might (and this is a considerable might, at best) temporarily relieve the symptoms. Old antidepressants such as Elavil put more serotonin in the synapses. New antidepressants such as Prozac accomplish the same function by preventing the re-uptake of serotonin in the synapses and creating a larger pool of serotonin on which to feed. However, what serotonin actually does is create a hardening of the self and an unconflicted selfishness. It intensifies an emotional hardening toward others. When fighting, you are hard and cruel. Your enemy is an “it,” not a person. There is an attitude of coldness and hatred toward your adversary. This amplifies the emotional reality of the invisible sadomasochistic personas. The escalated hardness and coldness from adding in extra fuel for aggression is often experienced as feeling good. This is due to the fact that there is no conflict over hurtfulness. This has been numbed. To heal from cruelty, you have to feel the appropriate remorse and regret.
Let me emphasize that antidepressants do not fix the sadomasochistic war. Instead they allow the destructive process to deepen, while the patient may temporarily feel better. Second and even more important, the extra serotonin specifically explains why people act on their suicidal and homicidal impulses. In the context of emotional numbness, hardening and drug-induced cruelty, people are less conflicted about murdering themselves or others. This explains the rash of horrendous mass murders committed almost exclusively by people on antidepressants. These kind of events were unheard of until antidepressants came on the scene.
Real recovery is achieved by mourning, in psychotherapy, and ending the war, and allowing for the possibility of authenticity and love. Don’t worry, a different cortical drama alters the chemical brain all by itself. The brain chemistry simply follows from the actuality of the internal drama. An antidepressant drug fix, through a numbing psychogenic drug, estranges you from the possibility of change in your problematic play, and consequently from your best humanity and your best self.
To review, the issue is not in the neurotransmitters, but the mappings of experience that generate problematic plays. Serotonin does not exist in some stand alone way. It is merely a substance that specifically glues sadomasochistic plays together. The only issue is, in fact, the problematic sadomasochistic plays which come from trauma. This is what creates psychiatric symptoms. The treatment for problematic plays is psychotherapy. When we mourn the trauma, the sadomasochistic play is deactivated. The neurotransmitter glue is also deactivated. A new and loving play replaces the problematic play. There is no such thing as a chemical imbalance which needs to be fixed with extra serotonin. There is a traumatic play that needs to be mourned. As we have seen; the antidepressants damage the patient, and may be a significant factor in suicides and mass murders.
Psychiatric symptoms are signals that need to be heard and felt to address the something that they signify. Adding serotonin to the system numbs out and overrides the signal. It is the sadomasochistic play in the theater of the brain that is the pernicious situation that damages the patient. This is what needs to be addressed. Our unique human story is the subject of psychiatry; the cortical top-down characterological drama in the theater of the brain. The subject of our psychiatric endeavors is phenomenological reality and its enduring play.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.