Diagnosing the Cause

You don’t cure illness by medicating symptoms. Cold medicine doesn’t make your cold go away: it just makes you less drippy while you have it. Antidepressants don’t make you okay: they just make you less sad about being not okay.

The more I understand about physical and mental illness, the more obviously true it seems. And now perhaps with op-eds like this, and books like Lissa Rankin’s Mind Over Medicine, I’m starting to believe it’s happening.

We can’t keep thinking it makes sense to take medication for blood pressure and diabetes and sleep apnea without changing diet and exercise habits – or to go back even further and figure out why the diet is bad, why the exercise is avoided.

An op-ed by psychiatrist Robert J. Hedaya was fascinating to me; I’ve paraphrased it below. I’m not a physician but I am 100% sure of this: we need to pay attention to ourselves, more now than ever, if we want to keep our health in this wold that’s evolving too fast for us.

I suggest that we psychiatrists abandon our obsession with assumptions that behavior is based on neurons and neurotransmitters. Science has proven that all brain functions are inseparable from bio-psycho-social systems. 

1. The brain has more immune cells than neurons, and they react to inflammatory processes in the body. They affect sleep and stress responses, among other things. 

2. Specific nutrients turn on and off certain genes relevant to mental health. This means your grandparents’ nutrition and stress shape your brain function and mental health.

3. All of the systems that affect mental health are also at the root of chronic illnesses  – diabetes, heart disease. Thus people who have diabetes, for example, are much more likely to also have a psychiatric disorder such as depression.

I propose that clinicians focus on antecedents of chronic illness (genetics, childhood stress, socioeconomics, nutrition, lifestyle) and the hormones and neurotransmitters that act as mediators.

Detailing the chronology of a person’s illness,  then addressing the contributing factors, is more effective. It guides more data-driven interventions, which address the roots of illness, rather than the label, the neurotransmitter, or the pill du jour.