Psych-Out

from THE CIVIL WAR by Anne Sexton

I am torn in two
but I will conquer myself.
I will dig up the pride.
I will take scissors
and cut out the beggar.
I will take a crowbar
and pry out the broken
pieces of God in me.
Just like a jigsaw puzzle,
I will put him together again
with the patience of a chess player.

On October 3, 1974 Anne Sexton was unable to pry out the broken pieces. She closed up the garage, turned the ignition key, and waited for the waft of carbon monoxide exhaust to carry her off toward that “pint-sized journey” into death.

Anne Sexton

Was Anne Sexton’s suicide an inevitable result of parental hostility, or a child’s life gone astray? Was it alcoholism, bipolar disorder, her genes, or caused by some chemical imbalance that might have been corrected if Prozac, or Wellbutrin, or the right combination of Lamictal and Abilify were available then?

Don’t they know
that I promised to die!
I’m keeping in practice.
I’m merely staying in shape…

We like certainty. We like tidy explanations. We prefer our answers to “why” wrapped in simple, easy-to-organize, packages. “It’s in your brain” makes as much sense as finding causation in child-rearing, toilet training, or that kid who bullied you in 5th grade. A chemical imbalance? It’s enough to make us feel comfortable taking the pill because at least, now, we have a digestible explanation for “why.” We’ll call it a useful little lie.

When it comes to “whys” of human emotional sufferings, the truth is as elusive as it is messy. In the world of psychiatry, causation is a chimera. (1)

psychotic chimera

If there’s anything that modern neuroscience says for certain about the human brain, it’s to keep our humility. One human brain has over 100 billion neurons, 109 trillion synapses, and hundreds of thousands of interconnecting circuits. There are no biochemical, anatomical, or functional signs to distinguish Anne Sexton’s brain, from that of the Dalai Lama, or your neighbor next door who washes his car every weekend and obsesses over his front lawn. Yes, we’ve learned much in the last 10 or so years. But even then, we’ve not scratched the surface of understanding the workings of this magnificent, and at times troubling, organ.

“In a dot of brain no larger than a single grain of sand, 100,000 neurons go about their work at a billion synapses.” Diane Ackerman, An Alchemy of Mind

Drug companies have marketed the idea that depression represents a chemical imbalance — a decreased availability in the brain of the neurotransmitter serotonin. Before you jump on the wagon and proclaim your own chemical imbalance, however, consider that there are no tests to date that assess the chemical status of a living person’s brain. There are at least fifteen different serotonin receptors. We have little idea what these receptors actually do, or how they may relate to any psychological state. In fact, it is now estimated that there may be over 100 neurotransmitters, and most psychotherapeutic drugs affect many more neurotransmitters than were initially suspected.

As for genes? Every day we read some article about scientists uncovering a gene that causes shyness, or depression, or fearfulness, or talkativeness, or sexual promiscuity. One gene, one behavior. But, genes do not produce either behaviors or mental states. Genes carry instructions for producing amino acids and proteins, and then assembling these proteins into enzymes and anatomical structures.

Yes, somewhere down the line these structures, whether they be neurons, brain circuits, or the number, kinds, and functioning of synapses, are faintly related to what we do and how we feel. It’s never just one gene acting alone, however, but in concert with other genes. Even our genes have to be switched on or off by a chemical reaction caused by a specific environmental influences — like being spanked, or falling in love, or getting divorced, or reading the Brothers Karamazov, or taking LSD. How this all works to cause anxiety, depression or schizophrenia, we have only the faintest of clues.

Elliot Valenstein, in his book Blaming the Brain, reminds that there is no way that a mere one hundred thousand genes can determine the precise configuration of 10 trillion synapses in the human brain. Genes may build the structure of the house, but it’s our collection of experiences that furnish it, decorate the walls, landscape the yard, create the mood, whether chaotic, calm, or melancholic – in essence, make a life our home. (2)

Does it mean we should shun the help offered, whether it be talk therapy, pharmaceuticals, or some combination thereof? Of course not. Ask the tens of thousands who have been be mercifully spared the fate of the worlds’ Anne Sextons. Poet Jane Kenyon wrote:

We try a new drug, a new combination
of drugs, and suddenly
I fall into my life again

like a vole picked up by a storm
then dropped three valleys
and two mountains away from home.

I can find my way back. I know
I will recognize the store
were I used to buy milk and gas.

I remember the house and barn,
the rake, the blue cups and plates,
the Russian novels I loved so much,

and the black silk nightgown
that he once thrust
into the toe of my Christmas stocking (3)

Neither does it mean, however, we accept tidy, spoon fed explanations. The paradox is that psychiatry has been slightly better at solutions than causes – though the solutions are often hard fought, partial, and not without sometimes troubling trade-offs.

Concrete Blonde, “Dance Along the Edge“

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All Anne Sexton poems are from: Sexton, L. G. (Ed.). The Complete Poems of Anne Sexton. 1999: Mariner Books.

(1) Michael McGuire and Alfonso Troisi, in their book Darwinian Psychiatry, remind: “….some persons with depression grow up and live in adverse social environments while others do not; some come from families in which depression is common while others do not; and significant individual differences in depression-causing physiological systems have been reported. What is more, some respond to one type of anti-depressant medication but not to another; some do not respond to any type of medication but do respond to electroconvulsive treatment; and some do not respond to any known intervention.” (Quoted by Andrew Solomon in Noonday Demon, p. 401

(2) Valenstein, E. S. (2000). Blaming the Brain. New York: The Free Press.

(3) In Solomon, A. (2001). The Noonday Demon: An Atlas of Depressioin. New York: Simon & Schuster. (p.79)