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This summer, two academic papers took aim at our current medical model of mental health. In this current model, depression, anxiety, and other mental health conditions are the result of a broken machine: disregulated neurochemistry, faulty wiring between brain regions, etc. Published in highly respected scientific journals (Neuron and Molecular Psychiatry), these two research groups reviewed the science to date and found that there is no good evidence for the dominant idea of mental health conditions having a biological cause. The researchers in the article from Neuron write: “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition. Likewise, functional neuroimaging plays no role in clinical decision making.”
And the research group from the Molecular Psychiatry article conclude: “The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations.”
In other words, there is no physiological basis for the vast majority of mental health problems. Serotonin dysregulation has no empirical support. There is no use for neuroimaging in any psychiatric condition. We need a different model. Before I offer a different model of mental health, I’ll say a word about conceptual models in general. There’s a saying: “The map is not the territory.” This deep truth is poetically illustrated by Jorge Luis Borges in his short story, “On Exactitude in Science.” Our models (or maps) can NEVER correspond to reality in a 1:1 way. To do so would render our models unusable, just a like the worthless map in Borges’s short story that corresponds to its territory in a 1:1 fashion. Models and maps are necessarily wrong or incomplete in different ways. Their value lies in their utility. What do good models and maps help us do? They help us achieve our goals (like getting from A to B or understanding a bigger and more complex phenomenon). The goal I’m aiming for with my model is to leave behind mental health approaches that are less helpful and find ones that are more helpful. — I argue here for an orchestra model of mental health. This model completely accepts that our mental/emotional experience of the world is connected to the physiology and neurochemistry of our brain. We know this is true because if you zap particular parts of the brain, our mood/thoughts/reality will reliably change. If you take antidepressants, psychedelics, or alcohol, all of which alter the neurochemistry of the brain, your mood/thoughts/reality will reliably change (albeit not in the same way for everyone). So, how can we reconcile the fact that neurophysiology and neurochemistry are fundamental to our moods/thoughts/reality, but nevertheless are not responsible for our mental health problems? Think of your experience right now or at any point in time as a single moment in a symphony. Your experience is the sound of the symphony music the orchestra plays. Perhaps it’s beautiful and joyous (i.e, you’re in a good mood and feeling connected to life) or perhaps it’s dissonant and chaotic (you’re depressed and/or anxious). Even in the dissonant and chaotic experience, your orchestra’s instruments may be working perfectly. The problem is that the orchestra members are playing out of sync, out of tune, or playing different songs entirely. Perhaps the orchestra conductor is absent or distracted. Or perhaps each member of the orchestra is playing their own song, or they’re trying to lead or follow each other randomly. In this model, our neurophysiology and neurochemistry are the instruments, and they’re working just fine. The problem lies in the coordination between the orchestra members. The medical model of mental health uses antidepressant medication to fix the dissonant music (i.e., depression and anxiety) mostly by turning down the volume. If we experience anxiety or depression (dissonant, atonal, off-beat feelings), then turning down the volume can certainly work to get us through the day (but even then, large studies like this show that long-term use of antidepressants do not improve quality of life.) But the medical model approach doesn’t work to bring the orchestra into harmony, nor to make joyous, beautiful music. For this we need a model that first sees the orchestra players as parts of a whole, and, second, recognizes that there is a conductor. Internal Family Systems or “parts work” helps us do exactly this. It gives us a map for going into our inner worlds and coming into relationship with inner parts that are playing out of sync or are fighting with each other to take the conductor role, or playing loudly to drown out other parts. We can do this inner parts work to slowly but surely discover why our orchestra members are doing what they’re doing, and then to invite them to trust that you, the real conductor, are here, full of compassion and confidence, and ready to take the lead. The upshot of this orchestra model of mental health is that you are not broken. All of your orchestra members have perfectly working instruments and know how to play. They just need to learn how to work together and follow the lead of your calm, confident, and compassionate true self.
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