Serotonin? Never heard of her.

mental illness, the normalcy of untreatability, and (a little bit of) freedom

Sometimes I wonder what it would be like to have noticeable amounts of stuff like serotonin and dopamine. I don’t. We’ve checked. I even looked down the back of the couch and in the junk drawer, no dice. My levels of these things, while detectable, have never so much as glimpsed the bottom of a reference range.

This cute little flower-embellished serotonin molecule diagram is available for your crafting needs.

I don’t mention this because I think it’s particularly remarkable. I cannot possibly be alone in having weird brain chemistry. Most people never have theirs tested. Mine only got tested because I had a psychiatrist who was confused by my utter lack of any reaction at all, at any dosage, to quite a few different medications and he sent me off to see if the boys in the lab could figure out what the hell my problem was.

I mention it because as it turned out, my problem was that all those medications were created based on some assumptions about what a patient’s brain was going to be like that didn’t happen to be true in my case. Over time, this helped me think in some very different and useful ways about my own brain and mental health.

One of the things it helped me think about is that in all likelihood, the things that were presumed to be true about my biochemistry are also not true for plenty of other people too. There are billions of people running around the place here on Earth, and truly unique biologies are almost unheard-of. It might be rare. But honestly we don’t even know if it’s rare for a person to not have much in the way of these particular neurochemicals. Most people never get theirs tested. It might be that it’s far more common than we imagine, but we just haven’t looked. I only know it’s true in my case because some guy in a white coat got frustrated when all his usual magic tricks elicited precisely zero reaction in a patient whose disorder he thought he understood and knew how to treat, and he was sufficiently invested or egocentric or both to want to know why.

So we have no idea how common or uncommon it is to run around all your life with only a little garnish-type sprinkling quantity of the brain’s supposed “happy juice” chemicals. But there are a few things I can tell you about it.

Would you like to crochet your own dopamine? Of course you would!

I’ve known for half a decade now that my brain chemistry is several large bubbles off plumb. Yet I don’t have, and never have had, some of the symptoms I supposedly “should” have in relation to this. There’s no rhyme or reason to it. My system just hasn’t responded in all the ways it might’ve to my particular neurochemistry. But this simple fact has given me a robust skepticism about neuropharmacology and the current line of thinking that mental health and mental illness are “just a matter of chemistry.” It’s also given me a lot of insight into the ways in which attempts to tinker with brain chemistry, whether via medication or other means — like exercise in order to raise serotonin or dopamine levels, for example — may or may not be actually relevant in any given individual.

Don’t mishear me: I’m not at all saying that these things are worthless. Part of the point of doing science about such things is that we can show with actual observations and data whether they do certain things or not, and therefore whether those things might be worth trying for people who are trying to change their neurochemistry in particular ways. Another thing science can show us is whether or not changing neurochemistry in particular ways has a tendency to shift humans’ affective (emotional) experience.

What I am saying is that just as my organic brain chemistry weirdness hasn’t produced all the consequences that medical research has predicted such chemistry might, no other aspect of neurochemistry is likely to be entirely predictable either, or do the same things to everyone every time. There are a lot of variables.

For example, people like me with idiopathic (meaning that the cause is spontaneous or unknown) low serotonin and dopamine levels are outliers on the bell curve of what’s possible for human bodies in that regard. But what does that mean for us as human beings, or even as medical subjects? How much of an answer do we have to that question? If you were to successfully raise my serotonin, how much would you have to raise it in order for me to be able to tell? How would you even begin to start to answer that question? Are there well-established statistics on what kinds of serotonin levels there must be, either in the blood or in the brain, in order to have particular kinds of effects on a person’s brain activity? What about to have particular kinds of effects on a person’s emotional states?

Are we even sure we know how serotonin — and let’s not forget that the sale of drugs that act on serotonin is a many-billions-of-dollars business even if we limit it to the US — makes people’s affective experience better? Or whether it does? I mean, I’m not the first person to ask what’s up with these drugs, or tried to look critically at what they do and don’t do and start to poke at why: Peter Kramer’s Listening to Prozac is more than 30 years old now. Like Kramer, who’s since written other books saying so, I think the answer is that it’s complicated and we don’t know enough to make blanket statements.

Or to write blanket prescriptions. The brain, its chemistry, and how those things affect our minds are really not all that well understood at this point. We know more than we used to, and that seems miraculous. But new knowledge often seems that way. And it is miraculous, or comfortably close to it, to suddenly know something new, or understand something you didn’t understand before. But even miracles have their limits: the fact that they don’t happen to everyone, and don’t happen all the time, is exactly what makes them miraculous rather than mundane.

Saint Dymphna of Geel (Belgium) is the Catholic patron saint of the mentally ill, speaking of miracles. This beautiful icon of her belongs to the Basilica of Saint Mary in Minneapolis, and was painted by Debra Korluka.

Just because you understand one thing doesn’t mean you understand everything. Just because you understand how a thing works in a certain set of circumstances doesn’t mean you understand how it works everywhere always. One of the things I learned from going through the process of repeatedly trying antidepressants that didn’t do anything (except sometimes cause unpleasant side effects), then finding out one reason why they might not have, is this: a great deal of neuropsychiatry is and always has been done on the basis of educated guesswork and at least as much more is done on the age-old principle of research and development known as throw it at the wall and see if it sticks. I mean, we still don’t know why electroconvulsive therapy helps so many people with otherwise intractable disabling depression. We’ve tried it enough times to know that it does, though.

It is on that basis that I assume, given what science has been able to demonstrate so far about serotonin and dopamine and the brain and the mind and affective experience, that I might experience considerably fewer bad, sad, down, low, depressed, and apathetic feelings if I had more of those particular chemicals sloshing around inside me. Whether I’m correct to assume this, though, I really don’t know. Furthermore, nobody else does either.

Based on experience, however, I can tell you something that I know for certain is correct: having weird brain chemistry is inconvenient insofar as it pretty much wipes out your chance of a massively lifechanging mental health breakthrough thanks to a medication.

I can also tell you for absolutely certain that while this is an inconvenience, it’s honestly only as much of an inconvenience as you had pinned your hopes on having a medication solve this particular problem. This can be considerable. But it’s also variable. You can change your mind about it, in fact. I did.

This is, by the way, NOT where I tell you to do more yoga, eat more kale, or put a donut under your hat on the full moon and it’ll fix everything. Anyone who’s trying to tell you the One Crazy Trick Doctors Don’t Want You To Know doesn’t know a damn thing and is only trying to make a quick buck off your suffering, your curiosity, or both. Anyone who gives you any version whatsoever of the old If You Just Do X, Everything Will Get Better is similarly full of shit, for the simple reason that, as I just finished explaining, bodies and brains and minds and bodyminds are pretty complicated and there is probably not any magical X that works for absolutely everyone all the time.

This IS, however, where I tell you that if you struggle with your brain or your mind or some combination of both, and especially if you struggle with finding things that help your brain behave better and your mind feel less shitty, that

a) there might be reasons for that

b) you might not know what they are

c) knowing what they are might or might not be helpful

and most importantly

d) it is eminently possible that you’re not struggling because you’re not doing something right, but that you’re struggling because you’re dealing with something that is a whole lot more complicated and slippery and tricky than people sometimes make it out to be.

I spent ridiculous, inordinate amounts of time trying to figure out what I was doing wrong that must have been, had to have been, the reason that I couldn’t seem to get my brain to behave itself better or on a more reliable basis. Or what I wasn’t doing enough of, or what I was maybe doing too much of, or what I wasn’t doing that I should’ve been doing instead of what I was doing. I did this both before and after I found out about my wonky brain chemistry, in fact, because I reasoned that just because my neurochemicals were weird didn’t mean I couldn’t figure out what to do about it anyway.

What I discovered is that no, I couldn’t. Alas for me, no matter how giant and bulbous and freakishly good at some kinds of problem-solving my brain may be, this was not one of the puzzles it was going to be able to conquer.

I can state that with great confidence, for the simple reason that there’s more to the mind that the brain, and even if I could figure out how to fix all the stuff that’s not working well in my brain, I was still going to have all the mind stuff to figure out, not to mention a whole lot of things that are both and neither and also distinctly other. Did you know that childhood trauma can cause damage to bits of the brain and brain function, for instance? It’s a real thing. But time still only flows one way, last I checked, so good luck with that.

Mmmmm, brains! These happen to be some fMRI images of brains that show some of the differences between the brains of people who were maltreated as children and those in a control group.

Naturally, it doesn’t stop there. In other words, you’re not doing anything wrong if you can’t figure out how to convince your brain to straighten up and fly right. There might not be a medication that’s going to do the job either.

Living your best life might just require other strategies.

You might never get rid of the invisible pain that happens inside your head. I probably won’t. Weirdly, once I faced the fact that I probably wouldn’t ever be able to get rid of it completely or permanently, it became a lot easier to handle. It’s easier now to notice it and say “Oh, we’re having Stupid Brain Tricks time again.” It’s easier to just grit my teeth because I know it’s just that thing that happens, not something I’m doing wrong, and that there’s nothing really to be done for it except continue to do all the things — eating food that doesn’t screw up my gut or my metabolism, sleeping, moving my body around from time to time, taking showers, talking to other human creatures, petting the dogs and cats — that have a decent chance of making sure that whenever my brain gets around to taking a break from the Stupid Brain Tricks, I’ll still be in okay condition.

Once I realized that it wasn’t about me, I stopped taking it quite so personally. This made it better. This also made it easier. I got to stop trying so hard to fix it, and I got to let go (most of the time, old habits die hard) of the horrible guilt that I couldn’t seem to fix it. I got to take some of that time and energy and attention and do other things with it.

It’s a small liberation. But given that I’ve got a brain that regularly tries to kill me and likes to torture me with pointless pain that signifies nothing but its own dysfunction, you know, I’ll take what I can get.

Turns out you don’t need much in the way of serotonin or dopamine to do that.