Symptoms are Signals

Unraveling the Central Fallacy of Modern Psychiatry

Despite hundreds of billions of dollars in annual spending on conventional mental health and substance use treatment in the United States, we are in the midst of an ever-worsening mental health crisis of epidemic proportions.

Depression affects over 330 million people worldwide, anxiety affects over 350 million people, and every year, nearly a million lives around the world are lost to suicide. The Centers for Disease Control (CDC) and National Institute of Mental Health (NIMH) currently estimate that more than one in five U.S. adults suffer with a mental illness each year. After 20 years of steady climbing, suicide is now the second-leading cause of death among 10- to 34-year-olds.

And yet—in ironic fulfillment of one famous definition of insanity—since the advent of the first antidepressants in the late 1950s, the field of psychiatry has continued to do the same thing over and over again, expecting a different result. Recent evidence shows that 40-50% of depressed patients treated with conventional antidepressants fail to respond to them. For those patients that do find relief, these medications eventually stop working in up to 57% of cases.

This is not because psychiatrists and other mental healthcare providers are insane, or stupid, or lazy. It is because we have all been laboring from inside a broken paradigm, one that teaches us that the causes of mental illness can be reduced to faulty brain chemistry, and can thus be fixed with drugs designed to correct those chemical imbalances.

Clearly our existing treatment models aren’t doing enough, and it’s not because we simply need more powerful symptom-suppressing drugs or neuromodulating technologies. What we need is a drastically different approach.

Conventional psychopharmaceuticals, as the terms anti-depressant and anti-anxiety imply, are designed to suppress the symptoms of mental illness. This does provide our patients some short-term relief from their suffering, and that can indeed be life-saving, especially when combined with conventional psychotherapy and other psychosocial interventions. I am not here to disparage or minimize that reality.

The problem is that because of our broken paradigm, we have deluded ourselves into believing that the combination of conventional psychiatric medicines with conventional psychotherapy constitutes an adequate approach. As we have seen, however, this approach is the furthest thing from adequate.

Using a symptom-suppressing drug as the mainstay of mental health treatment is the equivalent of taking the batteries out of your smoke alarm and expecting this to be an adequate response to your kitchen fire. After close to 70 years of this misguided strategy, we should not be surprised that our house is now in serious danger of burning down.

Treatment-Resistant, or Treatment Failure?

The field of conventional psychiatry likes to apply the label “treatment-resistant” to the many millions of people for whom our conventional approaches prove inadequate. The field’s knee-jerk response, when conventional treatment approaches fail, is to blame the patient, instead of doing what it ought to do, which is to question the methods it has been using, which generate this so-called treatment resistance in the first place.

The truth is that these patients are not treatment-resistant. They possess an inner healing intelligence that is alive and adaptive, and is sending up the symptoms of depression, anxiety and other mental health disorders not because their brains are malfunctioning, but because these symptoms carry vital information: signals from deep-rooted psychological wounds that require healing.

The human brain is a living, intelligent organ, constantly revising the connections of its neural circuitry and the expression levels of its neurotransmitters and the receptors that interact with them. It responds to environmental factors both internal and external to itself, which includes the daily presence of psychoactive drugs. Given enough time, the brain, guided by its inner healing intelligence, will find a way to adapt to and circumvent the strategies used to silence its signals, and this is why our conventional treatments so frequently fail.

Conventional psychiatry fails to recognize the contribution made to “treatment resistance” by the brain’s intelligent adaptation to conventional, symptom-suppressing interventions, to say nothing of the importance of the subjective contents of the psyche, which cannot be reduced to mere neurological activity (more on this in an upcoming series of articles).

A Radically Different Paradigm

The use of ketamine, Spravato, MDMA, psilocybin and other psychedelics as adjuncts to psychotherapy in the treatment of mental illness is grounded in a radically different paradigm—one that recognizes that psychiatric symptoms are indeed signals that need to be listened to, and at times amplified, so that their root causes can be brought to the surface and healed.

When combined with the proper safeguards, and delivered in the context of competent psychotherapy, psychedelics can help our patients in ways that no conventional intervention can.

As the root causes of mental health disorders are addressed, long-term symptom alleviation becomes the welcome byproduct of a true healing process rather than the result of a misguided, and only temporarily effective strategy of suppressing the signals communicated by our patients’ inner healing intelligence.

This is the treatment approach we employ at InnerMost, the interventional psychotherapy clinic that I co-founded in New York City, where I serve as Chief Medical Officer. If you would like to learn more about how our treatment approach might be helpful to you or someone you love, you can book a free discovery call with one of our care coordinators.

In my next few articles, I’ll be delving deeper into a model I have developed that seeks to demystify what is taking place in a psychedelic-induced non-ordinary state of consciousness, which can perhaps shed some light on the mechanisms by which healing takes place in psychedelic-assisted psychotherapy.

Finally, as always, if something here resonated—or provoked—I’d welcome your thoughts in the comments. And if you found this worth reading, I hope you’ll pass it on to someone who might as well.

Until next time,
Casey

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