The Balance Of Power

Or, perhaps, the power of balance?

The human body is a grand experience in chemistry. All of our parts can be broken down into elements which are easily found in the "periodic tables" in high school chemistry textbooks.

Some of our chemicals are rigidly fixed into structures which change slowly (calcium in bones, for example) while others vary in amount and location. So what's the deal with "chemical imbalance"?

The most variable of our chemical constituents are in our blood, and their amounts depend on factors such as time of day, time of our last meal, and whether we are under stress of some sort. There is a "normal range" for the variable substances - for blood sugar it's roughly 65 to 100 for the fasting state, and can be 150 to 180 right after a meal. Having an idea what's best for itself, the body has ways of keeping blood sugar in the normal range. Now, extend this idea to cover all of the hormones, salts, fats, etc. present, and you are rapidly overwhelmed by the complexity of it all.

"Normal" is never an absolute number - it's always a range. Some people will be at each end of a range, but unless they stray too far up or down, they are still normal. Most of us will be concentrated in roughly the middle of a range, but we aren't any more normal than those at the extremes. For bragging purposes, some of us like to point to our location in the precise center. This is not only dumb, it's kind of boring. Like Stepford Wives.

Several years ago, the chemistry of the brain was unraveled (in the laboratory, you ghouls!) resulting in partial knowledge of what creates departures from mental normalcy. Most of us believe that all of the activity in our brains is the result of chemistry rather than simple electricity. With this concept, and more and better ways of measuring brain-active substances (names like serotonin and norepinephrine come, literally, to mind ), we have a better understanding of the causes of mental symptoms. Depression, for instance, is accompanied by generally low levels of serotonin and norepinephrine. There is "range of normal" for these substances, which ought to mean that there is also a "range of normal" for the behaviors they (presumably) control.

Mostly by chance, early anti-depressant medicines altered these chemical substances. (Research pharmacologists experimented with many different compounds with no clear idea of how they might work.) Later antidepressants were developed to target a specific problem, and alter levels of the appropriate neuro-transmitter molecule. This was really a giant step toward better use of medication.

(A topic for an entire column is the idea that neurotransmitter levels can be altered by behavior and experience, no drugs needed.)

Something has happened to mental health along this road to understanding what makes us think. There is now a widely held belief that all departures from an absolutely healthy mental state (whatever that is) can be explained by a "chemical imbalance". This can then be corrected, presumably, by altering levels of neurotransmitters in our brains. If that's true, two things present themselves for discussion.

The first is who decides, and how, which ones among us are not right in the head? In order to make the decision, "normals" for mental and behavioral health must be established, and here the going gets sticky.

"Normal" for a child in Sunday School may not be "normal" when he's playing soccer. When do two common symptoms, depression and anxiety, depart "normal" and become abnormal? Does the patient get to decide he's "abnormal", or is the decision made by an objective observer with no personal interest in the outcome? Is there a "range of normal" for behavior just as there is a range for the chemicals which affect behavior?

Another troublesome issue is our lack of tolerance for and acceptance of behavior and thinking which doesn't match our own. When does someone get far enough out on the bell curve to warrant their being dragged back closer to the center with a drug? An unusually high number of our brightest and most creative people might be considered to be chemically out of balance if uniform standards are applied. Far too frequently treatment is begun not for the sake of the individual but for the comfort of those around him.

Whether it's the way your pancreas functions, or how you react to life stresses, everything has a "range of normal". Only those who sit way out on the ends of the teeter-totter may qualify for an "abnormal" label. There is regrettably a lot of normal that gets diagnosed and treated as abnormal, to the detriment of our overall health.

Another thing warrants comment before we quit. That's the tendency of some people to wear their diagnosis of "chemical imbalance" like a badge. Does this mean they get a free pass whenever thorny problems need solving?