October 28th 2013
Originally published on Thinking Mom's Revolution
As a conventionally trained, dyed-in-the-wool psychiatrist, I learned that mental illness is a manifestation of an imbalance of brain chemicals that can be largely reduced to too little serotonin and/or norepinephrine, too little dopamine, or messed up excitatory signals at the membrane level. These deficits required pharmaceutical intervention for repair, just as one of my attendings once patronizingly said to an inpatient post-suicide attempt: if you had poor vision, you would need glasses. There would just be no way for you to navigate the world without those glasses no matter how much you wanted to.
I don't believe this anymore. I've left the church and I've run into the woods where I'm listening to the sermons delivered by the natives there...those who believe in a natural order, in the body's capacity to heal, in the sanctity of a clean environment, and in the interconnectedness of spirit, nourishment, and movement. But this was a journey for me. I started to open my eyes during my first pregnancy, when I began my fellowship in treating pregnant and postpartum women. I learned how to consent them, and what informed consent really looked like, around treatment with psychotropics in pregnancy and lactation. Many of these women had been on medication for the better part of their adult lives and either found themselves pregnant, were planning to become, or developed symptoms despite treatment. I poured over the literature for hundreds of hours, memorizing authors and statistics, distilling complex analytic concepts, and building a rational path, with some forks in the road, for these women to travel. I helped them to understand the known risks, the unknown risks, the alternatives, and allowed them to assess the perceived benefits. This process would often culminate in a 90-120 minute session involving all and any interested family members and extensive communication with other providers - general psychiatrists, obstetricians, therapists, so that everyone was on the same page.