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I get asked this all the time:  “What if it’s only chemical?”

Good question.  Why talk to a therapist if you can take a pill and be done with it?

Freud was intrigued by the possibility.  According to Peter Gay, in Freud’s late work, “Outline of Psychoanalysis:”

“[he] speculated that the time might come when chemical substances would alter balances in the mind and thus make psychoanalytic therapy, now the best available treatment for neuroses, quite obsolete.”

It’s appealing to treat mental illness as a chemical problem because chemistry seems clean and precise.  The fundamental functioning of the brain is both chemical and electrical, based on the difference in potentiality between sodium and potassium.  No problem.  You identify an imbalance, add ingredients, stir, and restore order.

But there is a problem.  The brain is also a ball of flesh, soaking in countless compounds we scarcely comprehend.

Injecting a drug – one more chemical – into your bloodstream is a primitive way to fine-tune complex chemistry.

That’s why psychiatric drugs are most effective when blunt, simple results are called for.  They can slow you down.  They can speed you up.  They can numb you or narrow your emotional bandwidth.  If you are bi-polar, they may help stabilize your emotional swings.  If you are psychotic, they may bring you back to reality, or at least closer to it.

For subtler changes in brain chemistry, talk therapy – or maybe talk therapy in tandem with a drug treatment component – produces better results.

How could talking in a therapist’s office affect the chemistry of the brain?

Your emotions are chemicals.  When you feel angry, your amygdala, a region in the center of your brain, releases a chemical signal.  That chemical – or series of chemicals, is what you experience as “anger.”  Joy, fear, sadness – all the emotions you feel as fundamental responses to the world around you – are chemicals.

Your thoughts are also chemicals.  When you admire a sunset, you are releasing chemicals which trigger electrical impulses that race through the circuitry of your brain.

Your thoughts affect your emotions.  So if I can affect  your thoughts, I can affect the chemicals triggering your feelings.

The brain is extremely mutable – neural pathways can be rerouted.  If I can make you aware of your thoughts and feelings, I can reroute the neurons in your brain, so different chemicals are released.

This isn’t as far-fetched as it sounds.  Here’s an example:  If you are depressed and I tell you to go for a run because it will cheer you up, I’m not merely nagging.  Aerobic exercise releases endorphins in your brain.  These chemicals cheer you up, relieving depression.

In the process, you will also create a memory – a piece of stored chemical information – that links depression with going for a run and feeling better.  A faint, newly formed neural link, and a piece of memory supporting that link, have been created.

Here’s another example:  if you are denying your anger – the typical pattern that creates depression – and I arrange during a session of psychotherapy for you to address your father, or your mother, or your boss or your girlfriend, and you feel anger well up and put that anger into words, saying what you’ve kept silent for years…that’s going to have effects on the chemistry of your brain.

When you get the words out, and feel your buried anger, new pathways will form between the ancient regions governing emotion in the center of the brain and more recently evolved cognition areas in the outer cortex.

New thoughts circulate new chemicals, create new memories, and effectively rewire the way you think.

You leave my office realizing you were angrier than you thought, and knowing it felt good to get it out.  You experience a lightening of mood.  Your girlfriend, when you get home, senses that you are less defended – your resistances are down.  This alters her behavior towards you, and she starts to open up to you emotionally to a new degree.  You begin questioning your old responses to her, and your old ways of doing things in general.

Your brain is flooded with new chemicals, and new pathways have been formed, that might, with further talk therapy, begin to replace old ones.

Subtle changes have been made to the chemistry of your brain – to who you are, how you think, and how you behave with others.

That’s what psychotherapy is all about:

Better living through chemistry.

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How does psychotherapy actually work?

Good question.  The answer is interesting and has to do with how your brain works.

The basic idea of psychotherapy is that you take emotional content from a primitive part of the brain and bring it to another more sophisticated, thinking part, where it can be examined and understood.

Here’s a quick primer on the design of your brain.

Due to quirks of evolutionary history, the human brain contains three distinct parts, which evolved separately.

In the center, there’s a small, rather rudimentary brain.  It resembles the brain of a lizard.

Wrapped around that, a second brain evolved much later – the paleo-mammalian brain.  It resembles the brain of a dachshund, or any other warm-blooded animal.

Sitting atop these two brains, there is the cortex.  That’s the grey, wrinkly stuff that you probably think of when you think of a brain.  It’s much larger than the other two brains, and is unique to humans, having evolved only very recently.

Like all higher animals, you have five basic emotions:  anger, fear, caring, hurt and happiness.  They exist entirely in the two more primitive parts of your brain – the lizard and dachshund parts.

Your thoughts – and your sense of awareness – exist only in the outer, sophisticated brain – the cortex.

There’s a reason for this.  All animals feel some emotions, but only humans have higher consciousness.  We alone think. (Actually, it could be argued that dolphins and some higher apes do too, but I’ll set that debate aside for now.)

Anger and fear reside in the innermost, lizard brain, because they reflect the primitive fight or flight instinct.  Faced with a ferocious predator, a tiny lizard needed to reflexively know whether to get angry and fight, or get scared and flee for its life.

The other three emotions are located in the paleo-mammalian brain.  That’s because they relate specifically to childcare instincts.

A lizard lays eggs – lots of eggs, and it doesn’t invest much time in caring for its young.  But a mammal bears only a small number of live young, and its off-spring are helpless for a period after birth.  So while a lizard might ignore its own large brood of young (or even dine upon a few of them), a mammal, with its small number of helpless off-spring, developed three important emotions related to childcare:  caring, hurt and happiness.

These emotions, located in the paleo-mammalian brain, lead the parent to care for its young, love them, and find happiness in caring for them, or hurt if they leave before the parental bonds are detached.

That’s your emotions, explained.  Now for psychotherapy.

Speech, and communication in general, including non-verbal communication like art and dance and music, are located in the cortex.  Psychotherapy is talk therapy.  A therapist’s goal is to get you to put your feelings into words.  In neurobiological terms, the idea is to take emotional material from the two inner, primitive parts of the brain – the lizard and dachshund parts – and translate them into speech – forcing them through the neural passageways of the cortex.

In essence, the thinking you is forced to process material from the feeling you.

In Freudian terminology, the two inner brains are the “unconscious” (the superego and the Id) and the outer cortex is the “conscious self” (the ego).  By funneling primitive brain activity into communication, therapy forces the unconscious into consciousness, integrating the self.

It’s a bit like an intellectual holding a conversation with a lizard and a dachshund, which is why the process isn’t always easy, and can take a while.

In any case, it’s better than living unconsciously – walking around thinking you know what’s going on while a lizard and a dachshund are secretly operating the controls.

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