“Brain Energy” is a book by Christopher M. Palmer, MD., 2022 [LINK], a psychiatrist and researcher from Harvard, USA. In Brain Energy, Palmer discusses some problems that he perceives in how psychiatry has evolved and the major shortfall in therapeutic care that results from this. Palmer conjectures that all mental disorders are metabolic disorders of the brain, specifically problems in the mitochondria of each cell. Palmer proposes some guidelines on how to address this problem. I agree with much of what Palmer is saying, but disagree on his simple conclusion and solution.
The book can be divided into 3 major parts.
Part 1 – The current state of psychiatry
In this section, Palmer helps the reader understand how mental disorders are often missing the mark as to what is going on, leading to many different names and treatments for the same basic set of problems, which leads to lots of problems in knowing what is actually going on and thus what to do about it. Effectively, it’s not pretty, but it is what we have.
I agree that the current diagnostic manuals have many names for the same thing, because different schools of health noticed similar groups of things, defined them in their own nomenclature and then devised their own treatment plans, mostly that don’t work.
For example, most of the “personality disorders” are just what Autistic ADHDers look like in various spectrum presentations to someone who doesn’t understand Autism and ADHD. In trying to treat a personality disorder, they miss what actually needs to be done to help Autism and ADHD, leading to poor results.
Part 2 – The case that metabolic disorders of the brain are the root behind mental disorders
In this section, Palmer makes a case that behind most persistent mental disorders is an underlying biological problem, specifically metabolic, and then draws a tenuous link to the mitochondria – the power source of each of your cells.
In my opinion, people who experience mental ill health for 2 years or more are almost always dealing with a biological problem first, which has mental ill health symptoms second. In my opinion, people who are dealing with these health differences from childhood or birth, or for more than half a decade, will highly likely need some mental health therapy to manage the behaviours developed to manage the health condition and the consequences that had on their lives.
I am aware that mitochondria has some connection to disorders that affect how much effort people can put towards actions, such as chronic fatigue, fibromyalgia and some kinds of chronic pain disorders. I also know that some kinds of metabolic problems, such as diabetes, can affect the mitochondria. But after that, in my opinion, Palmer is reaching to make it all about the mitochondria.
Part 3 – The case for breaking the silos and looking at the whole situations
In this section, Palmer describes the priority to look at the person’s physical health first, situation second and mental therapy third. While this is not a strict order, this seems to be the majority of people. Palmer is willing to use medications where needed, and prefers to work towards not needing them where possible.
I agree that a person’s whole situation is vital to their health. These are not separate entities. Unfortunately, our Western Health system seems to have siloed far too much health care. Medical doctors take care of basic physical health, no one takes care of diet, dentists take care of the mouth rocks, psychiatrists take care of the brain medications, mental health therapists take care of behaviours and son on.
There are benefits to specialising, because there is so much to know that it is not possible to know it all. The problem arrives when specialists don’t talk to each other, when a person’s health complications span more than one silo, or fall between silos because no one technically specialises in that aspect. This leads to people with complex health issues being mistreated or not treated at all.
Palmer recommends that people go and see a specialist that can help them with their diet, exercise, social, mental health and medication. Which is smart, and I agree. Except that his first section above is pointing out that these people don’t exist and we should have them…
A bit tough to do.
Palmer also doesn’t make it clear enough that medication is not evil and if the appropriate solution, should be taken. It would be very easy to misread what he has said as “the best solution is not medication” and consider medication to be a failure of care.
Conclusion
This was a refreshing read. It mirrored many of my thoughts about the medical system and how mental health is traditionally done. I agree with about 90% of what Palmer says about the system, the whole person health and the kinds of things that fix that. I disagree with the core idea that mitochondria is intimately connected to anything. Sure, it is in every cell and many things are affected by or affect the mitochondria – but that doesn’t make it the root cause.
It is important to note that Palmer is not the only one who has most of these views, or the first one to express it. It is nice to see it compiled into a single fairly simple to read book though.
In my practice here at JD Therapy, we work on that whole body therapy. We try to get an idea of what your experience of your mental health is like, your physical health, your social and work health, and how you see yourself fitting in with the wider society. We look from symptoms and experiences to trying to figure out the underlying problems and then get those addressed.
That may be giving education on diet, exercise, and mental health; upskilling you in social, work or self management; and helping you integrate with various medical professionals better so that they can properly address your biological needs.