[Episode 147] Today's Social Work Podcast is about the brain. I spoke with Loyola University Chicago School of Social Work associate professor James Marley, Ph.D. in 2016 about the structure of the brain, neurotransmitters, and how social workers can use this information to work with clients, particularly around issues of medications.
In today’s interview, we talk about how trauma literally writes itself into the brain; why understanding neuroplasticity gives hope to clients who feel stuck; the importance of being a critical consumer of neuroscience headlines—because clients read them too; and how social workers—often the first to hear about new symptoms or med side effects—can respond with confidence and compassion. We also get into brain basics: structures like the prefrontal cortex and limbic system, neurotransmitters like serotonin and dopamine, and how meds like SSRIs trick the brain into adjusting. We talk about how social workers can talk about the medical side of medication without talking beyond our training, including the neurobiology of side effects, withdrawal, and why you shouldn’t go cold turkey off your meds. If you’ve ever felt underprepared to talk about the brain—or wondered why it matters for your practice—this episode is for you.
Now, I know what you're thinking. 2016? But you're posting this almost a decade later. Yes. That is true. The interview was fantastic and has been listened to by thousands of BSW and MSW students at Loyola University Chicago's School of Social Work. But, the information is so good that I wanted to get it to everyone (and Jim approved).
Download MP3 [45:07]
(In his own words): My primary focus has been on people with severe mental health problems, primarily adults with schizophrenia and other psychotic disorders. Having worked with them on inpatient and outpatient and residential programs and working closely with psychiatrists and neuropsychiatrists and other professionals around both the psychosocial as well as the biological interventions of people with psychotic disorders, it’s kind of been my population of choice for about 35 years. I also teach in the area of psychopathology and have over the years incorporated the tremendous amount of material on the brain, neurological functioning, psychiatric medications, and I'm frequently asked to give talks on things like psychiatric medications and the role of social work. Working in these sort of multidisciplinary settings where medication and neurological issues are piece of the process.
Transcript
Introduction
Hey there podcast listeners, Jonathan here. In today’s episode of the Social Work Podcast we’re diving into a topic that's often glossed over in social work education: neurobiology and the brain.
Now, on one hand, it makes sense. A lot of folks who go into social work didn’t exactly love biology in college. They didn’t choose majors like biology or psychology—or go into nursing or medicine—because anatomy and physiology weren’t their thing. But here’s the paradox: one of the few things that is universally true across all direct practice social work is that we’re trained to do biopsychosocial-spiritual assessments. It’s something we learn in our very first semester of social work school. And the first word in that mouthful? Bio. As in biology.
So it’s kind of wild that we often gloss over the biological part—especially the brain. We assume that we’re going to 'outsource' the biological side of the assessment. I’m as guilty of that as anyone. Need proof? The second episode I published on the Social Work Podcast (January 22, 2007) was on the biopsychosocial-spiritual assessment. It has been downloaded hundreds of thousands of times. And, looking back on it for this introduction, I realized that I included just a single sentence on the biological: “For bio, we're looking at your basic needs: food, shelter, clothing, medical, health, physical capabilities in a physical environment.” I didn’t even mention the brain. But, today’s guest, Dr. Jim Marley, associate professor, former interim Dean at Loyola University Chicago’s School of Social Work and a veteran social worker with over 40 years of experience explains, understanding the brain is not optional, especially if we want to be taken seriously on interdisciplinary teams, practice trauma-informed care, and help clients make sense of diagnoses and medications.
In today’s interview, we talk about:
- How trauma literally writes itself into the brain.
- Why understanding neuroplasticity gives hope to clients who feel stuck.
- The importance of being a critical consumer of neuroscience headlines—because clients read them too.
- And how social workers—often the first to hear about new symptoms or med side effects—can respond with confidence and compassion.
We also get into brain basics: structures like the prefrontal cortex and limbic system, neurotransmitters like serotonin and dopamine, and how meds like SSRIs trick the brain into adjusting.
And yes—we talk about how social workers can talk about the medical side of medication without talking beyond our training, including the neurobiology of side effects, withdrawal, and why you shouldn’t go cold turkey off your meds.
If you’ve ever felt underprepared to talk about the brain—or wondered why it matters for your practice—this episode is for you.
A couple of notes about today’s episode: Dr. Marley and I spoke in 2016. Why am I publishing an interview 9 years after recording it? The interview was fantastic and has been listened to by thousands of BSW and MSW students at Loyola University Chicago's School of Social Work. Indeed, there are several excellent interviews that Loyola students have access to as part of their social work education that aren’t public. But, the information Dr. Marley shared is so good and continues to be relevant that I wanted to share it with everyone (and Jim approved). Also, because the episode was recorded in 2016, some of the dates he mentions are a little… well, out of date. Another thing to know is that in the interview you’ll hear me talk about the occipital lobe as yellow. I feel the need to give a little context. When I was 12, I wasn’t doing so well in my biology class (hmmm… didn’t do so well in bio… chose social work… interesting). My uncle, Ron Singer, is a chiropractor and gave me Gray's Anatomy Coloring Book to help make learning anatomy and physiology more fun. I had a box of crayons and decided to color the occipital lobe yellow. So, during the conversation when Dr. Marley mentions the parts of the brain, I pictured my Gray’s Anatomy Coloring Book and the back of the brain colored yellow. That’s why I call it yellow. It has nothing to do with anything except my decision to pick up a yellow crayon when I was 12. Oh, and yes, the title of the TV Show, Grey’s Anatomy, is a pun based on the Gray’s Anatomy textbook.
And now without further ado, on to episode 147 of the Social Work Podcast: Neurobiology for Social Work: Interview with James Marley, Ph.D.
Interview
Jonathan Singer: So, Jim, thanks so much for being here on the Social Work Podcast and talking with us today about neurobiology and the brain. One of the things that we tell social work students is that the biopsychosocial spiritual assessment is really like the bread and butter of what we do when we think about what's going on with someone. And we also say, look, you're not a trained medical professional. So, there are a lot of things that you need to know medically, but we sort of outsource them, right? And so, what do social workers need to know about the brain, and why?
James Marley: Well, we start with the “why” question first. I mean a couple of things come to mind. I think, initially, there is so much going on with the brain across the lifespan and there is so much information out there that really impacts how social workers think about their clients at most ages of development. I think if you're going to be at the table talking with other professionals on interdisciplinary teams you need to be able to talk some of the language, have some sense of what's going on when issues of neurobiology, neurological issues come up, and I think it's been an issue in the training of social workers that very often it's kind of piecemeal what we get. I know in my own training it was really not until like post-Master’s individual interests that I sort of got caught up with everything that I missed out on in the area of neurobiology. So, if we're going to be active participants at the table in mental health, behavioral health, healthcare issues across the lifespan, we have to have at least an ability to communicate with other professionals. I think the other big issue in social work with the brain is obviously the large influence on -- the extensive research now on --trauma and how trauma writes itself into the brain. How trauma affects the brain, again at various points in the lifespan. I mean I know many people get trained in sort of trauma-informed care and interventions, but the under part of all of that is really understanding what trauma is doing to the brain. How the brain responds to trauma, and what that might then mean for the kinds of interventions you might want to think about. I think third, and this might come as a surprise to some people, over the last couple of decades as I've been involved in stuff with related to the brain, the picture within social work and stuff related to the brain is much more positive than it used to be.
Jonathan Singer: What do you mean by that?
James Marley: I think there was a sense when I go back to my own training and getting involved, that it was the brain was the brain and whatever happened to it, you were sort of stuck and you know, you peaked around 25 and it was downhill after that.
Jonathan Singer: I hope not!
James Marley: I hope not too. But I think when you start looking at some of the research on the flexibility of the brain, the ability of the brain to recover different interventions, whether we're talking about again, psychosocial interventions or biological interventions, I think there's a lot more optimism about brain health across the lifespan. And even when you're dealing with folks with what might be considered significant kind of neurobiologically based issues like psychotic disorders, I think there's, from my read of the research, a lot more kind of optimism about the brain. So, I know in the past I've had clients say things like, “Well, you know, we used to call this a mental illness. Now we're supposed to call the brain disorder. What good is that to me?” In some ways they felt more empowered thinking it was a mental disorder. And when they heard “brain disorder,” they sort of felt like that was there was nothing that could be done.
Jonathan Singer: Oh, that's interesting. So, it was like they were seeing “mental” as something that was sort of within their control, but the brain is an organ?
James Marley: The brain is an organ and once it's doing whatever it's doing there's nothing to be done so they actually didn't feel good about that They didn't feel like there was much of an empowerment perspective of that, and I could certainly empathize with that. Because people think there's not much you can do to the brain. But I think as the research has moved forward, we're seeing a lot more emphasis on understanding the way the brain responds to things and starting to see a lot of research showing how the brain can in fact change, heal, and respond based on the kinds of interventions. Going back to what you said the beginning --you know, one of the things that I think social work has always grappled with and embraced is the issue of complexity, that people in the system we live in are very complex and that’s one of the things you'll hear frequently in research on the brain. People will frequently use the term “things that are necessary but not sufficient.”
Jonathan Singer: Right.
James Marley: So that when you're looking at someone with a, let's say, a significant mental health problem, you might say, “Well, the brain is playing some role in that.” We have to be able to talk about the brain. But we can't just talk about the brain. So, you oftentimes will hear that whole “it's necessary to talk about the brain, but it's not sufficient to only talk about the brain” when we're talking about complex people and their systems. So, I think for all those reasons, it's helpful for social workers to learn some of the language, be able to engage in the dialogue, and at least learn how to be reasonable consumers of the literature out there. Part of the difficulty is that when research comes out on --brain research-- it's usually fairly complicated technical research, which then gets oversimplified into media blurbs. And very often people read the media blurbs and think, “Wow, we've stumbled onto something amazing!” And then you have a little lag time between the media blurbs and what's actually going to be helpful, so people need to be good interpreters of the literature, so they don't get sucked into overblown claims that frequently happen with brain research.
Jonathan Singer: And that would certainly be something that social workers should be able to do for their clients as opposed to expecting clients to be like, you know, “I saw this headline. But I went back to Pediatrics, and I read that article” or “I saw that thing in Nature and I, I disagree with those methods,” you know, or something like that.
James Marley: Yeah. I mean, again, people, our clients, read the newspaper, our clients watch the news. They hear, you know, the latest breakthrough. And if you're a social worker in a healthcare setting and you're working with families that are dealing with say, Alzheimer's, and suddenly something comes out in the news -- it’s important, but we're talking 5 to 10 years before any practical application. You're not doing a disservice to your family that you're working with, but you are trying to help them understand the realities of what's available.
Jonathan Singer: So, what are some of the things that social workers need to understand about the brain and some concepts and terms [to know] so that we can actually be intelligent, informed folks at the table? When you think about the brain and what social workers need to know?
James Marley: Again, I don't think social workers need to drill down to the level of a neurosurgeon or a neurobiologist. But when you think about the brain, there's a couple of ways of thinking about the brain that have some direct applications with clients and the work that we do with the client. I oftentimes, when I talk about this with students, I'll say, you know, “Imagine that you can take the top of your head off and look down at your brain and it's kind of an unremarkable mass down there.” And I think what's interesting is we're so used to opening up textbooks and seeing things that are color-coded and labeled, and all the different pieces are sort of like different colors. [But the] brain doesn't look like that.
Jonathan Singer: You mean that the vision part of my brain is not yellow? [Laughs}
James Marley: [Laughs} And there are no little tabs with little arrows pointing out different things. And in fact, when people talk about different parts of the brain, when you look at the actual slides of brains, or maps, the differentiations are oftentimes just minute, and I think it's surprising. I think people get surprised when they look at actual brains and usually what you're seeing when you like take off the top of your head and you're looking down -- what you notice initially is just the two hemispheres and what are called the gyrus and the sulci. These are the hills and valleys of the brain, the folds, and the little canyons of the brain. But when you talk about the brain and the research on the brain, what most people already know from previous education they may have had about the brain is you've got a variety of lobes in the brain. You've got the frontal lobe, which sits right behind your forehead. You've got the parietal lobe, the temporal lobe, the occipital lobe, and these all have different parts to play in what is going on with clients. Those control different actions of the body. The one that probably is most frequently talked about in the research related to mental health issues is very often the frontal lobe, the one that sits right behind your forehead, and in particular what's referred to as the prefrontal cortex, which is the very outside of that part of your brain. This is considered the part of the brain that manages things like higher level executive functioning, decision making, problem solving, things like that. And you will find in a lot of research on folks who are struggling with different kinds of mental health issues a lot of interest in the prefrontal cortex. It's often a surprise to people when they think about it that the occipital lobe, which is the very back of your head, is in fact where visual stimuli is sorted out, right?
Jonathan Singer: That's the yellow one. [Laughs]
James Marley: [Laughs] That's the yellow one. So, if stimuli come in your brain through your eyes, it has to travel all the way through your brain to the occipital lobe and get resolved and dealt with there. The other thing with the structure is the size of these lobes. So, you've got a number of individual places in the brain that you will find get referenced quite a bit. When people are talking about different illnesses or different kinds of problems people have, many of these are locations in the brain, sort of like deep inside the brain. They're not going to be on the outside of the brain. When you think about the way the brain is organized, it comes off your spinal cord and then you've got what is sometimes referred to as the brainstem, which is the lowest part of the brain, and then what's referred to as behind the brain, the limbic system and then the cortex. The idea being, from an evolutionary perspective, that the stuff that is way down in the brain, and especially in the central part, has been there for a long time.
Jonathan Singer: Is that what we call the reptilian, reptilian brain?
James Marley: Yes, and there's actually a place in the brain called the mammalian body, mammalian brain. And there's some great books out there—there’s a book, I think, on how we are similar to fish, how we are similar to hamsters. There's been a number of books looking at brain evolution. But in some of these areas, things like the hypothalamus, hippocampus, the pineal gland, all these are kind of deep in the center of the brain. And these all have major roles to play in the way that the chemical signals in the brain operate, and the primary assumption in a lot of health, mental health, behavioral health issues, is that when things start to go awry, when people start to experience symptoms, that it's either an issue of the structure of their brain -- that is, in the lobes, the white matter of the brain, something's gone amiss-- or it's embedded in one of these areas, like the hypothalamus, the hippocampus, the pineal gland, because those play a role in the production of things like hormones, neurotransmitters and how the body, how the brain’s chemical signals fire and get utilized. So, from a structural perspective, understanding the role the lobes play, understanding -- when someone says something like, “Is there a connection between depression and the pineal gland?” And that has been said.
Jonathan Singer: [Jokingly] Somebody, somewhere, said that.
James Marley: They've looked at, for example, the pineal gland plays a role in a lot of research on seasonal affective disorder and how your body responds and processes sunlight and why lack of sunlight might trigger some people in the seasonal affective disorder and you will find people referencing the pineal gland for that.
Jonathan Singer: So, is that something that social workers should know, what the pineal gland does and like its function? Because social workers do work with folks with seasonal affective disorder, [and] I mean social workers have seasonal affective disorder. Is that what you're saying?
James Marley: I mean it's essentially that when clients are struggling with understanding why these things are happening -- and this may be just me, but I've always seen it somewhat as trying to destigmatize things. I mean, “You're not faking it.” It's not always because of something that's totally within your control immediately. So, when people are sort of like, “I don't know why I'm depressed. I don't know why when October, November rolls around, I can't get out of bed.” You know, people are saying, telling me, “I'm lazy. My boss gets angry because I can't come into work and suddenly my job is on the line again.” You know, you may want to introduce the idea of, “Is there a connection here with seasonal affective disorder? Here's what we understand about it. Here are some effective interventions that are based on some of this brain science.” So, it gives people some hope that there are in fact things that can be done and so that they don't feel, like I said, stigmatized, that it's just them being lazy or that it's, again, kind of a mysterious thing. You can demystify some of the symptoms your clients are experiencing and give them some sense that there's something that can be done about it.
Jonathan Singer: As you're talking, it makes me realize that even though we're very -- that social workers, because they're not medical providers, they're not nurses, and therefore they can't talk about medications in the sense that they're prescribing them or anything like that. It doesn't mean they can't talk about the brain, right, and sort of the role of the brain in what's going on with them.
James Marley: Yeah, because I think the connection here is, as social workers become more informed about the brain, and for any social workers, it may be that you don't need to know everything about the brain. But as you work with certain populations more than others, you educate yourself about the research on the brain that impacts that population in particular. I've spent 35 years dealing primarily with people with psychosis, so I tend to read a lot of literature on schizophrenia and the brain. But other people don't ever work with that population, so they may read stuff on other things. But there is a real connection between some of the symptoms our clients present, and the role the brain may play in why those symptoms are present. The neurotransmitters that are connected to some of those symptoms and then why certain medications in fact might be used, given how those medications are connected to neurotransmitters which are connected to parts of the brain. So it fits together and I find that social workers, because we usually see clients more often than doctors do, we are oftentimes on the frontline of working with clients who will say things like “I'm having this symptom and it's getting worse, or the doctor put me on this medication. But I'm now having this reaction to it.” We oftentimes hear this stuff sooner and more frequently than the medical professionals do. And again, we have to be able to respond from a position of knowledge and try to help our clients get a handle on what's going on. Yes, we do not want to be prescribing medications, but we can certainly talk about why certain medications are being entertained. And I've had multiple clients over the years say things like “The doctor wants to start me on medication XY.” And so, we will go over their symptom profile, the research what this medication is thought to do, and it just tries to demystify the process. And then we can also talk about things that might happen while they're on the medication, side effects and such like that. So that if something starts to go on [with] this, they're not in the dark.
Jonathan Singer: As to why, it seems like it would be very powerful because you're talking to somebody who's saying, you know, “I started taking this medication and now I'm having issues with my vision for my appetite.” And if you know, the parts of the brain and you know what they do and how the medication is either supposed to tap that or not, then you could talk about it.
James Marley: The connection here, with, again, working with the clients around this is when I mentioned things about the pineal gland, the hippocampus, the thalamus, those kinds of areas within the brain. All of these are connected to, to some extent, the way the brain produces and utilizes what are referred to as neurotransmitters. And this is the chemical side of the brain, how the different parts of the brain communicate with each other. Again, you can't see this. When you look at a brain, you don't see the function of neurons in the brain, the wiring of the brain, [because] they're really small. They're really small stuff which you usually see blown up in really cool illustrations.
Because really what they're trying to show is when the brain picks up some kind of stimulus, it starts in this thing called a dendrite, and it moves down what's referred to as an axon to what's called the presynaptic terminal, and then there's a space called the synapse, and then it has to jump this space and then move into what's called the postsynaptic terminal and then continue that pathway. What jumps that space, what moves across from the presynaptic terminal to the postsynaptic terminal, are the neurotransmitters. So, the neurotransmitters are what helps the signals in your brain move efficiently around to get where they need to go. In many cases, and again, there's, you know, a dozen or more neurotransmitters, and for social work purposes you probably don't even need to know what all of them are. There are popular ones that pop up because of the kinds of things they're related to in terms of symptoms and medications. So, things like dopamine, serotonin and norepinephrine, just those three, I mean, cover of fair bit of ground, but there are others, GABA and other things that get looked at. Each of these neurotransmitters are in some ways affecting different parts of the brain and to a large extent the issues, the symptoms arise when you have either an overabundance or an underabundance of particular neurotransmitters. Because if we flood the system we have too much of something, that cuts down on its efficiency, and if you have too little of something, that [also] cuts down on its efficiency. And when the brain has too much or too little of neurotransmitters, it affects how things communicate [within] the brain. And so, then you start to see certain types of symptoms emerge. Whether that's things like anxiety, irritability, depression, things like that. What's interesting, and this is oversimplifying it, but it's the best way I can kind of describe it: most medications that people take to treat most of the major mental health issues, those medications primarily trick the brain into adjusting its production of neurotransmitters. So, when you take something called, for example, a “selective serotonin reuptake inhibitor” like Prozac and things like that, SSRIs and there's you know, NRIs, norepinephrine and serotonin reuptake inhibitors, and a whole variety of medications. Most of those medications are given because the assumption is made that the symptoms you're exhibiting are because of a under- or over-production of a neurotransmitter and this medication will alter the production, either increasing it or decreasing it. The idea being then if you can get the neurotransmitters back into balance, the symptoms will go away. So when I tell people, you know, like “Why does the doctor want me to take this medication?” and let's say they're being given Prozac for depression, I can talk about the fact that Prozac is thought to affect the production of serotonin, and that the production of serotonin is thought to be connected with things like depression. So that's why this medication is being given for this particular thing and that's a good example of how a social worker would use this understanding of neurobiology in a very helpful clinical setting. You want to be able to talk knowledgeably with your clients and ease their concerns or anxieties or address their questions because they will oftentimes say “Why?”, you know, “Why? Why is this being asked of me? Why do we want to do this?” You know, “What's what's the benefit of this?” Because you know medications, you know every medication has side effects. Some medications can be very expensive, and it's not always easy to talk with clients about, you know, if you don't, if you can't answer “Why should I put myself out to do this?” We shouldn't be surprised that they are anxious and reluctant to do it, right, so we can at least alleviate some of their anxieties by saying “We're not just guessing. Here's the evidence as to why this might be a good thing to try, given who you are, the kind of symptoms you're experiencing.” How those symptoms are tied into these areas of the brain and how this medication is designed to impact that kind of functioning in the brain. It doesn't necessarily alleviate all their anxieties, but it gives them more information to make an informed decision should they decide to take it or not.
Jonathan Singer: So, I've heard about serotonin and dopamine and norepinephrine, which I can never hear that without thinking of Nora Ephron and “When Harry Met Sally.” But I know that you mentioned that there are many of them. So, what are some of the other ones that social workers should know about?
James Marley: Well, I mean to some extent I think you mentioned the main ones. I mean dopamine, serotonin and norepinephrine are probably the ones that are most common in the literature, and when you start looking at different medications and symptoms, those [are the] most popular ones. If you take, for example, dopamine as a neurotransmitter, and I've mentioned earlier in terms of structure, one of the one of the structures in the brain, it's more kind of a web in the brain, something referred to as the limbic system. But the limbic system is kind of this interconnected web in the brain which reaches multiple [functions]. So, what's interesting is when something starts to go amiss in the limbic system, it can impact a lot of different areas of functioning, and dopamine is influenced by influences the limbic system. One of the issues with dopamine is when you've got too much dopamine in your system. When the brain overproduces dopamine, you start to have issues with things like hypervigilance, paranoia, perceptual distortions, things that start to sound a lot like psychotic disorders. And in fact, for a long time there was what was called the “dopamine hypothesis” about something like schizophrenia. And when you think about the symptoms of schizophrenia, everything from visual distortions, odd beliefs. You know, speech difficulties, motor difficulties. It would make sense in some ways that something like the limbic system that touches on all these parts of brain would result in a fairly broad symptom profile. When you look at something like, say, serotonin as a second, as a different neurotransmitter, serotonin is connected through like the hypothalamus and actually has an impact on many [functions of] the brain. But with serotonin, the issue is that you've got, for example, too little serotonin. If your brain produces a lack, [if] there’s not sufficient serotonin going on in the brain, you start to have issues of irritability, depression, aggression, things like that. I mean for an example, if we stick with serotonin for a second, if the issue is there's not enough serotonin in the brain and therefore you have problems. The issue is how do you trick the brain into producing more serotonin?
Jonathan Singer: Yeah.
James Marley: And so, you have these class of medications called selective serotonin reuptake inhibitors. And what these medications essentially do, if you're taking them, is when those neurotransmitters get to that synapse and they're going to make the jump across that little gap. The serotonin moves across that gap. It fills the receptors on the other side of that gap. Now there may be then serotonin that was extra and wasn't needed, and so things can happen to that extra serotonin. One of the things that can happen is it can get reabsorbed back in the presynaptic. That's the part of the gap where they left from, so they can get reabsorbed. It's called reuptake. So, they can be then used again. Well, if you take a medication called SSRI, selective serotonin reuptake inhibitor, what's happening is that serotonin that is not needed to make the jump across the synapse, the medication blocks its reabsorption. It blocks the reuptake, so it’s [called] a reuptake inhibitor. So, when it can't be recycled, the brain thinks, oh, you need to make more. And so, a selective serotonin reuptake inhibitor, by blocking that recycling process, tricks the brain into saying we need more serotonin. If the brain starts pumping up more serotonin, you get more of what you need. And then hopefully those medications would then take away the irritability, take away the depression by again tricking the brain. [it’s] similar with norepinephrine, which gets talked about all the time. Here the issue is, if you have too much norepinephrine going on in your system, you may experience things like anxiety, arousal, irritability, tension, what’s sometimes referred to as “startle response.” These are people oftentimes who just seem like they're constantly sort of on edge. Now you can also have too little norepinephrine, and then that kind of flips the picture and then you've got people who are feeling depressed, very kind of low mood, things like that. Kind of the reverse of that. So again, when most medications to treat mental health issues are developed, at least now that we're into like our third or fourth generation of medications, most of these medications are being designed to specifically target very specific neurotransmitters as opposed to old school medications, which just kind of flooded the brain. So, you oftentimes would find different kinds of side effect profiles with older medications and newer medications. But because you're messing with the brain-- and all medications -mess with the brain, all medications have side effects --I think from a social work perspective, [you need to] learn about the connection between the different parts of the brain and the production of neurotransmitters, how neurotransmitters are tied to particular symptoms. [You need to know] why certain medications would then be used to treat those symptoms. You can educate yourself about the kinds of side effects. Side effects are one of the top reasons why people stop taking medication. Whether it's things like weight gain, sexual issues, appetite issues, dry mouth, blurry vision, and there's a whole host of side effects which are not uncommon. Many of them can be adjusted to or coped with, but again, you need to inform your clients so they can make an assessment of how it's going to impact them. And like I said, most of the time I find social workers are the ones that people complain [to about] the side effects. You will have clients coming in saying “I had to go buy glasses because this medication is making my vision blurry, so I had to stop by Walgreens and get reading glasses. How long is this going to last?” You need to be able to talk about that.
Jonathan Singer: Well, I think that really clarifies the distinction between not talking about prescribing medication and that kind of thing, but really talking about the things that people are actually interested in, which is. “What is this doing to my brain? Why might I be feeling like this? How come this is interfering with my ability to go to work, to hang out with my friends? What's happening? I thought this medication was supposed to make me feel better and it's just making me feel these other things.” Right?
James Marley: And that's a key issue because again, our clients who are looking at us for good interventions, they want to feel better. They want to feel like, you know, their symptoms are being addressed. [They] can easily get very frustrated when the medications that might be offered have a side effect profile that they find intolerable. And again, there's a lot of good information out there. Most of the information I get because it's a good resource is I use, you know, NIH, National Institute of Health, National Institute of Mental Health has wonderful web resources on all of the medications. What they are, what their side effects are. The thing that I struggle with, though, it's online now -- there used to be what was referred to as I don't if you ever used it – the Physician’s Desk Reference—
Jonathan Singer: The PDR [note: free online].
James Marley: The PDR was sort of a Bible, but a real pain to use, because I would frequently have clients who would say “Well, can you like Xerox off the PDR on this medication?” and the thing with the Physician’s Desk Reference is it had to publish every negative outcome, no matter how few people ever experienced it.
Jonathan Singer: And [if] it was like a 5000-person trial and one person blacked out, right? It’s there.
James Marley: Yeah, it's there. And so, we used to just joke all the time, it's like everything is in the PDR --somebody died, you know, and it's there. And so, I'm like, I don't want to Xerox this off the clients. That's more information than they need, and usually when you start digging you realize this person had kind of [a] complicated system or immune deficiency or there was something going on that was not related to the medication. But if you use the NIMH, they publish wonderful things giving overviews of the medications and what they're targeting. I do think one of the interesting areas that's popped up just within the last year related to neurotransmitters and medication is what's now being referred to as discontinuation syndrome. And this has caught a lot of people by surprise, though I'm starting to see some literature coming out about it. But we oftentimes tell people about the side effects of medication when they're on it. We don't always talk about the side effects they experience when they come off of it, and especially people who just stop cold turkey because of side effects. Most of the time people will be told “Do not stop cold turkey unless there's some really major complication” like lithium or something like that, where you could get something like lithium toxicity, or with some antipsychotics and the condition called a granular cytosis, which could be potentially fatal. But most of the time you're told if it's not agreeing with you, we will wean you off. But some people just say I'm stopping because it's so uncomfortable. And then they have a whole flood of side effects because they stop. And that has driven some people to then start the medication up again because they want to avoid the side effects of coming off of it. And there's now a whole science behind working with clients, about how you come off of medication, discontinue it, and it's and there's this thing called discontinuation syndrome, it's been noted primarily in the selective serotonin reuptake inhibitor, but it's not exclusively in those meds. But for people who stop cold turkey, they will have the equivalent of things like migraines. They'll talk about like almost like lightning flashes in the brain, really severe side effects of not taking the medicine. And the dilemma I find is we don't ever talk about that side that the equation we're always like, “When you take this, you might experience this.” We need to be much better about saying “And if you want to come off of it, here's the smart way to do it to avoid these things.”
Jonathan Singer: Now is that a conversation that you as the social worker would have? [Or] are you saying this is something that we need to make sure that the prescribing provider has with [the client]?
James Marley: I think it's both. I mean I think we need to be [communicating] with the doctors we work with. Again, if you're in hospital, you're working with interdisciplinary teams. If a decision is made that a client ought to start a particular medication, a good question to always ask is “What should we say to this client about potential side effects of that medicine? And is there anything we need to say to this client about the discontinuation of the medicine?” And hopefully the team can then figure out what is an appropriate response to those questions. Those questions might come up, and if they don't come up [it may be] because the client doesn't know to ask them. We shouldn't just ignore it. We should say “You might be wondering . . ..”
Jonathan Singer: “You should be asking about . . ..”
James Marley: “You know, when you see the doctor, ask about these things.” Again, I'm not suggesting that social workers substitute for the M.D. But we can both be possessors of knowledge, as well as advocating for our clients the kinds of questions they need to ask the people who have that knowledge. That includes side effects of being on the medication and the side effects of choosing to come off the medication.
Jonathan Singer: That's really great. I'm really glad that you added that piece because I think it is a very practical side of talking about medication that I know when I was trained, nobody talked about discontinuation even though we would see it.
James Marley: And like I said, I think the dilemma is a lot of individuals who have experienced this discontinuation syndrome, it's sort of the wonders of the technological world --and YouTube. I think there are now people out there like doing, what do they call them, like “medication hacks,” like DIY do-it-yourself discontinuation. And that makes me a little nervous that you would take advice from a YouTube video about how to stop taking the medication as opposed to talking to your social worker or your doctor. But I understand the frustration that if there are consumers of these medications who feel like no one has told me about this, they're going to figure out a way. But yeah, knowing that there's sort of, like quote unquote, “medication hacks” out there makes me nervous.
Jonathan Singer: Well, and I think that's a good note to end this interview on. DIY Medication hacks on YouTube.
James Marley: Avoid them.
Jonathan Singer: Avoid them. Well, Jim, thank you so much for talking with us about neurotransmitters, about parts of the brain, about medication, about why social workers should be more informed about this and what they can do with this information. I really appreciate you taking the time.
James Marley: Thank you. I appreciate it.
Glossary of Key Terms
- Axon: A long, slender projection of a nerve cell that typically conducts electrical impulses away from the neuron's cell body.
- Biopsychosocial-Spiritual Assessment: A comprehensive framework used in social work to understand a client's experiences by considering biological, psychological, social, and spiritual factors.
- Brainstem: The lowest part of the brain, connecting the cerebrum and cerebellum to the spinal cord, responsible for vital involuntary functions (e.g. breathing, heart rate, and sleep-wake cycles).
- Cortex: The outermost layer of the cerebrum, playing a key role in memory, attention, perception, cognition, and consciousness.
- Dendrite: A short branched extension of a nerve cell, along which impulses received from other cells at synapses are transmitted to the cell body.
- Discontinuation Syndrome: A set of adverse effects that can occur following the abrupt cessation or reduction of certain psychotropic medications, particularly antidepressants like SSRIs.
- Dopamine: A neurotransmitter involved in reward, motivation, pleasure, and motor control. Dysregulation is associated with conditions such as schizophrenia, ADHD, and Parkinson’s disease.
- Frontal Lobe: The largest lobe of the brain, located at the front, involved in executive functions, decision-making, planning, and personality.
- GABA (Gamma-Aminobutyric Acid): A primary inhibitory neurotransmitter in the central nervous system, reducing neuronal excitability.
- Gyrus (plural: gyri): The ridges or folds on the surface of the brain.
- Hippocampus: A part of the limbic system involved in memory formation, learning, and emotional responses.
- Hypothalamus: A small region of the brain below the thalamus, involved in regulating various bodily functions, including hormone release, hunger, thirst, and sleep.
- Interdisciplinary Teams: Groups of professionals from different disciplines (e.g., social workers, psychiatrists, nurses) who collaborate to provide comprehensive care for clients.
- Limbic System: A complex set of brain structures located beneath the cortex, involved in emotion, motivation, memory, and learning (sometimes referred to as the "mammalian brain").
- Neurobiology: The study of the nervous system, including the brain, its structure, function, development, and pathology.
- Neuropsychiatrist: A medical doctor specializing in mental disorders attributable to diseases of the nervous system.
- Neurotransmitters: Chemical messengers that transmit signals across a chemical synapse from one neuron (nerve cell) to another target neuron, muscle cell, or gland cell.
- Norepinephrine: A neurotransmitter and hormone involved in alertness, arousal, stress response, and the “fight-or-flight” reaction. It plays a role in attention and mood regulation; imbalances are linked to anxiety, depression, and PTSD.
- Occipital Lobe: The rearmost lobe of the brain, primarily responsible for processing visual information.
- Pineal Gland: A small endocrine gland in the brain that produces melatonin, a hormone influencing sleep-wake cycles; referenced in relation to seasonal affective disorder.
- Postsynaptic Terminal: The part of a neuron (often a dendrite) that receives a neurotransmitter signal from the presynaptic neuron across the synapse.
- Prefrontal Cortex: The very front part of the frontal lobe, crucial for executive functions, complex decision-making, planning, and social behavior.
- Presynaptic Terminal: The specialized area of the axon of the transmitting neuron that contains and releases neurotransmitters into the synapse.
- Psychotic Disorders: Severe mental disorders characterized by a loss of contact with reality, often including hallucinations and delusions (e.g., schizophrenia).
- Reuptake: The reabsorption of a neurotransmitter by the presynaptic neuron after it has performed its function, allowing it to be reused.
- Seasonal Affective Disorder (SAD): A form of depression (formally diagnosed as Major Depressive Disorder with Seasonal Pattern) that typically occurs during the fall and winter months and is associated with reduced exposure to natural sunlight.
- Selective Serotonin Reuptake Inhibitors (SSRIs): A class of antidepressant medications that work by increasing levels of serotonin in the brain by blocking its reuptake.
- Serotonin: A neurotransmitter that affects mood, appetite, sleep, and digestion. Imbalances are linked to depression, anxiety, and irritability.
- Sulcus (plural: sulci): The grooves or "valleys" on the surface of the brain, separating the gyri.
- Synapse: The small gap or space between two neurons where nerve impulses are transmitted from one neuron to another via neurotransmitters.
- Thalamus: A large mass of gray matter in the dorsal part of the diencephalon of the brain, involved in relaying sensory and motor signals to the cerebral cortex and regulating consciousness, sleep, and alertness.
- Trauma-Informed Care: An approach to service delivery that recognizes and responds to the pervasive impact of trauma, understanding how trauma affects neurological development and functioning.
APA (7th ed) citation for this podcast:
Singer, J. B. (Producer). (2025, July 28). #147 - Neurobiology for Social Work: Interview with James Marley, Ph.D. [Audio Podcast]. Social Work Podcast. Retrieved from http://www.socialworkpodcast.com/2025/07/neurobiology.html
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