Caroline came to her appointment with great reluctance after giving in to her friends’ insistence that she see me. She was fed up with doctors and was not happy about telling her sad story to yet one more doctor.

It was challenging taking Caroline’s history. She was angry. She said, “I’m sick of doctors. They haven’t been able to help me. I’ve wasted so much time and money—for nothing. I’m only seeing you because my friend practically forced me to. I doubt there’s anything you can do for me. No offense.”

I answered, “I’m not offended. I actually know what you mean about not being able to get the help you need from doctors. I was once in a situation like that myself.”

Caroline began to relax a bit. Through her tears, she told me she had been treated by a psychiatrist twice a week for suicidal depression and had been on many different kinds of anti-depressant and anti-psychotic medication during the past three years of intensive treatment.

After all those years of treatment, the depression was no better. In fact, she said she was getting worse. To top it off, Caroline said she was struggling with feeling drugged all the time, one of the many side effects from all the medications. She was no longer able to work for a living and depended on her parents’ support.

Here’s what I learned: Caroline had a childhood without any kind of significant emotional trauma. Both her parents were kind and loving; there was no history of mental illness in the family. Caroline had never experienced depression until three years ago when she began feeling tired, with frequent headaches, and a pervasive sense of despair and hopelessness—for no apparent reason.

Nothing had changed in her life. Nobody had died or broken up with her, there was no change in her diet, no financial worries. It was a total mystery as to why Caroline felt so terrible—even to the point of contemplating suicide on a daily basis.

The psychiatrist she saw dug around for unresolved childhood issues to talk about during the twice-weekly appointments, as well as trying a series of psychiatric drugs.

I asked Caroline many questions about her lifestyle, including what kind of food she ate. She said she spent a lot of time cooking in the kitchen. She loved to make healthy, nutritious meals, mostly organic. She had no food sensitivities, but avoided gluten and sugar because she felt better not eating those foods.

After hearing her story, I wrote out a list of possible environmental causes of her triad of symptoms—fatigue, headaches, and suicidal depression—and gave it to her to contemplate. Among the list of potential triggers were toxic chemicals, mycotoxins produced by mold spores, and gas leaks. She looked over the list and assured me she had nothing toxic in her home. With difficulty, I persuaded her to have her home checked.

Fortunately, we were able to locate a well-trained “healthy home inspector.” The inspector discovered a gas leak that the utilities company had missed. The pipe that carried the gas to her stove leaked right where the pipe joined the stove.

Several weeks after getting the leak fixed, Caroline was able to slowly wean off her psychiatric medications. Her road to wellness was a long journey, but she was excited to be heading in the right direction at last. After about six months, she went back to work. The last time I saw her in town, she was smiling, making jokes, and generally looked happy and healthy.

Mental illness, including depression, is commonly regarded as a purely psychiatric problem, without consideration of other possible origins of the illness. The conventional approach to mental illness includes medication and talk therapy about the past. These modalities are valuable, especially in times of crisis, but the search for underlying physiologic causes of the mental illness is usually left out of the treatment plan.

The brain is affected by the same substances that affect the rest of the body—sometimes even more so due to the brain’s unique composition.

With even a little training in environmental medicine, doctors will understand the importance of including in their evaluation the possibility of the following:

• Heavy metal overload, especially lead and mercury
• Past history of pesticide exposure
• Formaldehyde exposure from new building materials
• Exposure to solvents, such as paints, sealers, and glues.
• Past or present exposure to mycotoxins made by molds
• Carbon monoxide exposure and gas leaks
• Unhealthy diets with high sugar and refined foods, allergens like gluten and dairy, and nutritional deficiencies that affect the brain, like B-complex and fish oils.
• Gut microbiome imbalance with overgrowth of harmful bacteria and fungus
• Drug reactions, including pharmaceutical drugs, recreational drugs and alcohol.

Of course the above list does not include all the possible environmental contributors to mental illness—just a sampling of the more common ones.

As an added tool, we now have affordable genetic testing to evaluate the patients’ predisposition to having extreme problems with toxins in the environment and toxins in the food supply. Since each one of us is unique in our genetic make-up, the one-size-fits-all approach is no longer justified.

Caroline was furious with her psychiatrist for not considering other causes of her depression. I pointed out to her that she did the best she could. Sadly, psychiatrists have no training in environmental medicine.

Caroline urged me to give talks at psychiatric conferences about non-psychiatric causes of mental illness. I told her I would give the idea some thought.

Inspired by Caroline’s words about helping psychiatrists understand the role of the environment in contributing to mental illness, I had the intention of giving talks on environmental medicine at the annual psychiatric conferences. The snowboarding accident in 2007 derailed those plans.

Now, I’m thinking I might reach more people if I gave a TED talk on this subject. We’ll see what unfolds.

I welcome your thoughts on this subject.