Chemical Imbalances and Other Black Unicorns

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“What do you think caused your problems?,” I asked.

“I have a chemical imbalance, a chemical imbalance, an imbalance in the brain that makes me ill.”

Sarah* had a diagnosis of bipolar disorder. Since her adolescence she had become acquainted with dark, shifting moods that meant she was sometimes uncontrollable and frenzied, and other times found it so effortful to live that she would retire to her bed for weeks, not eating, not bathing, not sleeping. Her every waking moment was spent contriving her own end, but to do that was too effortful itself.

Sarah joins an ever-growing troupe of patients who tell me that they have a chemical imbalance in their brain. Some have been told this by psychiatrists, others by their relatives, others still from mental health charities. None have heard this term from me. The notion that mental illnesses are caused by chemical imbalances is neither true, nor helpful. Worse still, the idea of mental illnesses as chemical imbalances is making us ill.

 

Medical or a Marketing Term

The term ‘chemical imbalance’ is not a medical or scientific term. Indeed a quick scientific literature search will show that the term is conspicuous by its absence. Despite this, patients and their families are often told by their physicians that their problems are caused by a chemical imbalance in the brain. Most pharmaceutical advertising for psychiatric drugs also tells consumers that mental illnesses are caused by chemical imbalances. The wide array of information for patients and their families on mental illness also frequently couches mental disorders as due to chemical imbalance. At once so simple and yet technical, it is easy to see why so many people find the idea their problems are due to chemical imbalances so compelling. It provides a simple explanation during a time when individuals crave certainty, and is packaged in the respectable veneer of pseudo-medical jargon. Make no mistake, however. There is only one reason why we have ‘learned’ that mental disorders are caused by chemical imbalances. To sell more drugs. There is one main reason too, why doctors tell their patients their problems are due to chemical imbalances. To convince people to take these drugs.

It was supposed to be a beautiful narrative. A previously well person becomes depressed, feels too listless and tired to live. A chemical imbalance is identified as the perpetrator. The ‘chemical imbalance’ is corrected with an antidepressant, and the patient is restored to her previous self. It is a story of restitution. It is a story where medicine is the hero and bad biochemistry the villain. It is a story with no basis in reality. Instead, we have convinced individuals that they are in some way defective and in need of lifelong treatment.

Making Us Sick

When a physician prescribes an antidepressant, he cannot but help but also prescribe an idea. He may not wish to prescribe the idea, indeed, he often is not aware he is prescribing the idea, but the physician nevertheless is prescribing the idea. The idea is that the problem is a chemical one, with a chemical solution. If it is a chemical problem, then it is largely outside of one’s control. The source of distress is no longer rooted in the fabric of society, interpersonal discord, a life story punctuated by loss, trauma and abuse, but it is located within the individual. It is located within the brain. Suddenly, the problem is no longer unemployment, widening inequality, social disadvantage, or alienation: the problem is you.

Once individuals become inculcated in dealing with their problems with psychiatric medication, they often increasingly see their emotions and life problems as outside their control. Further, they have little problem with medicating away emotions within the usual scope of mental life. It is not unusual for such patients who are a little upset, a little anxious, or angry, and mostly understandably so, to dull away these feelings with a dose of antipsychotic or benzodiazepine. In doing so, they undermine their coping skills and ability to tolerate the rich array of emotions threaded into the tapestry of life.

The most troubling aspect of the message is, instead of one of resilience and recovery, it is one of vulnerability and reliance. Although part of the reason why antidepressants ‘work’ is the idea provides a lifeline to an individual as a message of hope, this is transient. Eventually, patients come to wonder, ‘If I have a chemical balance, won’t it come back if I stop taking this pill?’ or ‘If antidepressants are like insulin for diabetes, don’t I need to take this forever?’ Whilst antidepressant prescriptions have on the whole been rising, the number of new prescriptions for antidepressants has not been increasing year on year. This fits with epidemiological data that show that the number of new cases of depression has actually been decreasing, but the total number of people depressed has been increasing2. What this suggests is not that more people are becoming depressed, but that fewer people are getting better. It is not so much we are all becoming depressed, but when we do, we’re staying that way. In convincing people that they have a chemical imbalance, we have disempowered them to look at how they can change their life for better, and instead made them reliant on medication. As a result instead of making people better we have kept people sick.

 

The New Phrenology and the Eclipse of the Social World

Today, the majority of research into the causes of mental distress focuses on neuroimaging and genetics. There are other niche interest including immunology, endocrinology, and proteomics, but on the whole, most research is biologically-oriented and focuses on brain scanning and genes. This has come at the expense of research into the social world in which people become depressed, go manic, or have psychotic experiences.

Now we should not ignore avenues of research that have the potential to transform our understanding and help individuals. My contention is that, with the possible exception of dementia, not a single patient has actually benefited from any neuroimaging research. Despite billions of research dollars, many at the public expense, not a single treatment or innovation has come out of this funding. In contrast, the finding that the relapse rate for schizophrenia was higher in families with high expressed emotion led to the development of family therapies, the finding that depression followed particular life events led to the development of interpersonal therapy, and the finding that women lacking a close confiding relationship were more likely to develop depression led to the development of befriending programs for depressed women. Yet, it has become exceedingly hard to get research funding to explore further the social and environmental determinants of health. If I wanted to do a study neuroimaging manic hedgehogs, I would not find much difficulty getting funding. On the other hand, If I wanted to explore the role of social support in outcomes for those who have psychotic experiences, it would be an uphill battle.

It comes as no surprise that when there is a Republican administration, research exploring the social determinants of mental health dwindles, and there is more funding for biological research. The obfuscation of the wider social determinants of mental distress is deliberate. Unfortunately, we have become so obsessed with finding the elusive cause of mental illness using new technologies, we have become complicit in forgetting about the determinants of our mental health in the social world.

Like a black unicorn, we have cultivated a dangerous mythology in the promotion of the notion that mental illnesses are due to chemical imbalances. Whilst there is of course a biological basis to our emotions, thoughts and behaviors, this level of explanation is unhelpful because it ignores what our feelings and experiences of living mean, and ignores the context in which we experience joy, love, anger, sadness and fear. By convincing individuals that their problems are due to chemical imbalances, we have succeeded not only in creating a generation who has recoded their moods and feelings into neurochemicals, we have undermined their ability to manage these problems themselves. Most troubling of all, the notion of chemical imbalances has transformed mental illnesses from temporary aberrations of mental states understandable within a particular context, to permanent disorders of the self embedded in the brain.

*Sarah represents a composite of different patients and not one individual.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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40 COMMENTS

  1. Not only are a lot of “patients” convinced that they are suffering from a “chemical imbalance” but, what is worse, a lot of doctors and mental health staff are brainwashing their patients into believing it. I tried in vain to tell the psychiatrist and the CPN that I didn’t think that my son suffered from such an imbalance. Not only that-they insist on watching over you and are actively stopping you from taking charge of your life and getting on with it. The psychiatrists themselves are not interested in listening when you try to explain to them what brought it all on. They know better: you have a chemical imbalance, you are suffering from a “serious mental illness” We were told all this only 2 years ago. Shouldn’t the psychiatrists be the first to “retrain”?

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    • I am sorry to hear that. My point is that psychiatrists of the current generation do not learn that mental disorders are caused by chemical imbalances. I cannot speak to the training of older psychiatrists. I suspect psychiatric nurses do learn this however, as they seem to be more likely to tell patients and their relatives about this. Personally I find it more helpful to elicit what it is that people believe is responsible for their problems. Whether what they say is correct or not, it provides some valuable information to work with.

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      • “My point is that psychiatrists of the current generation do not learn that mental disorders are caused by chemical imbalances. ”

        Psychiatrists of the current generation certainly ARE told that these are brain diseases, whether it is called a ‘chemical imbalance’ is beside the point.

        The point is you are trained to believe there is ‘something’ diseased about the brains of people you label and drug.

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        • well it probably depends where you train. there has actually been a shift, and mental illnesses are no longer characterized as brain diseases so much, as to cause brain disease themselves! An idea that has been gaining popularity is that there is something neurotoxic about psychosis such that individuals end up with brain disorder, rather than brain disorder (whatever that means) being responsible for mental illness!!! The evidence for this appears rather flimsy.

          I cannot speak for everyone but I don’t recall being told/taught that most mental illnesses (with the exception of dementias) are diseases at all, though there are of course people who believe this.

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          • “My point is that psychiatrists of the current generation do not learn that mental disorders are caused by chemical imbalances.”

            “I cannot speak for everyone but I don’t recall being told/taught that most mental illnesses (with the exception of dementias) are diseases at all, though there are of course people who believe this.”

            “sorry i was a bit lazy and have not posted the references but there is a clear correlation between republican government (and conservative governments in the UK) and a decline in research in the social determinants of (mental) health.”

            From my own experience;
            “What records? All they have is the current assessment notes,” I suddenly realized, wondering if the psychiatrist had actually perjured himself with this *lazy* intimation during a legal hearing?

            Perhaps its an age thing, but so far Doctor your contribution looks like a young man who’s identified a target audience to whom he hopes to sell a book. Brainstorm a catchy title, fill it with what the audience wants to hear & it should sell reasonably well.

            Yet where is the non-obvious insight that will tell your readers something they don’t already know? For example, after 32 years of psychotic experience, I would love to hear your views on its possible cause and best practice management, social supports or otherwise.

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          • So if they’re not taught this, then why are young Psychiatrists, still actively propagating this myth, and worse still, insisting that patients “agree” and “accept” this explanation? Such as the ones which sought to treat me last year. Surely the teaching in New York can’t be that bad/poor quality?

            (Whilst I appreciate you’re not a mind reader, and don’t know what the individual Doctors I dealt with were thinking, I would like your thoughts on why they may have said what they did).

            Also, re: your point that chemical imbalance theory is not really related to involuntary hospitalisation, I disagree for the following reasons:
            – If the rationale for hospitalisation is to provide treatment; and
            – The entire treatment focusses on medication (no other treatment was provided); and
            – If the reason for providing medication is that it “fixes” a chemical imbalance in the brain…
            – If medication is essentially nonsense, then there is surely no legal justification for involuntary hospitalisation….as if there is no genuine/legitimate treatment being offered…the legal argument goes out the window.

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    • I would really like it if most of the psychiatrists I have met retrain as mechanics or middle managers of job centres. They have a skill set that matches these job profiles and it would help us all if they considered perusing another career.

      Recovery starts with non-compliance, as the slogan goes, and recovering the mental health system will happen when enough of us no longer comply with the wishes of drug company influenced psychiatrists and other staff

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  2. No General Practitioner told me about a chemical imbalance.

    However, numerous psychiatrists at Beth Israel medical centre (NY, NY) told me the following at the end of 2011:
    – “you have very severe depression. This is caused by a chemical imbalance in your brain”
    – “You need to take medication for your depression, just like a diabetic needs to take insulin”
    – “This illness is not a sign of weakness, it is physiological”
    – “You have to accept that you need to take this medication for the long term, if not for the rest of your life”.

    …this was from Psychiatrists. In 2011.

    I was not asked “why” I felt the way I did, I was “told” why…

    Worse still, I had to tell them that I agreed and accepted all of the above. If I didn’t there was the ever present threat that I would be kept within the inpatient unit (against my and my family’s wishes) for even longer.

    Given that I’m 30, the idea of taking medication for what, the next 50 years?! Thank God I didn’t believe them. And since coming out of the “therapeutic” environment that is their inpatient ward, I now know better, and can make informed decisions about my health.

    Dr Datta – do you think the Doctors I was dealing with may actually know that it’s all “BS” or, do you think it’s likely they just make it up because they think it’s a better way for (their presumably thick) patient to understand? Or something else? I.e. are they ignorant (scary in itself) or unethical (lying)?

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    • it’s probably more complicated that i made out in the post. I think the main reason for the explanation is to convince people the rationale to take the drugs. The second reason is the notion that the chemical imbalance theory implies ‘no fault’. That maybe true, but it also implies no hope and no power of doing anything except taking medication. The third is it is a dumbed down explanation of the complexity of mental experiences, which obviously have some biological basis, but this is not the same as ’cause’, nor it it in the only level of explanation. The fourth is it provides a veneer of moral authority to psychiatrists as it suggests only psychiatrists or medical doctors can legitimately treat these problems.

      Some people do benefit from taking medications, and I do prescribe medication, because they can provide some symptomatic relief, help with sleep, agitation etc. But let’s not pretend they correct some sort of defect inherent in the brain.

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      • “The third is it is a dumbed down explanation of the complexity of mental experiences, which obviously have some biological basis, but this is not the same as ’cause’, nor it it in the only level of explanation.”

        Give us the non-dumbed down biological explanation of our experiences Dr. Datta, pray tell. I’m all ears.

        “Some people do benefit from taking medications, and I do prescribe medication, because they can provide some symptomatic relief, help with sleep, agitation etc. But let’s not pretend they correct some sort of defect inherent in the brain.”

        You prescribe drugs because adults are not allowed to buy their own drugs, you call them ‘medications’ because you believe there is something ‘medical’ about this activity, and you label people’s experiences ‘symptoms’ because you again, believe there is something medical about this activity.

        I repeat, as you didn’t answer my question below, are you going to drug my brain if a judge orders you to against my will?

        And is prescribing for ‘agitation’ a code phrase for tranquilizing people you think are a problem?

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        • The rest of the myth of a chemical imbalance (or any biological explanation for psychosis) is that “psych drugs DO help some people” and “in extreme cases” they calm the person down.

          For the some people who are “helped” it is most likely placebo effect, which includes a doctor who is telling them it will help– pscyhological placebo. If the doctor said, “I’ll give you these pills, but they probably won’t help”, they most likely won’t.

          As for the “extreme cases”, this is where I have a problem.
          Because what is “extreme” to one person isn’t extreme to another, and who gets to decide? Not the person in the extreme situation.

          Not only that, but hypothetically, if a drug “helps” an “extreme case”, that reinforces the myth that at least some people DO, indeed have a biological or chemical imbalance that can be “fixed” by drugs!

          This is all or nothing, people!

          It is either biologically based, or it isn’t.

          I believe it isn’t. I believe an “extreme case” (and people aren’t “cases” but that is always the word used, since it dehumanizes them, making them easier to “treat”) can be talked to, calmed in some non-violent way.

          Let’s face it, if a gorilla escapes the zoo it would be considered an extreme case and be shot with a tranquilizer dart.

          How is that different from a human in distress? The gorilla is stronger, still basically wild, and non-human. And you can’t ask a gorilla why he escaped from the zoo, though I’m sure if he could talk, it wouldn’t be something a doctor would want to hear.

          The word ‘agitation’ jumped out at me in Anonymous’s post. Haldol is the drug of choice for ‘agitation’, and while it makes the person appear calm on the outside, the agitation inside is a living hell, and what I see as torture, cruel and inhumane punishment.

          This whole argument about biological based “mental illness” is really about power, control, human rights, and the medical profession being involved in an area where it doesn’t belong.

          And an “us vs. them” mentality in which one person loses their human right to think and feel so that another person can think and feel superior, for whatever ego-related reason they need to.

          It has also become an easy way to deal with a complex problem. Whitaker calls this a magic bullet.

          A new diet drug was approved yesterday by the FDA. This is so parallel to the psych drug problem, in that it misses the point.
          This new diet pill “fools the brain into thinking the stomach is full.”

          Nobody’s stomach needs to be fooled into thinking it is full. It has actually been full on numerous occasions and the person kept on eating. So they are eating for some reason other than wanting to “feel full.”

          Guaranteed not to work, because they miss the mark. We will still have an epidemic of obesity, just like we still have an epidemic of mental illness, both based on faulty premises and driven by money and power.

          One last word about an extreme, out of control person: they are usually high on another drug. If this is taken into consideration, then a psych drug should be considered only an antidote, used once, just as any other poisoning is treated in the ER.

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          • But, isn’t it possible that there are times when the body thinks there is an extreme danger, and goes into an extreme reaction (which may be to something real; an injustice, an irreconcilable conflict, but not something for which a bodily stress response is likely to be helpful), when a short-term medication may be helpful to get out of fight-or-flight response and into a more adaptive way of functioning? Bob Whitaker’s research indicates that small amounts of antipsychotics for short periods are proven to be helpful. Could this be because the body needs a way to de-escalate from stress?
            If so, it is possible that some have mistaken this effect for both an underlying pathophysiology and its cure, and extrapolated from this to a life-long condition that never was.
            I like your point that admitting to “extreme cases” opens the door, or leaves the door open, to a medical model. But does shutting that door completely really solve the problem, given that the body is still involved, still implicated, one way or another, in everything we do?
            I think that trauma research shows the body is involved. The medical model doesn’t have to be ALL wrong to have gone wrong. The question is; how do we explore the whole range of entry points at which we might address the problem?
            Open Dialogue does not refuse a seat at the table for psychiatrists; it just doesn’t start with the assumption hat the problem exists within an individual, either medically or psychologically. Even then, it admits to the possibility that psychiatry may have something helpful to offer; albeit short-term and in limited quantities.
            This point has never occurred to me before; that the “pathology” involved is not necessarily itself an aberration, but is instead a natural reaction that happens to be imperfectly adapted to our unnatural world. This, over time, can lead to physical problems in their own right, but perhaps the elusiveness of these problems owe to this mismatch between stimuli and reactions, and it’s in this gray area that our anger and frustration simmers.

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      • Thanks for responding, and I do appreciate your candor.

        I thought it may have something to do with “convincing” and trying to have a “blame neutral” explanation, but after doing my own research, I’ve just been left angry. I feel like I was lied to, and I don’t see how them making up a fairy tale is reconcilable with the doctrine of informed consent.

        I think of the other people who believed their Doctors and don’t know the truth, and it makes me angry.

        It leaves me wondering when, if ever, Psychiatry as a profession will start living up to the codes of ethics it claims to follow and just be honest with their patients, we’re not morons.

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      • As I interpret it, the “chemical imbalance” theory is, was, and always will be a manipulation to get the patient to agree to take drugs.

        Same with “brain disease” or “diseased brain circuits.”

        Many doctors have not troubled to deconstruct what any of this jargon means. They merely say it’s too complicated to explain fully, trusting that some rumor of brain scans or serum components explains it all.

        A very wise person once told me if something is too complicated to explain, it doesn’t exist.

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    • I experienced all the same, Anonime.

      Doesn’t it make you see them as … mentally structured?

      They are taught to have a certain frame of mind. Then they feed these lines to people and like you said, we catch on pretty quickly that we HAVE to tell them that they’re right (even when we know they’re not). They PAID to have their minds built and constructed as they are, so they’re not likely to think that what they paid for was so wrong.

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      • Hi MJK,

        I don’t doubt for a minute if you ask the Doctors that thought they were treating me, whether the treatment they gave was “successful” they would say “Yes”.

        But it’s not. All it’s done is give a pretence of compliance, so as to avoid further incarceration, and now that I know better, confirmed to me that if I am ever that way again, NEVER to seek help from that profession.

        And I never will…

        That’s success is it?

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        • Well – the doctors, nurses and social workers are all still in it. Maybe they need our “help”, huh? I make a half-joke out of it:

          I work for the United States Department of Social Security. Between my cash payment, food stamps and housing assistance, it is the equivalent of working a 40 hour week at $11.00 per hour – a little over $22,000 per year. My job is to be SECURE / safe. Right: safe FROM PSYCHIATRY.

          My job is to keep myself “well”. Welfare means “well being” but “welfare” also means “poverty”. I guarantee that the work I do is well worth over $22,000 per year. I’d love to see all these people do their jobs CORRECTLY and for *change*, not dollars. See how they like it.

          Like it’s a joke: some people are working for “change” (coins in jars and pockets), while others work to make A DIFFERENCE and some others are working to MAKE A KILLING.

          Success will be the day I watch *fraudulent* psychiatry be condemned as it rightfully ought to be. I will NEVER forget “Dr. Coincidence” who stood outside of an ATM machine in front of his maroon corvette looking around – wanting to be noticed. He had no idea that it was ME sitting in traffic at the red light, noticing him. I had a moment of ecstasy that day. Total bliss. One of the best memories I OWN. In my time of great, great need – he smirked at me, dismissed me, misdiagnosed me, drugged me and told me that everything was all a big “coincidence” – thus his nickname.

          Seeing him at the ATM is one *Heavenly* coincidence! LOL.

          I hear the “mental health” industry is over 300 BILLION dollars per year. I’ll gladly accept .001% as compensation. Yeah right, I’m being delusional. Sigh…

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  3. Black Unicorns Indeed!

    And as Alix points out the superior judgement is strictly adhered to, with a complete refusal to listen to any alternative explanation. So self assured that they can be caught off guard though, once we point out to the legal system the statistics on medication effectiveness. When like the general public the judicial system is also convinced mental illness is the same as cancer or diabetes. Consider;

    “In the consultation room I calmly watched the M.D. as he reached for his glasses and asked about patient diagnosis.

    ‘Bipolar 1, hypo-manic symptoms,’ the good psychiatrist replied.

    ‘When I walked into the room I knew the long walk thing had stirred you up,’ I said.

    ‘Are you reading my mind Mr Bates?’

    I shook my head at his adolescent response and his steadfast refusal of any open and honest communication. We’d been locked in this Mexican stand off since the first words we’d spoken to each other. Or rather I’d spoken and he’d just sat there with his pre-determined judgment.

    ‘Do I look hyper-manic to you?’ I asked the middle aged M.D., who just shrugged his shoulders in that classic self-preservation response of the employable institutionalized. I closed my eyes thinking, “no sense of in the moment responsibility, just follow the staff preservation rules and cover your ass regulations,” then I reached for my cell phone and called my son.

    ‘Believe it or not I’m being sectioned for the first time in my life, this is just amazing.’

    ‘Look, if you want to get out here, just take the medication,’ was his first reaction to my pleading for understanding. Exactly the same mantra had been pronounced about a certainty that I was hypo-manic and would become hyper without medications. I explained my belief about an emotional development issue, with a possibility that post traumatic stress disorder was involved somehow.

    ‘That’s gobbledygook really, you have a serious mental illness that can be successfully treated with medications like any other illness.’

    ‘You really believe its similar to having cancer?’ I asked him.

    ‘Yes, and you need to accept the illness and work with the experts to sort out the medications that will work for you.’

    ‘So your prognosis is that without any medications my condition will worsen?’ I asked, and of coarse he agreed.

    ‘Then stop the injections and just monitor me,’ I demanded. At first he dismissed the suggestion as plainly ridiculous and a symptom of my illness, a loss of insight and a denial. We went over my behavior in refusing medication and I asked him to consider that I’d acted responsibly towards staff needs, while upholding my own conscience. He agreed to discontinue the medications, for now, he said, although neither he or any other psychiatrist had explained what would be happening within two days. Shortly after my meeting with the head of psychiatry there was a mandatory visit from a social worker, Monday was her part in this procedural play.

    ‘You will go before a magistrate (judge) on Wednesday, a hearing that will seek a statutory two week detention order,’ she explained.

    ‘So four days after I’m arbitrarily detained, it’s the social workers job to explain to me what is actually going on here,’ I replied with an added comment about mental illness and cancer patients.

    ‘Your best hope is to let me point out the anomalies in treatment here and ask for a second opinion,’ she told me. She started her presentation and questioning of the hospital’s representative by pointing out a suspected hypo-manic condition in the sectioning order and the grounds for the hearing.

    ‘Doctor do you still maintain that my client is in a hypo-manic condition and will become hyper-manic without appropriate medications?’ She asked the junior psychiatrist assigned to the hearing.

    ‘That is the assessment of Mr Bates current condition, yes.’

    ‘Can you explain on what evidence such an assessment is made Doctor.’

    ‘On the evidence of presenting symptoms, and also the records of Mr Bates long history of Bipolar Disorder.’

    ‘Can you confirm that my client is not currently receiving any medications, Doctor?’

    ‘That is correct.’

    ‘Can you also confirm that a decision was made to discontinue medications, three days after my clients involuntary admission to the hospitals acute care ward, apparently in a hypo-manic state,’ she asked, drawing a perplexed look from the magistrate.

    ‘It was agreed to discontinue medication at Mr Bates request, yes.’

    ‘With all due respect, it seems a rather strange health care decision considering my clients condition is expected to deteriorate without medication.’

    ‘Treatment of mental illness can be a complex process.’

    ‘I’m reliably informed of evidence that up to thirty percent of mental illness sufferers are known to be medication intolerant, and receive little benefit from ongoing medication use. Was this a factor in the decision to discontinue medication, Doctor?’ At which point the magistrate asked for clarification of what he’d just heard, turning to the psychiatrist with a look of bemusement.

    ‘There are some studies that suggest up to forty percent medication intolerance, yes.’ An answer which seemed to alarm the magistrate somewhat as he straightened his posture and became far more formal and considered in his choice of words.

    ‘I have not been made aware of such information before this time and will take it into consideration,’ he said, before asking my legal counsel to proceed.

    ‘My client informs me that he presented a different understanding of his condition during the consultation in which it was agreed to cease medication, can you confirm this Doctor?’

    ‘Mr Bates has a view of an emotional development disorder, for which there is no compelling evidence.’

    ‘My client also holds a view that there is no empirical evidence of a disease process in mental illness either. Is he perhaps delusional in his view Doctor? A symptom of his hypo-manic state perhaps?’

    ‘Its very difficult to gain empirical evidence from an organ of the body as complex as the brain, yet there is reliable evidence of symptom expression and effective treatment with medications.’

    ‘And yet by your own admission Doctor, up to forty percent of medication treatment may not be effective and you actually discontinued my clients medication, I’m becoming a little confused here.’

    ‘I’ve heard enough submission here, Mr Bates I recommend you seek a second opinion and I will only order a maximum stay of five days,’ the magistrate announced and quickly brought proceedings to a close.

    ‘You won, I’ve never seen a mandatory two week order rejected like that,’ my happy legal counsel announced as we walked towards the recreation room.

    ‘Its hardly justice, you didn’t even mention the idiot who arbitrarily sectioned me,’ I told her, feeling disappointed that I was still incarcerated.

    As I lay in bed that night thinking about my options and the fastest way to secure my release, the second opinion of a private practice psychiatrist was an obvious choice. I went over and over every gesture and uttered word spoken during the legal hearing. How the young psychiatrist had been caught off-guard by unexpected questions, in a normally routine and rubber stamped procedure. The genuine shock of the magistrate when what might have been an irrelevant comment by my legal counsel was confirmed and even compounded by the mental health expert.

    “Surely what was said and admitted to was evidence of inappropriate detention,” I mused. I rehashed the psychiatrist’s responses over and over, “On the evidence of presenting symptoms, and also the records of Mr Bates long history of Bipolar Disorder.” “What records? All they have is the current assessment notes,” I suddenly realized, wondering if the psychiatrist had actually perjured himself with this lazy intimation during a legal hearing? I resolved that in the morning I would go on the attack by pointing this out, and demanding to be assed by a private psychiatrist.

    ‘It was just a figure of speech, your son told us of your medical history.’

    ‘A slip of the tongue which gave the impression that your assessment was based on the solid foundation of written records about my past episodes, and spoken under oath?’

    Within an hour I was released with an apology and fervent wish that I would not have to be hospitalized again. And so began my five year road to redemption through dedicated reading research and my heart felt unfolding of “psychosis.” And why I’ve acted out online and recorded three full term psychosis since this one and only sectioning in 2007.

    http://www.bipolarbatesy.blogspot.com/2012/06/sectioned-on-road-to-redemption.html

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      • Hi John:))

        I did get a bit lucky that day, with young man who was caught off-guard by unexpected questions, in a normally routine rubber-stamp procedure.

        What the incident shows is the underlying nature of chaos in the anxiety of the lived moment, even though we try to impose order on it, with our cause & effect logic.

        The head of psychiatry was caught out by his own smug superior position, as we argued in the heat of the moment, and he agreed to discontinue my medication injections.

        What the staff could not defend themselves against, was my complete consideration for their position, and my full and respectful cooperation with their needs.

        What actually got me released, was a lazy slip of tongue comment about hospital records and concern that I did have grounds for a legal challenge. Yet what happens afterwards is typical of the educated priesthood and way they stick together.

        My legal aid solicitor was not interested in challenging the hospital further, and her glee after the hearing was typical of the legal professions, winners & losers attitude. The magistrate was more embarrassed for the “professional classes” than concerned about justice or my welfare.

        If you read blog posts and comments here on MIA, you see the same “priesthood” attitude of selective response deficit, towards anyone not seen in this simplistic “superior” light?

        Our pretense of intellect is built on instinct & impulse. The orienting response of the motor cortex which fires our postural attitude to life, and tones our subjective thinking.

        By pointing readers towards the sources of my own self-empowerment education, I try to point out that these “unconscious” responses are utterly predictable once we understand where we’re coming from. Consider our superior young man in this blog post;

        “One interesting group of activists is made up of members of professional and scientific organizations who attempt to use knowledge and social status to further entangle the triangular emotional system. To summarize the process, it begins with emotional tension in a bipolar situation, it spreads by involving emotionally vulnerable others, it is fed by emotional reactiveness and response to denial and accusation and it becomes quiescent when emotional energy is exhausted.”

        Monica McGoldrick’s profound statement “Loss is the pivotal human experience.” Drives the conservative thought process, in a fear of loosing “face” if exposed to critical debate, which will undermine its “rank & status.” Hence the “selective response deficit,” of the superior educated priesthood here on MIA?

        The quiet readers begin to notice how utterly predictable this becomes, in the facade of concern about mental health? Consider;

        “The societal projection process: The family projection process is as vigorous in society as it is in the family. The essential ingredients are anxiety and three people. Two people get together and enhance their functioning at the expense of a third, the “scapegoated” one. Social scientists use the word scapegoat , I prefer the term “projection process,” to indicate a reciprocal process in which the twosome can force the third into submission, or the process is more mutual, or the third can force the other two to treat him as inferior.

        The biggest group of societal scapegoats are the hundreds of thousands of mental patients in institutions. People can be held there against their wishes, or stay voluntarily, or they can force society to keep them there as objects of pity. All society gains something from the benevolent posture to this segment of people. A fair percentage of people are too impaired to ever exist outside the institution where they will remain for life as permanently impaired objects of the projection process.

        The conventional steps in the examination, diagnosis, hospitalization, and treatment of “mental patients” are so fixed as a part of medicine, psychiatry, and all interlocking medical, legal, and social systems that change is difficult. There are other projection processes. Society is creating more ‘patients” of people with dysfunctions whose dysfunctions are a product of the projection process. Alcoholism is a good example. At the very time alcoholism was being understood as the product of family relationships, the concept of ‘alcoholism as a disease” finally came into general acceptance.

        There might be some advantage to treating it as a disease rather than a social offense, but labeling with a diagnosis invokes the ills of the societal projection process, it helps fix the problem in the patient, and it absolves the family and society of their contribution. Other categories of functional dysfunctions are in the process of being called sickness. The total trend is seen as the product of a lower level of self in society. If, and when, society pulls up to a higher level of functioning such issues will be automatically modified to fit the new level of differentation. To debate such a specific issue in society, with the amount of intense emotion in the issue, would result in non-productive polarization and further fixation of current policy and procedures.

        The most vulnerable new groups for objects of the projection process are probably welfare recipients and the poor. These groups fit the best criteria for long term, anxiety relieving projection. They are vulnerable to become the pitiful objects of the benevolent, over sympathetic segment of society that improves its functioning at the expense of the pitiful. Just as the least adequate child in a family can become more impaired when he becomes an object of pity and over sympathetic help from the family, so can the lowest segment of society be chronically impaired by the very attention designed to help. No matter how good the principle behind such programs, it is essentially impossible to implement them without the built-in complications of the projection process.” _Murray Bowen.

        From all that “fearless” thinking of the 1950’s which was a reaction to the carnage & loss of two world wars. Older members of our survivor community will remember and mourn its sad demise, with the accent of the technology era and the “mechanically minded” left-brained younger generations of the educated class?

        Readers will also note that nobody wants to go anywhere near my question;

        “Why are American’s going to Finland to study a model of family therapy born in their own backyard?”

        Perhaps people don’t understand that “open dialogue” is based on the “Milan Family Therapy” model?

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    • If you mean have ever involuntarily detained anyone before, the answer is no. Psychiatrists do not have the power to involuntarily detain individuals in the state of Washington, a state appointed mental health professional (and a psychiatrist is not a mental health professional as the law defines) is the only one who can. In the UK I was only once asked to section a patient (I was not working in psychiatry) and I didn’t even know how! This however is not relevant to the current discussion, as the notion of ‘chemical imbalances’ is not typically held up as a reason for involuntary treatment. It is certainly not one that would be approved by any court I know of.

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      • “This however is not relevant to the current discussion, as the notion of ‘chemical imbalances’ is not typically held up as a reason for involuntary treatment. It is certainly not one that would be approved by any court I know of.”

        I would argue even if you say psychiatry’s brain based theories are not held up as a reason for forced drugging, people’s brains are being forcibly drugged with ‘treatments’ based on those theories, so it is relevant.

        What ‘reasons’ do you believe justify forcibly altering peoples’ brains? Or are you against forced drugging?

        You say you didn’t even know how to section a person in the UK? I would wonder how it is you satisfied the requirements of your training if you were not taught how to do this. I know for a fact it is something every graduating psychiatrist is trained how to do in the UK.

        Do you ever prescribe psychiatric drugs to people?

        How do you justify prescribing drugs that alter the brains of people when you cannot prove their brain is diseased?

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  4. Great expose about the nocebo effect of the chemical imbalance hypothesis.

    I think a very similar argumentation would also apply to various other unproven claims about diagnosis/prognosis and treatment, if the chemical imbalance theory was replaced by epigenetics, neuronal dynamics, post-trauma determinism, the idea of schizophrenogenic mothers, some astrology practices, or oedipus complex.

    You focused on what patients believe and are telling you. You mention your own view, but I would curious to know more about what you are answering your patients when they present themselves with those beliefs.

    On a different point, I don’t think the democrats versus republicans influence on research corresponds to a biological versus social model. The difference between republicans and democrats is about what kind of society and family culture lead to mental suffering, and which lead to mental health (republicans do believe “healthy” families, church and communities impact the individual character and health, even if they are averse to use any word that starts with “social” to describe those contexts, in the same way democrats believe about virtue and individual character but are often averse to use any word that start with “moral” to talk about those beliefs). In any case, I don’t see biology-obsession as a politically partisan issue.

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    • sorry i was a bit lazy and have not posted the references but there is a clear correlation between republican government (and conservative governments in the UK) and a decline in research in the social determinants of (mental) health. This is not surprising. I did not mean to suggest that republican administrations spent more money on biological research because of course they spend far less on medical research in the first place. but compared to social research, there is a relatively more biological research representing less funding for looking at social factors, rather than more funding for biological factors.

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  5. I think this is a good re-statement of what we’ve known about the chemical imbalance myth for some time. We can’t say or hear this message too much so I always applaud and encourage it.

    Your statement:

    “When a physician prescribes an antidepressant, he cannot but help but also prescribe an idea.”

    Is one I believe I can use in our local efforts to bring about reform. I agree with you, but I think physicians don’t always realize they are prescribing an idea. A good point to bring up in our conversations with them.

    You can replace “antidepressant” with any type or method of intervention though and make the same point that whatever we do promotes an idea or view of people (usually based on our own experiences — David’s piece above shows this perfectly.

    This is why, in my opinion, people may want to seek help from those most similar to them. It’s more likely that what is offered is consistent with how you see yourself and the world.

    Thanks for this piece.

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  6. Vivek Datta, M.D. you are missing the horror. The horror is once the “patient” takes the prescribed psychiatric drugs (or is forced to) they DO have a brain chemical imbalance.

    If the patient acclimates to the drug, once they reach homeostasis, they won’t want the physical and psychological withdrawal from the drug. The patient needs a legal drug dealer for the rest of their life.

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      • The brain does NOT become addicted?

        The original process of brain stem neural re-organization begins to “awaken” again once the sedating effect of medication is removed.

        The autonomic nervous system re-news its attempt to bring the organism back towards nature’s intended trajectory of maturing growth. A trajectory thwarted by traumatic experience, which the human animal is particularly vulnerable to? The “mind” itself thwarts this natural “unconscious” process, and a culture of super-natural belief in a “higher power” “out there,” prevents us from confronting our own NATURE.

        See my own “metamorphosis” from my last four “psychosis” acted out online, and transforming a once to rigid postural attitude of FEAR towards ab open embrace of the lived moment. Consider;

        “Highly traumatized and chronically neglected or abused individuals are dominated by the immobilization/shutdown system.

        These sufferers tend to be plagued with dissociative symptoms, including frequent spacyness, unreality, depersonalization, and various somatic and health complaints.

        Somatic symptoms include gastrointestinal problems, migraines, some forms of asthma, persistent pain, chronic fatigue, and general disengagement from life.

        In sympathetic hyper arousal, we can observe a tightening of the muscles in the front of the neck and the upper shoulder muscles, a stiffened posture.

        When immobilization is triggered from a perception of threat, from without or within, one holds still and conserves one’s vital energy. (Asthma)

        When this most archaic system dominates, one does not move; one barely breathes; one’s voice is choked off; and one is too scared to cry. One remains motionless in preparation for either death or cellular restitution. This last ditch immobilization system is meant to function acutely and only for brief periods.(P, 105)

        A therapists job in reaching such shut-down clients is to help them mobilize their energy to help them, first, become aware of their physiological paralysis and shutdown in a way that normalizes it, and to shift toward (sympathetic) mobilization. The next step is to gently guide aclient through the sudden defensive/self-protective activation that underlies the sympathetic state and back to equilibrium, to the here and now and a reengagement with life. Generally, as a client begins to exit the freeze state, the second most primitive system (sympathetic arousal) engages in preparation for fight or flight. (p, 106)

        The important therapeutic task in the sympathetic/mobilization phase is to ensure that a client “contains” these intense arousal sensations without becoming overwhelmed. In this way they are experienced as intense but manageable waves of energy, as well as sensations associated with aggression and self-protection. These sensory experiences include vibration, tingling, and waves of heat and cold. When one is able to ride the bucking bronco of one’s arousal sensations through, and begins to befriend them in a slow and steady way, one is gradually able to discharge the energy which had been channeled into hyper-arousal symptoms.” Exerts from “In an Unspoken Voice” by Peter Levine, PhD.

        Are the above impulsive posts on facebook.com, in November 2011 simply the product of a diseased brain process, as my Bipolar type 1 medical diagnosis would have the general public believe? Or can I show a skeptical, critical, left-brained scientific community that there is indeed more to PSYCHOSIS than meets the eyes of a rational, intelligent, instinctual sense of “I” A sense of I mediated by our autonomic nervous system and its stimulation of the heart, in our reflexive orienting responses, which are the very foundation of the mind.

        http://www.bipolarbatesy.blogspot.com/2012/06/mad-visions-or-mental-illness-part-2.html

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  7. The sad thing is that everywhere you look on the Internet, you will find stated again and again that psychosis, depression or bipolar are chemical imbalances. How is the lay person who has come in contact with the psychiatric services for the first time to know that it is by no means a proven thing. It took me ages to find like-minded people who thought otherwise.

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    • It takes a fairly radical frame of mind to accept a reality where ALL the so-called “evidence” is questionable.

      We’re looking at a giant edifice of studies and commentary on studies and surveys of studies that has no more medical validity than religious dogma.

      The amount of dishonesty, stupidity, and willful blindness in psychiatry is something usually described only in the most elaborate conspiracy theories. It’s incredible that a branch of medicine (or pseudo-medicine) could go so completely wrong.

      The numbers of billions of dollars accrued by all this corruption is also incredible — psychiatric drug purchases amounted to $40 billion in 2011 alone, according to Robert Whitaker.

      For the last decade, psychiatric drugs have provided a huge chunk of the income of major pharmaceutical manufacturers. For example, in 2009, Zyprexa represented 23 percent of Lilly’s total sales http://topics.nytimes.com/top/news/business/companies/lilly_eli_and_company/index.html

      In psychiatryland, truth is stranger than fiction!

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      • I was talking with a friend about food and eating healthily a little while ago….my friend said “oh and the good thing about that type of food is that it increases serotonin which is good for your depression”….(seriously?!)

        To which I pointed out that that entire theory is not true.

        But he just dismissed it as me being some sort of borderline conspiracy theorist…I would pay good money to see the APA put their own adverts on TV announcing to the public that the chemical imbalance is not true, never was…and then we can see the public uproar.

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  8. This is to Kermit Cole who responded to my comment:

    “I think that trauma research shows the body is involved”.
    I agree with this. In trauma, there are hormones and body “chemicals” going back and forth and amping up the fear and anxiety. Thyroid, insulin, adrenaline, cortisol?

    This is possible in either a crisis or after trauma where the fear and anxiety has built up to a critical point.
    These are naturally occurring body chemicals that are out of balance because of the thoughts and feelings of the person, but they are NOT the neurotransmitters that have been “isolated”–serotonin, dopamine, and norepinephrine, and then blocked by the drugs currently in use.

    The brain/body seeks homeostasis. Selecting a few neurotransmitters, out of at least a hundred, to work with, making a backwards assumption that, for example, serotonin is in short supply in a sad person’s brain, without asking why they are sad– they might know and avoid an attempt at a chemical fix.

    We already recognize that the research that identified which neurotransmitters are out of balance is out of date and seriously flawed.

    In the early 1950’s phenothiazines, which are actually pesticides, were given to patients for allergies and a side effect was that the person calmed down, or at least appeared to calm down, and the “tranquilizer” was born. However, phenothiazines will tranquilize anyone who takes them, not just the “mentally ill”.

    I have known people with diabetes who were psychotic and disoriented, and improved immediately when their glucose levels were balanced. New research shows that senile dementia may be “Type 3 Diabetes.” What irony. It’s just like diabetes after all.

    I also have noticed that people in their quest for a magic bullet have turned to vitamins and supplements, which also throw the brain and body out of balance.

    Something is out of balance, but what?

    The mental health field has been completely derailed for sixty years in the search for a chemical cure.

    Go back to that psych ward of 1954 and you will find the answer. It began with drugs that benefited the staff, not the patients. Thorazine made the lives of the caretakers easier, and that is still what this is all about.

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    • The work of Robert Sapolsky and Peter Levine on stress in the wild and in society shows that what would be normal, adaptive responses to stress in the wild, with their own natural course, go awry in our wholly constructed social world. There are many ways to ameliorate this and, among them, drugs at least have the appearance of doing the trick – but are not the only choice. The discussions on this website have the potential to add to the awareness of options and contribute to the information needed to make (at least adequately) informed choice.
      There will always be disagreement about WHICH information is needed, or when it’s even possible for informed choice to occur (Samaritan laws exist because there are in fact times peoples’ choices need to be assumed for them). But we can at least choose the company we keep when we get our information, and we can hope that we are creating a community on this website in which people will feel comfortable with the information they are getting.
      Sapolsky’s work on serotonin in primates, while not supporting the serotonin theory of depression, did demonstrate a role of serotonin in social hierarchies and depression, without suggesting anything about the role of it in human depression. But it’s interesting to contemplate this nexus of community, individual experience and serotonin in considering how and why the serotonin theory of depression did gain the ascendency it has. This does not replace a thorough interest in and exploration of peoples’ individual experience, and does not suggest what sort of ‘remedy’ might help, but it’s just interesting to contemplate.
      That’s what keeps me going through the research every day. No one study is dispositive, but each tiny factoid, if allowed to find some places to nestle, can potentially help to create a picture. I spend my time looking for studies that may provide grist for people who come to the website looking for support for alternate theories. There are some people who will only respond with “where is your evidence,” and it’s nice when I can offer studies from the world of hard science research that can be interpreted to support non-medical theories. I understand that some of the studies I post may seem reductive and objectifying, but I only look at them as traces left by larger forces at work, and hope that over time we build up enough of a base of research here to be able to offer credibly supported arguments built on current, or at least recent, research.
      It’s a lot of work to find them; three or more hours a day of sifting through the volumes of research that comes out, but it is out there and when it’s good, it’s good.

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