Open Letter Re: This Morning‘s Feature on Depression

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Dear Dr Chris Steele

RE: This Morning Feature on Depression – 18th of March 2014

We would like to express our grave concern over the information and advice you gave several of your participants on the programme including Dee, and then Nicola and Dan specifically, during the phone-in.

On the majority of occasions whilst imparting your medical knowledge (and personal experience) on depression, you clearly stated that this condition was due to a ‘chemical imbalance’ in the brain caused through a depletion of serotonin. You stated quite categorically that anti-depressants (ADs) would be the main answer to help people get back on track (like they continue to help you). You even stated a person might need to be on anti-depressants for life and that this would be ok.

It was clear Dee has major social difficulties and this is having an impact on her ability to manage and cope. Although you stated Dee’s circumstances caused a depletion of serotonin in her brain and that drugs would correct this, there is no scientific evidence to support your assertion that Dee actually has a “depletion” or chemical imbalance and that ADs correct any imbalance.  What is the proper level of serotonin?  What medically established, peer reviewed test, measures serotonin in the brain?  What region is this serotonin being sampled?

It was also very clear to us that Dan was suffering from bereavement due to the recent loss of his father. He said he was feeling tired, grumpy, couldn’t sleep and was crying all the time. Yet again you said Dan had all the symptoms of clinical depression and therefore it would be better for him to see his practitioner, who would hopefully prescribe anti-depressants. Can I ask you: If Dan’s above reactions are ‘symptoms’ of clinical depression, then what would you say are the signs of understandable grief? Grief is not an illness and feeling overwhelming emotions is a natural human response. In fact, there can be a number of stages someone will go through like shock, sadness and anger to name a few. Doctors are supposed to use the least intrusive method possible first, and recommending he begin taking a brain-altering drug was unhelpful and potentially harmful considering the main effects of taking ADs such as aggression, suicidal ideation, and suicide itself. Bereavement cannot be ‘medicalised’ in this way and to suggest this is sending out the wrong message to a person having to accept loss and work through the grieving process.

Regarding Nicola, you again pushed the use of long-term drugs, saying it ‘gets you back to normal.’ Drugs cannot make you ‘normal’, as their very mode of action is to impair true normal brain functioning.  You are making yet another recommendation for drugs to correct an imbalance that has never been consistently found and shown to cause depression. Quite the opposite in fact: Research has shown that psychiatric drugs do indeed create ‘perturbations in neurotransmitter functioning’ thereby affecting normal homeostatic mechanisms that exist in the brain, which in the long term can cause permanent neural dysfunction (Hyman 1996). As a result, we feel Nicola would clearly have benefitted more from intensive talking therapy to explore her underlying fears and anxiety, and certainly from the support of caring friends and family rather than resort to long term ADs.

The notion of a ‘chemical imbalance’ is now a fairly outdated view, and it is irresponsible and unethical to continue to indicate to the public they suffer from an imbalance where non has ever been consistently found and replicated within the peer reviewed professional journals.

“There is no scientific evidence whatsoever that clinical depression is due to any kind of biological deficit state.” (Ross 1995, Associate Professor of Psychiatry)

Stanford Psychiatrist Dr. David Burns has stated:

“I spent the first several years of my career doing full time research on brain serotonin metabolism, but I never saw convincing evidence that any psychiatric disorder, including depression, results from a deficiency of brain serotonin.” (Lacasse, J. 2005)

In fact the American Psychiatric Association has openly admitted for a long time now that this theory of a chemical imbalance was all just a metaphor, a myth invented by the pharmaceutical companies to generate drug sales!

“The psychiatric profession has finally come clean and confessed on a national media outlet that there is no evidence to support the Serotonin Theory of Depression . . . However, according to Pies, it was the pharmaceutical companies who espoused the theory, and not well-informed, practicing clinicians, because the psychiatry community has known all along that the theory is not true.” (Leo, J. and Lacasse, J., 2012)

There are many more academic papers and journals highlighting these findings. We feel to ignore such evidence is unprofessional, naïve and unethical.

To imply to viewers there is known scientific evidence to support the ‘chemical imbalance’ theory is misleading and could potentially do more harm than good. If a person is led to believe they have a ‘chemical deficiency’ then this can affect how they perceive themselves, how other perceive them, cause them to take drugs thereby masking the main external difficulties, affect ‘treatment’ plans and more so, create a prolonged road to healing. Instead of focusing on how they can sort their external life out, they resolve themselves to believing there is nothing they can do due to their ‘illness’. To suggest a person needs anti-depressants only reinforces that they are ‘ill’, with ‘a magic bullet’ being the only solution.

The chemical imbalance theory of depression can affect a person’s perception of himself or herself. Compared to a bio-psychosocial explanation, the chemical imbalance explanation was less credible and led to decreased personal and moral responsibility for depression, a worse expected prognosis, and the perception that psychosocial interventions are largely ineffective. (Deacon and Baird 2009) 

To suggest that a person has a depletion of chemicals in their brain actually leaves the problem at the person’s door. So, as in the cases of Dee, Dan and Nicola it implies that suffering is caused by an internal biological abnormality, which can be treated with drug intervention. So who helps to support Dee with her social problems, Dan with his grief and Nicola with her deep rooted fears? Detracting from their external predicaments and suggesting a physiological internal cause, is equivalent to using people as scapegoats and ignoring the moral and social responsibilities we all have as people to support the vulnerable and to challenge the wrongs that reside within society.

This also brings us to the point that during your TV appearance, the advice you gave placed the greatest emphasis on psychiatric drug interventions.  We felt that ‘talking therapies’, social work or carer support – not to mention support and love from family and friends, participation in external activities etc was gravely omitted from your advice. We felt these options would have been far more effective for Dee, Dan and Nicola enabling them to explore and manage their life circumstances. Yet, you instantly jumped to drugs as the remedy without consideration for their extenuating circumstances.

Research has actually shown that ‘antidepressants’ are no more effective than placebo and clearly have unwanted side effects like agitation and anxiety.

The problem is not that people do not improve on medication. They do, and on average the degree of improvement is clinically significant. But people also improve on placebos. This suggests it is not the drug that is making people better (Kirsch 2009)

Even more alarmingly, it’s now recognised by the medical profession that suicidal thoughts and feelings can increase, whilst starting and during the first few weeks and even months of taking an anti-depressant.

To suggest also that someone should be on them for life ‘which is ok’, we find even more shocking considering the long term physical damage that can occur. We also find it quite sad that you actually feel you need to be on anti-depressants for life yourself. Based on the research, we would question your claim and wonder if you too, have actually bought into the myth of the chemical cure or if your own drug usage is the reason for such recommendations? If this is the case then using yourself as an example, is not evidence-based interventions based on peer reviewed long term data but rather personalised marketing. In some circumstances medical professionals also have vested interests in the pharmaceutical industry and patients deserve to know if this is the case, although we are not suggesting this here with you.

Dr Steele, bearing in mind the findings from the research we have highlighted above and the ever growing publication of research on this subject matter, we trust you will take our concerns onboard and refrain from using information that cannot be substantiated scientifically. To continue to do so is not only misleading but also grossly unethical. Making claims via the media that cannot be proven scientifically we feel actually has serious implications for the health and well being of This Morning’s viewing audience and therefore the programme could be an infringement of broadcasting legislation.

We would appreciate a response from yourself or producers of This Morning as soon as possible.

Regards

Julie Leonovs (with contributions by Nick Redman)

Cc:

Julie Leonovs: BSc (Hons), MSc Psychological Research Methods, Mental Health Advocate

Nick Redman: Bristol Hearing Voices Network

References:

Deacon, J. B and Baird, L. G. (2009) “The Chemical Imbalance Explanation of Depression: Reducing Blame at what Cost? Journal of Social and Clinical Psychology, Vol 28, No. 4: pp. 415-435

Hyman, S. (1996) “Initiation and adaptationA paradigm for understanding psychotropic drug action”. American Journal of Psychiatry 153 151-61

Kirsch, I. (2009) The Emperor’s New Drugs: Exploding the Antidepressant Myth. The Bodley Head, London.

Lacasse, J. (2005) ‘Serotonin and Depression: a disconnect between the advertisements and the scientific literature’. PloS Medicine  Vol 2.: 1211-16

Leo, J and Lacasse, J (2012) Psychiatry’s Grand Confession [online] Available from: http://www.madinamerica.com/2012/01/psychiatrys-grand-confession/ [Accessed March 2014]

Ross, C (1995) ‘Pseudoscience in Biological Psychiatry’. (New York: John Wiley & Sons) 111

In support of this letter:

Rachel Waddingham: London Hearing Voices Project Manager, Mind in Camden

Patrice Campion: BSc (Hons), MSc Psychological Research

Mental Health North East (MHNE) England.

Dr R Huws: Consultant Psychiatrist, Sheffield

Hugh Middleton: Hon. Consultant Psychiatrist Nottinghamshire Healthcare NHS Trust & Associate Professor, University of Nottingham. Co-Chair, UK Critical Psychiatry Network.

Dr James Davies: Senior Lecturer in Psychology and Social Anthropology, University of Roehampton

Suman Fernando: Visiting Professor, Faculty of Social Sciences & Humanities, London Metropolitan University. Former Consultant Psychiatrist

Philip Thomas: Honorary Visiting Professor, Social Science and Humanities, University of Bradford. Formerly Consultant Psychiatrist Bradford District Care Trust

Sami Timimi: Consultant child and Adolescent Psychiatrist, Director of Medical Education Lincolnshire Partnership Foundation NHS Trust

Paula J. Caplan: Ph.D., clinical and research psychologist, Associate, DuBois Institute, Harvard University, former member of two DSM committees, and author of They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal.

Mary Maddock: Board Member MindFreedom International/Co-author Soul Survivor – A Personal Encounter with Psychiatry.

Katie Mottram: Development Group Member UK Spiritual Crisis Network

Marian B. Goldstein: Counsellor, Co-char Danish Hearing Voices Network

Olga Runciman: Psychologist and Chair of the Danish Hearing Voices Network.

Speak Out Against Psychiatry (SOAP)

Cheryl Prax

Bernadette Bushe

Susan Kingsley-Smith: IC – Contributing Author: Coming off Psychiatric Drugs 2014 by Peter Lehmann Speaker: Proactive Planning – Reducing Reliance on and Considering Safe Withdrawal from Psychiatric Drugs, Companion Guide to the PACE Manual: Creating Your Own Proactive Plan; Founder Empowering Solutions project.

Nancy Rubenstein Del Giudice: Director of Public Education and Volunteer Coordinator The Law Project for Psychiatric Rights (PsychRights.org)

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Julie Leonovs

After a masters in Psychological Research Methods and a degree in psychology, Julie’s main focus has now switched to the myth of psychiatric diagnosis and how labelling can harm those suffering emotional distress. She strongly feels there is an over-reliance on the disease-based model which can ultimately detract from an individual’s personal suffering. As, a consequence Julie is a strong believer in the non-drug approach towards healing and would prefer professionals to recognise and utilise the many alternative ways for supporting those going through trauma and crisis. What is needed is a complete paradigm shift in how we view those experiencing emotional overwhelm and subsequently how we then support and enable individuals to heal. Consequently, through her own experiences she is now a strong advocate in promoting the rights of those engaged within mental health services and similar environments based in the UK.

(Thank you to Nick Redman for his support in compiling this letter.)

55 COMMENTS

  1. Great article. The only thing I would add is that, in describing the idea of an imbalance as some kind of “metaphor,” I would suspect that the establishment is trying to head off suits for malpractice. There is, after all, nothing about the idea of an imbalance that is metaphorical. “My luv is like a red, red rose” — that’s metaphorical. Putting the idea out there, — a quite specific, detailed, and scientifically based idea — that the chemicals in your brain are out of balance is not metaphorical in any way. The problem is not the use of poetic language. It is the theory itself, and the actions that followed, using that theory as justification. Letting them call it a metaphor is to let them wriggle out of responsibility.

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  2. The fact that I’m such a lousy librarian and secretary is getting on my last nerve right now. If anyone has a link to an article that includes a quote from a psychiatrist acknowledging that there is no evidence for the “chemical imbalance” theory (hypothesis) and saying that it’s something that the patient can “understand”, please link to it here. With the chemical imbalance charade, the other metaphor— that an antidepressant for depression is just like insulin for diabetes— comes into play and likely wins.

    With this bio-belief, psychological intervention is rendered useless, therefore, the psychiatrist wins the race and the jackpot that comes with it. People also are led to believe that SSRIs only act on serotonin, correcting the imbalance, and have no other effects. While under the influence of an SSRI, the patient may not be able to tell that something is an effect of the drug, and not them or their “disease” that is responsible for any behavior or thoughts that are induced by the drug.

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    • Nice comments wileywitch. That is the danger isn’t it. When psych drugs are taken then it becomes hard to establish what is the effect of the drug and what are the issues that originally were causing the difficulties? The boudaries become blurred.

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      • Hi Fiachra, the video does seem somewhat contrived doesn’t it. He promotes quite a great deal of medicines for physical health too, which makes me think…just who is paying him? I know he says he takes anti-depressants himself (for life – sad), so I think he believes he needs these – for life. Either that or he is using himself in a very clever marketing/advertising ploy (allegedly). I am a medical doctor and I take all of these drugs, including psych drugs – so trust me they are fine (££$$).

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  3. How much ignorance is feigned I do not know, but I suspect many psychiatrists realize they are phonies and that they are really no different from the witchdoctors their ancestor laughed about. Still there are bills to pay and miles in an expensive car to go. Without the drugs many of these men and women would be out of a job. So there you are.

    In my opinion depression and mental illness in general are a matter of two things: identification and agency. If I do not know who I am how can I claim to be the negative emotions I experience? If I drive through a dark and dismal slum I do not immediately conclude I am a dark and dismal slum. Why not? If I see a cat, I do not conclude I am a cat. Again why not? When I perceive a negative emotion and a negative thought why must I conclude that is me? So the important thing is to get a self certifying answer to the question, who am I.

    Secondly, who is the doer? Can anyone give a certain answer to that one? Clearly when a loud unexpected sound goes off nearby, and I jump, my agency is not apparent at all. At what stage do I become the genuine doer? The German philosopher Schopenhauer gave this answer regarding our actions: Doing comes from essence. That was a medieval answer to the question. Thus the thoughts and emotions that come into my mind are in some sense a reflection of who I am as a unique person. I have not simply been thrown into the environment. But almost all of the time thoughts and impulses simply arrive unannounced are acting upon or not. It is with great difficult that anyone can make any sense out of the notion of free will other than the legal definition–involving sanity and not being coerced at the time.

    Depression is often a long journey through the subconscious slums like a journalist living for months or years in a war torn country. Destroyed edifices, smoke, hungry people, wounded and dead, torn trees and cloudy skies and the sounds of gun fire and motar shells.

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    • Very profound Agniyoga. You ask some soul searching questions. Sadly, by taking drugs though such as antidepressants, these ‘ownership’ questions may never arise. The drugs can take away feelings of ‘who I really am’. They can blur and numb those profound questions you may need to explore. Your autonomy and ownership can be stripped away.

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  4. Excellent article; thank you for your community service!

    It’s wrong to prescribe medicine to “cure” normal biology; depression is the natural, normal response to depressing experiences. My biggest criticism of psychotropic drugs is that the drugs cause fatigue that reduce the ability to work through the real problems that cause emotional distress.

    Best wishes, Steve

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  5. Great read, good argument. I wonder whether with the medical approach drugs could be done away with and placebos be prescribed instead? After all, if placebos are effective (as effective as drugs laden with harmful effects) wouldn’t it be beneficial to take them? The bind here of course is that you’d have to believe you’re taking ‘medication’, which means that somebody has to lie about what they’re giving you and at the same time they’d presumably profit from the lie! Also, I’ve found in my case an ‘extended’ or ‘extra’ placebo effect occurs, whereby particular people buy the ‘chemical imbalance’ line, I’m guessing because it invariably comes from a doctor, and somehow, miraculously, when I’ve taken prescribed medication it’s had an instantaneous effect. They believe they’ve done something positive when I take the drug, their behaviour changes instantaneously to a state of relaxation and, in this now non-confrontational environment, I’m able to relax myself. To the other party, this easing of tension in the room is evidence of the efficacy of the medication! Pointing out that nobody in the medical world claims so-called medications act instantaneously never helps. So, love the letter posted above, it highlights some of the arguments which one would hope might persuade more people to question medicine’s ‘biological fix’ approach.

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    • Thanks Unravel for you kind comments. As regards the placebo effect I think many factors can contribute as to how they may be effective, and likewise with ‘genuine’ drugs too. I also think in both cases above the doctor/patient relationship can be a significant factor (e.g. good and bad relationships). Obviously settings, hierarchy, information given, personal desire for a drug to work, the amount of distress a person is under etc, can also have a powerful influence on the belief that a drug will work.
      I am aware of Professor Ted Kaptchuk from Harvard Uni who does research on placebo effects. I don’t know a great deal about his work but believe he conducted a study on people with IBS telling them they would be given a placebo to help, so as not to dupe them. He found the placebo effect still worked but wore off affer a few week and people naturally sought more of these sugar pills. It would seem placebos certainly do work but much better if people are duped. But obviously, moral and ethical issues arise here. Clearly more research is needed here but under the umbrella word of ‘placebo’ many factors can play a part in this as mentioned above.
      I would like to think of other healing factors too such as good friends, family, support, healthy eating, exercise, fun activities, creativity, music, hobbies etc!

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    • It’s interesting that people would ask for what they know is a placebo. In this case, the added benefit would be that the placebo does not have other unwanted effects, that antidepressants certainly have.

      It’s not unusual for transplant recipients to feel so good on their anti-rejection medication (steroids) that they stop taking them. They don’t start to feel bad until a significant amount of time after their body starts rejecting the organ. The good feelings are a drug induced state that don’t work in their favor. A lot of drugs do work for what they’re supposed to work for and the failure to take those drugs has life-threatening consequences.

      The fact that the placebo effect is so significant in antidepressants is a side effect of the fact that for most people these drugs don’t really do much for “depression”. When all the data is properly collected and analyzed, the effectiveness is not much different from placebo. That doesn’t mean that an antidepressant doesn’t have a significant and positive effect on some people— way over placebo— ,but that they’re not effective on the whole and should stop being promoted as a likely solution to the problems of “depression” for anyone who anyone thinks is suffering from it, whatever “depression” means.

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      • The problem with giving a placebo to a distressed person is that it implies there is a “medical” problem.
        If we want to change the paradigm from a medical model to a psychological one, we shouldn’t even “pretend” pills of any kind are helpful.

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      • Wileywitch, I think people may ask for a placebo (strange as it may seem), probably because even on this, it was shown to have a few weeks of benefit. It must have been mind over matter, therefore these people may have thought it would work again – or they could harness more of their mind/body power? And some of these people who agreed to the IBS placebo research were quite desperate over their condition – so would be happy to cling to anything. Plus, as you say the fact that it offered no unwanted side effects may have attracted them…although there appeared to be a craving developing for the ‘benefits of the placebo’. So much so that one lady raced around all her local pharmacy shops to see if she could acquire more of these ‘sugar pills’!
        As for placebos for emotional distress, depression etc again I would say the power behind them is the same for physical ailments. I think if you believe a drug will work – then it is more likley to have a postive effect. As many other things can do too such as walking, exercise, listening to music, even talking therapies. Which again highlights as you state the ineffectiveness of using AD’s really because placebos can produce similar benefits – but without the harmful effects.

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  6. @ Julie Leonovs @ Nick Redman

    Thank you for the clear wording and the call for a response on why psychiatrists still give recommendations that are clearly biased towards neuroleptic drugs. The late confession that ‘the psychiatry community has known all along that the theory (on Serotonin depletion) is not true.” (Leo, J. and Lacasse, J., 2012) can make a rather cynical read with regards to guidelines and practices, and primarily, to harm done to patients.

    In my view it is important to support a paradigm shift from ‘treatment’ to ‘reciprocal learning’ using diverse sources of insight, experience, embodied, psychological and social factors in mental health disturbance and step-wise subjective recovery (based on respect for a person defined relation to her unusual experiences). Therefore exploration and evaluation of the social, emotional, developmental, growth processes, the pocesses of change through dialogue and learning in different ‘talk therapies’, peer-run or co-facilitated support groups, peer-run and co-facilitated recovery education programs is needed. It is needed exactly to be able to evaluate the beneficial and possible distressing effects in face-to-face and group-based exchange, learning, growth and empowerment processes vs processes that can lead to distress and rejection. In my view a much better understanding of beneficial and challenging social learning processes in facilitated peer support groups as safe spaces (sic) has shamefully been neglected in research. This may be due to the public opinion, and I am afraid many mh professionals’ view, that peer support is only self-help and the real effective treatment must be conducted by psychiatrists and psychologists.

    The research and evaluation into consumer-led/user-led/co-produced experience-based support groups which make use of psychological and social learning processes, using experienced based planning of subjective recovery (with respect to ongoing vulnerability or unusual perceptions whilst supporting constructive meaning-making and self-empowerment, more personal control over distressing experiences and support for the up-take of social, educational, vocational activities) has only been expanding over the last years and funding is still scarce. However, in parallel to social and political activism, it is decisive, in my opinion, to build systematic and broad evidence on the potentials, processes, benefits, but also challenges and potential harms to be addressed, inherent to experienced-based, reciprocal learning and social empowerment in peer support and recovery group programs.

    I agree, the notion of subjective recovery needs be nuanced and critically discussed. I here refer to a fundamental right to socially mediated recovery of self in a subjectively meaningful and active life highly dependent on social opportunities for many people. Social mediating refers to the necessity for most people to be heard and listened and answered in order to listen to themselves, give more hopeful responses to thoughts, voices, roles of self. Facilitated peer support & recovery group programs have unique experiential knowledge, real social diversity and therefore safety to offer which has been too little explored and evaluated.

    To abstain from exploring and evidencing the complexity of processes and benefits as well as challenges in facilitated peer support & recovery learning programs does, in my view, serve traditional treatment policies at the dispense of these ‘new’, experienced-based, facilitated support and recovery group programs.
    The issue of ‘brain imbalance’ is far too complex, in my view, to be debated in dichotomous injections of yes or no, for or against, which miss and distort how the brain and bodily cns work in super-complex ‘imbalance regulations’ being informed by embodied interactions, intentional thoughts and expectations related to social interactions, values, norm and power disparities or structural and interpersonal violence. It is because people know that their brains, bodies, emotions and thoughts (all organically and socially mediated) function in regulated and structurally shaped ‘flows of imbalances’ that nearly everybody, professionals and clients, gives some credibility to the ‘brain imbalance’ claims. Fundamentally, what has been shown through knowledge of brain and embodied functioning is that the brain is not a causal actor and that drug consumption easily and most often result in harmful effects because psychotropic drugs non-specifically target striatal, meso-limbic and neocortical neurological circuits and significantly interfere with the necessary ‘grades of freedom’ for regulation of body-cns-brain. However, this discussion exceeds my knowledge. My contribution is to caution not to get trapped in ‘brain imbalance, true or false’ – debates which by their very over-simplistic wording seem misleading and unhelpful to me. I welcome all research evidencing how the neuroleptic over-dosing of the whole living organ-cns-brain leads to extreme and enduring physiological harms, emotional and psychological impairments, etc.
    Research into activities which support restauring embodied and neurological complexity and flexibility of functioning has been far too little undertaken. This is only partly due to the complexity, dynamics, inter-connectedness and inter-activity to be accounted for. Nevertheless, there may be promising developments in embodiment and inter-action research, and one day more ‘robust and rigorous’ evidence on the healing emotional and organismic and mental (complex inter-regulations restauring) effects of yoga, animal contact, multi-layered processes in music making, and many more.

    In my view building a scientific research paradigm for embodied, emotional, intention and interaction supporting ‘holistic’ activities has been badly neglected. I mention this to emphasize that the ‘brain-gaze’ needs be opened up to a perspective on a more ‘socio-ecological’ research paradigm. This will enhance our knowledge on dialogical, embodied, inter-actional and socially supported healing, recovery and empowerment processes, plus how these can be supported by ‘healthy lifestyle’ activities. The usefulness of these approaches for drug withdrawal, with only minimal use of neuroleptic drugs in the beginning of truly severe organismic, affective and mental ‘terror-disturbance’, is part of my thinking. I hope it becomes clear to the reader why I chose to offer broader questions and perspectives and not respond in a more targeted way.

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    • Much appreciated Ute for broadening the debate here. I am all for reciprocal learning and a holistic approach to emotional distress. I would say I come from a person-centred perspective where we need to consider all aspects of an individual’s life and their experiences from the psychological, social, emotional, physical and spiritual etc. In a way resorting to drugs does not address anything for the helper or the one going through a process of healing. And it is often a misconception that the ‘professional’ knows best. In a way individuals are ‘experts by experience’ and I think this is where the strength of peer support can be very effective. If an individual has gone through trauma, emotional/distressing experiences then this can help open up dialogue between people going through similar experiences. I would say peer support initiatives are now only starting to be recognised, especially in the UK but as you say to date – not much research has been established yet in to how effective these ‘encounters’ will prove to be. I would say though, that in all therapeutic encounters it has been shown just how important the relationship itself is. Forget the theory; forget the goals or aims etc, if the relationship itself is flawed then little beneficial progress will be made. I suspect this would also apply to peer support groups too? We are relational/social beings so it would make sense that the relationship above all else would prove a crucial factor in all aspects of support and ‘recovery’.

      In terms of the ‘brain imbalance’ you are right, it isn’t as straight forward as saying just ‘yes’ or ‘no’ there is chemical deficiency here. And yes, it is true that our external environments can have an effect on our physiological makeup. But I would say until ongoing research is conducted to show just where there is a ‘chemical imbalance’ in the brain and by how much of a deficiency exists; then psychiatrists and big pharma should hold off making such claims of an internal cause. Plus stating they have specific drugs to target such internal chemical abnormalities is not only irresponsible, but unhelpful and can be lethal too. In the meantime we have individuals taking drugs not to correct an ‘imbalance’ but rather to numb them from themselves and their life! Oh, and probably keeps them quiet so others can move on and live their life too (the scapegoat effect). As you state, the individual is left open to possible neuroleptic over-dosing of the whole living organ-cns-brain leading to extreme physiological, emotional and psychological harm. You only need to look at cognitive impairments, emotional blunting and physical tremors to see the damage long term use of psych drugs can instigate.
      Again I am with you on the alternatives to drug use and the move away from the detached, reductionist paradigm. We need to focus more on community and social support/interactions, creativity, the arts, complimentary therapies, physical activity, empathic healing, healthy living etc. At the end of the day we are all embodied, emotional and interactional beings and as you say, these areas in terms of healing have been badly neglected to date. Thanks for you comments.

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    • I agree. Thinking of mental/emotional distress as homeostatic imbalance (rather than dysfunction) that likely involves every system of the human brain/mind/culture would embrace the complexity of our lives, minds, and problems.

      For nicotine addicts, for instance, the relapses that occur up to a year after quitting are often interpreted as psychological problems or a failure of will, but are really a sort of wig-out, a temporary physiological state in which the pleasure/pain center of the brain appears to be going haywire in an effort to reach balance. It’s a necessary step that is uncomfortable to tortuous— it can feel like mania or depression; but is really just a wild swing of the pendulum in its effort to reach homeostatic balance. It will pass, and efforts to analyze oneself psychologically during these times are a waste.

      It takes a full year for a brain to return to normal functioning after quitting smoking. This is true for a whole lot of drugs that pass the blood/brain barrier and alter the chemical functioning of the brain. Could mental habits or responses such as those that result in learned helplessness also affect the chemical functioning of the brain in the same way some drugs do? How could they not? The thoughts are inseparable from the chemical phenomena. Could changing habits do as much to contribute to homeostatic balance in the brain as well as other interventions?

      The mind/brain is inseparable and the individual/social being is inseparable. We are social animals with a highly developed and very sensitive brain living in a highly-developed world that demands a lot from us. Many of those making the demands are nameless and faceless and appear to have no obligations to us. Our culture expects a lot from us, expects us to feel individually responsible for fulfilling it’s expectations, and discourages us from thinking of ourselves as the communal animals that we are.

      Divide and conquer is a tried and true method of social control. Othering people who suffer from the effects of pathological social behavior as if they were the pathology itself is a mean tactic and more effective and powerful when denied than it would be if it were seen for what it is.

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      • “Divide and conquer is a tried and true method of social control. Othering people who suffer from the effects of pathological social behavior as if they were the pathology itself is a mean tactic and more powerful when denied than if it were seen for what it is.” This is how I’ve been told the religions have been covering up child abuse for decades, if not longer. And it’s what my family dealt with, I agree it’s pure evil.

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      • “For nicotine addicts, for instance, the relapses that occur up to a year after quitting are often interpreted as psychological problems or a failure of will, but are really a sort of wig-out, a temporary physiological state in which the pleasure/pain center of the brain appears to be going haywire in an effort to reach balance. It’s a necessary step that is uncomfortable to tortuous— it can feel like mania or depression; but is really just a wild swing of the pendulum in its effort to reach homeostatic balance. It will pass, and efforts to analyze oneself psychologically during these times are a waste.”
        This is more or less what happens when someone goes on or comes off psychiatric drugs Wileywitch. Hyman in my reference above states this very process by which the brain needs to re-adjust to the chemical onslaught it has just been subjected too. The neurotransmitters can either go in to over-drive or decrease the levels of chemical in the synapses while trying to return to its natural homeostatic order. Such re-adjustments (or the ‘haywire effect’) as a result can be interpreted as the ‘distress’ or ‘illness’ returning, when in actual fact the brain is just trying to restore its natural balance. Of course the answer to this ‘haywire effect’ is to quickly place the individual back on the drug, often at a stronger dose or even worse a stronger drug altogether. Withdrawal was assumed to be a wrong move. But as you stated above, this compensatory adjustment is a necessary step that the individual’s brain has to go through. Sadly many individuals never get past the withdrawal stage due to the above reasons and so, get trapped on drugs for life.
        I think no one would dispute that we are individuals with a highly sensitive brain and will react to our environment at a physiological level. We only need to look at the ‘fight or flight’ response and our adrenalin kicking in ready to defend our self at a moments notice. I am also a great believer that children who have been subjected to long term family abuse will in fact become highly sensitised to their environments in order to be ‘one step ahead’ and ready for attack. No one can deny this wouldn’t have an effect on the physiology of the body, not to mention the emotional or mental effects. But I think it is how we address such issues. It seems wrong to suggest that such a person ‘is the pathology’ and so would need to be placed on drugs, or even diagnosed with a psychiatric disorder (not based on scientific fact). To do this is to say the problem lies with them. It is their internal biology that is at fault, it is their mind that is disordered. We need to start looking outwards and deal with the external problems, not detract from them by saying someone is ‘ill’ or ‘disordered’ and then rely on drugs as the solution. Perhaps as the external antecedents get sorted (if possible) who knows, the individual’s physiology may also become restored towards a healing balance. If you take the external stressors away then common sense would suggest both internal stress and anxiety may subside too. If you place a person on drugs, then we need to ask just what has really been sorted or restored?
        Yes, a clever tactic by the psychiatrists and big pharma to pathologise people and as a result can even divide families. Thanks for your comments!

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  7. How many of these professionals, doctors, psychiatrists have actually suffered from depression themselves. Unless you have been through it personally you have no idea what it is like. Only the person who is suffering actually knows how they feel inside, the rest is speculation. Also, has it ever occurred to you that perhaps some people prefer to think that it is a chemical imbalance in their brain which makes them feel the way they do as opposed to thinking this is a normal part of life when very clearly it is not a normal part of life as those who have truly suffered would not wish the way you feel when suffering from depression on their worst enemies. I can’t stand these pompous academics who have nothing better to do in their lives but to speculate, comment and earn money from an illness they truly have no understanding of.

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    • upanddown – I totally hear you and I think, have a good understanding of what you are expressing. Having experienced a full range of what psychiatry said was a “disease” what I have discovered personally is that 1. their problem focus and blaming my biology and genetics served only to keep me hopeless and helpless to change any of it. And 2. that there ARE solutions to the issues said to be a “disease” that must be managed with toxic chemicals “for the rest of my life”.

      At first – I appreciated the diagnosis. It gave me hope that if they could “find what was wrong” with me that they could offer me a solution. Yet after 15 years of this I was in worse shape than when I first asked for their help. And – I totally believed that this was my “illness”.

      I reached a point where I decided that if I could not find a way to “get better” that I no longer wanted to live that life that I called “the life of the living dead”. Yet – what I also discovered, quite accidentally, after an uninformed psychiatrist experimented on me by forcing me into a complete cold turkey withdrawal from multiple (polypharmacy) drugs including benzodiazapenes, mood stabilizers and anti depressants in 2007 – is that as I started going through the forced wd process is that it was the DRUGS that were making me sick. (I am NOT endorsing just “going off” psych drugs to ANYONE. For info on safe wd please visit http://www.beyondmeds.com). I slowly started to reclaim my brain, my health and my life.

      Even after going off the drugs though I realized there was more I could do to improve my “mental status”. The thing was – it was no “quick fix”. This process of healing the physical issues that influence my emotional well being and energy levels has taken quite some time and a lot of effort but – today I live drug free, I feel happy, have consistent good energy and I know that when I am not feeling well that by listening to my body and inner wisdom that I can right myself without chemical intervention. I also understand that life will have ups and downs, light and dark and have I learned how to “ride it out” vs thinking it would be “forever”.

      I am so sorry to hear that you still suffer and most compassionately hope that you find your way to what might set things right for you.

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    • Hello upanddown. I am sorry you feel as you do.
      Can I just say that because there are those (e.g. academics, psychiatrists, psychiatric survivors, psychologists carers etc) who question the ‘chemical imbalance theory’; this is NOT meant to detract from an individual’s pain any less. What we are doing is questioning the lack of scientific evidence to support this, we are not saying the pain does not exist. And certainly I am not suggesting that because a ‘chemical imbalance’ may not exist that this means the pain is a normal way of living that you just have to accept. Quite the contrary! Depression is a very dibiltating condition but to just mask this off with drugs will not get to the root of a person’s pain or help them in the long term. I would prefer to ask, why is the depression there? What has instigated this? Why now? Was it physical, emotional, trauma, social issues etc? What can be done to ease the person’s pain and how can I help and support this person to help themselves? Granted there are those who would choose to take drugs and that is that person’s choice but in the long term, I would feel there are more effective ways to help an individual rather than give them a bottle of pills and send them on their way. I would want to support and help this person until they are in a position to independently help themselves – by whatever means they choose. If the option is drugs then that is their choice. I think though that if we can move away from the myth of the chemical imbalance, then that allows an individual to focus more on their situation and how this can be recified. In a way we are recognising and validating the pain and depression more by taking the ‘chemical imbalance’ out of the equation. So I am not stating we ignore the depression a person is going through, in actual fact I am focusing moreso on the soul damaging feelings. However, again some people may choose not to go there. Again that has to be respected.
      Can I just also say many academics, psychiatrists, psychologists are not immune to emotional distress and life’s traumas – it is because they have experienced such debilitating pain themselves that they chose to speak out and hopefully help others. ‘Experts by experience’. Take care.

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      • Hi Julie
        You explain it so well, I agree with nearly everything. The chemical imbalance idea, which is still being promoted at one level or another is madness.
        Most people (usually young people to start with) have got have got real situations that can be helped, and the symptoms are not the main thing.
        Irish Psychiatrist Ivor Browne describes it in terms of people needing help to develop better methods (than they are using) in dealing with a life which isn’t easy for anyone.

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        • Thanks for this Fiachra. If the message can get through in a small way then I would be happy.
          So called ‘symptoms’ seen as a sign of ‘mental illness’, can often mask the external issues. That is the danger.
          Ivor Browne is great and very insightful. I would hope he would help individuals find the strength to move away from their ‘crazy making environments’.

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    • In about a weeks time we will be writing another letter to the TV programme. They have not responded yet. We will also direct them to this MIA site to show them there are in actual fact important issues to debate here. How they respond is their choice. They already ignored one letter last year and now this. We shall see.

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  8. Julie, thank you for writing this open letter, it is very thorough. The only thing I would personally add is mentioning that in addition to antidepressants increasing the risk of suicide and violence. They also can cause mania, which is frequently misdiagnosed as bipolar.

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    • Good point Someone Else. I have heard this many times before that a person going on AD’s has caused more mood disturbances that could be interpreted as ‘biploar’. Over time the boundary between the presenting distress and main effects of the drugs can become blurred. Also when withdrawing, withdrawal effects can be interpreted as a sign that the distress is returning, so the person is put back on the drug or even a stronger version. And so the vicious circle of a life time on drugs can continue.

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  9. Julie,
    ‘Chapeau’, thanks and applause for you responding to every single post. I have just up-dated my reading of today’s posts andyour answers. I find it enormously validating how you reflect all the main issues and arguments posted, share your thoughts and compassion about each. Awesome and very constructive. Is their a blog ‘author’ and ‘facilitator’ award somewhere out here for us to dedicate to you? So well merited!

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    • Well thank you Ute! I do feel if people have taken the time to read and comment, then they deserve a reply back. As with much of the system of psychiatry though these issues need to be highlghted and discussed. We need debate, we can’t ignore such matters. Thankfully MIA allows all out voices to be heard, which I am grateful for. I shall endeavour to get around to everyone in time! Namaste.

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  10. An intriguing question: if you were approached by someone who appeared to possess considerable power and given these choices which would you take?

    Alternative One: you are depressed and miserable because you are a sinner and unreformed. God is now punishing you in hopes that you will see the light. Give up your errant ways and do His will. Etc. You are not alone: there is God, his angel and the demons.

    Alternative Two: you are acutely depressed because you have a chemical imbalance. It may be genetic. We do not know. After all we are organic machines with lots of parts and perhaps some of yours are broken or badly formed. This drug may help. No guarantees of course, but we do have other drugs. And science is working away day and night to find others. Aside: yes, you are alone in the vastness of inner space.

    Alternative Three: There is some connection between the way you feel now and your past. It is not likely that you were born feeling miserable and depressed. It is not the natural condition of a human being. If you do a few healthful things though you might wonder why and find a good mentor to tell your stories to, you will recover and find some contentment and happiness. In the meantime you might find it useful to think of yourself as a traveler on a journey. Try to enjoy the journey. You can imagine yourself years from now feeling happy enough and looking back on now and wondering why you did not enjoy the scenes out the window . . . you might as well. It is a real part of being human to feel down in the dumps. It does not make you a freak. Great men and women have gone through lots of despair at times. Perhaps it is your greatness as a human being that is trying to get born; and birth can be painful. Don’t be misled. Have some faith in a flower or a tree; walk in a park and breath deeply. You are fine.

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    • No competition at all for me AgniYoga. I would choose option 3 all the time. We are all travellers on our own personal journey and we meet and interact with fellow travellers on their journey too. We affect each others journeys along the way. We have good times and bad times and it is how we accept and deal with these milestones that will hopefully guide us through safely. I believe life is a process and we have to learn from whatever happens to us. We can then impart that knowledge to others who may be struggling with their own journey. Above all else we can never lose sight of hope. My own personal opinion is that drug intervention can often take that long term hope away. The drug becomes the hope, which I think isn’t the best way to view how your
      life should be.

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  11. Thank you so much for this open letter. It breaks my heart that these false narratives are still being propagated through our culture. Of course, I am angry at the professional institutions that perpetuate false information. But I am equally angered by the state of our media, which regularly colludes with big, powerful institutions rather than maintaining the skepticism and spirit if critical inquire essential to an informed public.

    In simpler language, its bad enough that doctors and psychiatrists regularly lie or regurgitate ignorance misinformation. It’s worse that our entire info-tainment culture consistently lets them get away with it. Thank you for calling that out.

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    • Couldn’t agree more Andrew. Misinformation via TV, movies, news reporting etc. It breaks my heart too but more so I am like a red rag to a bull when I hear this kind of information being spresd.
      I also think that mental health anti-stigma campaigns funded by governments, and with a vested interest from big pharma etc, generate far more harm that good. They help propagate the myths. We need anti-anti-stigma campaigns!

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  12. Excellent letter, thank you to all involved for composing it. I gave a lecture to some University academics the other day (from arts and humanities faculty), and they were shocked to hear that the chemical imbalance theory of depression has no scientific grounding. I just mention this just to illustrate how successful the marketing of the chemical imbalance has been. The general public just have no access to information debunking it, and as you point out, the media continue to propagate it. Leading psychiatrists know that the chemical imbalance theory of depression and justification for antidepressant use is unproven and ‘metaphorical.’ They do not want to challenge it publicly though because it helps to support disease-based theories of depression, which psychiatry is so fearful of losing.

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    • I agree the pharma industry’s marketing models of ‘chemical imbalance’ are as vague and unspecific as the drug compounds’ effects on the scandalously broad target areas in the brain (and wider neuro-hormonal system).
      With regards to the implication of ‘chemical’ changes in the functional pathways in striatal-meso-limbic and inter-connectivity of ‘higher neo-cortical areas’ – preshaped in evolutionary circuits and adapted through behavioral plasticity – I would be interested in two main questions
      – specification of the useless and dangerous ‘chemical imbalance’ propaganda by context-behavior-related research into functional organic and neural pathways, using dynamic continuum models, and taking into account regulatory mechanisms of mind-body-context inter-connectedness
      – thereby exposing the falseness of an artificial disease model of un-located, non-pathway specific neuro-transmittor deficits or increases like in ‘chemical imbalance in the brain’
      However, my view only, I find it dangerous to promote an idea of there being no chemical imbalances in the brain as this is how it works, through regulated functional changes in transmittors and other compounds. My opinion is that a generalistic stance like ‘done with chemical imbalance theory’ – central and peripheral nervous system interregulation and enablement of organic, affective and mental states, through ‘functional chemical imbalances’ have no crucial role in major distress or fear/victimization/mental responses – can easily discredit the ‘naturalistic opinions’ (anti-medication, anti-chemical imbalance-based disease theory’ especially in the survivor/user/consumer movement. Most often, the critical and conventional psychiatric professionals and especially reseachers are at a much lesser risk to be ridiculed ‘ignorant’, exactly due to their knowledge of neurophysiology and interrelations between neurofunctional pathways and organisms ‘meaningful’ states (alert, attention, fight, freeze, flight etc) and their impact on behavior. In my view many in the survivor/user/consumer movement are vulnarable to ‘naturalistic anti-chemical-imbalance ideologies for two reasons – having suffered real harms by the overmedication with neuroleptic drugs and poly-pharmacy – lack of physiology and neurophysiology education related to organism’ enabled and cns interregulated experiences and behaviors.
      I just wish it is not the survivors/users/consumers who will be blamed of irrationality and extremism again for simplistic opposition to and rejection of the fraudulant abuse of chemical imbalance paradigm for sales of ‘overall’ brain-disease-related neuroleptic pharmaceuticals.
      PS My interest lies rather in the implication of neuronal pathways in central evolutionary circuits as possibly engaged – via organism in context – in fear/agitation/perception/mentalization in ‘delusions, paranoia, mania’. I am interested in possible relaxing and calming processes through embodied and contextualised, be it individual, be it social network, ‘interventions’ with as little use of carefully explained and agreeable neuroleptic medication as possible.

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      • Sounds like good research Ute in order to expose the  ‘chemical imbalance’ myth by taking in to account context/behaviour related research and focusing specifically on mind/body inter connectedness. I would hope this would expose the falseness of the artificial disease model and also discredit the areas within which these abnormality are claimed to exist. Of course chemical imbalances exist but I think we need to exercise great caution  when we hear researchers say this is the cause of mental distress. Correlation does not equal cause. Most psychiatrists fail to take in to account context/behavour relatedness, or if they do, the external factors are viewed as instigators for an already existing mental disorder, which lay dormant until  these precipitating external factors occurred.  I do not believe either that ‘chemical imbalances’ should be seen as playing a major role in trauma, fear or distress etc. Researchers are naively looking in the wrong direction here.

        Ok, the scientists may have  ‘expert” knowledge within their own field but the survivor movement includes ‘experts by experience’, which is a crucial factor to pay heed to. Consequently,  traumatised/distressed survivors should  not be ridiculed or considered ignorant because they may be viewed as deficient in scientific knowledge to discredit the ‘chemical imbalance’ notion. More so such researchers could be considered ignorant as they fail to address the external, contextual antecedents of distress as they may never have experienced such traumas.  Maybe if they had then they wouldn’t be looking down a microscope for the answers or viewing pretty coloured images of specific brain areas on a screen. Like I have always said – they need to broaden their horizons outwards, not inwards. This looking for unicorns has to stop.

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        • Thanks for your critical comments, Julie.
          I regard the internal-external devide as false. The conplexe functioning of the central and peripheral nervous system in living and moving organisms has developed evolutionaly and in the individuals as interacting with environments. Instead of causal models we need better understanding of the organismically and neuro-pathways/circuitries as enabling ‘functional’ behaviour and conscience as well as the patterns and structures of the environment. What I regret is rather the lack in concepts of beavior which takes into account the evolutionary pre-shaped and individually differenciated neuronal pathways for behavior and organismic ‘states’ (arousal, affects, etc.) in the implicit and conscious interaction with ‘self’ and ‘environment’. I understand that due to the false and fraudulant misuse of nonsensical claims about ‘chemical imbalances’ rejection of the relevancy of neural pathway circuitries enabling of behavior can liberate from harmful generalized overprecription of neuroleptics and other psychotropic drugs. My interest is different cause I question the role of neurodevelopmental and organismic distress: how do chronic and acute fear and alert as enabled by neurofunctional-pathway circuitries play a role in emotional and mental extreme experiences. What I find important is – I realized this in my strong malaise about the ’empty noise of chemical imbalance talk’ – it’s about organismic and neuro-structured enabling of functional behavior. Such the magic-noise of generalized transmittor imbalances gets contradicted by the structured and regulated complex functioning of the nervous system of the interacting organism. The contrary is the prove by psychotropic overdose/or maintained neuroleptic drugging: severely disturbing the complex neurological circuitries’ enabling of functions is the result of bombarding multitude of receptors with drug compounds. Therefore I come to agree that any talk, and even my above writing, about ‘chemical imbalances’ is nothing but false. And terribly harmful in the abuse of psychiatry-presciribed, generalized neuroleptic and psychotropic drug consumption.

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  13. Thank you for responding to this letter Joanna and for your support. I think the majority of the public still believe in the notion of the ‘chemical imbalance’ theory, so it does not surprise me at all by the reaction you got from these university academics. I not so long ago heard a psychologist spout this ‘chemical imbalance’ myth to me (wrong person) and I responded by saying there was no evidence to show this. To which he tried to quickly redeem himself by saying, “Oh, I meant the organic diseases such as epilepsy and alzheimers.” (!) And, if I hear the words ‘similar to diabetes’ one more time I shall scream!

    The marketing of the ‘chemical imbalance’ is something that is deeply ingrained within society and probably one of the most successful brainwashing campaigns ever! The fact that people are advised to take drugs only reinforces this belief that there is an internal biological abnormality at work here. Plus these so called ‘do good’ mental health campaigns such as the Mental Health Foundation and Rethink do more harm that good in propogating such myths of mental ‘illness’ etc. As you state, the majority of people who have no access to literature to dispel these myths are the ones who are most susceptible to believe this information. It also makes our job harder when many mental health professionals hold on to their belief of the ‘chemical imbalance’ theory. Let’s face it, if psychiatry doesn’t have this to grasp on to then where will that leave it as a ‘profession’? In a void with no direction to go and no backing from its greatest bed partner – the pharmaceutical companies.
    And when we have ignorant (or misinformed) TV producers who refuse to act on the broadcasting of these harmful messages, the general public hardly stands a chance!
    We can only but try. Thanks for your comments.

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