Psychiatry’s Manufactured Consent: Chemical Imbalance Theory and the Antidepressant Explosion


The title of Edward Herman and Noam Chomsky’s book Manufacturing Consent derives from presidential advisor and journalist Walter Lippmann’s phrase “the manufacture of consent” — a necessity for Lippmann, who believed that the general public is incompetent in discerning what’s truly best for them, and so their opinion must be molded by a benevolent elite who do know what’s best for them.

Starting in the 1990s — despite research findings that levels of the neurotransmitter serotonin were unrelated to depression — Americans began to be exposed to highly effective television commercials for antidepressants that portrayed depression as being caused by a “chemical imbalance” of low levels of serotonin, and which could be treated with “chemically balancing” antidepressants such as Prozac, Zoloft, Paxil, and other selective serotonin reuptake inhibitors (SSRIs).

Why has the American public not heard psychiatrists in positions of influence on the mass media debunk the chemical imbalance theory? Big Pharma’s corruption of psychiatry is only part of the explanation. Many psychiatrists, acting in the manner of a benevolent elite, did not alert the general public because they believed that the chemical imbalance theory was a useful fiction to get patients to accept their mental illness and take their medication. In other words, the chemical imbalance theory was an excellent way to manufacture consent.

In January 2012, National Public Radio correspondent Alix Spiegel began her piece with the following personal story about being prescribed Prozac when she was a teenager:

When I was 17 years old, I got so depressed that what felt like an enormous black hole appeared in my chest. Everywhere I went, the black hole went too. So to address the black-hole issue, my parents took me to a psychiatrist at Johns Hopkins Hospital. She did an evaluation and then told me this story: “The problem with you, she explained, “is that you have a chemical imbalance. It’s biological, just like diabetes, but it’s in your brain. This chemical in your brain called serotonin is too, too low. There’s not enough of it, and that’s what’s causing the chemical imbalance. We need to give you medication to correct that.” Then she handed my mother a prescription for Prozac.

This chemical imbalance story, countlessly repeated on antidepressant commercials and by psychiatrists from prestigious institutions, has been so effective that it comes as a surprise to many Americans — including Alix Spiegel — to discover that the psychiatric establishment now claims that it has always known that this theory was not true – an “urban legend” – the term used by Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times. As Pies stated in 2011, “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend — never a theory seriously propounded by well-informed psychiatrists.”

Truly well-informed psychiatrists have long known that research showed that low serotonin (or other neurotransmitter) levels were not the cause of depression. The American Medical Association Essential Guide to Depression stated in 1998: “The link between low levels of serotonin and depressive illness is unclear, as some depressed people have too much serotonin.” But the vast majority of Americans—who didn’t read this textbook—never heard this.

In the 1990s, Pedro Delgado (the current chair of the psychiatry department at University of Texas) published research that showed that if nondepressed people are depleted of serotonin, they will not become depressed. Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, in Blaming the Brain (1998), detailed research that showed it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.” But how many Americans heard about this?

Editor-in-Chief Emeritus of the Psychiatric Times Ronald Pies, a staunch defender of psychiatry and the American Psychiatric Association, believes that the APA fulfilled its obligation to inform the general public of the truth with a 2005 statement for the general public about depression that begins: “The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers.” But how many Americans read APA statements? And even if they had read that statement, they would not necessarily have come to the conclusion that the chemical imbalance theory was fiction and that drug commercials were deceptive. Even Pies admitted on April 15, 2014, “But still, shouldn’t psychiatrists in positions of influence have made greater efforts to knock down the chemical imbalance hypothesis, and to present a more sophisticated understanding of mental illness to the general public? Probably so.”

Thomas Insel, director of the National Institute of Mental Health (NIMH), in recent years has been increasingly critical of some of psychiatry’s theories and practices. In a February 25, 2007 interview with Newsweek, Insel did more explicitly tell the American people the truth that depression is not caused by low levels of the neurotransmitters serotonin or norepinephrine. However, he did not proclaim that drug commercials’ depiction of the cause of depression was patently false.

Given the drug commercial propaganda onslaught, for the American people to become aware of the truth, psychiatrists in positions of influence would have had to zealously publicize that the research had rejected the chemical imbalance theory, and they would have had to use the mass media to proclaim that the drug commercials are false. That never occurred. Why? NPR correspondent Alix Spiegel, as part of her January 2012 story, also interviewed several well-informed psychiatrists in positions of influence, and we get a clue as to the reason.

Alan Frazer, professor of pharmacology and psychiatry and chairman of the pharmacology department at the University of Texas Health Sciences Center, told NPR that by framing depression as a deficiency — something that needed to be returned to normal — patients felt more comfortable taking antidepressants. Frazer told NPR, “If there was this biological reason for them being depressed, some deficiency that the drug was correcting, then taking a drug was OK.” For Frazer, the story that depressed people have a chemical imbalance and that the antidepressant is correcting that imbalance is a story that has enabled many people to come out of the closet about being depressed.

And even Pedro Delgado, whose research helped debunk the serotonin deficiency theory of depression, agreed with Frazer that the fiction of the chemical imbalance theory has benefits. Delgado pointed to research showing that uncertainty itself can be harmful to people; and so simple and clear explanations, regardless of how inaccurate, can for Delgado be more helpful than complex truthful explanations.

Prior to the chemical imbalance campaign, many Americans were reluctant to take antidepressants — or to give them to their children. But the idea that depression is caused by a chemical imbalance which can be corrected with SSRI antidepressants sounded like taking insulin for diabetes. Correcting a chemical imbalance seemed like a reasonable thing to do, and so the use of SSRI antidepressants skyrocketed.

The U.S. Centers for Disease Control and Prevention (CDC) reported in 2011 that antidepressant use in the United States increased nearly 400 percent between 1988 and 2008, making antidepressants the most frequently used class of medications by Americans ages 18-44. By 2008, among Americans 12 years and older, 11 percent were taking antidepressants, and 23 percent of women ages 40–59 were taking them.

SSRIs skyrocketed despite research which showed that SSRIs such as Prozac, Paxil, and Zolfot were not any more effective in reducing depression than the older tricyclic antidepressants such as Elavil. While for some antidepressant users, SSRIs had fewer adverse effects than the tricyclics, for many others, the adverse effects were just different and sometimes even worse (for example, the Food and Drug Administration forced SSRI manufactures to label SSRIs with “black box warnings” stating that SSRIs were shown to cause increased suicidality in patients under the age of 25). While SSRIs are neither more effective nor safer than the older tricylics, what is different is that tricyclics had never been marketed as correcting a chemical brain imbalance.

The chemical imbalance theory of mental illness has made Big Pharma billions of dollars by making it easier to sell SSRIs and other psychiatric drugs, and Big Pharma spread some of that money around to their favorite psychiatrists. And some well-informed psychiatrists in positions of influence, while not on Big Pharma’s payroll, have maintained the biochemical imbalance theory of mental illness to manufacture consent, because these psychiatrists have believed that it was in their patients’ best interest — making it easier for them to accept their depression and take their medication. 

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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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  1. Our economic system allows money to corrupt our democracy, our medical and behavioral health services and the very systems that are there to protect the public interests. We need to focus on getting private money out of our government in my opinion if we hope to get truth in psychiatry. Overturning Citizen’s United is an essential step #1 to begin the process.

    Thanks for your enlightening, well written article!

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  2. Thanks for this, Bruce. I’ve been on my own personal campaign to get the word out about this bogus theory but encountering a huge amount of resistance. It’s strange to me how many of my acquaintances resist this information. Adamantly resist, get pissed off at me for even linking to pharma profits. Curious and scary.

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    • Hmm. Sounds familiar.

      You believe in woo? You have no scientific understanding? ‘Oh, it’s the evil drug companies’ (just another conspiracy crank, right)? You want people to suffer with mental illness when there’s a solution because you’re so backward and judgmental? You don’t want to decrease the stigma against mental illness? Maybe you’re mentally ill and SHOULD be on drugs? You don’t want to decrease the stigma of mental illness by making sure people diagnosed with mental illnesses are drugged so that they won’t do any of that crazy mentally ill violent stuff? Anyone who does crazy violent stuff is mentally ill, don’t you get that? You don’t want them all identified and rounded up and treated so that they can’t be a bother to people who are most concerned that the mentally ill be helped for their own good?

      All this from people who are adamant about citing sources but dismiss what you have to say out of hand, because psychiatry is ‘science’. Is so. Is so. Is so. You’re just anti-science and don’t want to admit you are. They don’t need to look at your links to articles and papers by psychiatrists and the NIMH, or any other source that contradicts the reigning paradigm. They don’t think they’re victims of advertising. How can they be, they’re just so rational that they indiscriminately adhere to the status quo and insist that others do as well, because science and numbers and studies and double-blind randomized control and stuff? Such is their scientificity.


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      • I usually throw a few publications at them to shut them up. I don’t know if that really changes their mind though because I doubt they actually go int the trouble of reading them.
        It’s most annoying from the people who acknowledge that what was done to me was wrong and stupid but they somehow don’t see that it’s not just an isolated problem and when you’re trying to convince them it’s like “well, but there are people whom it helps”. Always these magical people nobody has ever met or if they were met they were drugged up and unable to voice their opinion. Like the NAMI mammy – “my kid is so much better on this drugs but he can’t tell you about it because I have to keep her locked up in her room”. Yeah…

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  3. As the last/latest scam of the biopsychiatry/Big Pharma cartel like the bogus SSRI’s for depression “just like insulin for diabetes” LIE has been more and more widely admitted and exposed, one should not make the huge mistake of believing these human predators have any conscience, regret or honesty about this fraud perpetrated against humanity with huge consequences like creating mania with these toxic drugs to push lethal neuroleptics with the latest fad fraud bipolar stigma even more life destroying and deadly than the bogus depression stigma.

    Here, the very witty, intelligent blog of The Last Psychiatrist exposes the truth behind those like Nassir Ghaemi pushing to create such expanded, bogus bipolar guidelines that just about everyone on the planet will qualify for the absurd bipolar “spectrum” that can now exclude mania and hypomania and include just about every commonly used DSM stigma including depression, anxiety, PTSD, borderline, compulsive eating and any behavior that is not typical of or for the psychopaths in power preying on the rest of humanity to inflict mass suffering at the greatest profit:

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  4. Psychiatrists are not the only ones to blame. The depressed people are as much to blame themselves. They want to believe in the chemical imbalance theory and they want a magic pill to cure their problems. My very own husband is one of those. He keeps pestering our GP for some antidepressants. To be fair to our GP she has been resisting him valiantly and advising him to change his way of life instead.

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    • The fastest way to get a guy turned against anti depressants is to warn him that long term use may lead to some permanent sexual dysfunction . SSRI negatively affect all aspects of the human sexual response cycle, including altering neurotransmitter functions, such as nitric oxide, serotonin, acetylcholine, dopamine, norepinephrine and prolactin.

      Anti-depressants reduce the production of nitric oxide, which reduces blood flow that leads to a flaccid penis. By increasing the inhibition of serotonin recycle, excessive amounts of serotonin interact with other dopaminergic and cholinergic receptors that have negative influences on sex-related functions. For example, SSRI drugs elevate prolactin production, leading to a pituitary functional disorder called HyperProlactimia. High levels of prolactin in your bloodstream or any blockage of parasympathetic and sympathetic nerves will prevent an erection.

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    • I’m very impressed with your GP because her sensible approach is unusual. Personally, I don’t think depressed people should carry as much blame as psychiatrists. It’s not unreasonable to start from the premise that medical professionals are well-informed and conscientious. Unfortunately, as we all know, neither of these adjectives apply to the average psychiatrist. It’s not just psychiatrists, though. I’ve been given bad advice by doctors in other specialties too.

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    • Depressed people are depressed. You can’t blame them for wanting something magical to just get them out of the dark place and kudos to your GP for acting like the actual doctor should. Some people when they’re down get illegal drugs or drink till they pass out, it doesn’t mean that your doctor should be giving you a prescription for whiskey and LSD. Personally I even think these drugs should be legal but depressed, desperate people are the ones who are most likely to end up abusing them and addicted. I’ve seen it happen with a friend of mine – he took drugs his whole life without a problem until he broke up with his gf and it got out of control. When he fixed his personal life he was back to being fine.
      Depression or any other state like that is when people are vulnerable to mind-altering substances because presumably anything is better than this. They should be shielded and protected from falling into this trap and not pushed over the cliff by the so-called “doctors”.

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  5. This was good, I remember feeling almost stunned the first time I read about the lies of biological psychiatry. Wait what , depression was never proven to be caused by low serotonin levels somewhere between my brain cells ? On top of that they had me believing it was to sell me these dangerous pills !

    To this day the dishonesty of all this just blows me away. How long can this lie live on ? CNN the pharma ad channel won’t be telling the masses anytime soon , I just don’t know.

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      • True. For a long time I was convinced that there is some objective diagnosis for schizophrenia and autism. I’ve never really believed too much in all these depressions and anxieties and personality disorders but sure if someone hears voices that has to be a well-identifiable disease, right?
        It’s amazing how unscientific and pathetic the whole field is.

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  6. Since the Pharma Cartel has caused so many deaths and uncountable suffering wouldn’t we be justified in petitioning President Obama to assign all the seal teams to the hi-priority mission of capturing the heads of this criminal cartel and other main profiteers which is far more deadly than Bin Laden ever was and besides is an internal security threat to the American people and other peoples of the world ?

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  7. The notion of “manufactured consent” is reminiscent of Sally Satel’s phrase “benign paternalism,” how she refers to forced psychiatric drugging of those too inept to realize it’s for their own good. This kind of attitude is one of my rage triggers and I try not to think about it too much.

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  8. Truth is – these are all psychotropic drugs which alter you state of mind. How they alter it largely depends on the person. Claims that these drugs are anti-something (depression, psychosis…) is also a propaganda lie.
    I remember asking the psychiatrist why the hell was he putting me on the anti-psychotic when I wasn’t psychotic. He had no good answer for that. He also had no good answer to what these drugs were exactly supposed to do. He was just handing them out hoping that they will somehow solve the problem. Guess what, they didn’t.

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  9. Dr. Levine thank you so very much for this well written and much needed article. Alan Frazer hit it out of the park when he said in your article, “by framing depression as a deficiency — something that needed to be returned to normal — patients felt more comfortable taking antidepressants.” RIGHT ON!!! Whomever creates & controls the frame exercises the greatest influence. Big Pharma, the insurance industry & the medical model has created an overarching pathological view of human beings & their human struggles. Anyway, Dr. Levine I hope you continue carrying the torch of truth. I am joining you in this battle for truth.
    Anthony Verderame, MA

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