The Spurious Chemical Imbalance Theory is Still Alive and Well

Philip Hickey, PhD
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On April 5, 2015, Scott Alexander, MD, a trainee psychiatrist, posted an article titled Chemical Imbalance on his website Slate Star Codex.  (The writer tells us that Scott Alexander is a blog handle and not his real name, but for convenience, I will refer to him as Dr. Alexander.)

Dr. Alexander begins by noting that there have been a number of articles recently that have criticized psychiatry for “botching the ‘chemical imbalance’ theory.”

“According to all these sources psychiatry sold the public on antidepressants by claiming depression was just a chemical imbalance (usually fleshed out as ‘a simple deficiency of serotonin’) and so it was perfectly natural to take extra chemicals to correct it.”

“This narrative is getting pushed especially hard by the antipsychiatry movement, who frame it as ‘proof’ that psychiatrists are drug company shills who were deceiving the public.”

[Actually, it’s proof that psychiatrists are either very misinformed or very deceptive.  Proving that many of them are drug company shills is a separate matter.]

. . . . .

As an example of this trend, he cites an article of mine that was published on Mad in America on June 6, 2014.  The article was titled Psychiatry DID Promote the Chemical Imbalance Theory, and was written specifically as a response to three statements made by the eminent psychiatrist Ronald Pies, MD.  Here are the three statements:

“…the ‘chemical imbalance theory’ was never a real theory, nor was it widely propounded by responsible practitioners in the field of psychiatry.” (April 15, 2012)

“In truth, the ‘chemical imbalance’ notion was always a kind of urban legend – never a theory seriously propounded by well-informed psychiatrists.’ (July 11, 2011)

“But I stand by my claim that no respected representatives of the profession seriously asserted a simple, ‘chemical imbalance’ theory of mental illness in general.” (September 2, 2011; response to comment on July 11, 2011 article)

My article was lengthy (6079 words), and I quoted seven prestigious psychiatrists in which a simplistic chemical imbalance theory was promoted unambiguously.

“In the last decade, neuroscience and psychiatric research has begun to unlock the brain’s secrets.  We now know that mental illnesses – such as depression or schizophrenia – are not “moral weaknesses” or “imagined” but real diseases caused by abnormalities of brain structure and imbalances of chemicals in the brain.”  Unlocking the Brain’s Secrets, by Richard Harding, MD, then President of the APA, in Family Circle magazine, November 20, 2001, p 62.

“ADHD often runs in families.  Parents of ADHD youth often have ADHD themselves.  The disorder is related to an inadequate supply of chemical messengers of the nerve cells in specific regions of the brain related to attention, activity, inhibitions, and mental operations.”  Paying Attention to ADHD, by Timothy Wilens, MD, Associate Professor of Psychiatry at Harvard Medical School, and Psychiatrist at Massachusetts General Hospital.  Op. Cit., p 65

“…the way nerves talk to each other, and communicate, is through the secretion of a chemical called a neurotransmitter, which stimulates the circuit to be activated.  And when this regulation of chemical neurotransmission is disturbed, you have the alterations in the functions that those brain areas are supposed to, to mediate.  So in a condition like depression, or mania, which occurs in bipolar disorder, you have a disturbance in the neurochemistry in the part of the brain that regulates emotion.”  Causes of Depression, a video by Jeffrey Lieberman, MD, Psychiatrist-in-Chief at NewYork Presbyterian/Columbia University Medical Center, and then President-elect of the APA.  Video made by The University Hospital of Columbia and Cornell. (June 19, 2012)

“The various forms of mental illness are due to many different types of brain abnormalities, including the loss of nerve cells and excesses and deficits in chemical transmission between neurons; sometimes the fault may be in the pattern of the wiring or circuitry, sometimes in the command centers, and sometimes in the way messages move along the wires.” (p 221) [Emphasis added] Nancy Andreasen’s book The Broken Brain: The Biological Revolution in Psychiatry (1984).  Nancy Andreasen, MD, PhD, is Chair of Psychiatry at the University of Iowa.  She served on the DSM-III and DSM-IV Task Forces, and is past president of the American Psychopathological Association and the Psychiatric Research Society.

“Since the pharmacological agents that ameliorate depression and mania appear to act upon and alter the concentration and metabolism of the biogenic amines in what are presumably corrective directions, it may be inferred that in the affective disorders there exists a chemical pathology related to these compounds…positive evidence is slowly accumulating and negative evidence is thus far lacking.” [Emphasis added] opinion piece for the American Journal of Psychiatry (September, 1970, p 133), titled Affective Disorders:  Progress, But Some Unresolved Questions Remain, by Morris Lipton, PhD, MD.  The late Dr. Lipton was Chair of Psychiatry at Chapel Hill at the time of writing.

“Depression is known to be caused by a deficit of certain neurochemicals or neurotransmitters, especially norepinephrine and serotonin.” (p 47) Daniel Amen, MD, from his bestselling book Change Your Brain, Change Your Life (1998)

I also provided the following quote from the psychiatry textbook Psychiatry (2003),  Tasman, Kay, and Lieberman (eds.)

“A final reason for studying the mechanisms of psychopathology is to inform our patients, their families, and society of the causes of mental illness.  At some time in the course of their illness, most patients and families need some explanation of what has happened and why.  Sometimes the explanation is as simplistic as ‘a chemical imbalance,’ while other patients and families may request brain imaging so that they can see the possible psychopathology or genetic analyses to calculate genetic risk.” (p 290, Vol 1)

I made the point that although this passage is not entirely clear, it does suggest that it is OK to tell clients and their families the chemical imbalance lie if they ask for an explanation.

Dr. Alexander reproduces two of my quotes – those from Drs. Harding and Lieberman – and continues:

“I have no personal skin in this game. I’ve only been a psychiatrist for two years, which means I started well after the term ‘chemical imbalance’ fell out of fashion. I get to use the excuse favored by young children everywhere: ‘It was like this when I got here’. But I still feel like the accusations in this case are unfair, and I would like to defend my profession.”

And here’s his defense: [incidentally, he confuses Mad In America with me personally, but his meaning is clear.]

“I propose that the term ‘chemical imbalance’ hides a sort of bait-and-switch going on between the following two statements:

(A): Depression is complicated, but it seems to involve disruptions to the levels of brain chemicals in some important way

(B): We understand depression perfectly now, it’s just a deficiency of serotonin.

If you equivocate between them, you can prove that psychiatrists were saying (A), and you can prove that (B) is false and stupid, and then it’s sort of like psychiatrists were saying something false and stupid!

But it isn’t too hard to prove that psychiatrists, when they talked about ‘chemical imbalance’, meant something more like (A). I mean, look at the quotes above by which Mad In America tries to prove psychiatrists guilty of pushing chemical imbalance. Both sound more like (A) than (B). Neither mentions serotonin by name. Both talk about the chemical aspect as part of a larger picture: Harding in the context of abnormalities in brain structure, Lieberman in the context of some external force disrupting neurotransmission. Neither uses the word ‘serotonin’ or ‘deficiency’. If the antipsychiatry community had quotes of APA officials saying it’s all serotonin deficiency, don’t you think they would have used them?”

In other words, he’s saying that the quotes from Drs. Harding and Lieberman were not simplistic chemical imbalance assertions, but were in fact more nuanced, and that they recognized the complicated, contextual aspects of depression.

So let’s take a look at the quotes in detail.  First, Dr. Harding:

  1. Neuroscience and psychiatric research has begun to unlock the brain’s secrets.
  2. We now know
  3. that mental illnesses such as depression or schizophrenia
  4. are not ‘moral weaknesses’ or ‘imagined’,
  5. but real diseases
  6. caused by abnormalities of brain structure and imbalances of chemicals in the brain.

And Dr. Lieberman:

  1. Brain circuits are activated by neurotransmitters.
  2. Disturbances in this chemical neurotransmission lead to disturbances in function.
  3. So [implying causality],
  4. in depression or mania, there is a disturbance in brain neurochemistry.

Dr. Alexander contends that these quotes do not promote a simplistic chemical imbalance theory because:

1.  Neither mentions serotonin by name! I had never said that they mentioned serotonin by name.  Nor had there been any mention of serotonin in Dr. Pies’ original statements.  The issue was (and still is) that they promoted the chemical imbalance theory.  Dr. Alexander’s introduction of serotonin is irrelevant, and is, I suggest, an example of precisely the kind of intellectual dishonesty which he attributes to me.

2.  Both talk about the chemical aspect as part of a larger picture. This is simply false.  Dr. Harding clearly cites “imbalances of chemicals’ as a cause of mental “diseases.”  The fact that he also promotes abnormalities of brain structure does not modify or contextualize the primary contention.  And the fact that his article was embedded in a five-page “Special Advertizing Feature” for Paxil leaves little room for doubt as to his meaning. 

3.  Dr. Alexander contends that Dr. Lieberman’s statements about chemical imbalance was made in the context of  “…some external force disrupting neurotransmission.”  This, I suggest, is a very creative reading of Dr. Lieberman’s statement:

“And when this regulation of chemical neurotransmission is disturbed, you have the alterations in the functions that those brain areas are supposed to, to mediate.  So in a condition like depression, or mania, which occurs in bipolar disorder, you have a disturbance in the neurochemistry in the part of the brain that regulates emotion.”

Dr. Lieberman makes no reference to an external force disrupting neurotransmission, but even if such an external force were implied, the fundamental message is clear:  conditions like depression and mania are caused by disturbances in chemical neurotransmission, i.e. chemical imbalances!

. . . . .

It’s noteworthy that Dr. Alexander made no mention of the other quotes in my article, e.g:

Nancy Andreasen, MD, an eminent psychiatrist:

“The messages passed along these circuits are transmitted and modulated primarily through chemical processes.  Mental illnesses are due to disruptions in the normal flow of messages through this circuitry” (p 219)

Daniel Amen, MD, successful CEO and Medical Director of six psychiatric clinics, and a Distinguished Fellow of the APA:

“Depression is known to be caused by a deficit of certain neurochemicals or neurotransmitters, especially norepinephrine and serotonin.”

There’s not much ambiguity there.

And, incidentally, Dr. Alexander’s statement:  “If the antipsychiatry movement had quotes of APA officials saying it’s all serotonin deficiency, don’t you think they would have used them?” is a red herring.  In Dr. Pies’ original statements, to which I was responding, there’s no mention of APA officials.  Rather, Dr. Pies’ contentions embraced “responsible practitioners in the field of psychiatry”; “well-informed psychiatrists”; and “respected representatives of the profession.”

. . . . .

In addition, I also provided numerous unambiguous quotes promoting the chemical imbalance theory from :

  • Child and Adolescent Bipolar Foundation;
  • Depression and Bipolar Support Alliance;
  • Mental Health America; and
  • National Alliance for the Mentally Ill

and I pointed out that all of these organizations had eminent psychiatrists on their advisory boards, and that it was reasonable to infer that these advisers approved, or at least had made no objection to, the chemical imbalance messages.

. . . . . 

Nevertheless, Dr. Alexander concluded:

“So if you want to prove that psychiatrists were deluded or deceitful, you’re going to have to disprove not just statement (B) – which never represented a good scientific or clinical consensus – but statement (A). And that’s going to be hard, because as far as I can tell statement (A) still looks pretty plausible.”

Dr. Alexander himself concedes that statement (B) is false, but he refuses to accept the evidence I presented in the quotes – clear evidence that leading psychiatrists did promote the simplistic and false chemical imbalance theory.  And I should stress that I limited my search to psychiatrists who had achieved a measure of eminence and stature in their field (because that was the challenge presented by Dr. Pies).  If I had widened my search to include less prestigious psychiatrists, I’m sure I could have found a great many more.  The fact is that the promotion of the chemical imbalance theory is no secret.  I have personally heard dozens of psychiatrists proclaim it with total confidence, and I truly could not begin to estimate the number of clients I’ve talked to over the years who told me that their psychiatrists had told them they had a chemical imbalance in their brains, and that they needed to take the pills for life to correct this imbalance.  Even today, I regularly receive emails from readers contesting the assertions in my posts and telling me in no uncertain terms that they have chemical imbalances in their brains that cause their problems.

In addition, the simplistic chemical imbalance theory is still being promoted by some prestigious psychiatrists.  Cognitive Psychiatry at Chapel Hill (CPCH) has published 10 Common Myths About Psychiatry on their webpage.  Here are two quotes:

“Actually, the majority of patients we see have an actual illness or imbalance (much like diabetes), that with the proper treatment, the imbalance is corrected and they are no longer ill.”

“… many patients that see a Psychiatrist actually have an illness or imbalance that is causing a mental discrepancy. Once this imbalance is corrected, they are, in fact, cured of their mental illness.”

. . . . .

Dr. Alexander’s article was critiqued on Mad in America by Rob Wipond on April 15, 2015.  Rob’s article cites numerous other examples of psychiatrists promoting the chemical imbalance theory of depression.

The promotion of the chemical imbalance theory did occur, and continues to occur, and is a most shameful chapter in psychiatry’s history.  It is arguably one of the most destructive, far-reaching, and profitable hoaxes in history.

. . . . .

But, although the chemical imbalance theory has been soundly refuted, and the more astute psychiatrists, such as Dr. Pies, are actively distancing themselves from it, Dr. Alexander is clearly still a believer.  Here’s his final paragraph:

“So this is my answer to the accusation that psychiatry erred in promoting the idea of a ‘chemical imbalance’. The idea that depression is a drop-dead simple serotonin deficiency was never taken seriously by mainstream psychiatry. The idea that depression was a complicated pattern of derangement in several different brain chemicals that may well be interacting with or downstream from other causes has always been taken seriously, and continues to be pretty plausible. Whatever depression is, it’s very likely it will involve chemicals in some way, and it’s useful to emphasize that fact in order to convince people to take depression seriously as something that is beyond the intuitively-modeled ‘free will’ of the people suffering it. ‘Chemical imbalance’ is probably no longer the best phrase for that because of the baggage it’s taken on, but the best phrase will probably be one that captures a lot of the same idea.”

This paragraph is not entirely clear, but here’s my best shot at a paraphrase:

  1. Psychiatry never promoted a simple chemical imbalance theory.
  2. But psychiatry did promote a complicated chemical imbalance theory.
  3. The complicated chemical imbalance theory is plausible.
  4. There are chemicals involved in depression. [This is non-contentious.  Brain chemicals are involved in literally everything humans do, think, and feel, from the simplest eyeblink, to writing great works of art, and everything in between.]
  5. It’s useful to emphasize that brain chemicals are involved in depression, in order to convince people that depression is a serious problem that can’t be conceptualized in ordinary human terms.
  6. But we can’t use the term “chemical imbalance” any more because it’s been outed as a hoax.
  7. We need a new phrase that will mean essentially the same thing.

How about Chemical Imbalance, Version II?

And lest I be accused of putting words in Dr. Alexander’s mouth, here are some quotes from earlier in his paper:

“In other words, everything we do is caused by brain chemicals, but usually we think about them on the human terms, like ‘He went to the diner because he was hungry’ and not ‘He went to the diner because the level of dopamine in the appetite center of his hypothalamus reached a critical level which caused it to fire messages at the complex planning center which told his motor cortex to move his legs to…’ – even though both are correct. Very occasionally, some things happen that we can’t think about on the human terms, like a seizure – we can’t explain in terms of desires or emotions or goals an epileptic person is flailing their limbs, so we have to go down to the lower-level brain chemical explanation.

What ‘chemical imbalance’ does for depression is try to force it down to this lower level, tell people to stop trying to use rational and emotional explanations for why their friend or family member is acting this way. It’s not a claim that nothing caused the chemical imbalance – maybe a recent breakup did – but if you try to use your normal social intuitions to determine why your friend or family member is behaving the way they are after the breakup, you’re going to get screwy results.”

So if a person is despondent because of a marital break-up, one can’t conceptualize his despondency in ordinary human terms.  Doing so will produce “screwy results.”

“There’s still one more question, which is: are you sure that depression patients’ experience is so incommensurable with healthy people’s experiences that it’s better to model their behavior as based on mysterious brain chemicals rather than on rational choice?”  [Note the spurious implication that there are only two options.]

“And part of what I’m going on is the stated experience of depressed people themselves. As for the rest, I can only plead consistency. I think people’s political opinions are highly genetically loaded and appear to be related to the structure of the insula and amygdala. I think large-scale variations in crime rate are mostly attributable to environmental levels of lead and probably other chemicals. It would be really weird if depression were the one area where we could always count on the inside view not to lead us astray.”

And there it is – the very core of bio-psychiatry!  Political opinions (and, presumably political activity), criminal behavior, and, by implication pretty much anything else that we do think, or feel, are all best conceptualized in terms of brain structure and chemicals.

. . . . .

Twenty-five years ago an elderly friend of mine lost his wife in a car accident.  They had been married for sixty years.  I visited him, and found him understandably despondent.  His demeanor, normally active and curious, was downcast and withdrawn.  His face was haggard; his shoulders slumped; he was at times tearful; and his gait was slow and heavy.  We talked, and he told me that he felt utterly lost.  I asked him what was the worst thing about his situation.  He thought for a long while, then said:  “I have nobody to talk to.”

His words, which I’ve never forgotten, seemed to me to embody some of the essential elements of grief and despondency:  loneliness, helplessness, and isolation.  But according to Dr. Alexander, this kind of thinking is “screwy.”  Despondency is really a matter of chemicals, and we need to “convince” people to abandon their intuitive assessments of their feelings of despondency, and to recognize the psychiatric “truth” that, whatever its trigger, depression is essentially  “…a complicated pattern of derangement in several different brain chemicals…” And we should embrace this “truth,” despite the fact that several decades of highly motivated research has failed to identify any such “derangement” or “imbalance” or whatever similar term Dr. Alexander would choose.

So, just when we imagined that we had begun to lay this particular piece of inanity to rest, here it is surging back from a brand new psychiatrist, prescription pen poised, ready to put the world to rights, one aberrant molecule at a time.

This isn’t just faulty logic and poor science.  It is a fundamentally dehumanizing and intrinsically disrespectful way of conceptualizing human loss and suffering.

 

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37 COMMENTS

  1. Dr. Alexander mentions a study on the monkey model. Who is diagnosing macaque monkeys with depression? When they do diagnose monkeys depressed, in my view, it is probably for one reason, and one reason alone. Namely, drug research and development. I can’t really imagine any urgency being applied to treating depressed monkeys in the wild. That’s one advantage of being a free monkey right, no monkey psychiatrists. Researchers, using monkeys as guinea pigs, that’s another thing entirely.

  2. Yikes.

    http://slatestarcodex.com/2015/04/26/ot19-dont-thread-on-me/

    Alexander is soliciting donations for “in-crowd member” crazymeds.us, where responses like this to people trying to quit antidepressants are the norm:

    “You talk like the Effexor was a crutch or a vice, like a bottle of whiskey, as if being on the medication made you less of a person or symtom free, that you had to do it the “natural” way or some sh*t. It’s silly talk to be quite honest. Would you say the same if you were on high blood pressure meds or anticoagulants to prevent a stroke? [clc: I would…]

    And that was written by this person:
    Diagnoses: MDD, Social Anxiety
    Current Meds: Effexor XR, Wellbutrin XL, Neurontin, Klonopin, Propanolol, Seroquel, Zyrtec

    Scary stuff.

    In the same blog entry, Alexander blames his declining blog traffic on WordPress. Is he really a psychiatrist? This could argue either way: “I get self-esteem and occasionally money from blog hits, so this is kind of bothering me.”

  3. It seems really bizarre to me that the psychiatric profession does this. Obviously, the more sophisticated ones, like Dr. Pies (?) don’t want to have to defend the indefensible.

    I am wondering, though, whether this garbage is really worth the effort. It isn’t, I don’t think, an issue that most people care about that much, at least divorced from its context (pushing drugs). I think it may be diverting us from more important things, like trying to find an overall strategy for how to deal with the power of the psychiatric profession to abuse people almost at will.

    • It’s been selling drugs pretty well though. Now the mainstream propaganda piece is “it’s broken brain circuits” – I read it more and more on various blogs and fora.

      The problem with chemical imbalance myth and its successors is that it helps to convince people to take what they know are essentially narcotics. Normally people have a well-grounded fear of getting addicted and doubts about how it’s better than getting drunk/stoned in response to their circumstances. But selling the drugs as medicines takes the fear and the guilt away. I think that is why there are quite a few patient defendants of the drugs and the whole myth – they simply can’t admit they’re taking a narcotic to help them with the daily life. Which is not necessarily a bad thing (who doesn’t take some kind of a drug) but it’s imperative that this is done in conditions of informed consent. For some the whole “chemical imbalance” bs is just an excuse for an alcoholic to keep drinking. For others it’s a “gateway” to drugs if you will and then an important part of denial when they figure out that they can’t get off the drug although they feel worse and worse.

  4. Ted – Most definitely, on the ostensive action-event-organizing blog you would put this epic coverage of chemical imbalance marketing fraud under a subheading. No matter how you look at it, the interest among the people who follow the issue stays lively enough to suggest that the movement should investigate prospects for exploiting the facts of it in regard to the failed paradigm supported by mainstream psychiatry. This patch of criticism keeps all that as publicly available as the medium allows, right? But I don’t myself know how to quantify that potential value to an antipsychiatry movement, and haven’t got the skill set to pronounce on it the way that Bonnie Burstow could, either.

  5. ” The idea that depression is a drop-dead simple serotonin deficiency was never taken seriously by mainstream psychiatry. The idea that depression was a complicated pattern of derangement in several different brain chemicals that may well be interacting with or downstream from other causes has always been taken seriously, and continues to be pretty plausible.”

    Yeah, “god of the gaps” argument. If the opposition shows your argument is bs simply move the target and say that it’s not what you proposed originally.

    “This isn’t just faulty logic and poor science. It is a fundamentally dehumanizing and intrinsically disrespectful way of conceptualizing human loss and suffering.”
    True that. According to this “Dr” love is probably also best explained by chemicals in the brain. OR following his logic – the best response to someone being hungry is not giving him/her food but some pills to correct the imbalance. What a … (fill in with the expletive of your choice).

  6. Poor Dr. Alexander. It must be a bit depressing for him to wake up every morning and realize that everything he’s going to do for the day is deterministically “caused by brain chemicals”. 🙂

    Dr. Hickey, the real problem is that psychiatrists have been afflicted with Absence of Common Sense Disorder, which will be in DSM 6. It’s not their fault – their brain chemicals are misfiring and causing this illness. We should sympathize with them, since they just can’t help it. That will help remove the stigma that might otherwise develop around Absence of Common Sense Disorder.

    Seriously, the level of denial and foolishness, in not being able to appreciate that past and present environmental experiences could account entirely for whatever distressed or non-distressed chemical state that the brain is in (versus the brain chemicals in isolation somehow “causing” an “illness” in a reductionistic way) is simply astonishing.

    Sometimes I wonder if these psychiatrists have been taken over by bodysnatchers who are writing these ideas as some type of joke. Their ideas ares darkly comical, if read in a certain way… until you remember how greatly they are harming and discouraging people via their deterministic attitudes and “treatment.”.

  7. It is strange how many people buy this stuff, you can have supposedly skeptical people, even scientists that seem to have this blind spot when it comes to psychiatry.

    It’s weird. Like these geeks or atheist types that can rail against all forms of religion or cult, but there’s this massive load of pseudoscience going unnoticed right under their nose !

  8. If you say you think these psychiatrists are over prescribing medicines for money to treat problems that can be easily resolved by dealing with the root causes through talking to someone, they consider you as delusional and proceed to diagnose you accordingly. God forbid they get the chance to forcibly medicate you as the country is sadly heading because of the inability to treat mentally ill people ethically rather than greedily.

  9. Harm that has been made by Psychiatry postpones the evolution of humanity by at least one century. It is not about faulty logic only, but logical criticism is the thing which could stop ‘them’. I dream one day I’ll finally take DSM in my hand, pursue a logical analysis of it – word by word and then just send it to whoever on the planet by posta, e-mail, anything. I would flood the world with a book where, according to the laws of logic – not to mention the ethical ones – Psychiatry has been deeply failing. I’ll be waiting till I won’t resist anymore or till someone else will write this type of book. What I feel is beyond of words. Sometimes I wonder why do I feel doing this, while only to analyse the word ”Psychiatry” provides of all answers? Check this out:
    Etymology
    The word psyche comes from the ancient Greek for soul or butterfly.[3] The fluttering insect appears in the coat of arms of Britain’s Royal College of Psychiatrists[4]

    The term “psychiatry” was first coined by the German physician Johann Christian Reil in 1808 and literally means the ‘medical treatment of the soul’ (psych- “soul” from Ancient Greek psykhē “soul”; -iatry “medical treatment” from Gk. iātrikos “medical” from iāsthai “to heal”). – Wikipedia

    • Well said Bbrenarda

      i personally take an integral/holistic view of my condition/experiences – bio/psycho/social/spiritual – that things are mediated across spirit – soul/psyche – physical body/brain – social/environmental. i don’t see any either/or with it all, but rather that everything is interrelated & interdependent.
      imo Carl Jung spoke a lot of sense on all these matters, as have others.

      Current mainstream psychiatry primarily focuses on the physical – the physical body/brain. Psychological & social elements often seem secondary to that, & the areas of the soul & spirit are usually excluded.

      Obviously it is impossible to argue a case for the spiritual with a materialist, as many now appear to be.
      i’ve spent the past 10 years on-line trying to raise awareness of & explore the spiritual in mental health, to little avail. Am interested in other people thoughts on the matter. Thanks.

    • In contrast to psychiatry, most medical specialties end in -ology, which indicates a science or the study of a topic. Oncology, Cardiology, Neurology, Dermatology.

      Psychiatry got stuck with its second-class name because psychology existed before it did and was outside of medicine, where it belonged.

      By the way I like the idea of a logical analysis of the DSM.

  10. Are not my eyes reflected in yours?
    And don’t all things press
    On your head and heart,
    And weave, in eternal mystery,
    Visibly: invisibly, around you?
    Fill your heart from it: it is so vast,
    And when you are blessed by the deepest feeling,
    Call it then what you wish,
    Joy! Heart! Love! God!
    I have no name
    For it! Feeling is all:
    Names are sound and smoke,
    Veiling Heaven’s bright glow.

    Goethe’s Faust

  11. There IS a chemical imbalance. It is occurring in the synaptic gap between Dr and patient, the doctors desk. Chemicals are traveling in one direction, and money in the other. Looks imbalanced to me :).

    Well done Dr Hickey. Some time back I posted a link in one of your articles to our Mental Illness Fellowship whose pamphlets on Bipolar and Schizophrenia clearly stated that these illnesses were CAUSED by a chemical imbalance. They have since been removed.

    Similarly there was a documentary shown during Mental Health Week with the head psychiatrist of one of our largest hospitals saying precisely this, “like diabetes” etc.

    One really doesn’t have to look very hard to find it, so where is this echo chamber Dr Alexander exists in?

    Regards
    Boans

      • Everywhere including “Autopsy” (22/04/2015.)

        The Forensic Pathologist stated;
        “Mirtazapine is a drug that is used to treat major or severe depressive illness.”
        “One of the reasons for depression is that the level of neurotransmitters – chemicals that pass the signal from one nerve to another inside the brain is too low.”
        Mirtazapine acts by increasing the levels of two of these neurotransmitters- noradrenalin and serotonin and so alleviates the symptoms of depression.”
        This was visually emphasised by animated brain signalling images in three dimensions, with flashing lights.

        (The above was carefully transcribed from the broadcast and I believe that it is a correct record. It is hence posted “in good faith”)
        The phrase “one of the reasons for” clearly implies there believed to be are other reasons for? There is no implied criticism of the presenter or the program. However, this observation does seem to contradict Dr Alexander”s assertion perhaps?

  12. Social Darwinism and determinism at their worst. :p

    What frustrates and saddens me are all the people in the system convinced that they have “broken brains” and “chemical imbalances.” And they say it with a degree of relief–or it sounds that way.

    Why? Are they so willing to be exonerated from poor choices that they not only want to submit to druggings, but give up the idea of being free moral agents?

    I admit to making bad choices. Once I’m off these brain drugs, I hope to be able to make better decisions!

  13. Greetings Dr. Hickey,

    I’d like to suggest an answer to Scott Alexander’s argument that when Psychiatrists say “chemical imbalance” they really mean

    “(A): Depression is complicated, but it seems to involve disruptions to the levels of brain chemicals in some important way”

    At one level, this seems completely reasonable. If brain chemistry determines how I’m feeling and I’m feeling bad, there must be something wrong with my brain chemistry, right? What could be wrong with that?

    To see what’s wrong, imagine that your laptop has a virus and has developed “laptop depression.” Your laptop is sluggish, unenthusiastic and sleeps too much. Suppose you take it to the Apple store and they say that since everything happening in your laptop is determined by electrical signals, your laptop has an “electrical imbalance.” We are therefore going to try increasing your clock speed, add some more wires and pull out a few capacitors. Notice that even though it is correct that your laptop’s behavior is determined by electrical signals, the Apple store is about to make a very serious mistake that will likely harm your laptop and will likely not solve the problem. The point is that the Apple store has mistaken a software problem for a hardware problem. I think that depression (at least) is essentially a brain software problem and not a brain hardware problem. I think that depression is essentially caused by an ingrained, habitual, unconscious thinking pattern and not by neurotransmitter imbalances. If that’s so, it’s not surprising that no biochemical test for depression has been found. It’s the same for laptops. You can’t get out a voltmeter and test if your laptop has a virus. Notice that technology improvements won’t change what you should do here. Even if extensive research into laptop depression shows that you can sometimes electrically determine if a laptop has a virus, the right treatment is still going to be to remove the bad software and not to have a hardware intervention.

    Regards,

    Saul Youssef