The Spurious Chemical Imbalance Theory is Still Alive and Well

by Phil Hickey on April 27, 2015

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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 [note the unambiguous expression of certainty]
  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.

 

Related posts:

  1. Psychiatry DID Promote the Chemical Imbalance Theory
  2. The Chemical Imbalance Theory:  Still Being Promoted
  3. Depression is Not a Brain Defect
  4. The Use of Neuroleptic Drugs as Chemical Restraints 
  5. The Illness Theory Is Everywhere

Tagged as: Mad in America, Psychiatric "spin"

  • cledwyn “corpse in the making”

    Seems like a neuromaniac. Such people are like film critics who examine the camera to understand the film. He seems to have very little understanding for the connections between the mind, the body, and the environment, and the reciprocal relations therebetween.

    The foremost boon of such an understanding oriented towards the neurology of the patient is that it functions as a safety blanket, protecting the psychiatrist from the emotional and social reality of the patient, a viewpoint that if internalized by the patient precludes the possibility of symbolization, that is, the process of investing our experiences with meaning, often achieving greater understanding and catharsis thereby, such as happens when engaging in creative activity, which helps us to make sense of our experiences and to work off our frustrations and aggression within a purely symbolic context, as opposed to the custom and tradition honored mode of taking them out on other people directly; or through the contemplation of the works of genius that center on the suffering of the species, the salubrious effects of which Leopardi elaborated in a passage in his “Zibaldone”;

    “…works of genius have this peculiarity that, even when they represent the nothingness of things, even when they clearly demonstrate and makes us feel the inevitable unhappiness of life, when they express the most terrible moods of despair, yet to a great mind, even though it may be in a state of extreme depression, disillusionment, blankness, ennui, and weariness of life, or in the bitterest and most paralysing misfortunes, they also serve as a consolation, re-kindle enthusiasm; and though they treat of and represent no other subject than death, they restore to such a mind, at least momentarily, that life which it had lost. Consequently that which when seen in the reality of things stabs and kills the soul, when seen in imitation or in any other way in works of genius opens the heart and restores it to life….The very contemplation of nothingness is a thing in these works which seems to enlarge the soul of the reader, to exalt it and satisfy it with itself and its own despair.”

    Positivist psychiatry discourages this process of searching for, and the investiture of our experiences with, meaning (which is not without its own pitfalls, admittedly) by framing this issue in such narrow, reductionist terms, requiring the surrender of the patient to the doctor possessing the requisite specialist knowledge.

    Nevertheless, I do agree with the criticism of the voluntarist framing of depression, which for me has very limited explanatory value.

    Depression is something that attends the lot of every man. The problem is, most people suffer in ignorance, having learned, unlike those of us of a more philosophical bent and possessed of a greater store of curiosity, the necessity of anchoring one’s life in all the distractions, activities, and trivial pursuits, preoccupations and pastimes, that allow one to endure this shitemare we call life, contemplation whereupon only depresses further, though it must be stressed that such is inevitable for men of sensibility and a philosophical bent, finding as they do only comfort in things that slake their thirst for the profound, because the absurdities and trivialities within which people try to lose themselves and to escape the agony of thinking about life (and which explains the equally comical, tragic, and frankly insane obsession with sport) inspire in men in which consciousness has developed to a higher level with a sense of tedium and despair, and an awareness of the absurdity of the species to which such people are tethered, and of life itself.

    This lack of dwelling on things allows people to keep their constitutional misery at a subconscious, manageable level, though it is assisted in this regards by the tendency of men to give people who ventilate their misery a wide berth, acquaintance with whom would be emotionally unprofitable, and to limit their circle of acquaintances to grinning martyrs, around whom men gather like flies around a honey pot (and who likewise withdraw when there is no more honey in the human pot).

    Nevertheless, it is possible that some people live in the fool’s paradise. It might be fair to say that life is bearable in proportion as we are capable of hoping for something better, but even the most hopeful cannot escape the truth, which always illustrates the futility of hope, which is the only thing that stops life, along with our treacherous fear of pain and death, from degenerating into a suicidal orgy, the human capacity for which (hope, that is) is by no means diminished by bitter personal experience of Hope’s (which stamps life with the character of perpetual deception) failures to make good on its promises; indeed, even pessimists only acknowledge the reality of hope’s inconsistency with knowledge of life at a purely discursive level, whilst nevertheless hoping all their lives unconsciously for all the things that their reasonings show to be unattainable, until, as Schopenhauer pointed out, man, upon learning that he has been duped by Hope, goes contentedly to his grave.

    Nevertheless, while it might bring temporary reprieve from the misery that constitutes the general pattern of existence, which attends the lot of every man, and never really deserts us, hope heightens our suffering through its contrast with the pleasure we derive from it, and the pain and disillusionment to which hope leads, and which follows in realization’s train, is rendered all the more shattering in proportion to the intensity of the hope we nourished in our breasts theretofore. Hope is nothing more than the face the self-preservation instinct presents to men in order to keep them toiling in an existence that all knowledge shows to be pointless.

  • all too easy

    Sweet Poor Old Phil,

    When you experience the impact of ethyl alcohol after imbibing, why do you feel the intoxicating effects? Do the alcohol molecules deprive your big toe of its cognitive function? Do they starve your toenails of desperately needed oxygen? No? Does alcohol deprive neurons of oxygen, huh? Does a person’s brain undergo a change in the way it processes information, expresses its thoughts, drives a car, when you saturate it with alcohol? Well, guess what? That is you, your brain, on alcohol. Not your toes, Phil. It is You, your brain, your will, your thoughts, your behavior, your life. You see, you and your brain are inextricably and intricately connected. Remove the brain and you will never have mental illness! Ain’t that grand! Until then, all kinds of chemicals pass through the blood brain barrier to feed it and oxygenate it and remove toxins. (Some molecules which are necessary might not make it which presents problems as well.) Chemicals, electricity, biological tissue, oxygen, nutrients, etc., comprise the grey matter. Sorry bro, sickness of the brain is as easily provable as I just made it.

  • heartofatum

    My personal view is that the primary aetiology in the vast majority of cases is psychogenic & should be addressed as such, with more comprehensive psychological & social support approaches. i’d still think there are varying degrees of physiological (biologic) aspects to what people experience.

    We don’t fully understand the brain/CNS/Genetics & other factors involved in physical health, nor do we understand how the physical interrelates with the mind & environment, especially in relation to consciousness. At best the most logical conclusion is some kind of integral view & panpsychism.

    Biomedical psychiatry is off the rails, but so too is anti-psychiatry, our entire society/civilisation is off the rails.

  • Laura Soriano

    thought process can change mood and behavior. It is all about thought process not some “alcohol analogy”. Of course the brain is susceptible to chemicals there’s no need to prove that. We have the capacity of reasoning though which has nothing to do with drugs.

  • Rob Bishop

    Many millions of people claim passionately they can’t start their day without the drug caffeine, and that this drug is incredible helpful and they cannot function otherwise. These people claim if they don’t take the drug, they feel unbearable terrible. Does this mean caffeine treats some underlying biochemical illness? I think this analogy has some merit regarding some of the topics discussed here. Any thoughts?

  • Harry hobbes

    The brain cannot be influenced by chemicals. Not according to the hapless hate psychiatry first crowd. The brain exists on a different level than everything else. If you admit drugs impact brain tissue, you must admit the brain isn’t perfect. Haters cannot admit that.

    A brain soaked in alcohol doesn’t think clearly my love

  • Phil_Hickey

    Rob,

    Absolutely! Also, I’ve known a good many smokers who stated that smoking helped them concentrate. Should we assume that they have a nicotine deficiency imbalance?

  • Harry hobbes

    Every sip of booze you drink, you destroy neurons. Nicotine is a proven substance, acting like stimulants, that improves one’s ability to concentrate.

  • Rob Bishop

    And how about the millions of people who need psychoactive drugs to sleep at night? I guess a lot of people have a benzodiazepine imbalance. Has insomnia been declared a mental illness?

  • M.

    Count me as one of the people told by a psychiatrist that my troubles were caused by a neurotransmitter imbalance. I’m supposed to believe I only imagined my psych explaining how norepinephrine, serotonin, etc. can get out of whack before she drugged me to oblivion back in high school? Hah. It’s like the entire field is trying to gaslight its former patients.

    You may not be aware of this, but one of the grand ironies here is that Scott Alexander isn’t simply another psychiatrist defending the field; he’s also a prominent member of the online “rationalist” community. These guys claim to be devoted to science and the criticism of logical errors and faulty reasoning. Yet here he is, defending the unscientific claims of bio-psychiatry without realizing his own field has an intellectual swamp for a foundation! It’d be hilarious if he weren’t also out there drugging and involuntarily committing people in the name of science and medicine.

  • Saul Youssef

    I suspect that many psychiatrists and MDs still say this simply assuming that what you feel is determined by your brain chemistry. If you are feeling bad, then, therefore, there must be something bad about your brain chemistry. Future research will clarify the exact neurotransmitters involved and the exact genetics, but in the mean time, the current drugs are the best we have. That sounds reasonable, doesn’t it? If you don’t believe this, perhaps you are being irrational [ :) ].

    I think a good way to see that this really can be very, very wrong is to imagine that your laptop has “laptop depression” because you have downloaded a virus. You take it to the Apple store and they tell you that since everything happening in your laptop is determined by electrical signals, your laptop has an “electrical imbalance” and we are going to address it by increasing your clock speed, adding some more wires and pulling out a few capacitors. You can see that even though the Apple store is correct about electrical signals being everything, they are nevertheless about to do something that will likely damage your laptop and will not solve the problem. So what is their mistake? They have mistaken a software problem for a hardware problem. I think that depression (for instance) is essentially a brain software problem and not a brain hardware problem. From that point of view, it’s not surprising that there is no biological test for depression. It’s the same with laptops. You can’t pull out your voltmeter and test if your laptop is running bad software. Notice that research into the details of laptop depression isn’t going to help. Even if you someday have an electrical way to detect computer viruses in some cases, the right treatment will always be to stop running the bad software and not to have a hardware intervention.

    As Dr. Hickey has pointed out, the chemical imbalance story is dramatically disempowering. It makes you think that you are helpless to do much of anything other than listen to the experts and take the drugs. On the other hand, if depression is brain software problem, then, actually, you and only you have control over your own thoughts and only the patient has the power to do something about that.

  • M.

    Right, I think bio-psychiatry makes a grave error by conflating ontological reductionism (a human being is simply a collection of chemicals) with methodological reductionism (the best way to *understand* human beings is at the level of neurons and chemicals). Hardware and software is a reasonable analogy for the distinction between pathology at the biological level and problems at the level of thoughts and feelings.

    I’m reluctant to fully accept your contention that “you and only you have control over your own thoughts and only the patient has the power to do something about that.” though. I think that can be disempowering too. I fear it still individualizes problems that often have causes *outside* one’s own thoughts. Environment and circumstances matter. Trauma exists, loss exists, powerlessness exists, and focusing solely on an individual’s thoughts obscures the reality that many forms of suffering or unusual thinking (which get called mental illness) are quite natural responses to a person’s world.

  • heartofatum

    Using the computer analogy – stuff can go wrong with hardware, software can also effect the hardware, & hardware can effect software – so can environment. & we’re Not a laptop – although the analogy works to some degree as us being a biological computer at the physical level.

    Some computers are high spec & work very well, & others Not so.

    i think that cases are individual & complex – that we’re mind, body, soul & spirit within environment, & stuff from a whole range of levels/areas effects us. i don’t think that any of this can be reduced to simply analogies or categorical answers. No one has the full answers to these experiences/conditions.

    We need to take far more comprehensive & integral views to it all, imo.

    Maybe in a lot of cases the primary aetiology is psychogenic & we need far more comprehensive psychosocial approaches of care & support – i also disagree with the anti-psychiatry propensity of placing all the responsibility on the individual. There are cases of very severe mental illness, & maybe in some of those cases there is a large physiological/biological component.

    We need a far better understanding of what these experiences/conditions are to begin with, & far better approaches of healing, care & support. & i don’t see any side providing those answers/support in any really satisfactory way.

    The endless polemics also get very boring.

  • Saul Youssef

    “We need a far better understanding of what these experiences/conditions are to begin with, & far better approaches of healing, care & support. & i don’t see any side providing those answers/support in any really satisfactory way.”

    Hi heartofatum,

    I was trying to give an easy way of understanding that there really is something wrong with Alexander’s proposition “(A)” above, but, OK, it’s fair to ask what the alternatives are.

    I do have an alternative explanation for depression. I think that depression is caused by a single specific unconscious habitual thought pattern. This predicts a specific cluster of symptoms that should be common to depressives, it predicts how and why the symptoms should get worse over time and it predicts which treatments should work and which shouldn’t. In particular, because it’s supposed to be unconscious, you would expect training your way out of it to work better than talking or reasoning your way out of it. That’s partly why I was attracted to a behavioral web site. Here’s some more if you are interested:

    http://egg.bu.edu/~youssef/SNAP_CLUB/

    It is, at least, an alternative explanation of what’s going on in the sense you’re asking for. I think it’s even correct, too.

  • heartofatum

    “It is, at least, an alternative explanation of what’s going on in the sense you’re asking for. I think it’s even correct, too.”

    Thanks – i think primarily a lot is psychogenic.

  • Rob Bishop

    Interesting comments! “If you are feeling bad, then, therefore, there must be something bad about your brain chemistry.” This common perspective reveals how we create our own misery. To call a feeling “bad” is purchasing a first class ticket to major depression and anxiety. The more we resist a “bad” feeling, the stronger it gets, which becomes a downward spiral.

  • all too easy

    “Evidence has unequivocally established that ‘mental illness’ has definite correlates with brain dysfunction . . . QEEG promises to have greater expanded use as psychiatrists become more familiar with its many applications.”

  • all too easy

    Quantitative EEG (Brain Mapping)
    Clinical studies have demonstrated distinctive forms of brain electrical activity in psychiatric conditions including attention deficit disorder, schizophrenia, major depression, and obsessive-compulsive disorder. AETNA

  • all too easy

    “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.” Phil
    No one has to take a drug to save himself from utter despair. We have no law that points a gun at the grieving person’s head and demands that he take Prozac or else.

  • M.

    So? There are biological correlates with stress, falling in love, drug abuse, and jet lag too — but those all involve healthy minds under unusual circumstances. They haven’t demonstrated illness, nor have they demonstrated a *causal* relationship between the measured differences and undesired subjective experience and irrational thinking. Biological correlates do not prove biological abnormality.

    I also note that you’ve been rather selective with your quote here. They also say the following:

    “Quantitative EEG has been proposed for use in a broad array of potential applications. This evidence has focused on the diagnostic accuracy of QEEG. There is, however, a paucity of evidence regarding its clinical utility.

    There are no current guidelines from leading medical professional organizations recommending the use of quantitative EEG as a screening test for neurological and psychiatric conditions. In addition, there are no peer-reviewed published prospective studies of the use of quantitative EEG screening for these conditions showing that management is altered such that clinical outcomes are improved.”

    “In accordance with the American Academy of Neurology/American Clinical Neurophysiology Society’s assessment and available evidence, Aetna considers the use of quantitative EEG experimental and investigational for all other indications, including any of the following diagnoses because there is inadequate scientific evidence to prove its clinical usefulness for these indications:”

    [emphasis added, and a list of conditions follows]

    In any case Phil is talking about the chemical imbalance theory here, and not qEEG, which is apparently the new biopsychiatric rabbit-hole they want everyone to go down now that the chemical imbalance myth is becoming difficult to sustain. Please stay on topic.

  • M.

    Uh, you’re wrong. Look up the Florida Mental Health Act of 1971, aka the “Baker Act” or Section 5150 in California. They can force medication on people.

  • Rob Bishop

    We don’t necessarily have control of our thoughts and emotions, but we have control over our reaction to them. It’s the reactions that can create disturbed negative states of mind. Each day we make hundreds of cognitive choices what to focus on, and these choices create our state of mind. The ADD movement proposes millions of people don’t have the ability to choose what to focus on (without drugs). The ability to not focus on thoughts and emotions is a skill.

  • Saul Youssef

    This is why I like the laptop analogy. When my laptop gets “laptop depression” (i.e. when malware is running), distinctive forms of electrical activity can sometimes be detected, just as with brains. It may be slow, it may reboot at strange times, strange files may appear. That doesn’t mean that strange files or unexplained reboots are the source of the problem. Even though these are hardware issues, it doesn’t mean that the problem has a hardware solution. The solution is a a software solution: stop running the malware. Notice that no amount of research into detecting subtle hardware effects of computer viruses is going to change what you should do for this problem: you should stop running the malware and not have a hardware intervention.

  • Phil_Hickey

    Saul,

    Thanks for commenting here. Back in 2013, I wrote a post in which I also used the computer analogy. You might find it interesting.

  • all too easy

    They can force a dangerous person to be subdued. Thank heavens

  • all too easy

    Let me suggest that when you address a scientific fact, pay attention to it. Try again if you’d like, but don’t respond to me. I grow weary of nonsense. “Clinical studies have demonstrated distinctive forms of brain electrical activity in psychiatric conditions including attention deficit disorder, schizophrenia, major depression, and obsessive-compulsive disorder.” AETNA

    Thar she be.

    “they want everyone to go down…” names, please. Who are they, all of them?

    “There are no current guidelines from leading medical professional organizations recommending the use of quantitative EEG as a screening test for neurological and psychiatric conditions.” Well, duh. The proof of its efficacy has just been published. And Aetna ain’t thrilled to start dishin out bucks to pay for its use.

  • M.

    You disregarded my first point. You haven’t proven *causality*. Until then you’ve got nothing.

  • M.

    You’re astonishingly cavalier about violating people’s fundamental rights. Forced treatment was involved in all the greatest abuses of psychiatry over history — lobotomies, ECT, suppression of political dissidence in the USSR… and the abuses of involuntary treatment continue to this day.

    It is is morally wrong. You are on the side of evil.

  • all too easy

    You are through. Next time, instead of returning with a different title while spouting the same ridiculous positions, try using sound logic and staying on topic. You can’t honey, I know, but try with someone else. Maybe somebody on your level, what do you say?

  • M.

    Argue with somebody on my level? Aight, guess I’ll find somebody cleverer to argue with then. :) Ciao.

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