Home > Books, Health, Learning > so-called imbalances & so-called cures

so-called imbalances & so-called cures

In 2013, I began to suspect that mental illness was more than a simple matter of “chemical imbalance.” I didn’t say much about this suspicion, because I had very little–apart from personal experience–to substantiate it.

I’ve spent the last couple of weeks reading Robert Whitaker’s 2010 Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America. Above and beyond confirming my suspicions with abundant (non pharma-funded) research studies, he tore apart the whole idea of mental illness as resulting from “chemical imbalance.”

Whitaker’s research suggested that “science” here was designed to fit very profitable pills from the beginning. Furthermore, and most alarmingly, he discovered strong correlations between medication and worse long-term outcomes. It was as if, he hypothesized in the book’s early pages, the medication itself was responsible for today’s mental health epidemic, with outcomes far worse than those reflected in a century’s worth of mental history data and for far, far more people.

There’s no way to summarize nearly 400 pages of meticulous documentation here. I won’t even bother, though I will encourage you to read the book if you’re curious what science actually supports.

What I do want share is a startling segment from the 2015 research afterward. It’s one thing to have a critic suggesting standard wisdom is far from wise; it’s another to have a member of the critiqued group confirming the same.

In a section titled “The Death of the Chemical Imbalance Story,” Whitaker includes an excerpt from an article written by the editor-in-chief emeritus of Psychiatric Times:

Catch that? “Chemical imbalance” is an “urban legend” never–despite abundant, often quite public historical evidence otherwise–advocated by psychiatrists.

In 2015, the same editor-in-chief doubled down on his prior position: “To my knowledge, no professional psychiatric organization has ever publicly promoted a ‘chemical imbalance theory’ of mental illness in general.” He points to a 2005 brochure that states, “The exact causes of mental disorders are unknown.”

Whitaker had plenty to say about all of this in his responsive article:

The “Let’s Talk About Facts” brochures that the APA published in 2005 were part of an ongoing pr campaign titled “Healthy Minds, Healthy Lives,”  and that same year the APA also published a brochure for the public titled, Let’s Talk Facts About Depression.  This brochure, in a section titled “How is Depression Treated,” informed the public that: “Antidepressants may be prescribed to correct imbalances in the levels of chemicals in the brain.”

There is more. That same year, 2005, the APA put out a press release celebrating the fact that, based on a survey it had conducted, “75 percent of consumers believe that mental illnesses are usually caused by a chemical imbalance in the brain.” The survey results, said APA President Steven Sharfstein, was evidence of “good news for [public] understanding of mental health.” Indeed, the APA stated in its press release that a psychiatrist was “a specialist specifically trained to diagnose and treat chemical imbalances.”

After processing all of this, I searched my own blog to see if “chemical imbalance” came up anywhere. I was certain it had, multiple times. After all, I’d learned all about the “chemical imbalance” origins of mental illness in my 1995 Psychology courses, and held on to the explanation until 2013.

I was surprised and relieved to discover it occurred only once, in a 2004 journal entry I included in “The During, part 3: Treatment beyond Our Consent” (emphasis added):

Laying there in my bed, the fan on to dispel some of the humidity, I was wordlessly heartbroken. It was only when I sat up and thought, I need to write, I need to make some sense of this, that actual words started forming. But here’s the thing: sense can’t be made of it, not asleep, not awake, not halfway-between.

My mom is gone to me, gone to my siblings, the beautiful things about her consumed by this madness which is, biologically speaking, an expression of some kind of physiological defect. It’s rooted in the brain, somewhere in that tremendously complex brain, some kind of chemical imbalance or slight swelling of certain regions so they impede the functioning of others. It’s something treatable, in some degree, perhaps fully in the future when we better understand what causes it, treatable like an infection with common penicillin, but for which any treatment is beyond our control because treatment is beyond our consent.

Even before reading Anatomy of an Epidemic, my so-called political readings of the last year left me virtually certain most mental illness could more accurately be characterized as social, not biological, in nature:

Many of my political reads revealed a strong correlation between abuse, stress, poverty, lack of support systems, and what appeared to be mental illness. On the basis of my political+ readings alone, I was heartsick to understand that my mom’s “mental illness” might well have been simply been the understandable consequence of for too long carrying far too heavy a load, virtually alone.

I was far from alone in learning that mental illness originated with “chemical imbalance” and that medicine helped rectify those imbalances. This message has been spread so far and so wide for half of a century now that it will inevitably take time before its counter reaches everyone who internalized it.

Though my heart aches for everyone who’s suffered and will yet suffer the long-term impacts of (individually, societally; physically, emotionally; monetarily) costly drugs that treat fictive chemical imbalances, I’m also hopeful. The seeds of change are blowing, and as they blow, there’s cause to believe fewer and fewer people will suffer illness often created by the so-called “cure.”

  1. August 11, 2017 at 9:50 am

    It’s the growing disconnect between people that’s part of the cause. Hours spent watching TV and on games, Facebook and on without positive interactions with people and the growing amount of judging and negativity out there. I constantly fear doing or saying the wrong thing in this society. This past year in my small city alone there’s been 6 or so or more suicides. Last Friday a 16 year old committed suicide. A couple weeks before an 18 year old was found by her parents hung in their porch, an acquaintances brother, a high school teacher. It’s so extremely sad.

    • August 11, 2017 at 5:07 pm

      I don’t know if the growing disconnect is cause, consequence, or both. I suspect it’s the latter. However it is it came to be this way, it’s a horrible problem with even more horrible, often fatal consequences.

      Last weekend’s visit was such a good example of what “the village (it takes to raise a child)” looks like. For several days, we had a handful of kids (usually) joyously interacting with each other and multiple parents. I felt the village so keenly, and understood deep in my guts that it’s that kind of communal support we’r missing. Many people have little to no community there physically day to day, so that all the burden falls on one or two people to do the work that, for much of human history, many did together. It was such a joy to experience, but sad to do so only briefly.

  2. August 11, 2017 at 2:26 pm

    The brain is one of the last mysteries. And its illnesses fall into the same category. No easy answers and definitely no ‘one size fits all’ solutions.
    I would agree with octopus lady that a personal disconnect has a part to play. How big a part? I know not. As well as being a part of the problem it points towards partial answers too.

    • August 11, 2017 at 5:12 pm

      What’s stunning to me is how concerted and intense an effort the psychiatric community took, for decades, to indicate they’d cracked the code and found the cure. Now, after millions of people are suffering the results of these greatly exaggerated claims, they’re putting on the breaks and saying, oops, no, probably not a one-size-fits-all origin or treatment! (I translate this to, it wasn’t us!)

      Such confident, boldly presented assertions of causes and cures should never have been presented as fact. That it was, and that there have thus far been precious few consequences or attempts to meaningfully regulate have meant tragedies the scale of which I can still barely fathom.

      If it takes a while to crack the code moving forward, as I expect they will, I hope additional “cures” will be offered with caveat, and as last–not first–resort.

  3. August 11, 2017 at 4:48 pm

    As somebody diagnosed with major clinical depression, I do agree that not all mental illnesses are caused by chemical imbalances, but I do believe some are. Having once found a med that made my depression go away, but unfortunately it never made it to market. 😦

    • August 11, 2017 at 5:21 pm

      I like how the author summed it up in the final paragraph: “While psychiatric medications may be effective over the short term, and while some people may fare well on them over longer periods of time, on the whole they worsen the long-term outcomes of major mental disorders.” There were small segments of populations that really did, in some studies, fare better over the long term.

      Also, I really appreciate how much nuance he can fit into a single sentence. It’s the opposite of various psychiatric organizations over the last several decades; desperate to hold their terrain against psychologists, they emphasized their powers of prescription, coordinating a massive effort to discredit any/all non-biological explanations for mental illness. In their efforts then to set themselves apart, so many patients lost opportunities to try non-medication approaches, as pills were pushed that treated symptoms instead of causing cures. These pills became the first line of defense instead of, say, the eighth, for reasons not to patients’ benefits.

      I digress …

      Still so much to digest! I’ve been supplementing with podcasts and it’s all fascinating, but, man … it is now seriously time to read some more fiction. (Luckily for me, I just picked up a few at the library!)


  4. August 11, 2017 at 10:09 pm

    I’ve seen that trend to that not everything can be a chemical imbalance. Yes, they do advertise this though because I’ve been shown this before in my psychology classes. It’s crazy though. There’s so much more to people than chemical imbalances. – Even as my anxiety advanced, I never thought medicine could “balance” me. I don’t know why, but I felt it. I’ve been doing much better off now and I’ve never taken a single med to balance me out.

    • August 12, 2017 at 7:19 am

      The claim that psychiatric organizations never advertised the “chemical imbalance” origin of mental illness is mind-boggling and maddening! This was so even before I read the Whitaker’s history of the active, considered push toward biological explanations of illness. Not only did the psychiatric community tout the chemical imbalance origin notion far and wide, they engaged in massive, costly, concerted efforts to ensure psychiatrists stayed on message when communicating with the public! They touted the explanation, then reaped the rewards of people believing it, though they themselves had limited understanding of (1) genuine causes and, lacking that understanding, (2) effective cures. (How, after all, do you cure something when you don’t really understand what’s causing it? With a hope and a prayer, which you then dress up as something more official? Argh!)

      When you say “I don’t know why, but I felt it,” I so relate. Yesterday, I spent some time thinking about it, and I wonder if hearing my mom talk about her (not remotely positive) experiences with anti-depressants was part of my own disbelief in being balanced by medicine. When I was prescribed Ativan to help me get on an airplane after I had a panic attack* and deboarded, I was wary, but decided it was OK to use on a limited basis. Eventually, I decided the momentary relief wasn’t worth how flat-to-angry I felt after each use. I stopped taking even as needed, and was fine.

      Later, when a doctor prescribed me trazodone for insomnia, I took only one dose. He told me that it was actually an anti-depressant more typically used for insomnia. It helped me sleep, sure, but I felt like a zombie after that single dose. There was hardly anything “balancing” about it.

      Whatever its source, I’m glad for its wariness. There have been such dire long-term consequences for pills being the first, almost reflexive response to any kind of psychological symptom. Had I been less wary, my life could have taken a very different trajectory. I’m so sad for those who found themselves struggling worse due to the drugs than they did when they first sought relief from whatever ailment the drugs were meant to cure. What a messed-up situation.

      * The doctor was curious how I realized I’d had a panic attack, having never had one before. I said it was pretty clear after I got off the plane. Once back in the wide airport corridors, all my anxiety eased, so that I went, “Wait, that means I wasn’t having a heart attack or something. Which makes it a panic attack, I guess?”

      • August 13, 2017 at 7:23 am

        I agree with you. It’s crazy how they keep advertising the “chemical imbalance” thing. But it’s never going to change when it’s such a taboo to talk about mental disorders. I find it easier to talk to younger people around my age about it, but no older folk ever want to talk about it. They turn away almost every time.

  5. DV
    August 12, 2017 at 4:08 am

    I came across Whitaker’s book a while back, doing my own research during a protracted and seriously unpleasant SSRI withdrawal, but only recently got around to reading it.

    My own experience matches up with a lot of what he says in the book – firstly, that once I started examining my life and asking the right questions it became obvious that my depression was much more related to social factors/ complex trauma than to anything biological, but my medical training had been very much oriented to the biomedical model so I believed what I was being told about my own illness; and secondly, that the drugs themselves can be harmful both in the short term and the longer term. I developed bizarre and violent suicidal ideation in the first few months of being on SSRI’s even though I was supposedly not in the at-risk age group (I was 38), after 12 years on them it was almost impossible to distinguish withdrawal from relapse (and of course the manufacturers have a vested interest in calling it relapse and saying you need to stay on the drugs), and I developed symptoms after withdrawal that I never had before going onto drugs in the first place (e.g. severe anxiety).

    I accept that there may be people who do genuinely benefit in the long term, but personally I feel as if I have been duped and that I have suffered irreversible harm as a result of being prescribed antidepressants for problems which have responded much better to long term therapy. It’s just as well my own field of medical work does not involve having to prescribe these drugs, because I would be very conflicted about using them.

    • August 12, 2017 at 7:43 am

      I’m so sorry to hear about your experiences. I’m grateful to you for sharing them.

      Your comment about SSRI’s and “bizarre and violent suicidal ideation” is one that I wouldn’t have understood even a couple weeks ago. What got me reading Whitaker’s book was psychiatrist Kelly Brogan’s A Mind of Your Own. I’d bought the book last Spring but set it aside because Brogan sounded so paranoid to me.

      I ended up picking it up again last month. I didn’t feel like again reading It Starts with Food, the book that had originally pushed me toward eating an anti-inflammatory diet, but I realized I had to read something to get me inspired again. Forcing myself to do it wasn’t working, so that I figured I needed the reminder why it’s so important to make the right choices.

      With all the reading I’d done the last year or so, Brogan no longer sounded remotely paranoid to me. The deeper I read, the more insistent I felt about going back to clean eating, and making other lifestyle adaptations. I also started listening to podcasts featuring Dr. Brogan. She’s generally very soothing, but she said something that alarmed me, discussing “akathisia-induced impulsivity” in the context of things like mass shooting. Everyone to virtually everyone who’s committed such an act either recently started or recently quit taking neuroleptics. She talked about a man who’d killed his own son after being prescribed medication for … anxiety, I think it was. Around him, people were impressed how calm he’d become, but it was all a facade; inside, he was on fire.

      I was astonished that anyone could freely prescribe medications that have this impact on a portion of the population, and that virtually no prescribers first test to see if a given patient has the liver enzyme variant that would incline them toward such a reaction.

      I decided I had to read Whitaker’s book, and quickly. I’d only read Brogan’s book to get me back down the path to anti-inflammatory living, but here I was wandering down this other path.

      Brogan has a few articles about akathisia. This one has a seemingly innocuous sentence that’s absolutely terrifying: http://kellybroganmd.com/the-violence-inducing-effects-of-psychiatric-medication/ – “All returned to their baseline personalities when the antidepressant was discontinued.”

      Everything I’ve read the last few weeks leaves me … I don’t even have a word for it. I’m just horrified by how much work has gone into prescribing medicine that leaves many people worse than when they started, without prescribers understanding causal mechanisms in the first place, and with such enormous efforts to conceal not-profitable outcomes. To me, it reads that millions of patients’ lives were sacrificed on the altar of some doctors’ unwarranted confidence. Their numbers aren’t just words on a page to me. They are horrific aggregations of the unnecessary, unwarranted suffering of those who hoped to find some relief.

      I believe there are some folks who might benefit, even long-term, from careful, considered, monitored use of this or that drug. If only those folks were sorted out by walking through other, non-prescription measures first, so that all those who could fare well with other, non-prescription interventions were given that chance, instead of sacrificing their long-term well being for short term relief, without having even been informed that such a trade-off is being made.

      It all breaks my heart.

      • DV
        August 12, 2017 at 2:31 pm

        I agree with everything you’ve said, especially how unnecessary it all is. It seems pretty obvious to me that a major factor is attempts by governments and insurers to cut costs by focussing intervention on drugs which are relatively cheap, but it simply shifts the costs elsewhere in terms of disability, and if the *real* costs of mental illness were considered then it would be clear that psychological and social interventions (including in larger scale issues such as access to education, employment, housing etc) are economically rational and beneficial to society as a whole as well as being better for those with mental illness. It’s a particular soapbox of mine and I could go on for ages, but your comments section is probably not the best place to do that.

        The violent suicidal ideation I experienced wasn’t really accompanied by akathisia so I’m not 100% sure if it was the same thing that is described in articles I’ve read, but I’ve never had anything like it before or since. The downside of having it manifest in a fairly quiet way and my maintaining just enough insight to realise that if I revealed it I’d get in trouble, was that the drugs were not stopped or changed at that point. But it has made me sure that now I’m off the drugs I don’t ever want to risk going back on even for short periods. I am aware of the inflammatory aspect of depression and that this can be improved by diet but I haven’t looked at the details in any serious way yet.

  6. August 12, 2017 at 4:37 am

    Hello, My daughter Hazel has been diagnosed with Borderline Personality Disorder as well as Autism and Anorexia. A Total of 5 Psychiatrists have given that Diagnosis. Is Personality Disorder caused by an Imbalance in the Brain If not what causes Personality Disorder . Is anyone able to help me on this one.


    • August 12, 2017 at 6:51 am

      Based on what I’ve read so far, which is limited to summations of research versus the research itself, there’s not one universal cause. Rather, different circumstances in different people can present psychiatric symptoms. Psychiatrist Kelly Brogan has a video on “psychiatric pretenders,” or things that present as psychiatric disorders while being rooted in other biological causes (for example, blood sugar dysregulation and some vitamin deficiencies): https://www.facebook.com/KellyBroganMD/videos/689504204589764/?hc_ref=SEARCH

      What caused me to initially question the universal “chemical imbalance” notion was my own personal experience. After I was exposed to environmental toxins a few years back, I had some pretty terrible symptoms that grew worse instead of better. Other folks around me seemed to adapt to the environment, but I did not. I kept telling myself I’d get better, so I just had to give it enough time … but when my sister told me I sounded like our mom at the peak of her mental illness, I knew I had to leave. Leaving and eating an anti-inflammatory diet made a huge difference within days. It also made me very, very wary about what I’d learned to date about the causes of mental illness. What if, like me, my mom had had a reaction to environmental and social circumstances?

      I had post partum depression after my second son was born. When I had my six-week follow-up, I told the doctor I’d had suicidal thoughts, among other things. She asked if I’d like a prescription for something to help. I said that I was extremely wary of medication, and that I was going to try lifestyle changes first. I took up running again, set aside time for quiet reflection, and resumed my anti-inflammatory diet, all of which had me feeling okay within a couple of weeks. I’m so glad I took this path, because a lot of people are given “short term help” that turns into long-term horrors.

      I’m not a medical doctor and I’m definitely not making any recommendations. But I do want to explain my own trajectory, especially since it so, so closely aligns with other now-healthy folks I’ve talked with the last four years or so.

      Much, much love and support as you walk this road. &heart;

      • August 13, 2017 at 2:20 am

        Thank you so much for sharing some very personal aspects of your life and letting me have all the information required and the Links of course . You are a star and once again Thanks Laurence xxx

  7. her diffident way
    August 12, 2017 at 9:03 pm

    Which mental illnesses are you referring to? Bipolar disorder? Schizophrenia? Would they be included?

  8. August 13, 2017 at 12:32 pm

    I was once told that I couldn’t possibly have a metal illness because pills didn’t work with me. They then went on to tell me I evidently didn’t have a serious problem. I can never fathom out our need to assume that what helps one will help all ( and also that all illness affect people differently)

    • August 13, 2017 at 12:39 pm

      I can’t fathom it, either. I was never able to explain why different bodies could respond different ways to the same thing … now, having read Brogan’s excellent explanation, I’m glad to know how to start trying.

  9. Brandon Neifert
    August 16, 2017 at 8:15 am

    Jordan Peterson has some interesting things to say about this. Mental Illness is a result of “Complexity” in life. If you’ve ever noticed, most people with mental illness have had massive traumas in their life prior to the mental illness. He says that the “Genetic Disposition” that makes the body its weakest, whether the mind, the heart, the lungs, that is the point at which the illness happens, whether schizophrenia, heart disease or melanoma.

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