Please Stop Calling Mental Illness a 'Chemical Imbalance'


Editor’s note: This piece is about the cause of mental illness, not about the effectiveness of medication. Medication helps people manage the symptoms of their mental illness every day, and there is no shame in taking medication if it helps you. Please talk to a doctor before starting or stopping a medication.

“I’m on medication because I have a chemical imbalance in my brain.”

How many times have we either heard or uttered that or a similar phrase? I believed and repeated it ad nauseam. Why? Because it had become a part of the conversation surrounding mental health and wellness. Convenient, succinct and simplistic in its view of mental illness, the phrase and belief caught fire and permeated our consciousness.

There’s only one problem: It hasn’t been proven to be true.

It’s not even a theory in the scientific sense. Theories have been tested, replicated and proven. Consider evolution and gravity. We know they’re true and the mechanisms by which they function. I’ve found the “chemical imbalance” view has its roots in two problematic places: a division of medicine fighting for legitimacy while still in its infancy, and a pharmaceutical industry focused more on increasing their profits than on promoting facts and health.

Psychopharmacology and psychiatry, even into the eighties, were primarily viewed with an eye of disbelief at worst and skepticism at best. They needed a foundation, a keystone upon which they could base their practices. With the introduction of the first psychopharmacological treatments, “chemical imbalance” was a simple way to explain their necessity. What you need is medicine, and I’m the only one qualified to determine your treatment!

Take a moment and give it some thought. Why is it that we can’t identify which medication will work best for a person given their symptoms? Why does a treatment plan succeed with one person and not another, even with nearly identical symptoms? Even now, in many cases, we aren’t sure how or why our mental illnesses work. We have educated guesses and not much more.

The idea of a chemical imbalance as the cause of mental illness is rooted in the belief that we have somehow lost the ability to regulate the neurotransmitters within our brains. There is, however, a fatal flaw in that idea: Not only do we have no way of testing for those levels, but there is no evidence to indicate it as fact. The only thing we have is that some people respond to medications that we think change those levels. At best, it’s circumstantial and at worst its a weak correlation and nothing more.

Truth in mental wellness is an elusive and ever-changing animal, a chameleon that changes depending on the person, the situation and, it seems, the day of the week. The myth or idea of the chemical imbalance makes a diagnosis significantly more palatable and less fear-inducing for people. It can also have negative consequences, as Dr. Nick Haslam found.

Is it possible that some kind of imbalance is to blame or, more accurately, contributes to mental illness? Yes. But, the burden of proof isn’t on the folks who say it’s not. Much like belief in a God, the burden of proof falls on those who make the claim, and not those who dispute it.

The awful and unfortunate truth of mental illness is that we don’t know. We’re learning more every day, and there are researchers dedicating their lives to the hunt for answers, but we’re still so far from any certainties. If we were looking at a timeline for the treatment and diagnosis modalities of mental illness, we’re probably still closer to Phrenology than we are to cures and hard, factual truth.

I’m just some mental health advocate, a glorified blogger with no paper hanging on the wall calling me an expert. I read voraciously, and mental health is my passion, but it isn’t yet my profession. Why should you believe me? Because the facts back me up. Here are just a few places you can find reputably sourced materials.

The National Institutes of Health
Psychiatric Times
Medscape
Harvard

From a piece published by Harvard Medical School:

It’s often said that depression results from a chemical imbalance, but that figure of speech doesn’t capture how complex the disease is. Research suggests that depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems. It’s believed that several of these forces interact to bring on depression.

To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells. There are millions, even billions, of chemical reactions that make up the dynamic system that is responsible for your mood, perceptions, and how you experience life.

What are we to think, then, of a diagnosis of depression, bipolar disorder, etc? How can it be real if we have no way of “measuring” it, if the chemical imbalance idea is off base? In a situation like this, it can feel as though you’ve been invalidated, your struggle has been self-inflicted and the naysayers were right. “Just be happy. Smile and eventually you’ll feel better.” I can’t tell you what to think any more than I can tell you how to feel. On the other hand, you’ve gotten this far because you want to know what I have to say, so I’ll close with the following:

Your mental illness is real precisely because you feel it and experience it every day. We can still treat it (and for some, medication does help) and you can still heal. What’s important is what we do to make ourselves better. Just because it can’t be explained in one catchy phrase doesn’t make your mental illness your fault. Your mental illness probably isn’t a “chemical imbalance” — but it’s still valid.

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Thinkstock photo via Jolygon

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