Do You Still Believe in the “Chemical Imbalance Theory of Mental Illness”? (counterpunch.org)

It continues to come as a great surprise for many people to learn that psychiatry’s leading authorities, including the former longtime director of the National Institute of Mental Health (NIMH), have discarded the “chemical imbalance theory of mental illness”—an idea which has had a profound impact on millions of emotionally suffering people and on our entire society. Acceptance of the idea that a chemical imbalance causes depression transformed the public’s comfort level about taking antidepressants. With a belief that a chemical imbalance caused their depression, accompanied by repeatedly hearing that Prozac, Zoloft, and other selective serotonin reuptake inhibitor (SSRI) antidepressants “work to correct this imbalance,” it seemed irresponsible not to take these antidepressants. So, when exactly did psychiatry discard its chemical imbalance theory? While researchers began jettisoning it by the 1990s, one of psychiatry’s first loud rejections was in 2011, when psychiatrist Ronald Pies, Editor-in-Chief Emeritus of the Psychiatric Times, stated: “In truth, the ‘chemical imbalance’ notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists.” Pies is not the highest-ranking psychiatrist to acknowledge the invalidity of the chemical imbalance theory. Thomas Insel was the NIMH director from 2002 to 2015, and in his recently published book, Healing (2022), he notes, “The idea of mental illness as a ‘chemical imbalance’ has now given way to mental illnesses as ‘connectional’ or brain circuit disorders.” While this latest “brain circuit disorder” theory remains controversial, it is now consensus at the highest levels of psychiatry that the chemical imbalance theory is invalid. The jettisoning of the chemical imbalance theory should have been uncontroversial twenty-five years ago, when it became clear to research scientists that it was a disproved hypothesis. In Blaming the Brain (1998), Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, detailed research showing that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.” But how many Americans heard about this? Ronald Pies claimed in the Psychiatric Times in 2014 that the American Psychiatric Association (APA), the guild of American psychiatrists, fulfilled its obligation to inform the general public with a 2000 public statement that begins: “The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers.” Pies did acknowledge that psychiatry should have been clearer and louder, “Shouldn’t psychiatrists in positions of influence have made greater efforts to knock down the chemical imbalance hypothesis, and to present a more sophisticated understanding of mental illness to the general public? Probably so.” Apparently, authorities at the highest levels have long known that the chemical imbalance theory was a disproven hypothesis, but they have viewed it as a useful “noble lie” to encourage medication use.

Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics, and psychology intersect. His most recent book is A Profession Without Reason: The Crisis of Contemporary Psychiatry—Untangled and Solved by Spinoza, Freethinking, and Radical Enlightenment (2022). His Web site is brucelevine.net

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