COMMENTARY

Nuances, Narratives, and the 'Chemical Imbalance' Debate in Psychiatry

Ronald W. Pies, MD

Disclosures

April 15, 2014

In This Article

A Chemical Cliché: Introduction

Religions, cultures, and political groups all have their narratives -- usually favorable or flattering accounts of their origins and beliefs. But narratives are not the same as truths, and usually lack the nuances of truth, which is rarely black or white. To see how this applies to psychiatry, try answering the following question:

Which one of the following statements best characterizes the American Psychiatric Association (APA) 2005 position on the causes of mental illness?

1. All mental illness is caused by specific and identifiable chemical imbalances in the brain.

2. The most serious mental illnesses, such as schizophrenia and major depression, are caused by specific chemical imbalances.

3. Chemical imbalances of some sort cause some mental illnesses.

4. The exact causes of mental disorders are unknown.

Now, if you were to give credence to a recent online polemic posing as investigative journalism,[1] you would probably choose the first or second statement. In the narrative of the antipsychiatry movement, a monolithic entity called "Psychiatry" has deliberately misled the public as to the causes of mental illness, by failing to debunk the chemical imbalance hypothesis. Indeed, this narrative insists that, by promoting this simplistic formulation, psychiatry betrayed the public trust and made it seem as if psychiatrists had magic bullets for psychiatric disorders. (Lurking in the back-story, of course, is Big Pharma, said to be in cahoots with Psychiatry so as to sell more drugs).

However, if you had actually investigated the APA's 2005 statement, you would have chosen statement #4. Here is the complete passage from the APA's Healthy Minds Website, intended for the general public[2]:

The exact causes of mental disorders are unknown, but an explosive growth of research has brought us closer to the answers. We can say that certain inherited dispositions interact with triggering environmental factors. Poverty and stress are well-known to be bad for your health -- this is true for mental health and physical health. In fact, the distinction between "mental" illness and "physical" illness can be misleading. Like physical illnesses, mental disorders can have a biological nature. Many physical illnesses can also have a strong emotional component.

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