Chemical Imbalance of the Brain: An Idea That Must Die

Patient Expert

Last year, I began doing pieces based on Edge questions. Edge, which bills itself as an online salon, annually asks a provocative question of leading scientists and writers and the like. Their answers are published as a series of  books.

You can find my five previous bipolar takes to the following questions by clicking the links below:

What Have You Changed Your Mind About? Why?

What Scientific Concept Would Improve Everyone's Cognitive Toolkit?

What Is Your Favorite Deep, Elegant, or Beautiful Explanation?  

What Scientific Idea is Ready for Retirement?

What Do We Believe But Cannot Prove?

This year's Edge question is framed as a statement: This Idea Must Die: Scientific Theories That Are Blocking Progress. This was an easy one:** Chemical imbalance of the brain.** The scientific community emphatically laid this idea to rest ages ago, but you would never know that by looking at the literature handed out to patients. This from a depression fact sheet on NAMI's website:

Norepinephrine, serotonin and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers.

Since NAMI is by far the largest family-patient mental health advocacy group in the US, you can appreciate the magnitude of this misinformation.

Yes, our neurotransmitters do play a major role in our mental health, but as I pointed out in a piece last year, it is more helpful to think of them as signaling agents in our neural circuitry, namely:

Our circuitry connects the disparate parts of the brain into a working whole. A breakdown in the circuitry can have profound effects. These breakdowns typically have to do with the strength or weakness of the signaling.

Thus, we may hit the right neurotransmitter, but in the wrong circuit. Or we may reduce the symptoms of our illness, only to wind up feeling much worse and far less capable of coping with life's challenges.

"Chemical imbalance" also completely ignores the complex interactions between the genes and our environment and how this plays out - via circuitry - in our thinking and behavior. This has been the dominating paradigm of brain science since at least the 1990s.

In addition, chemical imbalance disregards a number of number of other operating theories of mental illness, including brain development and epigentics, not to mention the effects of stress and trauma. Finally, it pays no attention to what is going on outside the brain, such as hormones secreted into the blood stream.

This is no mere esoteric argument. A simplistic explanation of a problem, together with its simplistic solution, discourages patients from making their own enquiries and coming up with more productive recovery strategies.

As well as standing in the way of our understanding and recovery, chemical imbalance unleashes the monster of stigma. Think about it - if a chemical imbalance is so easy to correct, then why does mental illness persist?

It must be our fault, right?

Crazy thing, NAMI and other advocacy groups promoted chemical imbalance as a way of combatting stigma. Ironic, isn't it?