One of the first terms that parents and others hear when someone shows symptoms of having a mental disorder is “chemical imbalance.” It is the catch-all that often is used to explain why someone suddenly shows signs of major depression, bipolar disorder or schizophrenia. I remember being shocked when I used this term in a news article and was later confronted by someone who proudly identified themselves as being “anti-psychiatry.” She told me that there is absolutely no evidence that mental illnesses are real and/or caused by biological problems inside the brain.
I soon learned that this is an ongoing argument, often a bitter one, waged between different factions in the mental health community.
So I was happy when I was sent an advance copy of the book: SHRINK RAP: Three Psychiatrist Explain Their Work written by Dinah Miller, M.D. Annette Hanson, M.D. and Steven Roy Daviss, M.D.. Their book is being published by the Johns Hopkins University Press next month.
The doctors, who write a popular mental health blog offer their take on “chemical imbalances” and I found their comments helpful.
“Chemical imbalance is a term with imprecise meaning…Saying that a psychiatric disorder is caused by a chemical imbalance, although an imperfect explanation, sometimes makes psychiatric disorders more palatable to patients and less stigmatizing. The term gives some credence to the practice of treating these disorders with medication. But there is no psychiatric disorder for which we know for certain which chemicals are “imbalanced” if any.
“We have reasons for believing that psychiatric disorders must certainly be mediated by biological factors. For one thing, psychiatric illnesses run in families, even when family members are separated at birth. Research has shown that genetic links, and even specific genes, may be associated with different disorders. Many studies have shown that the biological features of groups of people with illnesses are different from those same features in groups of people without those illnesses. What we don’t have, yet, is a specific reliable test for a certain genotype or enzyme level, or a brain scan finding that indicates that a specific person has a specific disease.”
The authors explain that if a person goes to the doctor because of increased thirst or urination and has a lab test done, and it shows markedly elevated blood sugar levels, then that patient most certainly has diabetes. But with a few rare exceptions, such as Huntington’s disease or Jacob-Creutzfelt dementia, there’s nothing like this in psychiatry — no blood test, no x-ray, no CT scan that yields a definitive diagnosis. In psychiatry, blood tests are ordered to rule out medical conditions that masquerade as psychiatric illnesses — especially thyroid conditions or high ammonia levels — or to monitor medication levels to make sure medications are not damaging a patient’s organs.
“We know that the medications used to treat mental illnesses alter the levels of certain neurotransmitters. The antidepressant Prozac increases levels of serotonin in the brain. We don’t know for sure that depression is caused by low levels of serotonin, or that raising these levels is the mechanism that helps to alleviate the symptoms, but many lines of evidence suggest such a connection. In simpler terms, we presume there is a ‘chemical imbalance,’ but it remains uncertain as to what that imbalance actually is. Serotonin may be just one step in the final common pathway, along with many other steps, that contribute to the syndrome of depression. Simply said, we don’t know the exact biological nature of what is wrong when someone has a mental illness; nor do we know for certain the exact mechanism by which medications or other treatments work.”
So does this mean the term “chemical imbalance” is a misnomer?
I don’t think it is. I agree with Shrink Rap. It is an impercise term used by laypersons to explain what we can’t define at this point. But in my view, based on what happened to my son, Mike, and what I observed doing research at the jail in Miami for my book, there is clearly something biological going awry. The heart can get sick and so can the brain.
I was fortunate enough to speak to Dr. Eric Kandel, the Nobel Prize winning doctor, who appeared on Minds on the Edge when it was produced by Fred Friendly Seminars. Dr. Kandel acknowledged that science simply hasn’t been able to discover the “biological underpinnings” of major mental disorders. But that doesn’t mean there is not one or more. He wondered why we continue to separate illnesses in the mind from illnesses in other parts of the body. Because we don’t understand them, doesn’t mean they are not real — as any of us with loved ones who show symptoms of severe disorders know first-hand.
The real tragedy, Dr. Kandel explained, is that medical research in nearly every other area of the body has moved forward significantly with the exception of our brains.
What’s your opinion?