"I don't believe I have ever heard a knowledgeable, well-trained psychiatrist make such a preposterous claim [that patients have a chemical imbalance], except perhaps to mock it...In truth, the 'chemical imbalance' notion was always a kind of urban legend—never a theory seriously propounded by well-informed psychiatrists." –Ronald W. Pies, M.D., Professor of Psychiatry, the State University of New York and Tufts University School of Medicine
Having practiced psychotherapy now for nearly a decade, I continue to be amazed by the number of patients who come in and claim to have a chemical imbalance in their brain. Not only is the chemical imbalance theory of mental disorder unsubstantiated by any empirical research, but it has also been widely and publicly refuted by a number of prominent psychiatrists, like Allen Frances and Ronald Pies above. In fact, I have found that the most militant proponents of the chemical imbalance idea to be nonpsychiatrists—like social workers and clinical psychologists—who cling to the theory as a way of validating their status as "health professionals."
What is the origin of the idea that mental disorders are caused by chemical imbalances in the brain? American psychiatrists of the 1960s and 1970s tended to be skeptical of biological theories of mental disorder. Many psychiatrists of that era were trained in the heyday of Freudian psychoanalysis and thought biochemical theories of psychiatric illness to be, at best, overly simplistic and reductionistic explanations of much more complicated psychological phenomena. It was not until the late 1980s, after the release of the landmark antidepressant Prozac, that the idea of the chemical imbalance hit the psychiatric mainstream. As the psychiatrist Peter Breggin (1991) points out in his book Toxic Psychiatry, the drug company Eli Lilly advanced the chemical imbalance theory as a marketing scheme to sell their new drug Prozac. There was, of course, no demonstrable evidence showing that depressed patients had any imbalance, but Lilly ran with it. Before long, psychiatrists and psychiatric patients alike came to identify with the idea that mental disorders are caused by chemical imbalances in the brain.
Why does the chemical imbalance theory live on despite the fact that it is well-established to be a myth? The idea of a chemical imbalance is a simple and succinct way for psychiatrists and other mental health professionals to communicate to patients and their families that psychiatric conditions are "real," regardless of whether they are medical or nonmedical. "Chemical imbalance" provides a seemingly scientific-sounding explanation to human problems that have historically evaded scientific inquiry. To this day, there exists not a single biological test for any mental disorder, despite claims to the contrary. To assert that a patient has a chemical imbalance is to validate and confirm the experience of the suffering person.
The chemical imbalance theory offers something else, however, and that is the opportunity for the psychiatric patient to limit responsibility for his condition. It has long been noted, particularly by psychoanalysts, that many of the problems labeled psychiatric symptoms are attempts by the person, consciously or unconsciously, to evade responsibility for his conduct. The depressed patient withdraws and removes himself from his stressful environment. The dissociative patient switches "alters" at times when it is most convenient. The psychotic patient creates his reality when he is no longer able to handle his affairs. It is no secret that human beings have a love-hate relationship with responsibility. They love the freedom that responsibility affords, but they fear the thought of being responsible for everything they do.
In addition to these factors, the chemical imbalance theory is perpetuated by self-interested psychiatrists who have a vested stake in repositioning psychiatry firmly as a branch of medical science. For many years, psychiatry was seen as the "red-headed stepchild" of medicine. Psychiatrists were not "real doctors," and they offered little more to their patients than custodial care. The chemical imbalance theory afforded psychiatry a way out of its subordinate position and into the mainstream of medicine. This, coupled with the very powerful financial interests of the pharmaceutical companies, has contributed to the widespread—but mythical—belief in the existence of a chemical imbalance causing mental disorders.
The late psychiatrist Ron Leifer said it best: "There's no biological imbalance. When people come to me and they say, 'I have a biological imbalance,' I say, 'Show me your lab tests.' There are no lab tests. So what's the biochemical imbalance?" (Citizens Commission on Human Rights, n.d.).
Breggin, P. R. (1991). Toxic psychiatry: Why therapy, empathy, and love must replace the drugs, electroshock, and biochemical theories of the “new psychiatry.” New York, NY: St. Martin’s Press.
Citizens Commission on Human Rights. (n.d.). Real disease vs. mental “disorder.” Retrieved from http://www.cchr.org/quick-facts/real-disease-vs-mental-disorder.html
Pies, R. W. (2011, July 11). Psychiatry’s new brain-mind and the legend of the “chemical imbalance.” Psychiatric Times. Retrieved from http://www.psychiatrictimes.com