A Plea For Holistically Minded Psychiatry
Psychiatrists encourage more holistic models of care
Posted September 29, 2020
Throughout doctors’ offices and mental health clinics, when suffering individuals report ongoing symptoms of depression, anxiety, mood swings, or other challenging mental health symptoms, they are often offered an explanation rooted in the chemical imbalance theory, which asserts that certain brains are chemically altered and deficient in certain neurotransmitters (usually serotonin) and are in need of a pharmacological fix.
From here, patients may receive a prescription such as Prozac, or another well known antidepressant, which is believed to increase the amount of serotonin in the brain, and thus "fix" the chemical imbalance.
For some, these medications work wonders and provide significant relief from debilitating symptoms. Others may struggle with the unpleasant side effects, and may find little to no relief. Despite how well they may work for the majority of the people taking them, this narrative that the mentally ill need psychiatric medications, perhaps indefinitely, in order to fix or correct faulty brain chemistry continues to dominate our culture's understanding of mental health treatment and pathology.
But what if we considered, just for a moment, how true this theory actually is?
What if it’s not as clear cut as certain helping professionals, pharmaceutical ads, or psychopathology textbooks make it out to be?
How might this change the way we view certain medications or larger treatment modalities? How might this impact the way we see ourselves, our brains, and our capacity to change?
To clarify, medications do have their place, and jumping on the anti-psychiatry bandwagon won't get anyone very far. May the following information, however, shed light on another narrative, one that rises above the notion that mental-ill health is rooted solely in a chemically deficient brain, destined to dysregulation and mental chaos without some sort of life-long pharmaceutical intervention. Alternatively, we are holistic beings in need of holistic solutions to the varying challenges and stressors of life.
The State of our System and the Rise in Antidepressants
Antidepressants have dominated the field of mental health treatment, and in 2010, the CDC reported antidepressants as the second most commonly prescribed medication, costing almost 10 billion dollars (1). Between 2011-2014, about 1 in 8 Americans aged 12 and over reported taking antidepressants, with females leading the way (2). There’s been a 65% increase in antidepressant use over a 15-year time frame, from 7.7% in 1999-2002, to 12.7% in 2011 -2014.
The Chemical Imbalance Theory: A Driving Force
Since the 1980s, pharmaceutical companies have directly promoted the "chemical imbalance theory" to consumers and practitioners, to supposedly explain the nature of how antidepressants work. This theory upholds the belief that certain forms of mental illness are tied to a chemical deficiency (serotonin) within the brain. If consumers are led to believe that their mental illness is directly related to a deficiency in their brain, then they will naturally gravitate towards a treatment that "fixes" this imbalance.
Yet, as Dr. Ronald Pies, a professor of psychiatry and editor-in-chief emeritus of Psychiatric Times, states, this "chemical imbalance theory" is more like, "The Theory That Never Was" (3). He writes:
"... SSRIs were accorded a rock-star status as effective antidepressants that they did not deserve. Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the “chemical imbalance” trope in their direct-to-consumer advertising."
Pies goes on to claim that within the field of psychiatry, there was never a "unified, concerted effort...to promote a chemical imbalance theory of mental illness."
While certain hypotheses and theories of mood disorders developed over the years, many have since been recognized as flawed and inadequate. Currently, the precise causes of major mood disorders are still unknown. Pies references the 1978 statement from the American Psychiatric Association as the closest and most accurate position on the etiology and treatment of psychiatric disorders:
“Psychiatric disorders result from the complex interaction of physical, psychological, and social factors and treatment may be directed toward any or all three of these areas" (4).
Dr. Stuart Shipko, a psychiatrist who focuses on anxiety/panic disorders and the side effects/withdrawal effects of antidepressants and benzodiazepines, has also spoken out on the flaws of this "chemical imbalance theory." Based on observations in the field, he developed an informed consent that addresses certain myths related to SSRI treatment along with areas to consider before starting or stopping antidepressants (5).
In his consent, Shipko writes:
"There is no such thing as a 'chemical imbalance.' This phrase evolved largely as a means to market the antidepressant drugs but has been erroneously picked up by physicians as explanation why patients should take antidepressants forever. Often physicians will tell their patients that they have a "chemical imbalance" and that the medications will correct this chemical imbalance. To date there has been no demonstration that patients with depression or anxiety have anything fundamentally wrong with their brain chemistry that causes depression. Although the drugs alter serotonin in the nerve synapses, depression is not a result of a diseased synapse. The decision to take an SSRI antidepressant should not be based on a mistaken belief that the drugs are correcting or curing a diseased brain. To be specific, the manufacturer's labels note that the mechanism of how the drugs work is unknown."
Now, claims stating that antidepressant treatment can cause long term, permanent damage are largely unsubstantiated. It seems as though much of these areas are still up for debate, as we have yet to fully understand the mechanisms behind these medications, and even the brain itself.
The Need for Holistic Treatment
Mental ill-health often involves a complex interplay between certain physical or biological factors, and in serious cases, antidepressant treatments can be very effective in treating symptoms, especially if there are some underlying physiological factors at play. However, the notion of a “chemical imbalance” continues to saturate our culture’s understanding of mental illness, and may limit us to narrow-minded perspectives and treatment modalities. Depression, anxiety, mood dysregulation, and other forms of mental distress may be tied to other underlying conditions (e.g., poor diet, inflammation, autoimmune problems), life-stressors, trauma, and/or other factors at stake—not merely a chemically deficient brain.
As Pies states, "As for the bogus chemical imbalance theory and its misattribution to the profession of psychiatry, it is time to drive the stake into its misbegotten heart. We must focus on providing our patients greater access to holistic, comprehensive psychiatric care."
©2020 Elizabeth Dixon, LISW-CP. All rights reserved.
1. Weil, Andrew. Mind Over Meds: Know When Drugs Are Necessary, When Alternatives Are Better and When to Let Your Body Heal on Its Own, 2017. Print.
2. Pratt, Laura A et al. “Antidepressant Use Among Persons Aged 12 and Over:United States,2011-2014.” NCHS data brief ,283 (2017): 1-8.
3. Pies, Ronald. “Debunking the Two Chemical Imbalance Myths, Again.” Psychiatric Times, 2019, www.psychiatrictimes.com/view/debunking-two-chemical-imbalance-myths-again.
4. American Psychiatric Association. Position statement on active treatment. Am J Psychiatry. 1979;136:753. http://www.psychiatry.org/File%20Library/Learn/Archives/Position-1978-Active-Treatment.pdf. Accessed September 1, 2020.
5. Shipko, Stuart. Dr. Shipko's Informed Consent for SSRI Antidepressants. Kindle ed., 2012.