Let’s avoid talk of ‘chemical imbalance’: it’s people in distress

I use chemical imbalance as a convenient terms for friends to explain that there is nothing they can really 'do' at the time in that particular expression of symptoms. "It's Chemical" is something they can understand.

A major issue is that a single cartel controls medical(physicians/AMA). It's not necessarily science backed, so this leaves non science issues filled with tradition and authority.

Are lifetime outcomes really better on all these Drugs? Maybe after you already created drug addictions, a different drug would help.

Prior to drug use, I imagine therapy, monetary support, education, etc... Would all be better than 2020s brand name Adderall.

Exactly. What I think people lose sight of is that people with chemical imbalances do, is to create all sorts of behavioral coping mechanisms in their daily lives before they ever see any type of chemical intervention. Once they get that chemical intervention, they then need to deal with the psychological and behavioral issues built up over the years of dealing with a chemical imbalance.

This isn't like a simple infection, where you take a pill and it will go away.

Many depressed people are very resistant to accepting treatment. In a perfect world, people would have no hangups about scheduling an appointment with a therapist and/or trialing antidepressant medication as an adjunct to their recovery.

However, in the real world many people are resistant to the idea of therapy and/or medication as it feels like admitting defeat. Or perhaps they've read cherry-picked horror stories of bad therapists or medication side effects on the internet.

Giving people the "chemical imbalance" narrative is a way to short-circuit many of those internal objections. It gives people a notion that the depression isn't their fault, but rather they are a victim of a chemical change in their body not unlike getting the flu or having low testosterone levels.

In terms of getting people to accept treatment, it's a win. Getting past the ego can be surprisingly hard, but the idea that we're treating chemicals instead of treating the person is a clever trick to sidestep that obstacle and shortcut to the treatment.

In terms of giving people the tools to address their problems, it's not so clear. The more we reinforce the idea that depression is simply chemicals in the brain, the longer it takes for people to realize that they do have some power to influence their thought processes and voluntarily replace negative thought processes with positive ones.

However, it's important to remember what a typical course of treatment looks like. If someone is suffering from depression, getting them to commit to weekly therapy sessions with another person as well as following up with the therapy homework (that is, actually implementing what was discussed at therapy) can be a difficult proposition. Getting someone to stop by the pharmacy on the their way home and spend 10 seconds taking a pill every morning for the next 30 days is an easier proposition. The medication is often the jolt that gets people into a place where they're receptive to therapy, or they start making life changes to improve their depression. It's a quick and easy way to give people space to solve their problems, which is why the "chemical imbalance" sales pitch has become the entry point to getting people on board with treating their depression. Get them to lower their guard, get them started on the easiest treatment, and then work on scaling the treatment up to a more intensive, longer-term plan after they've seen hints of success.

I don't particularly like the "chemical imbalance" sales pitch either, but it really does function as a decent hook for getting people over their objections to starting treatment.

Yes. Psychology must be treated cybernetically, as a historical system of self-environment relationships, which produce state changes within the self.

For anyone interested in "chemical imbalance" theory, I highly recommend reading Carhart-Harris and Friston's paper "REBUS": http://pharmrev.aspetjournals.org/content/71/3/316 -- the basic gist of Friston's model is that the brain functions as a prediction engine, whose "prior probabilities" are "programmed" by past experience (within some environment). This paper addresses the role of serotonin: it reduces the "weighting" of our "prior probabilities" which gives them some malleability, meaning we can allow ourselves to adjust more fully to a new environment (or, if you flood yourself in serotonin, like with psychedelics ... it can nudge your highest-level priors, such as "who am I"?).

So from this perspective, we can see depression as a mis-adjustment between one's self (i.e. adaptation to past environments) and one's current environment (no chemicals involved here), and serotonin can provide a little nudge toward re-adapting.