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

> In promoting a biogenetic causal theory, anti-stigma campaigners – as well as psychiatrists, the popular media, and others – hoped to convince people that mental illnesses are ‘just like’ other chronic physical ailments, such as ‘heart disease or diabetes’, to quote the APA, and could be medically addressed.

We're very caught up in naturalistic thinking. Speaking of a soul or the mind is frivolous at best, and superstitious at worst. But look where this way of thinking has brought us.

The brain and the heart are two different organs. But while we can use science to gain an understanding of the brain, the mind is understood by philosophy and religion.

Case in point, I once asked a friend of mine if he could prove that he loved his wife. He said if he were able to freeze time, and gain knowledge of every synapse, every chemical reaction, every electrical potential -- he could definitively prove that he loved his wife, and she loved him.

"When you get home," I responded, "remember to duck when you tell your wife you want to go have her brain scanned to prove she loves you."

> All of that changed after going on Prozac. I don't know why, and I've heard from many others that Prozac was harmful to them.

SSRIs are some of the most widely-used medications. Tens of millions of people in the United States alone use SSRIs regularly with good results.

No medication is perfect, obviously, and at scale we're bound to see a percentage of people have negative experiences. The problem is that when tens of millions of people have tried SSRIs, even 1% significantly negative reactions adds up to a very large number of people. If 1% of those negative reactions make a point of blasting their negative experience all over the internet, we'll see thousands of negative reports everywhere.

Combine this with the fact that few people are willing to publicly admit that SSRIs helped them, and the bias toward negative reviews online is huge.

SSRIs are a particularly difficult topic, because they have a noticeable treatment lag (can take up to 1-2 months for positive effects, with positive effects increasing up to 6 months out) and can, in some cases, temporarily worsen symptoms during the initial ramp-up period.

Even more difficult, not all SSRIs are the same. It might take 2-3 trials before someone finds the SSRI that works best for them. It might also take several dose adjustments to find the right tradeoff between efficacy and side effects. Unfortunately, many people go online and seek out horror stories before they have a chance to go through a few rounds of medication adjustments to make it work for them.

Thanks for sharing your positive success story online. SSRIs aren't for everyone, but it would be a shame for people to spend years suffering from depression when a few SSRI trials might reveal an easy improvement to their lives. Worst case, they can taper off (tapering helps avoid discontinuation effects) and move on to different treatment avenues.

From TFA:

> There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’.

The Lost Connections book, which I read a few years ago, really helped hit this home for me. Totally made me reconsider my view of depression and treatment.

Not to reduce a complex topic to an aphorism but: if the world is configured in a way thats antagonistic towards you, a negative response is understandable. A lot of this stuff fits neatly into a tradition of blaming people for their conditions that, by and large, they have little control over.

Oh, another aphorism that's always stuck with me is "the difference between 'crazy' and 'eccentric' is a million dollars."

>"There is some truth to the metaphor, but I wonder if it’s doing more harm than good."

In my experience, whether the metaphor does more harm than good really depends on the individual patient.

When faced with the chemical imbalance metaphor, some people will bristle and say they're not "broken." Or they'll feel disempowered because they feel like they can't do anything but take a pill (or three).

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For others, it lifts a weight off their shoulders. Most people battling with mental illness have struggled and tried various coping mechanisms to feel "normal." The understanding that the issue chemical, not behavioral, lets some people forgive themselves.

Instead of "not being normal enough", the cause is external; it's something they can't just brute force their way out of. Externalizing the issue lets the person stop feeling guilty that they weren't able to solve their own issue. This clears the slate for the person and leads them to a path toward recovery from mental illness.

NOTE: I'm not a doctor. But everyone in my immediate (and most of my extended family has been diagnosed with a chronic mental health issue. So has my wife, our girlfriend, and many others in my life. So it's well-founded anecdotal evidence. And, for what it's worth, I'm in the second cohort I described above.