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

psyche.co

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

#61

Post by jml7c5 »

css wrote: post #6

> to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece. *Even the study…

I'd like to pull the full quote, which is more nuanced:

>As I argue in my book Chemically Imbalanced (2020), to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language. Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’. Nor does the beneficial use of psychiatric medicines require it. In fact, their precise mechanism of action and relation to troublesome experience remains a mystery. It would be more truthful for mental health professionals and public health campaigns to acknowledge this.

It's helpful to note the flipped the burden of proof here: the author argues there is no evidence for "chemical imbalance" language, not that there is evidence against "chemical imbalance" language. I see it as an admission of uncertainty rather than claim of knowledge; the use of the somewhat tepid phrases "need to move away from", and "complex and indeterminate picture" are a further sign the statements are not categorical.

Though I could have misunderstood their thesis. I'll find out once I've read the book, I suppose. :-)

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

#62

Post by Barrin92 »

css wrote: post #6

> to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece. *Even the study…

'Chemical imbalance' as a causal explanation seems to me almost useless because every severe change in behaviour pretty much by definition corresponds to change in the brain. How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?

There can be a company pouring lead into a river, psychological hazard during a civil war, and it will always manifest in the brain, what kind of explanation is this? Of course these things can be found in the brain, it would be crazy if they didn't.

That's not to say there's no diseases that are actual individual pathologies of the brain of course, but to use 'chemical imbalance' as a sort of first order response to what may have actual social or environmental reasons say, is entirely circular reasoning.

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

#63

Post by calibas »

wincy wrote: post #50
sillysaurusx wrote: post #13

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused. Finally, a thread where I can point out my own experiences. Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why. All of that changed after going on Proza…

I started having disturbing, invasive thoughts a few months before the pandemic hit. I’d be watching a movie with my family after dinner then boom, I’d feel insane. It wasn’t suicidal just things like “soon you will be DEAD!” kind of stuff. Turned out it was me reacting to some of the food we were eating at home. The GP I saw suggested Lexapro which I’ve taken before and it’s not for me. I told him the problem had a…

Many neurological disorders are at least linked to gut bacteria, including autism and schizophrenia.

https://www.sciencemag.org/news/2019/05/gut-bacteria-may-con...

https://www.psychologytoday.com/us/blog/balanced/201903/schi...

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

#64

Post by verylittlemeat »

Is there any way to get off the euphemism treadmill?

First we had to create new terms because the old ones carried baggage. Now we have to righteously and victoriously claim the old ones because we should be proud of our baggage.

Call it chemical imbalance or call it people in distress; is any of this language vacillating actually enabling better treatment or is it just a way for people to get honors and headlines without actually having to actually produce science.

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

#65

Post by maksimilian »

wincy wrote: post #50
sillysaurusx wrote: post #13

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused. Finally, a thread where I can point out my own experiences. Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why. All of that changed after going on Proza…

I started having disturbing, invasive thoughts a few months before the pandemic hit. I’d be watching a movie with my family after dinner then boom, I’d feel insane. It wasn’t suicidal just things like “soon you will be DEAD!” kind of stuff. Turned out it was me reacting to some of the food we were eating at home. The GP I saw suggested Lexapro which I’ve taken before and it’s not for me. I told him the problem had a…

You should check out this company studying the gut brain axis :)

https://www.kallyope.com/

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

#66

Post by GordonS »

sillysaurusx wrote: post #13

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused. Finally, a thread where I can point out my own experiences. Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why. All of that changed after going on Proza…

I've suffered with depression my entire life, or at least as far back as I can remember. Even as a young child I felt that way - despite the fact that my mother was a manic depressive (with multiple suicide attempts and stays in psychiatric hospitals over the years), I didn't recognise it as depression until I was much older; firstly because it was how things had always been, and secondly I guess because I got so good at hiding it that I'd subconsciously convinced myself.

I was always sad, and saw little meaning in my life, or in life at all, really. I cried lot. I frequently fantasised about killing myself, though I never got close to actually doing so.

I never talked about the way I felt. I felt ashamed, and I felt that people wouldn't understand - I've often heard "normal" people talk of how depressed people should "man up" or "get over it". Over the years, I got very good at hiding my true feelings. AFAIK, nobody ever guessed.

Maybe 5 years ago I started taking 5-HTP, which I believe has an SSRI effect (but one that is more short lived than pharmaceutical SSRIs). I actually started taking it for another reason (neuropathic pain, which has of course not helped with depression!), as I'd never considered treating the way I felt with chemicals, but within a few weeks the difference in me was incredible - I realised I hadn't cried in a while, and hadn't felt the immense lows that I felt every couple of weeks or so.

I still take 200mg twice a day, and get immense benefit from it - it's not a cure by a long shot, but after a lifetime of feeling miserable, the change is amazing. I seldom cry for no reason, and I rarely experience extreme lows (and when I do, they are less severe and shorter lived).

More recently I also started taking ketamine for my neuropathic pain, but it's actually further enhanced the anti-depressive actions.

I've tried SNRIs and SSRIs for my neuropathic pain, but am unable to tolerable them. If anyone else is in the same position, I'd very strongly recommend reading about 5-HTP and thinking about trying it. If you've tried SSRIs and they've failed for you, then it might be worth looking into ketamine (though I realise that may not be an option depending on where you live).

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

#67

Post by slfnflctd »

PragmaticPulp wrote: post #33
sillysaurusx wrote: post #13

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused. Finally, a thread where I can point out my own experiences. Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why. All of that changed after going on Proza…

> 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 ten…

Great comment, I mostly agree. There are clearly many people who've been helped.

Some of the other contraindications (for the disparate group in that 1% you mentioned) are still important to mention, I think.

If you're not certain you'll always have health insurance. If you may ever want to try MDMA therapy, or just about any type of psychedelic therapy (or use them recreationally). If you're uncomfortable with being on something like this super long term and/or are concerned about withdrawal issues. If you can't stand the thought of risking becoming a happy-ish, functional zombie with no sexual interest in your partner. If you're worried the doctor won't diagnose you correctly. If you're not sure you can emotionally handle going through potentially a year or more of trial & error and having to wait months each time for results. Then think twice.

I am extremely glad for the people SSRIs have saved, especially those who wouldn't have made it otherwise. It is also incredibly clear to me that despite my continuing issues with depression, they are probably the wrong approach for me.

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

#68

Post by chasd00 »

sillysaurusx wrote: post #13

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused. Finally, a thread where I can point out my own experiences. Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why. All of that changed after going on Proza…

I'm the same way with ADD, getting on medicine changed my life. Unfortunately, i waited until my 30s to actually go to a doctor (at my poor wife's demand, i mean suggestion). All my life I had been told i wasn't smart enough nor studious enough to do the things i wanted and so struggled through it all. Getting on a medication changed everything for me. I use the analogy of imagining your day as a good, solid, sprint. You finish tired but you did it and feel good about it. For an unmedicated person with ADD it's a good, solid, sprint but up hill. Everything is just that much harder and exhausting than for a normal person.

ADD drugs obviously get abused and so I think they get a bad reputation and, for sure, can be dangerous and have side effects.

Same goes for pain medication. For real, genuine, chronic pain sufferers Oxycontin and the others are life changing. However, the drugs also get abused and are addicting so the real benefits can get masked.

The last thing i'll say is it takes a disciplined prescriber when dealing with these kinds of drugs. As software engineers, I'm sure we're all guilty of just throwing code at a problem. Many prescribers are guilty of just throwing Adderall at a problem or throwing Oxycontin at a problem without really understanding the root issue.

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

#69

Post by numakerg »

thelittleone wrote: post #41
sillysaurusx wrote: post #13

they struggled against the dehumanising notion that their thoughts, feelings or behaviour were mechanistically caused. Finally, a thread where I can point out my own experiences. Around four years ago, it would be fair to call me slightly crazy. It was a harmless sort of crazy, but it was quite self-destructive. I used to wake up wishing to die, genuinely, and not knowing why. All of that changed after going on Proza…

Thanks for sharing. I've always been firmly grounded and positive person. And then a few years ago riding my bike down the road, I felt a immense wave of anxiety coming over me so intense that I felt like jumping off my bike and running away from myself. As an ex army special forces guy I found this particularly disturbing. And this was just the beginning. My situation continued in that general direction until I star…

> Symptoms among others include anxiety, depression and irritability.

It wasn't until the late 1800s that the miasma theory of disease was overturned in acceptance by germ theory. At some point in the next century, computers will become powerful enough to closely simulate the entire human body. We'll be able to hook up our bodies and compare them to a common model in a sort of "debugging" process. I think what we'll find is a diverse host of viruses and parasites, or other curable abnormalities that are responsible for mental health problems.

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

#70

Post by abnry »

css wrote: post #6

> to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece. *Even the study…

It's interesting the author argues dropping the term to reduce stigma because many people argue for using the term in order to reduce stigma. That is, if you can explain what is going on with you with some biological case, it seems so much less of a personal indictment than if the case is considered to be psychological.

That said, I completely agree that the explanation should be dropped because we really have little to no evidence for it.

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