Earlier quoted context omitted.
It’s not either/or. The psychological shit is real, but the physical damage to the brain is real also. Both things are true.
A lot of the medication for psychological issues is aimed at altering the bio chemistry in the brain to mitigate physical problems. The reason that stuff works is because the issues are physical and not imagined. It's also true that certain disorders (e.g. psychosis) actually cause brain damage when left unchecked. This technically is not a single thing but more like a group of disorders with widely varying symptoms.…
Psychological doesn't mean "imagined", just means "in the realm of thought". Your thinking is not "imagined", nor is the impact of decisions, ruminating, etc to you.