The Question of “Chemical Imbalance”

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Dave: One of our readers, Elizabeth, wrote a thoughtful comment about the whole question of “chemical imbalance”.

images-7This was in response to my recent  remarks about “fake news” in a post (see December 10)  Fake News, Fake Ideas About “Mental Health”.  I made the point that the pervasive use of medication for treating conflicts in human experience was based on marketing which can be a form of fake news. The idea is that medications are given to treat chemical imbalances, the chemical imbalance behind depression, behind anger, behind eating disorders. But there is no definable chemical imbalance.

Elizabeth asked, “What am I to do? I am just a psychologist. Clients say, ‘My doctor said it is just a chemical imbalance. The drugs are going to fix it.’”

Late breaking news (Well actually it has been breaking for quite a while but ‘late breaking news’ works better in capturing attention): There is no chemical imbalance. At least there is none that can be measured or quantified. “Chemical Imbalance” is a persuasive metaphor used by psychiatrists, physicians and drug companies to convince people to take medication. Now I am just a guy, allegedly a psychiatrist, who is writing on a blog. And I might be submitting fake news. I can give you references; I already have in other postings. I just want to give Elizabeth some simple advice.

Here’s what I say when the ‘chemical imbalance’ barrier to interaction is thrown or dragged into the conversation:  “I don’t think that way.” That is a simple and honest images-6statement. It is based on my experience. I tend to think that honesty is the best policy. I have spent time trying to figure out what the second best policy might be. I have some ideas, but they come wrapped in humor. I will save that topic for later. Sometimes I put a little conversational seasoning around it, for example “That’s an interesting idea and it isn’t the first time I have heard it. But—I don’t think that way. My experience doesn’t support what your doctor told you.”
“I don’t think that way.”

How do you think?

That is an interesting question. I will try a simple answer. I think all the problems that bring people to therapy, all those problems in the DSM are based in interpersonal experience, what happens between people.
Interpersonal experience includes how you were raised, how your family thinks, how you have been hurt, how you have been loved. It includes what is going on in your lives right now. And includes your thoughts about how life ought to be, what you desire.

To go further, I believe all of the problems I am referring to are connected to caring; caring gone bad and turned into persuasion or manipulation, caring based on too much selfishness, hunger for caring, inability to accept caring, but that is kind of a crazy idea, so you probably shouldn’t listen.
The next part: I don’t attempt to persuade anyone to think like I do and suggest some version of “You would probably be better off seeing someone who thinks like you.”

References: The Drug Companies and How They Deceive Us,  by Marcia Angell. Also helpful is Robert Whitaker’s, Mad In America and An Anatomy of an Epidemic.

Then at the risk of being self promoting, I edited a book with Phoebe Prosky, Family Therapy as an Alternative to Medication: An Appraisal of Pharmland, which addresses some of these issues.



  1. In order to be honest in our field, we have to be brave as well. What helps me, is to read whether any claims have a solid backup based on ethical research (done by those without a conflict of interest).
    …and in the end the quality of the therapeutic relationship, the connection between client and therapist is the most powerful ingredient in therapy.

    1. If there is any more you want to know ask a few more questions. There is more to say.
      I am saying this with a sly smile. I hope you know how to appreciate a sly smile.
      If psychotherapy is a business, it is a business in which the customer is always wrong.

  2. Sorry, me again,
    Was thinking about my first love Carl Rogers “the facts are friendly” (Rogers, 1961, p.25).
    Rogers, C.R. (1961). On becoming a person. New York: Houghton Mifflin Comp.

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