In this podcast (episode #413) and blog, I speak with best-selling author, journalist and mental health advocate Robert Whitaker about the myth of the chemical imbalance, the politics of psychiatry and Big Pharma, and why we need to change the way we think and talk about mental health.
Whitaker sees his role as a science journalist as someone who is an honest communicator. Science journalism is a public service—it involves presenting real, evidence-based science to the public, not marketing.
This role as an honest communicator shaped Whitaker’s work as director of public relations at Harvard Medical School, and eventually led him to investigate the myth of the chemical imbalance, how medical professionals can delude themselves, and how money and business can corrupt medical practice, including psychiatry.
From the 1970s, drug companies and many mental health professionals have largely marketed psychiatric drugs as anti-psychotic, anti-depressive, or anxiolytic (anti-anxiety)—cures combating a particular disease, notwithstanding the lack of evidence for chemical imbalances or other pathologies related to mental illness. This was recently highlighted in a groundbreaking study led by the psychiatrist and researcher Joanna Moncrieff (You can listen to a recent interview I did with her here).
As Moncrieff and Whitaker point out (as do many other mental health professionals and advocates), the chemical imbalance approach is shaped by the assumption that symptoms of depression and other mental health issues are caused by a brain chemical abnormality, and psychotropics like anti-depressants help rectify this abnormality and improve mental health.
Although this hypothesis currently dominates the field of mental health and the public’s imagination, we have no evidence that it is the best way to understand mental issues and psychiatric drugs. There is no strong evidence that issues like depression are associated with particular biochemical abnormalities such as low serotonin, and we do not know if the mental health drugs we use correct any biochemical imbalances in the brain.
The mental health drugs we use are psychoactive, which means they cross the blood-brain barrier and change the normal state of the brain. They can change our feelings, thoughts, perceptions and even behaviors just in the same way a substance like alcohol changes our mental state. This is NOT purely “evidence” that these drugs work like insulin for people with diabetes, as is often claimed. In fact, there is actually a large body of evidence that long term use of these drugs may increase chronicity of mental disorders, and possibly even cause chemical imbalances in the brain.
Whitaker writes about this in his incredible book Mad in America. He examines the history of psychiatry in America up to present times, a history that is more often than not shaped by delusions about the merits of psychiatric treatments. He further examines the modern failures of psychiatry in depth in his book Anatomy of an Epidemic, as well as in articles for the Mad in America organization, which Whitaker founded to inform and help people who are suffering and to change the way we think about mental health.
We need to look no further than the chemical imbalance myth to see the need for changing the way we understand mental illness. A recent paper published by Joanna Moncrieff, Mark A. Horowitz et al. on the chemical imbalance myth and depression highlights the fact that “there is a long line of research that failed to find evidence supporting the low-serotonin theory of depression”, also describes how, despite knowing this, many mental health professionals, including the American Psychiatric Association, in concert with pharmaceutical companies, promoted the low-serotonin theory to the public long after it had been found to be without merit, which Whitaker believes is valid basis for a class action lawsuit.
The fact that the chemical imbalance theory has long been shown as inadequate and still promoted in mental health settings is unacceptable. As Whitaker points out, “surveys in recent years found that 85% to 90% of the public believed that low serotonin was the cause of depression, and that antidepressants helped fix that imbalance”, which is a sign of mass deception in the field of mental health—this is medical fraud. It is not okay to lie to psychiatric patients for decades and just push this information aside as nothing important.
In a recent article for Mad in America, Whitaker notes: “All societies need their medical communities to provide the public with honest information about what is known about the nature of an illness, and the risks and benefits of a treatment for that illness. The chemical imbalance story of depression violated that obligation of honesty, and egregiously so. In lieu of information necessary for a depressed patient to give informed consent, patients—and the public—were told a false story that benefitted guild interests [of psychiatry—to make them look more like “real doctors”] and the financial interests of pharmaceutical companies. In essence, a marketing story was substituted for a scientific one.”
These findings, alongside other research done in the field of mental health, highlight the fact that things are not getting better for many people. In a study by the WHO organization, for example, it was found that people that did not live in developed nations actually had better long term schizophrenia outcomes than people who have access to the supposed “gold standard” of mental healthcare.
But there is hope! If you look at what the scientific literature says, time and again you observe high natural recovery rates from issues like depression, anxiety and even psychosis. Contrary to popular opinion, we do not have to assume that all mental disorders are chronic, life-long disorders that people just have to learn to live with.
Human beings are incredibly resilient with an amazing capacity to recover. This is where we need to shift our focus—this should be the foundational narrative that informs our mental health systems and the way we structure our communities. This hope-centered narrative shifts blame away from the individual and towards finding ways society can change to meet people’s complex needs and enhance human flourishing. As Whitaker notes, if we have a different narrative, we can have a different paradigm of care.
For more on mental health and the chemical imbalance myth, listen to my podcast with Robert Whitaker (episode #413), and check out his incredible work and books. If you enjoy listening to my podcast, please consider leaving a 5-star review and subscribing! And keep sharing episodes with friends and family and on social media (don’t forget to tag me so I can see your posts!).
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5:05 Why Robert Whitaker is so passionate about mental health
6:00 The need for real mental health science, not marketing
8:13, 30:00 The myth of the chemical imbalance
9:15 Whitaker’s amazing book Mad in America & psychiatry’s many delusions
11:20 How psychiatric drugs can affect people in the long term
13:12 The recent scientific article that everyone is talking about
16:00, 44:40 We have all been lied to & it is time to take action
24:00 Debunking the myth of progress: the WHO study
27:40, 33:00, 1:12:00 There is hope!
30:00 Why Robert Whitaker started his organization Mad in America
41:00, 1:20:00 The pathologization of childhood
46:00 The disease model has made things worse
55:00 Drug outcomes in real world patients & how psychiatric drugs can impact the brain
1:08:00 How our experiences can change us mentally & physically
1:16:20 What is wrong with the DSM
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