# It's in peer-reviewed print: no mental illness "chemical imbalance" **URL:** \ **Category:** Great Debates\ **Created:** [November 9, 2005, 3:02am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158 "2005-11-09T03:02:06Z")\ **Posts on this page:** 20\ **Page:** 5
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [November 10, 2005, 6:10pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/81 "2005-11-10T18:10:34Z")
> [@threemae](#): > > **Wesley Clark** , I agree that changes in receptor sensitivity are the most likely mechanism for SSRI’s observed effects. I read an interesting paper in my Computational Cognitive Neuroscience class last year that made the argument that perhaps seratonin is actually positively linked to depression and depressive behaviors. Basically, the arguement continued that SSRI’s increased overall seratonin levels at first and the brain responded by overcompensating and being less sensitive to serotonin, and ultimately this is what led to the weeks long gap in their effects, their final effects in treating depression, and possibly played a role in the highly controversial claim that patients are actually at a higher risk for suicide immediately after beginning SSRI’s. That is interesting. However Inositol, which is a supplement that can increase serotonin sensitivity is used to treat depression as well. So I’m not sure how it works. [http://www.pdrhealth.com/drug\_info/nmdrugprofiles/nutsupdrugs/myo\_0145.shtml](http://www.pdrhealth.com/drug_info/nmdrugprofiles/nutsupdrugs/myo_0145.shtml) ---
**Author:** ![SnakesCatLady](https://avatars.discourse-cdn.com/v4/letter/s/4af34b/32.png) [@SnakesCatLady](https://boards.straightdope.com/u/SnakesCatLady)\ **Post date:** [November 10, 2005, 7:43pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/82 "2005-11-10T19:43:57Z")
> [@AHunter3](#): > > **Snakescatlady** , when you post something that is so easily read as “Well if you got locked up in the looney bin I’m sure that’s where you needed to be”, you should’t be too surprised if you get cussed out for it. That is not what I said. I’m sorry you decided to take that way. What I said was that people don’t usually get locked up just for shits n giggles, even though there are cases where people have been locked up who didn’t deserve it. ---
**Author:** ![Guinastasia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/guinastasia/32/5751_2.png) [@Guinastasia](https://boards.straightdope.com/u/Guinastasia)\ **Post date:** [November 10, 2005, 8:40pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/83 "2005-11-10T20:40:40Z")
**AHunter3** , I’m not trying to make fun of you. I’m simply saying that if your evidence of being right is > [@](#): > > I am right to be so enthused, especially insofar as my brilliant insights are indeed fucking brilliant and they are indeed the key to all manners of things, answers to age-old questions, and I know this because I am in personal contact with God and these things were revealed unto me. It’s a coincidence that the answers to my personal problems just happen to also be the answers to the problems the world is facing in the post-agrarian, post-patriarchal phase it happens to be in now. That God has revealed to you the answer, and thus, we should all take your word at it, well, you know damned well that doesn’t fly around here. And I resent that you seem to look down upon those who WANT to be treated. Maybe you don’t mean it that way, but that’s how it comes off. And I still don’t know what you’d do for those whose illnesses do make them genuinely dangerous. You’d punish them for something beyond their control? ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 10, 2005, 9:55pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/84 "2005-11-10T21:55:28Z")
WHOOPS! It’s the LONG allele (well, some of the variants of the long allele) that is more active, not the shorter one. At any rate, two copies, which alters 5-HT signaling, enhances risk for a variety of psychiatric disorders, and directly implicates serotonin, just as the drugs do. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [November 10, 2005, 9:57pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/85 "2005-11-10T21:57:26Z")
> [@Metacom](#): > > Which part of that are you calling a woosh? I agree with pretty much all of it… I was reluctant to believe **AHunter3** was serious in arguing that things like schizophrenia and bipolarity should be reclassified as non-pathological personal characteristics, like homosexuality. I’m sorry, but these things, however widespread and little-notices they might be in our society, are **illnesses,** and nobody afflicted with them can live or function optimally without treatment. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 10, 2005, 10:12pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/86 "2005-11-10T22:12:36Z")
[Here’s](http://www.reason.com/rb/rb080702.shtml) an OK article on linkages between antisocial behavior and deficiencies of the enzyme monoamine oxidase A. It’s interesting that two different drug classes, the reuptake inhibitors, and the monoamine oxidase inhibitors, specifically target molecules encoded by genes with variants that have robust linkages to psychiatric illness. And this reminds me of something I forgot from reading my mom’s textbooks: These drugs increase synaptic neurotransmitter levels, but the actual signaling of these neurotransmitters can be decreased by down-reglation of neurotransmitter heteroreceptors in the post-synaptic cell. Also, homoreceptors in the presynaptic cell play a role in regulation of neurotransmitter release and reuptake. The take-home message is the drugs screw with this system, and changes in neurotransmission ensue. In the case of antidepressants, it is these adaptive changes to artificially-increased signaling by some or many neurotransmitters that is hypothesized to mediate the therapeutic effect, and may also at least partially explain the delay in response to antidepressant meds., as the changes in neurotransmitter levels they induce are fairly immediate. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 10, 2005, 10:31pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/87 "2005-11-10T22:31:12Z")
[This](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12955294&dopt=Citation) is kind of interesting, and encouraging. The study indicates that when you go back and look a sertraline responders, the time-to-onset of efficacy, and efficacy itself, are impacted by patient genotype, specifically if they are homozygotes for one of the long-allele variants of the serotonin transportoer. In other words, the more they have of the drug target, the better response to the drug. Here we are witnessing, perhaps, the beginnings of effective psychopharmacogenomics. And again, of course, serotonin is involved. ---
**Author:** ![AHunter3](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ahunter3/32/368_2.png) [@AHunter3](https://boards.straightdope.com/u/AHunter3)\ **Post date:** [November 10, 2005, 11:19pm UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/88 "2005-11-10T23:19:30Z")
**BrainGlutton** : > [@](#): > > I’m sorry, but these things, however widespread and little-notices they might be in our society, are illnesses, and nobody afflicted with them can live or function optimally without treatment. Actually, I’m doing quite well and do not consider my condition an illness. I thank you very much for your concern, as long as your concern doesn’t take the form of imposing upon me “help” that I do not appreciate or want. **Guin** : > [@](#): > > That God has revealed to you the answer, and thus, we should all take your word at it, I didn’t say you should take my word for it. I didn’t say that back when my statements got me a diagnosis and a visit to the locked ward, either. What I’ve usually said is some variant of “I’ve had a revelation from God” \ “…of course I could be deluded about the ‘revelation from God’ thing, as could anyone making such a claim, and you should always do the grain-of-salt thing w/reference to such claims. If the content itself isn’t compellingly sensible to you, believing that I obtained it via divine inspiration isn’t going to make it any more so.” > [@](#): > > And I still don’t know what you’d do for those whose illnesses do make them genuinely dangerous. You’d punish them for something beyond their control? If such a person does not voluntarily seek treatment and/or arrange to be held where they can’t harm anyone, and then subsequently does something violent to others, then, yes. It’s what we do to people who hurt others. If that’s not an appropriate response to the hurting of people by others, we need to revamp the entire philosphy of criminal justice, but that’s what we’ve got. If the person is genuinely incompetent, then the designated guardian can make arrangements for that person’s care (and/or isolation from people that this person might harm). This is how we deal with people who lack judgmental capacity in general. In both cases, there should not be a separate set of standards and regs and laws pertaining only to people who are “mentally ill”. ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [November 11, 2005, 12:30am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/89 "2005-11-11T00:30:25Z")
> [@DSeid](#): > > **How good is the evidence that many mental illnesses have a large biologic component?** > > Overwhelmingly good. Of course it depends on the illness and for some psychosocial factors play a bigger role than others. What greatly raises my ire though, is that the “psychosocial factors” seem to be grossly neglected by the mental health industry as a whole, which has become increasingly dominated by a psychiatric viewpoint that seems overwhelmingly focused on those biological factors. I think there are several reasons for this: [ol] [li]Thinking of mental illness like it’s a physical disease absolves the patient of responsibility.[/li][li]Thinking of mental illness like it’s a physical disease absolves others in the patient’s life of responsibility (I’m looking at you, NAMI).[/li][li]Thinking of mental illness as a physical disease means pharmaceutical companies can make a LOT of money.[/li][/ol] Further, I think that there are many cases when “mental illness” is a normal response to an abnormal situation, and leads to a situation where medicating the symptoms is more common (and more profitable) then truly helping the person. (I’m also against non-consensual treatment, which is another thing that I dislike about the mental health establishment. But that’s definitely another thread…) ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 11, 2005, 1:53am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/90 "2005-11-11T01:53:50Z")
> [@Metacom](#): > > What greatly raises my ire though, is that the “psychosocial factors” seem to be grossly neglected by the mental health industry as a whole, which has become increasingly dominated by a psychiatric viewpoint that seems overwhelmingly focused on those biological factors. Haven’t spent much time in the “Self Help” section of the bookstore, I see. ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [November 11, 2005, 2:01am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/91 "2005-11-11T02:01:09Z")
> [@Loopydude](#): > > Haven’t spent much time in the “Self Help” section of the bookstore, I see. Do you think that the “Self Help” section of the bookstore represent the mental health industry? ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 11, 2005, 2:09am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/92 "2005-11-11T02:09:19Z")
Well, as far as the non-drug angle of that industry goes, given that many of the good books in the Self Help section are written by psychologists, yeah I do. There’s an entire field devoted to the notion that patients take ownership of their problems and strive to make their thinking more healthy and constructive. It surprises many that it’s not the “mental health industry” so much as the insurers that make getting talk therapy so difficult. Why? Because talk therapy is hugely expensive. ---
**Author:** ![ouryL](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ouryl/32/6067_2.png) [@ouryL](https://boards.straightdope.com/u/ouryL)\ **Post date:** [November 11, 2005, 2:12am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/93 "2005-11-11T02:12:32Z")
Lake Erie College of Osteopathic Medicine Lake Erie College of Osteopathic Medicine Lake Erie College of Osteopathic Medicine ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [November 11, 2005, 2:18am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/94 "2005-11-11T02:18:44Z")
> [@Loopydude](#): > > Well, as far as the non-drug angle of that industry goes, given that many of the good books in the Self Help section are written by psychologists, yeah I do. OK… I’ll agree that books that aren’t about drugs represent the non-drug portion of the industry. 🙂 I didn’t say that the non-drug angle didn’t exist, I said the mental health industry was increasingly dominated by a viewpoint that favored biological factors over psychosocial ones. ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [November 11, 2005, 2:24am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/95 "2005-11-11T02:24:56Z")
On second glance, you may have been keying off “grossly neglected by the mental health industry” as a whole, and not the immediate “increasingly dominated …” I believe both clauses, of course… ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 11, 2005, 2:36am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/96 "2005-11-11T02:36:44Z")
> [@Metacom](#): > > I didn’t say that the non-drug angle didn’t exist, I said the mental health industry was increasingly dominated by a viewpoint that favored biological factors over psychosocial ones. To which I say I disagree completely. Nearly every article one can cite on the subject of pharmacogenomics mentions the importance of environment in the etiology of mental illness. In fact, the most oft-mentioned reason for explaining the difficulty of finding the genetic components of disease has been the importance of environment, as the heterogeneity of phenotypes vs. genotypes tends to confound any attempt at making simple genetic linkages. It’s a completely built-in concept now: Genetic factors don’t act alone, and there is no single “depression gene” (or BPD gene, or ADD gene, or schizophrenia gene, or any other). The idea that talk therapy is helpful for a vast majority of cases, and can even be substituted for pharmacotherapy in many instances is virtually universally held among mental health practitioners (of which my mother is one). Both drugs and talk are regarded as useful tools, and as talk has few, if any side-effects, many a psychiatrist would rather see their patients get it. Again, the biggest hurdle in the way of patients getting the talk therapy they need are the draconian restrictions put on the number of sessions that will be funded before the patient must pay out-of-pocket. As a single therapy session can easily cost more than a month’s supply of psychiatric drugs, the math isn’t difficult to do. Plus, everyone wants a drug for what ails them, so in the popular media, talk about “the depression gene” and the “cure for mental illness” that comes in a pill gets all the air time. It’s not nearly as sexy on the tube as the months of sometimes arduous and/or tedious talk in an office or group setting that psychotherapy involves. The popularized notion of Prozac Nation is a gross distortion of how care is actually delivered, and how caregivers would like it delivered. ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [November 11, 2005, 3:13am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/97 "2005-11-11T03:13:30Z")
> [@Loopydude](#): > > To which I say I disagree completely. Nearly every article one can cite on the subject of pharmacogenomics mentions the importance of environment in the etiology of mental illness. That explains why that unhappy ovoid in the Zoloft commercial paused to explain that pills may not be the answer. > [@](#): > > The popularized notion of Prozac Nation is a gross distortion of how care is actually delivered, and how caregivers would like it delivered. That’s an overgeneralization. It may be a gross distortion of how care is delivered to some, but it’s a pretty accurate represenation of how it’s delivered to others. ---
**Author:** ![Metacom](https://avatars.discourse-cdn.com/v4/letter/m/ecae2f/32.png) [@Metacom](https://boards.straightdope.com/u/Metacom)\ **Post date:** [November 11, 2005, 3:36am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/98 "2005-11-11T03:36:11Z")
Does anyone have statistics on: [ol] [li]The number of prescriptions for psych drugs written by non-psychiatrists (like, say, pediatricians prescribing ritalin, or GP’s prescribing anti-depressants or minor tranqs) compared to the number written by psychiatrists.[/li][li]The number of people using meds as their sole form of treatment, the number using psychotherapy as their sole form of treatment, and the number using both?[/li][li]Of those using both psychotherapy and meds, how frequently are their sessions?[/li][li]The amount of money spent on psych drugs and psychiatrists vs. the amount of money spent on psychotherapy.[/li][/ol] Just to inject some hard facts into this mess, if that’s possible. 😛 You’re kind of proving my argument, **Loopydude**. You’re saying that we’re not a Prozac nation, then you’re saying that it’s much harder to get long term psychotherapy then psych drugs. The industry may acknowledge the importance of environment, but what matters isn’t what it believes but what it actually does. And, for a variety of reasons, in action it really seems to be favoring a predominantly biological model. That now-infamous Zoloft commercial may not have represented what doctors believe, but it does represent how many act–the “it’s just a chemical imbalance, take the pill” line isn’t some off-the-wall caricture. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [November 11, 2005, 3:51am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/99 "2005-11-11T03:51:57Z")
> [@Metacom](#): > > the “psychosocial factors” seem to be grossly neglected by the mental health industry as a whole, which has become increasingly dominated by a psychiatric viewpoint that seems overwhelmingly focused on those biological factors. I do not totally disagree that the biological/medical model is pre-eminent but I think there are other reasons more pertinent. Therapy aimed at psychosocial factors has little evidence of actually bringing significant results. (Cognitive Behavioral Therapy has an evidenciary basis but is not quite the same.) It is time and labor intensive and not at all cheap. Psychiatrists are not well compensated for therapy, they are compensated for volume. They are no longer well trained for therapy, they are trained well in psychopharmocology. They want to help and really only have one set of tools left in the box, the hammers that are meds. So lots end up looking like nails. Psychologists and social workers are trained in therapy but are paid less well and quality varies drastically. It takes time. Results are often unimpressive. Especially in the absence of treatment with medication as well. Payors often drastically limit the number of sessions approved. Paying for this out of pocket is out of the question for most … excepting Woody Allen, of course. Still there are many out there and therapy is hardly underrepresented as a treatment option. ---
**Author:** ![Loopydude](https://avatars.discourse-cdn.com/v4/letter/l/e56c9b/32.png) [@Loopydude](https://boards.straightdope.com/u/Loopydude)\ **Post date:** [November 11, 2005, 3:53am UTC](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158/100 "2005-11-11T03:53:23Z")
> [@Metacom](#): > > You’re kind of proving my argument, **Loopydude**. You’re saying that we’re not a Prozac nation, then you’re saying that it’s much harder to get long term psychotherapy then psych drugs. How so? You’re making odd and unsubstantiated assertions about what motivates the “mental health industry”, I say the perception of those motivations is distorted, point out how an unhealthy skew toward pharmacotherapy is largely a function of the expediency of drugs, and you say that proves your point. Nor does the “Prozac Nation” caricature in any way resemble the true status of the “industry”. Sure, drugs are probably used when therapy would be just as beneficial due to time or money constraints, and sure primary caregivers probably shouldn’t be doling out these drugs as much as they do, if at all, but again that’s a function of limited resources, not some self-serving campaign on the part of “the mental health industry” to make everything into a biological drug target for profit. [Previous page](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158.md?page=4) [Next page](https://boards.straightdope.com/t/its-in-peer-reviewed-print-no-mental-illness-chemical-imbalance/330158.md?page=6)