Mental Disease and Chemical Imbalances

I think Squink hit it solidly.
Too simplistic and dismissive? Well, not really when you get into detailed study of neurotransmitters and find that the maze expands.
Prozac may increase your serotonin levels, but whether that decreases depression or numbs your feeling of depression or what is still up for grabs.

And thanks for the link…never heard of Wikipedia before, looks interesting.

For the most part, the appropriate dose of skeptical salt has been added to this thread by other posters (pleasant surprise!).

Short answer: no one knows. The items called “mental illness” are poorly defined and poorly understood.

Political codicil: the fact that no one knows is obscured in part by the economic politics of the pharmaceutical industry which would like us all to believe that their wares work with far more specificity and reliability, and far fewer undesirable general effects and side effects, than is actually the case; in part by the social politics of involuntary treatment, because it is easier to defend imposing unwanted treatment on people if you can declare that you know with certainty that their disturbing behavior is caused by a chemical imbalance that will be fixed (with specificity and reliability and few side effects, blah blah blah) as soon as we shoot them up with the latest WonderDrug; and in part by the interdisciplinary politics of the field of medicine, which deserves a paragraph of its own.

The field of medicine is, as you know, subdivided into subfields such as neurology, endocrinology, gastroenterology, and so forth, and psychiatry is theoretically among them, but for reasons historical and social, not entirely, not quite. In the vicinity of a century ago, a great many human ills were not yet fully understood, but the hope was that the shining beacon of scientific inquiry would make them yield up their secrets; and the general disease-model they worked from made them think in terms of every ailment (symptom) being due to a specific and different disease which would be an infection, inflammation, or disordering of a tissue or organ, and the right medical intervention would address this and cause a cure. Problem was, mental health was being dealt with as a social problem rather than a medical one, as “madness” always had been since long before modern medicine, and in practice the doctors who were hired to be in charge of mental institutions were hired more to convey authority and gravity than to do treatment and research. The first major breakthroughs in understanding “mental illnesses” in conventional medical-model terms didn’t come from within psychiatry but from elsewhere: one dementia turned out to be latter-stage syphilis; another became understood as part of the pattern of epilepsy. What happened was that these diseases, now understood, were taken out of the realm of psychiatry – you don’t go to a psychiatrist to get your epilepsy or your syphilis treated – and over time what remained defined as “mental illness” were those things that had never yielded up solid etiological explanations. And the other branches of medicine continue to view psychiatry, not without a fair amount of justification, as pseudo-medicine. Within the understandably defensive field of psychiatry, there is a certain tone of “I am not a quack, look, we treat specific medical ailments which are scientifically known to be chemical imbalances of the brain and we know what causes them and we can fix them with our medicines, see?”

But it simply isn’t the case. Compared to how we understand schizophrenia and the other “mental illnesses”, our understanding of AIDS, cancer, Alzheimer’s disease, and other medical problems considered to be modern challenges for the medical field looks complete and rigorous in detail.

Back up that claim. Let me see cites from professional journals.

I work at the “Institute of Psychaitric Research” at IU Medical Center. I am a molecular biologist. I investigate gene regulation. I am a researcher in psychiatry. Next door are a group that investigate neurotransmitters and ethanol consumption by measuring nerve potentiation, chemical alterations, etc. They work in psychiatry and some of them are licensed psychiatrists. Downstairs are investigators who are working to correlate genetic polymorphism and several mental illnesses. They are doing research in psychiatry and some of them are licensed psychiatrists. Your claim is a bunch of twaddle. And Alzheimer’s IS considered to be a mental disease–at least within the field of professional Alzheimer’s research. Indeed, the biological and biochemical similarities between Alzheimer’s disease and other mental illnesses are turning out to be surprisingly greater than was once thought.

Dogface I always thought that bipolar and manic depression were different terms for the same disorder. However, someone who worked for a psychologist posted in another thread that there’s a difference. While a m-d will swing both ways (depression and euphoria), a bipolar will swing only one way. The difference, I guess, between a bipolar and depression, then, is that depression is always there, but in m-d, the person will be normal at times. Now, this is not what I’ve always thought, just what someone else posted. And I did know a young person who was bipolar who said that at one time the terms were interchangeable, but there’s a difference now. I did not question him at the time since I thought that he was wrong, and let it go.

In psychology classes, they’re still interchangeable, and when my boyfriend was (is) trying to fight his (mis-)diagnosis of manic depression, it was always referred to as bipolar disorder.



See how defensive they get? :wink:

Normally one does not diss other disciplines openly within professional journals, but the trend is pervasive enough I had no trouble finding this report, “Career Intentions in Psychiatric Trainees
and Consultants (CIPTAC) An investigation into recruitment, retention and attrition in psychiatry”:

It’s not exactly a state secret. You may feel it’s unjustified, but as an attitude it persists. Here’s a passing comment in an article critique in Capital Selecta Quarterly:

. The author is criticizing the piece as insulting to mental health professionals, indicating that he holds the profession to higher standards, but the concern for the field’s “reputation as a medical specialty, based on science”, reflects some ongoing concerns that maybe psychiatry is not always viewed as such, yes?

I have yet to read a review of a neurology or endocrinoloogy article that incorporates the same concern that a bad piece could undermine the scientific-medical reputation of those fields. Chiropractic, possibly. Perhaps podiatry. There are other fields whose acceptance within the medical profession is a bit tenuous, I’m not saying this is only true of psychiatry.

The reputation of psychiatry among the general population of medical doctors may possibly be on the improve, I don’t know – but I think I have adequate reason for believing that it has historically been a bit of a “black sheep” and regarded as semi-medical and semi-scientific by many in the profession. It’s simple enough to find references worded like this Abstract*:

(emphasis mine)

  • Journal of the History of the Behavioral Sciences, Vol. 37(4), 369-388 Fall 2001.
    © 2001 John Wiley & Sons, Inc.
    Divergences in American Psychiatry During the Depression:
    Somatic Psychiatry, Community Mental Hygiene, and
    Social Reconstruction

Hans Pols

DSM-IV does not even mention manic/depression, so I guess that is an obsolete term. It mentions two different types of bipolar, (I and II), and II is described as recurrent major depressive episodes with hypomanic episodes. Type I is further subdivided into 6 types. So, I’ll guess I’ll strike m-d from my vocabulary.