You have a chemical imbalance. Millions of people have been persuaded to take antidepressant medication by this simple phrase. Depression, an illness long associated with connotations of weakness and feelings of shame, is recast as a physical malady of abnormal chemistry-which naturally calls for medication by a doctor. How can a patient feel in any way responsible for a chemical imbalance? Why would any reasonable person refuse treatment for such a condition?
One good reason to do so is because no such chemical imbalance has yet been proven to exist. It can’t be identified by blood test or any other objective examination in patients with depression; nor has it been definitively confirmed in postmortem examinations, animal studies, or any other reliable research. Although it is purported to be the most scientific explanation we have for depression, it is not established scientific fact. Nonetheless, over the past two decades this clinical mantra has become an article of faith for psychiatrists, patients, managed care companies, and a multibillion dollar pharmaceutical industry. It is a singular example of a knowledgeable community falling for its own line of bullshit.
Those who have challenged this biological model of depression have typically laid the lion’s share of blame on Big Pharma, which has had the greatest role in bankrolling this myth and profiting from it. However, deeper examination reveals that the ascendancy of this theory has been driven by other factors as well, including the inherent inadequacies of psychiatric diagnosis, and the “quick fix” fantasies of managed care companies and psychiatric patients alike. On another level, faith in the chemical imbalance can be seen as the latest flawed answer to psychiatry’s longstanding collective prayer for deliverance from the grave insecurities that have plagued this medical specialty since its inception.