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> to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language

This is a pretty big assertion that the piece casually drops without backing. The reasoning as to why "chemical imbalance" is a bad descriptor is apparent* from the study [0] the author cites, but there is nothing that backs up this statement, which seems to be the crux of the whole piece.

*Even the study cited about placebo affects on depression doesn't _really_ prove the author's point that "chemical imbalance" is a bad term, it just proves that we do not yet understand the processes by which drugs treat depression. If we do not understand the processes, how can the author make the assertion that the characterization they are against is wrong? At most, they could claim "we don't know yet" but certainly not that "chemical imbalance" is categorically false.

[0]: https://www.frontiersin.org/articles/10.3389/fpsyt.2019.0040...

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I'd like to pull the full quote, which is more nuanced:

>As I argue in my book Chemically Imbalanced (2020), to defeat this othering and reduce stigma, clinical practice needs to move away from biogenetic causal language. Psychiatric research doesn’t support the notion of simple cause and effect in mental health, instead uncovering a far more complex and indeterminate picture of vulnerabilities. There is no evidence to justify the continued promotion of one-dimensional theories such as ‘chemical imbalance’. Nor does the beneficial use of psychiatric medicines require it. In fact, their precise mechanism of action and relation to troublesome experience remains a mystery. It would be more truthful for mental health professionals and public health campaigns to acknowledge this.

It's helpful to note the flipped the burden of proof here: the author argues there is no evidence for "chemical imbalance" language, not that there is evidence against "chemical imbalance" language. I see it as an admission of uncertainty rather than claim of knowledge; the use of the somewhat tepid phrases "need to move away from", and "complex and indeterminate picture" are a further sign the statements are not categorical.

Though I could have misunderstood their thesis. I'll find out once I've read the book, I suppose. :-)

'Chemical imbalance' as a causal explanation seems to me almost useless because every severe change in behaviour pretty much by definition corresponds to change in the brain. How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?

There can be a company pouring lead into a river, psychological hazard during a civil war, and it will always manifest in the brain, what kind of explanation is this? Of course these things can be found in the brain, it would be crazy if they didn't.

That's not to say there's no diseases that are actual individual pathologies of the brain of course, but to use 'chemical imbalance' as a sort of first order response to what may have actual social or environmental reasons say, is entirely circular reasoning.

"People in distress" is even more useless. "in distress" could mean anything from having fallen down the stairs, to running out of gas on the highway.

I don't mind changing language, as long as we're become more precise, not less.

If "chemical imbalance" is bad, suggest something better.

I think a bigger problem is that people are fixated on word definitions and offending others instead of solving problems.

>I think a bigger problem is that people are fixated on word definitions and offending others instead of solving problems.

I agree, and this is pretty much unavoidable when the current clinical term is vague enough to be used as a generic insult.

The general pattern I see

1. A vague term is used to describe symptoms of an issue we have a poor understanding of.

2. That term becomes associated with the symptoms, but is vague enough to be used as a generic insult (ex: playground school children yelling it at each other)

3. That term develops a stigma as an insult, and becomes more and more controversial

4. That term is replaced with a new term, rinse and repeat.

We've seen this before ex: Moron, Imbecile, and Retard all once had vague clinical meanings.

Then we went to mentally challenged, special needs, etc. Now even those are fairly loaded terms.

In all of these cases, the word/phrase describes something that people would rather not have or be, but it does it without clarity.

It will develop a stigma.

I find the folks who constantly advocate for changing these names well-intentioned, but basically a waste of time.

I would say this cycle happens regardless of how vague the term is.

Terms like Black, Dwarf, Gay, etc... were all, at some point, considered insults despite being specific. (note: I'm not saying these are illnesses - just that the same phenomena exists - there are probably much better examples of what I'm trying to say).

How is "distress" not the correct term? It is defined as extreme anxiety, sorrow, or pain which can be caused by any of the factors you described as well as many more you are not even aware of. It is an emotional state that is perceived on the part of the person suffering rather than observers outside of them regardless of the actual physical realities involved.

The term "chemical imbalance" can describe anything from acid reflux to genetic neurological pathologies or even snake bites and can certainly put people "in distress".

The problem is people aren't interested in using correct definitions for anything anymore.

> The problem is people aren't interested in using correct definitions for anything anymore.

Really? That's the problem? Not the mental disorder itself?

These semantic debates are less than worthless.

Problems can only be addressed once precisely defined.

> How else is it supposed to be manifest? Is there supposed to be drastic change in psychology without change in the brain?

There is an implication inherent to "chemical imbalance" that assumes a normative range. Modern medicine is universally based on normative ranges. If you are outside this range, it is considered a problem. Chemical imbalance is a generic and apt descriptor.

That was not my point. Obviously it's a descriptor of a problem, but not an appropriate explanation for a cause. Say you have high blood pressure. That may be because you weigh 400 pounds, or because you have a genetic condition, or because you smoke, or because you are stressed 18 hours a day, but it's not an explanation for anything, and everyone knows that.

Assuming you had an omniscient scientific tool every abnormal change in behaviour by definition has a correspondence to an abnormal state of the brain, that's just saying the same thing at a different level of abstraction.

When everyone is obese and has high blood pressure the correct cause of correction is probably setting different social incentives to fix a systemic problem, not mass producing insulin and betablockers, because you stopped at an overly reductionist level of description and mistook it for insight.

I don't think it is though. For example, one of the things we know is that IBS can cause depression/anxiety (or perhaps more accurately, people with IBS are more likely to have depression/anxiety).

In this case chemical imbalance would be objectively wrong. Their brain is being affected by another part of the body entirely, but you would have doctors selectively treating the symptoms (the 'chemical imbalance') rather than the cause.

> In this case chemical imbalance would be objectively wrong.

I disagree. Chemical imbalance is not necessarily a solitary cause, it's describing a condition regardless. shrug

> you would have doctors selectively treating the symptoms (the 'chemical imbalance') rather than the cause

Typically they treat both or in most cases, the easier problem with less severe treatment consequences (classic House MD - live in constant pain from muscle death vs lose a limb).

It's not an apt descriptor at all because there's no test for a normal range of a chemical that depressed people are outside of.

> It's not an apt descriptor at all because there's no test for a normal range of a chemical that depressed people are outside of.

As disconcerting as it may be, subjective feeling is a range (google "pain indicator charts") as well as professional (for some value of that) psychological analysis.

I think your view is minority view.

> I think your view is minority view.

It may be a minority view but only because of people's blind faith in a medical authority's ability to distinguish a patient's mind as 'abnormal'. What Barrin92 said is logically sound, an empirical diagnosis of the behavior coming from an individual is not a very precise measure of any type of chemical imbalance. That's not to say individuals suspected to have of mental illness shouldn't get treated, but that medical professionals shouldn't jump to medications as a primary end-all treatment (which is what I believe is what the linked article was trying to say).

There are normative ranges but being outside of such a range alone is usually not enough for a diagnosis. Especially in the arena of mental illness, "abnormal" behavior must also present as interfering with life to earn someone a diagnosis as nearly everyone has some "abnormal" behavior and it would be counter productive to literally diagnose everyone.

It might be a descriptor of a state but it does not explain the cause. The argument here is against the notion that depression is caused by chemical imbalance.

“It’s not a bug, it’s electronic misplacement”

Yes, but you have to see it in the historical context. Not that long ago, mental sickness was caused by various demons, curses and so on. Things change a lot faster now, but it is still taking a while. Hell, being gay was a mental sickness was only 30 years ago.

In other words, it is not useless. It may seem obvious now, but it is not useless.

>This is a pretty big assertion that the piece casually drops without backing

My understanding was that the results of the author's interviews were the backing for this assertion:

>As the interviews made clear, people adopted the biogenetic account because they thought it was based in science. The interviews also show how this account undermines the kinds of introspection and self-examination that can lead to meaningful self-knowledge. >Mental health treatment needs to re-engage with the language of persons. This means suspending the detached, third-person stance toward patients, and attending to their actual experience and circumstances. And it means encouraging patients themselves to avoid this stance and draw on the normal ways that people make sense of their emotions and actions.

Or do you mean that the conclusion the author reaches, that we should be attending to people's experiences instead of using "biogenetic causal language," isn't justified by the results of the interviews?

It's interesting the author argues dropping the term to reduce stigma because many people argue for using the term in order to reduce stigma. That is, if you can explain what is going on with you with some biological case, it seems so much less of a personal indictment than if the case is considered to be psychological.

That said, I completely agree that the explanation should be dropped because we really have little to no evidence for it.

If we don’t know then we don’t know. Calling it a chemical imbalance implies knowledge that does not exist.

In fact, isn't the point that the 'ideation' of mental illness as a chemical process seems to further the process somewhat, and therefore some degree of refactoring needs to be done of the language used so that we 'un-know' the details well enough to treat it subjectively?

Fascinating conundrum.

> If we do not understand the processes, how can the author make the assertion that the characterization they are against is wrong?

Generally, in a scientific context, characterizations are wrong if they lack any scientific basis.

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