What happens in your brain is not the cause of your problems.
Transcript of the post by conducteam
To put things in context, during the 1970s in the US, psychiatry had virtually no social validation (it was the profession practiced by "failed doctors"). The proposed solution to avoid disappearing was to medicalize psychiatry, that is, to begin promoting the unproven idea that "the origin of any behavioral problem lies in a medical condition."
With the arrival of medicalization, the Freudian repression and neuroses of the DSM-II were sidelined, giving way to the novel neuroscience of the DSM-III (1980), whose medical foundations, unfortunately, have persisted to the most recent editions of the DSM.
Thus, during the 15 years leading up to the publication of the DSM-IV in 1994, there was a tremendous need to add some "impressive theory" to the arguments for medicalization, ensuring that this viewpoint would not die out over time. This is where the unjustifiable argument of "neurochemical imbalance" originated.
In short, "neurochemical imbalance" posits that certain biochemical alterations in our brain's neurotransmitters, such as dopamine, serotonin, or norepinephrine (among others), cause "mental problems."
Psychiatry's new marketing strategy essentially focused on finding neurological and cerebral correlates and causes for any behavior, especially those we perform privately, such as perceiving, thinking, or feeling.
NEUROCHEMICAL IMBALANCE DOES NOT CAUSE YOUR PROBLEMS
Contrary to popular belief, Psychiatry has not always been associated with neuroscience. Furthermore, its close relationship stems from necessity and the need to survive as a discipline. Simply put, the generation of psychiatrists who made those decisions preferred to embrace mechanistic biological causality rather than lose their jobs.
So, firstly, it's necessary to mention that neuroscience isn't so simple, since those biomarkers that are sought with such faith remain just that, a "matter of faith," because they haven't been found anywhere after so many years.
Secondly, scientific research hasn't yet been able to firmly demonstrate the idea of "mental disorder" as a chemical imbalance. High or low levels of any neurotransmitter can be found in the brain, but it's not clear whether this is a cause, a result, or a correlation.
We would need more experiments that could yield more alternative results and rule out one or more possible alternative hypotheses. We need a "clean result," something indisputable in all people labeled with a particular "mental disorder," and not an absurd accumulation of many studies (if we had one definitive study, there would be no need for such a build-up of research). "Everything we do has consequences in the brain, since the fact that there are differences between human brains does not mean that we have found a definitive and scientific explanation for the differences in behavior between people.
THE PROBLEMS WITH THE DOPAMINERGIC HYPOTHESIS
The dopaminergic hypothesis, among other proposals that also refer to chemical imbalances of dopamine, serotonin, norepinephrine, or a mixture of all of them, has been the main argument used to try to "scientifically" support the importance of the medical model in Psychology.
However, the origin of the dopaminergic hypothesis is not what everyone thinks. The key experiment behind its popularity was carried out by Carlson and Lindqvist in 1963, and although they found that certain neuroleptic drugs increased the production and degradation of dopamine, it did not demonstrate the existence of "schizophrenia," much less a relationship between it and an excess of dopamine in the brain."
Despite this, by the end of the 1970s, the dopamine hypothesis was the leading biological theory for "schizophrenia," although most efforts to validate it empirically have failed.
It didn't matter that, from its inception, the dopamine hypothesis was highly abstract and nonspecific, as it has managed to persist over time because it is a very difficult proposition to falsify.
As Popper would say, this hypothesis has a low degree of falsifiability, since if one biological prediction was not confirmed, another easily took its place.
On the other hand, Kuhn might well have said that this hypothesis persists because a sufficiently prominent and more successful alternative theory was never developed.
It is a degenerative research program that can only describe the individual anomaly but does not account for new facts, as Lakatos would say. In addition to the above, the dopamine hypothesis argument is logically flawed, since medicine can provide many examples where the mechanism of action of a therapeutic drug is far removed from the cause of the disease. For example, anti-inflammatory drugs reduce symptoms of a wide variety of pathologies, but they act on conditions far removed from the direct causes of the pathology.
What is clear is that the "one neurotransmitter for one disease" hypothesis has become a perfect marketing concept for pharmaceutical companies. However, regardless of any conflicts of interest, no one has found anything conclusively abnormal about dopamine, or any neurotransmitter, in the brains of those labeled with a "mental disorder."
MAIN REASONS TO SUPPORT THE CHEMICAL IMBALANCE ARGUMENT
1. Obtain the social benefits of associating your work and opinions with medicine.
1. When others associate your view of psychology with medicine, it allows many "professionals" to be described as disciplined, scientific, and rigorous in their work.
2. Evading responsibility. There is no need to analyze or explain anyone's individual behavior, because the DSM diagnostic label already takes care of that.
3. Justifying the "chronicity of mental disorders." If you have chronic patients who "can never be cured," you have patients you can charge for life.
REFERENCES:
– Moncrieff, J., et al. (2022). The serotonin theory of depression: a systematic umbrella review of the evidence.
– Probst, B. (2015). Critical Thinking in Clinical Assessment and Diagnosis.
– Schildkraut, J. (2015). The Catecholamine Hypothesis of Affective Disorders: A Review of Supporting Evidence.
– El-Mallakh, R., & Jeannie Roberts, Y. (2011). Tardive dysphoria: The role of long term antidepressant use in-inducing chronic depression
– Whitaker, R. (2010). Anatomía de una epidemia.
– Deacon, B., & Baird, G. (2009). The Chemical Imbalance Explanation of Depression: Reducing Blame at What Cost?
– Kendler, K., & Schaffner, K. (2011). The Dopamine Hypothesis of Schizophrenia: An Historical and Philosophical Analysis
"As I began to see the structural and systemic roots of our distress, I increasingly moved away from “born this way” thinking. The more I prioritized intentional community building and reconnecting to my cultural roots, the more impossible it became to see my pain as separate from other people’s struggles. It’s all interconnected and psychiatric labels simply failed to capture these nuances that collectivist communities are built on.
Decolonizing also means letting go of bioessentialism
Maybe we shouldn’t assume anything of people who do or don’t carry a neurodivergent label. Maybe someone identifying as neurodivergent or NOT won’t help you understand much about them or circumvent the process of getting to know them with care, over time. Maybe we should let people open our world to new worlds. Maybe we shouldn’t covertly or overtly force people to turn to a colonial tool like the DSMV to figure out “what they have” or “who they are”. Maybe we don’t need to push people into categories excessively to make them comprehensible.
If terms under the umbrella of neurodivergence are important to you, then know that I’m not asking you to abandon them, nor am I framing them unilaterally as “bad”. I’m asking you to look beyond them, to be aware of how they can be leveraged for harm and to recognize that there are other ways for communities to make sense of their distress without these labels. I’m asking you to embrace complexity and create space for it. The rest of the world should not have to speak this precise language. The language of colonial psychiatry should never have been forced upon the global south and it shouldn’t be today, including any reclaimed version within the neurodiversity framework."
Psychiatric diagnoses & bioessentialism will not liberate us, Ayesha Khan, Ph.D.
https://wokescientist.substack.com/p/psychiatric-diagnoses-and-bioessentialism
#madpride #madliberation
.