Chemical imbalance?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


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Some of the ways mental illness is described disturb me. Chemical imbalance and minimal brain damage are especially troublesome. This post is about the whole idea of mental illness being the result of a chemical imbalance. I can see how these ideas got their start and why they continue to be popular, but they can be way misleading also. Below is a very oversimplified explanation of this issue.

One reason these ideas gained popularity was that it explains why some people were not able to “just snap out of it” even when they tried. We began to believe that mental illness was not a choice or a moral flaw but an illness. And if it was an illness then we should be able to find treatments for it. We also started to think there were risk factors and protective factors. Not everyone with a particular gene gets a particular disorder even when the gene increases the risk.

When I first studied physiological psychology way back in the dark ages of the 1960’s we studied mostly electrical potential and structure of the brain. There were a total of two neurotransmitters that were of any importance in that class. Forty years later I took a class on the effects of drugs and alcohol on the body and the brain. In that class, the text reported there were over 200 neurotransmitters in the brain and that brain chemistry was way more important than anyone had thought until that time. The book also suggested that there were probably another 200 or so neurotransmitters that had yet to be identified and named. That number has grown since.

One thing this diversity of chemicals in the brain might explain is the way in which drugs of abuse might work. There is one theory called the “lock and key” theory that says that drugs of abuse while not the same chemical as a neurotransmitter are shaped just like one and so they fit in the receptors, the locks, in the brain and these chemicals make the same things happen that happen when neurotransmitters move only way more so.

We now know, or think we know, that messages in the brain are carried within a nerve cell, called a neuron, by electrical charges. But from one neuron to another they are carried chemically. The role of the neurotransmitters is to move messages about. But there are other chemicals present also and they do many other things. It is a complicated world inside our brains.

We discovered that a medication that changed the way a neurotransmitter, serotonin, for example, was made, moved around, broken down, and recycled, could also impact mental illness symptoms. So the shorthand for this became that someone who had depression might have a shortage of serotonin. The expectation was that give this person a medication that increases serotonin and they should be cured. It has turned out to be more complicated than that.

The belief that a shortage or surplus of a neurotransmitter was causing a particular mental illness gave rise to the idea that in time we would be able to take a sample of the fluid in someone’s brain, decide which neurotransmitter or enzyme was out of balance, and then by adding or subtracting neurotransmitters they could be cured. People still come into our office and want to be “tested” to find out which chemical in their brain is out of balance. So far this hasn’t worked out. Let me suggest why.

Thoughts are carried from nerve cell to nerve cell chemically. You have lots of thoughts, conscious and unconscious. Hunger is a thought, so is tired. We may feel these long before we know that consciously. A depressed person might have a happy thought, might even laugh at a joke. The brain chemistry will change. They think about their depression or a bad experience their brain chemistry changes again. So the chemicals in the brain are constantly changing. We also find that changes in thinking can change your mood. That is the basis of conative therapies. Changes in muscles are also controlled by chemicals so that might explain why behavioral therapies work also. But psychiatric chemicals, like anti-depressants, do work also.

Another thing we are starting to read about in the popular accounts of scientific research is the way in which neurotransmitters may act differently in different structures of the brain. We also find that there is a lot more than one model of a neurotransmitter. If serotonin were like a car, say a sedan model, there would be two-door and four-door models and various colors. Turns out there are multiple varieties of neurotransmitters. So the more we learn about brain chemistry the more refined the medications become but the more questions there are that need answers.

Rather than being just a simple case of a chemical imbalance, it may be that some brains get more mileage out of one chemical than another. Some brains come with superchargers and need higher octane fuel and others stall on the same mix. Forgive the repeated use of the car analogy but it comes the closest of any I can think of as to why we can’t just test for a chemical imbalance and why some people respond well to a medication and other people do not.

So remember that it is not just a shortage of or surplus of a chemical that throws brains out of balance. The things you do and the thoughts you think also influence your brain chemistry. In future posts, I want to talk about minimal brain damage and the ways in which psychiatric medications like anti-depressants might be working. Remember this is coming from a therapist and counselors point of view. Before you make any changes in your medication, starting or stopping, please talk with your doctor. But in my world, it never seems to hurt if you add some counseling to the medication.

Staying connected with David Joel Miller

Seven David Joel Miller Books are available now!

My newest book is now available. It was my opportunity to try on a new genre. I’ve been working on this book for several years, but now seem like the right time to publish it.

Story Bureau.

Story Bureau is a thrilling Dystopian Post-Apocalyptic adventure in the Surviving the Apocalypse series.

Baldwin struggles to survive life in a post-apocalyptic world where the government controls everything.

As society collapses and his family gets plunged into poverty, Baldwin takes a job in the capital city, working for a government agency called the Story Bureau. He discovers the Story Bureau is not a benign news outlet but a sinister government plot to manipulate society.

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Dark Family Secrets: Doris wants to get her life back, but small-town prejudice could shatter her dreams.

Casino Robbery Arthur Mitchell escapes the trauma of watching his girlfriend die. But the killers know he’s a witness and want him dead.

Planned Accidents  The second Arthur Mitchell and Plutus mystery.

Letters from the Dead: The third in the Arthur Mitchell mystery series.

What would you do if you found a letter to a detective describing a crime and you knew the writer and detective were dead, and you could be next?

Sasquatch. Three things about us, you should know. One, we have seen the past. Two, we’re trapped there. Three, I don’t know if we’ll ever get back to our own time.

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