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For decades, modern psychiatry has leaned heavily on
(primarily) a singular, often uncritically repeated idea: that mental disorders
are primarily the result of chemical imbalances in the brain. While this claim
has been discredited by many within the field itself, the narrative continues
to dominate public discourse, clinical practice, and pharmaceutical marketing.
Why?
The answer may be less about scientific accuracy and more
about institutional survival. If psychiatry were to fully abandon the chemical
imbalance theory, it would be forced to confront a deeper existential question:
What is its core function? Without a clearly defined biomedical pathology to
“treat,” psychiatry’s entire identity as a medical discipline becomes far more
ambiguous and obtuse- less science, more philosophy or social care and control.
The persistence of the theory reveals more about the profession’s need to
legitimise its authority than it does about the nature of human suffering.
The chemical imbalance theory rose to prominence in the
latter half of the 20th century, popularised alongside the rise of selective
serotonin reuptake inhibitors (SSRIs) like Prozac. The basic claim was that
conditions such as depression, anxiety, or bipolar disorder result from
imbalances in neurotransmitters- especially serotonin, dopamine, and
norepinephrine.
In 2022, a major umbrella review of the evidence by
Moncrieff et al. found no convincing proof that depression is caused by low
serotonin levels, confirming what many critics had argued for years (Moncrieff
et al., 2022). And still, the chemical narrative continues to shape how
millions of people understand their experiences and seek help (Moncrieff et
al., 2022).
If we take seriously the idea that institutions operate
partly to preserve their own relevance, then the persistence of the chemical
imbalance theory makes sense. Psychiatry, supposedly as a branch of medicine,
relies on the assumption that mental distress is primarily pathological-something
“wrong” inside the individual that needs to be diagnosed, categorised, and
treated.
This model offers psychiatry a medical mandate. It justifies
the use of powerful interventions-diagnosis, compulsory treatment, drugging- by
recasting complex human experiences as clinical disorders. Without that
framework, psychiatry will drift into the territory of philosophy, pastoral
care, or social work- disciplines that are less clear-cut, less measurable, and
less institutionally powerful.
Even when some psychiatrists acknowledge that mental illness
is “multifactorial”- involving biology, environment, psychology, and culture- the
default orientation remains biomedical. The underlying assumption is that there
is something wrong with the brain. And from that assumption flows the
justification for medication, categorisation, and the authority of the
psychiatric profession (Moncrieff, 2025).
Pathologising Life: When Human Experience Becomes Illness
Perhaps the most troubling consequence of this framework is
how it reframes ordinary responses to life’s challenges as medical disorders.
Grief, sadness, anxiety, anger, existential confusion- once understood as
meaningful human reactions to adversity- are increasingly described in clinical
terms. Rather than being invited to reflect on the context of their suffering,
individuals are often offered a diagnosis and a prescription.
This isn’t to deny that severe mental distress exists. But
the problem lies in the expansive reach of psychiatric categories, which now
cover an ever-widening array of human emotions and behaviours. The result is a
culture in which suffering is not interpreted, but medicated or drugged.
This is what researchers such as Allan Horwitz and Jerome
Wakefield refer to as the “loss of sadness”- process by which normal human emotion is
absorbed into the language of disorder (Horwitz & Wakefield, 2007). In
doing so, psychiatry not only expands its territory but reshapes how we relate
to ourselves and each other.
The implications of this paradigm are far-reaching:
Loss of agency: If our thoughts and feelings are caused by
faulty brain chemistry, then the role of personal responsibility and inner
growth becomes secondary- or irrelevant.
Suppression of meaning: Instead of asking why someone feels
despair or anxiety, the question becomes how to correct the presumed imbalance.
Decontextualisation: Social, political, spiritual, and
economic factors are sidelined in favour of internal, individualised
explanations.
Pharmaceutical dependence: With biology as the focus,
medication becomes the default solution—even for problems that may be
relational, existential, or circumstantial in nature.
In this way, psychiatry has become a system that manages
symptoms rather than understands suffering. Its tools- diagnostic manuals and
medications- are not inherently harmful, but they become so when wielded
without philosophical humility and contextual sensitivity.
Meaningful change will require the field to confront its own
foundational myths. So long as psychiatry maintains the chemical imbalance
narrative as a pillar of its public identity, it will remain invested in a view
of the human mind that is ultimately reductive and disempowering (Davies,
2021).
We are not simply broken machines in need of chemical fixes.
We are complex, meaning-seeking beings navigating a world that often wounds,
confuses, and challenges us. To reduce those experiences to pathologies is not
only inaccurate-it is a failure of imagination, and a disservice to the
richness of human life.
Davies, J. (2021). Sedated, How modern capitalism created
our mental health crisis. Atlantic Books London.
Horwitz, A., & Wakefield, J. C. (2007). The Loss of
Sadness: How Psychiatry Transformed Normal Sorrow Into Depressive Disorder.
Oxford University Press.
Moncrieff, J., et al. (2022). “The serotonin theory of
depression: a systematic umbrella review of the evidence.” Molecular
Psychiatry. https://www.nature.com/articles/s41380-022-01661-0
Moncrieff, J. (2025). Chemical Imbalanced, The making and
Unmaking of the Serotonin Myth. Flint.
Moncrieff, J., et al. (2022. Is the chemical imbalance an
‘urban legend’? An exploration of the status of the serotonin theory of
depression in the scientific literature. https://www.sciencedirect.com/science/article/pii/S266656032200038X
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