I am a big proponent of being careful with language. I don’t think that we should oversimplify something simply because it sounds better or is better marketing. Especially when it comes to mental illness, we are so sloppy with our language as it is that I think we must be careful. I don’t like the idea that we should describe mental illness as “a chemical imbalance” because it deeply oversimplifies things. So I was fairly dismayed when I sat down to read an article in my local paper about the need to talk more about mental illness and it simply repeated over and over “mental illness is not biological” and that we need to spend more time talking about the pharmaceutical industry.
Many people do not pay enough attention to the biological factors of mental illness. Yes, we recognize that genes can cause a predisposition, but more than that, basic biological systems can deeply affect your mental health. A few examples: sleep deprivation can easily cause symptoms of mental illness. It can deeply affect mood, emotional stability, depression, anxiety, and other brain functions. Continual sleep deprivation can spur a mental illness. I’m not sure what one would call that if not a biological factor.
Similarly, food deprivation is deeply correlated with some serious signs of mental illness. In the hunger studies performed at the University of Minnesota, individuals who willingly deprived themselves of food became depressed, anxious, obsessed, violent, withdrawn…they had diagnosable mental illnesses that were not present before the removal of food. Again, this seems to be a strictly biological change that triggered a mental illness.
Factors like these are often heavily discounted when we talk about mental illness, particularly when we’re attempting to recover from mental illness. Not enough time is spent focusing on the fact that if you don’t have a healthy biological basis with adequate sleep, nutrition, and exercise, it is significantly more difficult to have a stable mood and recover from a mental illness.
In addition, we do know that genes play some role in mental illness. We know from twin studies that many mental illnesses are far more likely to occur in an individual if they have close family members with that mental illness. For some mental illnesses, we have identified specific genes that might be linked to that mental illness. The most likely theory about mental illness right now is that we are genetically pre-disposed to an illness (to varying degrees depending upon the person) and social or environmental factors then can trigger that mental illness. And yes, neurotransmitters and brain chemistry are implicated in that mental illness. Yes, there are physical processes that have been disrupted when we are talking about mental illness. No, it’s not just a chemical imbalance, yes it is more complex than that, but of course it’s biological because our brains are a biological organ.
This is intensely frustrating, because it makes it seem as if the social factors that affect our mental health have no bearing on the physical existence of our brain. In fact studies done on chimps have shown that certain brain chemicals are altered over the course of years by trauma or isolation (if a chimp is isolated at a young age they will have different levels of certain brain chemicals when placed in isolating situations than a chimp not isolated at a young age and these effects last for many years). This is a physical change brought on by an environmental factor.
Of course it’s important to be careful not to oversimplify, but obscuring that there clearly is a biological factor to mental illness is not helpful either. In addition, the fear of labeling mental illness as biological plays directly into the fear of overdiagnosing and overprescribing. When we repeat over and over that mental illness is not a biological illness that revolves around neurotransmitters and brain chemicals, we become even more paranoid about prescribing medication (something that people are already worried about in the case of things like ADHD and Xanax). Speaking as someone who takes medication, this is incredibly damaging. Medication can be a complete life-saver: it made my anxiety manageable and so it gave me a window to actually begin dealing with some of my underlying issues. I was afraid to begin taking medication because I didn’t want to “alter my brain”. Repeating the myth that pharmaceutical companies are out to get us all and that medications are not the proper way to treat mental illness reinforces that stigma.
Of course we should include various kinds of therapy when we’re working on mental illness, but it is actually incredibly difficult to get medication for many mental illnesses and particularly difficult to get insurance to cover it. People are already afraid of medication. People are already afraid of being turned into zombies by pills or having unknown side effects. It is possible to advocate for improved standards for pharmaceutical companies AND accept that medication can be an incredibly important part of treating mental illness.
We need to recognize that mental illness is complex, requires a number of kinds of treatments, and involves a variety of factors including the biological, social, environment, genetic, chemical, and situational. While it is important to move past the “chemical imbalance” trope, that doesn’t mean completely removing any mention of chemistry or biology from our descriptions of mental illness.