No, Mental Illness Isn’t “Caused” by Chemicals in the Brain
Biology is how our moods and mental states are expressed, but it’s not the root cause of them.
Biology is how our moods and mental states are expressed, but it’s not the root cause of them.
I was listening to an advice podcast this morning that I really enjoy (Danny Lavery’s Big Mood Little Mood), and the subject of depression’s manifold causes came up. The advice-seeker was a listless and burn-out lawyer who, after months of toiling alone at home during the pandemic, had begun to feel life had lost its meaning. They were seeking suggestions for dealing with the fact that the next forty or sixty years unfolding before them seemed doomed to be nothing but working, cooking dinner, doing a quick workout, and then heading off to sleep.
Danny Lavery recognized right away that the advice-seeker was dealing with an issue that’s both localized and global. Lots of people have been stuck alone at home for upwards of fifteen months at this point, and a lack of stimulation, meaningful social contact, and things to look forward to can leave almost anybody feeling pretty grim. His visiting co-host, Inkoo Kang, suggested that the advice-seeker find some sources of novelty and intellectual challenge in their regular day, to help recapture the joy they once felt as a college student with a fun course schedule and lots of free time.
Lavery remarked that it can be hard to untangle the existential dread that comes with being a conscious adult aware of their own mortality (and laboring under capitalism), and being a depressed adult with shitty job who needs to claw their way out. He also suggested that, while the advice-seeker is still sorting all of this out, they get into the habit of smoking more weed to take some of the edge off.
I really loved Lavery’s response (and the response of his co-host), which reflected that when it comes to states like depression, there is no clean line between having an interior problem and being in miserable circumstances. For a moment, Kang described depression as a “biochemical blankness” and suggested the advice seeker consider stabilizing their mood with anti-depressant. I was worried for a moment that she was going to say depression is caused by an internal chemical imbalance, but that wasn’t Kang’s point at all. Instead, her point was that though the advice seeker’s job and life situation were pretty depressing, those externalities can take a biologically observable toll. Lavery then said explicitly that taking medication won’t address the life problems the advice seeker was facing, but that it could help them feel good enough to make a clear-headed decision about what to do next.
Therapy was also suggested, since it seemed like the advice seeker could probably afford it. Yet there was never any implication that the letter writer’s mind or brain were the sole, or even necessarily the main, seat of the ‘problem.’ Individualized treatment could help make the present more livable, but for long-term, existential healing, the life circumstances of the advice seeker simply might have to change. The advice seeker had written that they missed when their days consisted of waitressing and hanging out with their boyfriend, and it’s not hard to see why. A fast-paced, interactive, and hands-on job can be rewarding and grounding at times, and nothing brings life more meaning than quality time with loved ones.
After Lavery and Kang were finished discussing the letter, I pulled out my earbuds and let out a little sigh of relief. They had managed to acknowledge the biology and the sociology of depression without pitting the two against one another, or seeing treatment of the two causes as at all incompatible. It shouldn’t be rare to find that kind of analysis, but it is. It’s so hard to find a good discussion of mental health that can acknowledge the interplay of internal and external factors, without claiming everything is an inborn chemical imbalance on the one side, or a problem completely created by capitalism that would never exist if we lived in an anarcho-capitalist utopia on the other.
The public has been reared on a biological explanation of mental health conditions like depression, anxiety, and ADHD for the past several decades, and so I run into people claiming mental illness is “caused by chemicals” pretty damn regularly. I also frequently encounter people trading pop-science tidbits about which parts of the brain “control” processes like memory, empathy, or even something as large and complex as personality. Someone on Twitter recently tried to tell me that Borderline Personality Disorder (a condition defined by a variety of emotional and relational patterns, not by biology) is a “disease of the brain,” for instance.
It’s easy for me to understand the appeal of biological explanations for mental illness. Saying a person low mood or inability to sleep is caused by their biology seems to let the sufferer off the hook, morally or ethically, for any disappointments their mental illnesses cause. Because we inhabit a world where hard work is seen as virtuous and being unmotivated, unfocused, or frozen in place is taken as a sign of shameful, immoral laziness, it can be quite a balm to say that depressed people (or anxious people, or ADHDers) aren’t at fault. They can’t help it. They have a chemical imbalance. They were born this way. They need a medication to fix what’s wrong inside.
People are drawn toward biological explanations of human behavior and emotion, in part because they sound more ‘sciencey’ than talking about psychology and sociology. Economic systems, family relationships, cultural traditions, and media messages are hard to objectively document and study the influence of. But it’s easy to photograph someone’s brain, or record their stress hormone levels by having them spit in a cup. Or at least it seems easy.
Some studies have observed that the public considers neuroimaging research to be far more trustworthy and believable than psychological research that doesn’t include brain scans, even when the two studies functionally do the exact same thing. This is despite the fact that most brain scan data is of limited usefulness, and low reliability and reproducibility. Photographing a brain actually isn’t that simple, you see. With the right tweaks and data cleaning procedures, you can create effects in brain scan research that aren’t really there, such as finding evidence of cognitive empathy in the brain of a dead fish.
Biochemical and neurological research are very much in their messy infancies. Many of their findings fail to be replicated, entire programs of research have had to be thrown out because of bad software riddled with errors, and most trustworthy findings only serve to describe which chemicals and brain areas are involved in a process that psychologists already know a lot more about. Put another way: neural and biological data can do a lot to illustrate the science of human thinking, but at present it offers little in the form of explanation.
It isn’t actually all that meaningful or interesting, scientifically, to observe that when an Autistic child who hates eye contact is forced to engage in it, the threat centers in their brain “lights up.” We could already tell from their behavior and emotional reactions that eye contact causes them extreme distress and makes them feel threatened. Nor is it particularly insightful to discover that a chemical in the brain like dopamine is involved in making financial decisions. Of course there are parts of the brain (and chemicals in the brain) that make such experiences possible.
The brain is a biological structure. The mind is a process expressed by that brain. Whether you’re studying the neuroscience of attitude change, love, fear, daydreaming, listening to music, or reading about Batman on Wikipedia, you are always going to find biological processes that are involved. That doesn’t mean there is a reading-about-Batman-on-Wikipedia chemical or a listening-to-synth-pop lobe of the brain. It simply means that all human mental processes occur via the brain.
For some reason, though, many non-scientists (including a lot of science journalists) take the fact that all mental processes have biological markers as a sign those processes are caused by the biological marker. This part of the brain “lights up” when someone is perceiving race, so this is the part of the brain that causes racism. This is the chemical involved in exerting willpower, so willpower must be caused by having a lot it. From this kind of thinking we get the idea that depression is caused by a lack of serotonin, anxiety is caused by a lack of serotonin and gamma-aminobutyric acid (GABA), and ADHD is caused by insufficient dopamine.
Claiming that depression is “caused” by a lack of serotonin or that anxiety is “caused” by a need for more GABA is a bit like claiming digestion is “caused” by having too much stomach acid. Put more accurately, moods and thoughts are a thing our brains do, a process the body can express, just as digestion is a process our digestive organs engage in.
Digestion is instantiated by the body, using our stomachs, intestines, gut flora, and yes, stomach acid, but the process is not caused by the body parts and chemicals that make it up. The process of digestion changes depending on what our body needs at any given time, what we’ve been eating and drinking and physically doing. We can observe and study the process of digestion by looking at the biology that makes digestion possible: examining a person’s stool samples, checking their throat for signs of acid reflux, analyzing their blood sugar levels, and more.
But when we look at the consequences and markers of the process of digestion, we aren’t observing the full process of digestion itself, not really. And we certainly haven’t observed all the variables that might affect the process. We don’t claim constipation is caused by having unmoving stool in the intenstine, for example. That’s just how we define what constipation is. The reason why the stool got impacted could be anything from a person’s diet, to their stress levels, to dehydration, and beyond.
I hope you’ll forgive the simplicity of the metaphor, but the exact same can be said of the brain, the mind, and the many moods and motivational states the brain makes possible. The mind is a process expressed by the brain. The mind needs the brain (or something similar to a brain) in order to happen, but that doesn’t mean the mind is a static thing located inside of the brain. We can’t observe the mind but we can look at the brain for signs of how the mind is currently being expressed by it. Blood flow, stress hormones, reactions to medications, and behavior can help us understand a bit about what someone’s mind is doing, but it doesn’t give us the full picture or tell us why it’s happening.
Moods and motivational states are things our brains do; depression is a mood state the brain creates using, among other things, serotonin. But why did the depressed person have insufficient serotonin? Was it their genetics, or was it them getting dumped? Was it a mix of both? If a person gets depressed when placed in depressing circumstances, can we really say they are sick? Or is their mind responding to stimuli in a sensible way, just as a starving person’s digestion will begin to slow down?
When you criticize the biomedical model of mental illness openly like this, people’s feathers tend to get ruffled. Some folks perceive any critique of neuroscience and psychiatry as being Scientology-level conspiratorial thinking. But pointing out that mental illness labels are socially constructed and that neuroscience is flawed is not the same thing as saying that experiences of depression, anxiety, and even paranoid delusions are not real. Noting that anxiety can have external and sociological causes doesn’t mean we should deny people access to the medications that help treat it. As Danny Lavery & Inkoo Kang’s reaction in the advice column shows, the external and internal explanations for mental health struggles work best in tandem.
Unfortunately, people get very attached to their biological understanding of mental health, and rebel when that worldview is questioned. Recently, my friend and colleague Jesse Meadows wrote a post explaining the science behind ADHD and one of its most popular treatments, pharmaceutical stimulants like Ritalin.
One of the most popular explanations for what “causes” ADHD is a lack of dopamine. Dopamine is a neurotransmitter involved in a litany of mental processes and is present in many regions of the brain, but most pop science writing focuses on its role in goal setting, attention, and motivation. ADHDers have trouble focusing and staying motivated, the dopamine theory goes, because they lack enough of the neurochemical that makes completing tasks rewarding. The solution, then, is to give them a stimulant that helps make up for that lack of internal drive. Patients are sometimes told that the ultimate test of whether someone has ADHD is how they respond to stimulants like Ritalin: if the drug helps you pay attention and get more done, that’s proof positive you needed it.
As Jesse writes, there are several problems with this explanation. The first is that psychiatrists are very open about the fact the ‘insufficient dopamine’ explanation is more a metaphor more than a biological truth. As objective and scientific as neurotransmitter activity sounds, we don’t currently have a way to actually measure it in patient’s brains. If someone exhibits common ADHD traits (trouble keeping track of time, a cluttered house, rejection sensitive dysphoria), there is no biological way to validate the diagnosis by checking their dopamine levels. We aren’t even sure if ADHD actually is caused or instantiated by differences in dopamine levels. And responding to Ritalin by having more energy and ability to focus… is normal. The average person will get more done when put on a stimulant (at least at first), just as the average person will have more energy after drinking coffee or doing meth.
When Jesse initially shared this research online, they were met with a barrage of outraged and defensive responses — almost exclusively from ADHDers who use stimulants and think of their disability as purely biological. Many of them no doubt had been demeaned all their lives for being “lazy” and “disorganized,” (as many ADHDers are), and were relieved to discover they had a nameable, perhaps biologically-caused disability that meant such qualities weren’t actually their fault. People who take psychopharmaceuticals are often judged for doing so as well, and can feel defensive when their need for the medication (or right to use it) is called into question. That wasn’t what Jesse was doing, but when a lot of public critiques of psychiatry amount to telling people to throw out their meds and go try coffee enemas, it’s understandable why someone might make that mistake.
Lots of people with mental illnesses and disabilities cling to biological explanations of those conditions, because it offers them an easy “out” from unfair social judgement. Unfortunately, those same biological explanations can contribute to the very stigma people are running like hell to escape, by implying that people with a particular diagnosis are all the same, and don’t have the ability to make decisions about their lives the way neurotypicals do. It may be preferable to be labeled broken than to be labeled evil, but it’s far better to stop defining certain human qualities as a fundamental brokenness at all, and to start examining the social conditions that have broken down around a person instead.
Sympathy for the Narcissist
Can we stop maligning people with a highly stigmatized mental illness?humanparts.medium.com
As a social psychologist with mental illness, I recognize both scientifically and on a personal level that the anguish of depression is real, that pain of sensory overload is as intense as any physical trauma, and that therapy and medication can contribute to a person’s overall wellbeing in significant ways. I recognize that the various moods and behavioral responses our brains create are not all equally adaptive, and certainly aren’t all pleasant to endure. Though much of my suffering as an Autistic person is caused by the loud, unrelenting, inflexible neurotypical world I am living in, I’d be lying if I said there weren’t features of my neurotype I’d cure with a pill if I could. If a medication meant I’d never have another crying, screaming, self-harming meltdown ever again in my life, I might take it. But instead of searching for a biomedical cure, my time would be far better spent fighting for Autistic liberation on a social and structural level instead.
I recognize that in my case, and in the lives of many neurodiverse people, the bio-medical model of illness will not offer me a route to salvation. I don’t want my every deviance to be buffed and polished into nonexistence. Instead, I want to be accepted and accommodated as I am. Just like the the advice seeker who wrote to Danny Lavery, my problems are social, economic, and contextual, as much as they are tied to my neurology. When I have no choice but to work long hours, I get more stressed and burnout. When an ADHDer must perform 60-hour work-weeks in a field that brings them no joy, in a working environment that is not accommodating to their disability, it’s no wonder they need a stimulant in order to survive.
Our brains may be where the pain of exclusion, anxiety, or sensory overwhelm occur, but when it comes to the reasons for that pain, the call is coming from outside of the house.