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The notion that a wide array of mental disorders are caused by a biochemical imbalance in the brain is the main rationale used today for the widespread use of psychotropic drugs. This idea usually presented as an imbalance in serotonin is widely promoted in the media, in commercials for psychotropic drugs, and by a large proportion of the medical profession as if it were an established scientific fact. Yet no one has ever scientifically demonstrated the existence of any such imbalance for any mental disorder. Many people have pointed out the complete lack of supportive scientific evidence for the biochemical imbalance idea, which should be reason enough to expose these claims as insupportable, since the burden of scientific proof rests on those making them. However, this has done little or nothing to stop these claims from being made. The reason for this is obvious, since without the biochemical imbalance idea the whole rationale for the widespread use of psychotropic drugs would disappear, and this runs counter to the interests of those who are so heavily promoting these drugs and advocating their use.

Therefore, it is necessary to make a much stronger case against the biochemical imbalance idea. This argument exposes the lack of supportive scientific evidence that the biochemical imbalance idea relies on and the blatant contradiction to the best established scientific evidence. The biochemical imbalance theory indicates a fundamental misunderstanding of the human brain, and is in complete opposition to the greatest traditions of both psychiatry and psychology. In truth, the biochemical imbalance idea is not a credible scientific idea at all, but rather a marketing strategy for promoting psychotropic drugs to the public by fallaciously claiming that most, mental disorder origins are an imbalance in the action of the drugs promoted.

Anxiety disorders, which are the most common mental disorders in America today, are routinely said by many of today’s psychiatrists and mental health providers to be caused by a biochemical imbalance in the brain. Yet by making such a claim, they reveal a profound lack of understanding of these disorders, while unknowingly exposing the biochemical imbalance idea as a pseudoscientific sham. It is easy to demonstrate beyond any scientific doubt that these disorders could not possibly be caused by a biochemical imbalance. For those knowledgeable about anxiety disorders it is an established fact that cognitive-behavior therapy a psychological therapy that focuses on the correction of distorted thinking and exposure to feared situations is a far superior treatment to psychotropic drugs.

In a 1989, a study published in the Journal of Mental and Nervous Disease and conducted at the University Of Pennsylvania School Of Medicine , by psychiatrist, Aaron Beck, clearly demonstrated that seventeen out of seventeen people diagnosed with panic disorders and treated with cognitive therapy were free of panic attacks at the end of treatment. Not one person had relapsed at a one-year follow-up for a 100% success rate. ^{^[1]} The unique success of cognitive-behavior therapy has been validated in numerous other studies with panic disorders as well as with all the anxiety disorders. The great majority of people with anxiety disorders who are given psychotropic drugs, however, relapse soon after discontinuing the drugs. In the case of panic disorder, most people are effectively treated within five to twelve sessions of cognitive-behavior therapy with lasting results; whereas people treated with psychotropic drugs often stay on the drugs indefinitely or even for life.

This same pattern holds for all the anxiety disorders.^{^[2]} Some people are able to overcome a clinical phobia in as little as one session of exposure therapy ^{^[3]}, while there is no effective drug treatment for phobias. Approximately 80% of people suffering from agoraphobia have no more agoraphobic avoidance after a four-day program of intensive exposure therapy.^{^[4]} However with psychotropic drugs alone agoraphobia typically remains a chronic and debilitating disorder. How could a psychological therapy treat any real biological disorder effectively, yet claim to do so with success rates as high as 100% similar to the effectiveness of antibiotics with bacterial infections? Moreover, if these were biological disorders, how is it even conceivable that only a psychological therapy can permanently resolve the problem when drugs cannot do this? In addition, other features of anxiety disorders show that the notion of a biochemical imbalance is a scientific impossibility. Anxiety disorders are usually specific to particular situations. How could someone have a biochemical imbalance that only flared up in an elevator, in front of an audience, or when traveling far from home? Real biochemical imbalances such as diabetes or hypothyroidism are internal biological phenomenon independent of external situations.

Anxiety disorders are also often the result of fear conditioning a specific form of classical conditioning where the stimuli in a highly frightening situation become associated with the fear and come to elicit fear themselves. Classical conditioning, discovered by Ivan Pavlov a Nobel Prize winning physiologist, is a feature of a normal brain, and is a scientifically validated paradigm supported by a hundred years of scientific research. To say that anxiety disorders are the result of a biochemical imbalance is the same as saying that Pavlov's dogs salivated to a bell, because they had a biochemical imbalance. This is substituting pseudoscience for real science and is a clear example of how today real science is simply ignored for promoting psychotropic drugs for profit. The outlandish claim that anxiety disorders are caused by a biochemical imbalance in serotonin shows clearly that the biochemical imbalance idea is nothing but a sham-marketing device to be used automatically for any kind of problem that has the potential to become a lucrative market for psychotropic drugs.

Today's biological psychiatry focuses almost exclusively on the brain yet ironically shows a fundamental lack of understanding of it. The brain is a functional organ, which is the organ of adaptation to the environment. Emotions, thinking, perceiving, learning, memory, and behavior are all functions of the human brain, and all of these functions are directed outwards towards the environment. The brain does not exist in a vacuum, but is always reacting to something outside of itself. Consequently, the activity of the brain cannot, itself be understood without reference to its environmental context. For example, the brain does not by itself create love, but rather we always love someone or something. Likewise, the brain does not create fear, but we always fear something. Furthermore, there is overwhelming evidence that the brain's higher psychological functions including thinking, learning, and memory have a profound effect in determining both emotional experience, and behavior and therefore in determining the biological activity of the brain.

One only need look at the power of the placebo effect to see this, since placebo is only a belief that one is getting a helpful treatment. On the other hand, there is little, if any evidence, that the brain by itself causes emotions due to some direct biological mechanism such as a biological abnormality. Looking at the brain as a biological organ in isolation is like working in the dark, since the causes of most brain activity are to be found outside of and not inside the brain. For this reason, focusing on what is going on biologically in the brain is completely misguided, since it is an effect and not a cause. What is going on in the person's life and in their mind is what is important. The incessant focus on what is going on biologically in the brain is looking for the problem in the wrong place. This is why only psychological therapy permanently resolves anxiety disorders, because it focuses on what the person fears in the environment and uses corrective learning to overcome that fear. The biological brain has nothing to do with this except as a normal mechanism responding to a message of danger. Locating the problem in the brain is to completely misunderstand what the real problem is. It fails to address the real cause of the anxiety and can only have a temporary symptomatic effect ironically by interfering with the brain's normal reaction to an input of danger. The basic fallacy involved here is to mistake a biological mechanism or correlate for a cause. Most of what passes for research in biological psychiatry is looking for biological correlates of mental disorders such as using brain scans and then illogically and erroneously claiming them to be the cause of the disorder. In fact, all the supposed evidence presented for biological causes for mental disorders is based on the logical error that causation can be determined from correlation, which means that there is no scientific evidence of a biological cause for any mental disorder.

In addition to the fact that there is no scientific evidence substantiating a biological cause for any mental disorder, the very idea of non-psychotic disorders, being caused by brain disorders makes no scientific sense. Real brain disorders such as Alzheimer's disease besides having a verifiable physical pathology are characterized by functional deficits that are clearly different in kind from normal functioning. However in the case of non-psychotic mental disorders what is considered abnormal is the same as the normal, but only experienced at a greater intensity or frequency.

For example, what differentiates a specific social phobia of public speaking from the high percentage of people who simply have high anxiety speaking in front of an audience is that the anxiety in the social phobia is a bit higher in intensity. Given many of today's psychiatrists, even claims that social phobias are due to a brain disorder means that if you have high anxiety in front of an audience you have a normal brain, but if you have extremely high anxiety then you have a brain disorder. However if you have even higher anxiety and always panic in front of an audience, but this is something you rarely if ever have to do and you are not upset about having this fear; then you do not meet the diagnostic criteria for social phobia, and you do not have a brain disorder. This is another example of the scientific absurdity of the biochemical imbalance/brain disorder idea.

Among the greatest thinkers of the last hundred years and even of all time must be included many of the great psychiatrists including such greats as Alfred Adler, Sigmund Freud, Karen Horney, Murray Bowen, Salvador Minuchin, Eric Berne, William Glasser, Viktor Frankl, Aaron Beck, Milton Erickson, and Joseph Wolpe. They differed in their specific theories, but they all had in common the belief that almost all nonpsychotic problems are psychologically caused in people with normal brains, and that these problems always arose out of the context of a person's life including their family relations, relations with other people, their past experiences, and their beliefs. Their insights ultimately led to the only truly fundamental treatments for mental disorders that regularly produce lasting results and are not just symptomatic treatments.

Not one of them believed that non-psychotic problems were the result of brain disorders but rather the result of normal psychological processes. For example, Joseph Wolpe who was the founder of behavior therapy the most effective treatment we have today for anxiety based disorders stated very clearly that these disorders are acquired by normal processes of learning, and the only thing that makes them different from normal anxiety is that the anxiety no longer serves a useful purpose. Likewise, every major school of modern psychology since the time of William James in the late 19^th century has viewed human psychological functioning as understandable only in relation to its environment.

All of the great psychiatrists and psychologists understood that the essence of human existence involves a whole human being living in the world and that most emotional suffering could only be properly understood in relation to its environmental context and particularly its interpersonal context. Today’s biochemical imbalance idea represents an utterly absurd biological reductionism that would be seen as ludicrous if it were not so heavily promoted.

According to this idea, there is no person and there is no environment, there is only a brain, but not a whole brain, and not a functional brain, that reacts to the environment. Rather there are one or two neurotransmitters out of over a hundred neurotransmitters existing in a static brain, which somehow just manages to get out of balance. In fact, just one of these neurotransmitters is said to be the cause of almost every possible emotional problem, including such very different problems as eating disorders, mood disorders, and anxiety disorders. Of course the neurotransmitter usually implicated, serotonin, just happens to be the one that matches the action of the drugs available to be prescribed. By simply proclaiming that a disorder is caused by a "serotonin imbalance", a completely new market is immediately created for these drugs. This is not science but pseudoscience dressed up in the language of biological science. It brings to mind the Greek physician Galen in the second century who thought that every conceivable problem was the result of the humors (blood, phlegm, black bile, and yellow bile) being out of balance.

Psychiatrists were once dominant in the field of psychotherapy but throughout the 1960's and 1970's found themselves in competition with an ever increasing number of non-medical practitioners including psychologists, social workers, and marriage and family therapists who charged less for their services. This trend presented a serious threat to the financial well-being of psychiatrists and could have had disastrous consequences for them with the advent of managed care, which favored the services of less expensive practitioners. In response, psychiatrists understandably went with their market niche that was psychotropic drugs, which only they among mental health practitioners could prescribe. However, people were reluctant to take drugs for what they believed to be psychological problems, so organized psychiatry simply began declaring that all the problems, which had formerly been accepted by psychiatry itself to be of psychological origin, were now in fact biological brain disorders. This occurred even though there was no real scientific evidence to support it.

However, the unsupported claim of biological causation had to be more specific. Of all the structures in the brain, and out of over one hundred neurotransmitters in the brain, the problem just happened to involve the one or two neurotransmitters that matched the action of the drugs they had available to prescribe. In the 1980, this was not nor-epinephrine, which fitted the action of the tricycles antidepressants, which psychiatrists were then most using, so depression was said to be due to an imbalance in nor-epinephrine. When the serotonin drugs came along they simply said that depression was now due to an imbalance in serotonin to fit the action of these newer drugs. They first did this with depression, but in order for the drug companies and psychiatrists to increase the market for their drugs they then went on to make the outrageous claim that almost every other emotional, behavioral, or psychological problem was also due to the same imbalance in serotonin. This claim was made even though there was no scientific evidence to support it. The notion that almost all human problems are due not to our relationships with other people, our past and present experiences, and our beliefs, but rather to one out of a hundred neurotransmitters in the brain is ludicrous. However, it has proven to be a wildly successful marketing device for psychotropic drugs. For drug companies it has been worth literally billions of dollars. Psychiatrists that were once facing the prospect of a diminishing number of psychotherapy patients at a maximum of one per hour could now see several patients per hour for medication and make substantially more money, increasing both their waiting lists and profits. The prospect of professional extinction was therefore eliminated. The formula for establishing and increasing markets for psychotropic drugs is simple:

The result of this formula: Spending millions of dollars in promoting the biochemical imbalance idea to physicians and to the public so that people believe they have biochemical imbalances that need to be corrected by a drug. The end result is billions in profits.

After saturating the adult market for these drugs focus was then strongly placed on the children’s “market” so that millions of American children can be labeled and drugged for fictional biochemical imbalances and "treated" with the very same psychotropic drugs that have already been banned in Great Britain due to their lack of demonstrated effectiveness and their increased risk of suicide. This is the tragic end-result to which the uncritical acceptance of the bogus biochemical imbalance idea has led.

In summary, the biochemical imbalance idea not only lacks supportive scientific evidence, but also is clearly contradicted by established scientific evidence as well as by the work of the greatest figures in modern psychology and psychiatry over the last one hundred years. It is based on an extreme biological reductionism, which reflects a lack of understanding of the human brain as a functional organ, as well as a critical lack of understanding of the nature of mental disorders. Scientifically the biochemical imbalance idea is a sham, and is in fact, a marketing scheme, which provides a phony theoretical rationale for promoting psychotropic drugs over much safer and often far more effective psychosocial treatments. What this means is that there is no legitimate scientific rationale for the widespread use of psychotropic drugs. In the case of children, the empirical evidence on the effectiveness of psychotropic drugs is very weak while the risks and side effects are well established. With the biochemical imbalance idea exposed as a sham, it is clear that there is no evidence that mental disorders are biological disorders, which require drug treatment. The core issue with children is not potential misdiagnosis or overmedicating, but rather why given the lack of any scientific rationale children are taking potentially dangerous psychotropic drugs at all.

[1] Beck, A.T., Sokol, L., et al. (1989). Cognitive Therapy of Panic Disorder, The Journal of Mental and Nervous Disease, 177, 711.

[2] Cognitive-behavior therapy gets better results alone than in combination with drugs, which only raises relapse rates.

[3] Ost, I.G. (1989). One-session treatment for specific phobias. Behavioral Research and Therapy, 27, 1-7.

[4] Personal communication Stefan Hofmann, Associate Professor, Center for Anxiety & Related Disorders at Boston University .