What would you say is the biggest myth around mental health or psychiatry today?
I think the myth that has become most well known was the story that the drugs fix chemical imbalances in the brain.
So, for example, depression was due to too little serotonin, and drugs that up serotonergic activity in the brain therefore normalized it, like insulin for diabetes.
And that was the story that was used to sell a whole second generation of psychiatric drugs and dramatically expand the psychiatric enterprise worldwide.
If you look at the number of people getting treated, the thing was, even as they were pitching that, and it really begins to be pitched in the United States in the late 1980s, early 1990s, a drug called Prozac comes to market in 1988.
And it is presented to the public as an incredibly novel drug, a breakthrough medication, because it fixes a serotonin imbalance in the brain.
The irony is that was a hypothesis, this idea of chemical imbalances that was born in the 1960s based on an understanding of how the drugs acted on the brain.
So, for example, the first generation of antidepressants, they both blocked the normal removal of serotonin from that tiny gap, the synaptic gap between neurons.
And so, they said, oh, look, it's boosting serotonin activity.
Maybe depression is due to too little serotonin.
That's 1965.
Well, they then had to investigate: do people with depression actually have too little serotonin before they go on the drugs?
Now, as early as the 1970s, they had to find methods for making that investigation.
But even by the early 1970s or late 1970s, people were saying, you know, we aren't really finding this.
In 1984, I believe it was, the NIMH did a big study on this question, and they said, we're not finding any lesion in the serotonergic system that it's abnormal in any way.
In 1998, I believe it was, the American Psychiatric Association's own textbook said that that story, that idea, the chemical imbalance theory of depression, it was no longer valid.
They said, we've investigated it in many ways, and we just haven't found that serotonin is abnormally low in people with depression.
You know, if I may jump in just for a moment, that is astonishing because I suspect that today, I mean, I certainly took this as an obvious fact for years.
And so do many people.
And I suspect even psychiatrists and GPs that are prescribing psychiatric medications.
So this is what was happening in the research literature and actually in psychiatry's own textbooks when the people that really knew were summarizing the sort of the history of investigation into the low serotonin theory.
And then, for example, there's a famous guy who writes a book called, his name is Stephen Stahl.
He writes a book called Essential Psychopharmacology.
It is sort of the book for brand new psychiatrists.
And he said, you know, we've looked for these and we have not found them.
The monoamine thesis, serotonin is monoamine, it's just not real.
So he says that in 2002.
You can find Kenneth Kendler in 2004, who was an editor of Psychological Medicine, a big researcher in this field.
And he said this, we have hunted for big, simple neurochemical explanations for mental disorders and have not found them.
But the public, that's not what the public was told.
What the public was told, and you can follow now the public pronouncements of the American Psychiatric Association, was that they had found this.
And you saw a website saying that depression is due to too little serotonin, that drugs fix that, like insulin for diabetes.
So what happened is there was a valid hypothesis.
It was investigated, not found to be true.
However, that story, American Psychiatric Association and the pharmaceutical companies understood was a great way to promote treatment, the selling of drugs, and also elevate the prestige of psychiatry because they now had, like other areas of medicine, a pathology they could talk about, which meant they were real doctors and they had an antidote to a pathology.
Now, that's a story that's going to greatly boost the legitimacy and the respect society has for a discipline, right?
Because they've made this great medical advance, which fits into a larger narrative in the Western society.
But yeah, that's the biggest myth.
And it's a profound myth, but it's telling people there's something wrong inside your head with your chemistry and you need this drug to fix that abnormality, when in fact it was a hypothesis born from understanding how the drugs acted on the brain, investigated, and basically fell flat early on, 70s, 80s, 90s, and was discarded by the late 1990s within the American Psychiatric Association's own textbook.
But we weren't told, when I say we, we, the public, weren't told that.
In the United States, you can advertise your drugs on TV, right?
So there were advertisements that showed you take this antidepressant and it fixed the chemical imbalance.
And then next thing you know, you're walking on a beach with a beautiful woman or a beautiful man, right?
So we had that part of telling the story.
But we also had a guild, meaning the American Psychiatric Association, pronouncing, telling the American public that this was what caused depression and our drugs fixed it.
And you can chart those sentiments.
You can see that they were telling this on their website.
They even put out a press release in 2005, 2006 saying psychiatrists are experts in fixing chemical imbalances in the brain.
So that's a long-winded story to tell of how this very simple saying, this sort of a way to sell drugs basically, it got started in the United States and then it spread like a meme around the world until the next thing you know, people around the world were talking about chemical imbalances.