A Very Old Idea
Hippocrates, around 400 BCE, and his followers put forward the idea that human illness came from an imbalance of fluids in the body. It was an early attempt to explain suffering, but in truth it was a religious idea dressed up as primitive medical theory. People were trying to make sense of pain, and this was the best story they had.
Fast forward to the 1960s. A few scientists studying the most extreme forms of depression and anxiety began to wonder whether recent discoveries in neurotransmission might hold a key. Insulin had been discovered, diabetes could be managed, and some thoughtful people speculated, maybe in these very severe cases of depression or anxiety there is some kind of chemical imbalance in the brain. It was not the worst idea in the world. It was a reasonable question at the time.
Billions Invested, Nothing Found
Then came the money. Billions of dollars were poured into trying to find the chemical culprit. Levels, balances, biomarkers, anything that would let us point to something measurable and say, “There, that is the problem.” And after decades of this, nothing clinically useful was found. As Thomas Insel, former Director of the National Institute of Mental Health, put it, “After spending $20 billion, we have not moved the needle on reducing suicide, reducing hospitalizations, or improving recovery for the tens of millions of people who have mental illnesses.” He ultimately abandoned the DSM as a research tool because it wasn’t producing the biological findings everyone had hoped for.
Meanwhile, something else was happening. Some very smart people in corporate offices and advertising firms realized that the chemical imbalance story was marketing gold. It was simple. It was memorable. And, most importantly, it made people feel hopeful that their pain had a clear, technical solution.
So, for the next several decades, the public was treated to a relentless advertising campaign, not a scientific discovery, a marketing campaign. And it worked beautifully. Most of the Western world now automatically associates depression and anxiety with malfunctioning brain chemistry. The problem is, this association was never grounded in strong science.
What the Leading Psychiatrists Actually Say
And here is where I want to be painfully clear. You do not have to take my word for this. Some of the most respected psychiatrists in the world have been saying this for years.
- Dr. Ronald Pies, former Editor-in-Chief of Psychiatric Times, wrote, “The chemical imbalance notion was always a kind of urban legend, never a theory seriously propounded by well-informed psychiatrists.”
- Dr. Allen Frances, who chaired the DSM-IV task force, said, “There is no biological test for any mental disorder. We have no identified chemical imbalances to correct.”
- Dr. Steven Hyman, former Director of NIMH and a Harvard neuroscientist, stated that psychiatric diagnoses are “not valid in the sense that we do not know the underlying pathophysiology.”
These are not fringe voices. These are leaders in the field. And they are all saying the same thing, the chemical imbalance story was never scientifically established.
Unfortunately, most of the Western world has not yet gotten the memo. Slowly, slowly, people are realizing that there is much more to their depressions and anxieties. This is a good thing.
A Shift Toward Emotional Relational-Malnourishment
The tides are beginning to turn toward a much older and more human tradition, a tradition that has taken many forms across history, but which I call Emotional-Relational Malnourishment.
Its core ideas are simple.
First, mild to moderate depressions and anxieties are universal. Anyone who lives a human life will feel these things. They are serious. They are unpleasant. And they call for care and attention. People need guidance in how to deal with them constructively. If that guidance is missing, later experiences tend to become increasingly painful and confusing.
Second, when depressions and anxieties become extreme or repetitive, whatever disruptions are happening in brain and body chemistry are symptoms. They are not the underlying problem. The underlying problem is chronic emotional-relational malnourishment. The human equivalent of not getting enough food, enough warmth, enough oxygen. But in this case, the missing nutrient is connection, support, honesty, vulnerability, repair, belonging.
Just like nutritional malnourishment damages the organs, emotional relational malnourishment affects every system in the brain and body. When I read Philip Flores’s book, Addiction as an Attachment Disorder, I had the same lightbulb experience many readers have had. It suddenly became obvious that supportive, connected, emotionally regulatory relationships are a necessity, not a luxury, for psychological health.
You Can Stop Obsessing About Your Brain
Your painful depressions and anxieties are not emanating from an imbalance or a broken brain. You are dealing with relationships that never provided enough emotional nourishment or safety or repair. What you are suffering from is an emotional-relational life that has not, and is not, providing you with sufficient nourishment – emotionally, relationally, psychologically.
As more people learn this, a new kind of hope becomes available. Not the hope of a technical fix. The hope of learning to live, relate, love, and connect differently.
I will be writing much more about this. I hope others do as well, because I care about it deeply and because the world needs a clearer, more accurate understanding of what anxiety and depression truly are, and what we can do to alleviate suffering for ourselves and loved ones.
