Throughout the history of psychology, there have been many perspectives and models, ranging from biogenetic to psychodynamic to sociocultural, and more, to understand depression and mental illnesses. One of the most widely known and conversed theories is that depression is caused by a chemical imbalance in the brain. Though, countless research has shown that the idea of depression emerging from having too little of a neurotransmitter, such as serotonin, is not supported by scientific evidence with a recent systematic review of studies by Moncrieff et al., (2022) reviving debate. A conflicting trend arises when seeing that while the psychology world has evolved, 80% of Americans view the theory as truth (Lebowitz et al., 2013). This is not meant to downplay the biological mechanisms that factor into mental illnesses, but to recognize the oversimplification of certain biological theories and their impact on treatment outcomes, stigma, and mood for people with depression and other mental illnesses. Biogenetic narratives have taken various forms throughout the decade. For instance, the origins of the chemical imbalance theory can be traced back to the 1950-the 1960s, with its popularity spiking around the 1990s as a result of increased prescriptions of antidepressants and advertising. The 1960s saw the emergence of the “monoamine hypothesis,” which emphasized chemicals such as noradrenaline due to their connection to regions in the brain impacting mood and emotions (Ang et al., 2022). This was further supported throughout the later half of the 20th century with the “serotonin hypothesis” and increased use of SSRIs (selective serotonin reuptake inhibitors). While some researchers claim that psychiatry embraced this theory, and thus are partly to blame for perpetuating it, others such as Pies (2019) lay the fault more on the pharmaceutical industry, stating that these companies “heavily promoted the chemical imbalance trope in their direct-to-consumer advertising.” To explain, messages claiming antidepressants would “correct” imbalances and similar lines of reasoning were heavily present in advertisements, book and article taglines, websites, leaflets, and more (Ang et al., 2022). In the late 1990s and 2000s, some psychiatrists and professionals concluded based on evidence that “no abnormalities of either catecholamine or 5HT (serotonin) systems have ever been replicated in a manner that has commanded widespread support” (Ang et al., 2022). Some mental health campaigns and organizations perceive promoting biogenetic explanations as beneficial for those with depression. For instance, The National Alliance of Mental Illness (NAMI), along with other healthcare providers see it as a way of reducing stigma and lowering individuals’ responsibility for their own mental illness (Rüsch et al., 2010). The idea of “genetic essentialism”, is nuanced for the fact that on one hand, it can lower personal blame for one’s illness, but on the other, it describes conditions as predetermined and immutable. Rüsch et al., 2010 analyzed “the link between endorsing genetic or neurobiological models of mental illness…and two key types of reactions to people with mental illness: decreased responsibility and blame versus increased fear and avoidance”. The results expressed that with the general public sample, support for genetic causes was linked to lowered stigma in terms of responsibility but higher stigma in terms of avoiding individuals with mental illnesses. The authors suggested that in this case, discriminatory beliefs and actions were more detrimental than thoughts regarding self-responsibility. Moreover, in one study, ideas of self-responsibility related to biological causes for depression heightened the general public’s “willingness to cut healthcare expenditures for this disorder.” (Angermeyer et al, 2011) To clarify, while supporting biological causes for depression may help the individual’s sense of responsibility, there are more significant implications beyond their experiences that serve to stigmatize those with depression.
The effects of accounting for mental illnesses on a purely biological and genetic basis are further displayed through research studying individuals’ perceptions of their own mental health and attitude. For instance, in a United States-based study, Lebowitz et al., (2013) sought to explore the connection between “biochemical and genetic attributions for depression” and “prognostic pessimism among individuals with depressive symptoms”. They found that participants who believed their depression resulted from a biochemical imbalance or genetics displayed more pessimistic attitudes, and was a predictor of “longer expected symptom duration” and “lower perceived odds of recovery”. This could potentially outline the danger of subscribing to such an idea, and how it harms the recovery and healing process. The same study also investigated how teaching that biology is not fixed to a group of participants decreased their pessimism and heightened their own agency in their own health and mood (Lebowitz et al., 2013). To emphasize, this describes a promising way of combating feelings of lowered autonomy and increased sadness in connection to certain beliefs and supports more malleable approaches for understanding depression.
Another study conducted by Schroder et al., (2020) looked at 279 patients apart of a behaviorally-based therapy program to gain more insight into individuals who experience more psychological dysfunction and had greater exposure to clinical settings. Participants were questioned about their opinions regarding causes of depression, treatment credibility and expectancy, and, depressive symptoms, Biologically-based causes of depression, such as the chemical imbalance theory were linked to less favorable treatment outcomes and expectations, as well as predicting “more depressive symptoms after the brief treatment program”. Aside from societal, media, and psychiatric influence, a possible internal source for believing biological causes may result in “participants who cannot explain the cause of their depression or pinpoint a triggering event may eventually attribute their depression to hidden, unknown biological mechanisms” (Schroder et al., (2020). It would be helpful for more studies to examine the external and internal factors that influence opinions about one’s own disorder. Ultimately, there should be an attempt to bridge the gap between professionals’ and patients’ perceptions and theories regarding depression to increase clarity and expand the current narrative.
In current times, many professionals advise an understanding of depression that is a combination of biological, environmental, and socio-cultural factors. As Pies (2019) claims, childhood stress, race and ethnicity of minority populations, and lack of social support are other factors that researchers have studied in relation to depressive symptoms and episodes. In addition, George Engel, a prominent scholar in the field of psychology revolutionized the way scientists view mental illness, creating a biopsychosocial model of depression (Fava & Sonino, 2017). He rejected the idea of a singular reason and acknowledged that “corporate interest in medical science” sought to make it a singular issue. The biopsychosocial model allows for a comprehensive understanding and analysis of the various factors that impact thought, emotions, behaviors, and disorders. As the consequences of subscribing to purely biogenetic reasons for the etiology of depression become more evident, there should be more pronounced support for spreading more effective narratives such as the biopsychosocial model to the public. Looking at depression and other mental illnesses from this angle also makes it so that each case is treated depending on a person’s unique situation, and recognizes the unique challenges people face.
Ang, Horowitz, M., & Moncrieff, J. (2022). Is the chemical imbalance an “urban legend”? An exploration of the status of the serotonin theory of depression in the scientific literature. SSM - Mental Health, 2, 100098–. https://doi.org/10.1016/j.ssmmh.2022.100098
Angermeyer, Holzinger, A., Carta, M. G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: Systematic review of population studies. British Journal of Psychiatry, 199(5), 367–372. https://doi.org/10.1192/bjp.bp.110.085563
Fava, & Sonino, N. (2017). From the Lesson of George Engel to Current Knowledge: The Biopsychosocial Model 40 Years Later. Psychotherapy and Psychosomatics, 86(5), 257–259. https://doi.org/10.1159/000478808
Lebowitz, Ahn, W., & Nolen-Hoeksema, S. (2013). Fixable or Fate? Perceptions of the Biology of Depression. Journal of Consulting and Clinical Psychology, 81(3), 518–527. https://do i.org/10.1037/a0031730
Moncrieff, J., Cooper, R.E., Stockmann, T. et al. (2022). The serotonin theory of depression: a systematic umbrella review of the evidence. Molecular Psychiatry https://doi.org/10.1038 /s41380-022-01661-0
Pies. (2019). Debunking the Two “Chemical Imbalance” Myths : And Moving Toward a Bio-psycho-socio-cultural Model of Major Depression. The Psychiatric Times, 36(8)
Rüsch, Todd, A. R., Bodenhausen, G. V., & Corrigan, P. W. (2009). Biogenetic models of psychopathology, implicit guilt, and mental illness stigma. Psychiatry Research, 179(3), 328–332. https://doi.org/10.1016/j.psychres.2009.09.010
Schroder, Duda, J. M., Christensen, K., Beard, C., & Björgvinsson, T. (2020). Stressors and chemical imbalances: Beliefs about the causes of depression in an acute psychiatric treatment sample. Journal of Affective Disorders, 276, 537–545. https://doi.org/10.101 6/j.jad.2020.07.061