Myth of the chemical cure

“Imagine a society that subjects people to conditions that make them terribly unhappy then gives them the drugs to take away their unhappiness”
— Theodore Kaczynski

FOR decades, a simple and reassuring idea has shaped how mental illness is understood and treated globally — that conditions such as depression, anxiety and schizophrenia are caused by “chemical imbalances” in the brain, and that psychiatric drugs work by “correcting these imbalances”. This narrative has become deeply embedded in public consciousness, medical training and health policy. Yet, as Joanna Moncrieff, psychiatrist and researcher argues in her book Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth, this explanation is more assumption than fact.

Psychiatric medications can alter mental states and some people experience relief while taking them. Moncrieff’s challenge is more fundamental. She questions the claim that these drugs treat underlying biological abnormalities in the same way insulin treats diabetes. She argues that psychiatric medications produce altered physical and mental states like sedation, emotional blunting and stimulation, which may dampen distress but do not correct any underlying chemical imbalance.

The chemical imbalance theory has been powerful because of its simplicity in selling the message to the public. It reassures patients that their suffering is not a personal failure and gives doctors a simple scientific rationale for treatment. In poorly developed health systems, medications are a useful response to distress.

Moncrieff urges us to ask: what exactly are these drugs doing, and what are we promising when we prescribe them? According to Moncrieff, decades of research have failed to demonstrate consistent chemical abnormalities that psychiatric drugs correct. For example, the idea that depression is caused by low serotonin levels has not been reliably supported by empirical evidence. Nevertheless, antidepressants are often described to patients as “correcting a chemical imbalance”.

Are we offering treatment, or are we managing distress in the most convenient way?

What antidepressants do clearly produce are altered states: emotional numbing, reduced intensity of feeling, and sometimes increased agitation, especially early in treatment. Antipsychotics, similarly, reduce psychotic experiences largely through sedation and suppression of activity of another neurotransmitter, dopamine, while also producing significant physical effects such as weight gain, metabolic problems and movement disorders.

This does not mean these drugs never help. It means their effects are better understood as psychoactive rather than curative. They may reduce distress in the short term, but they also impose costs that are frequently under-acknowledged — particularly in low-resource settings where monitoring is limited.

Furthermore, any account of the ‘chemical cure’ narrative must also recognise the role of the pharmaceutical industry in shaping it. The idea that psychiatric drugs correct chemical imbalances was not simply a scientific discovery but was actively promoted alongside new medications. Fluoxetine introduced in the late 1980s was marketed as correcting a serotonin deficiency in depression, a marketing ploy rather than based on scientific evidence that proved highly persuasive. This narrative helped brands make millions in profit and changed the public’s attitudes towards psychiatric drugs.

For countries like Pakistan, where mental health systems are very poorly developed, this argument has particular relevance. There are fewer than one psychiatrist per half a million people and psychiatric drugs are sometimes the only form of mental healthcare. They are routinely prescribed in outpatient clinics, often after very brief consultations, reinforcing a model of care that prioritises medications as an answer to deal with distress caused by poor social conditions. While there are no generics, several cheap ‘me too’ brands manufactured locally, are readily available. In Pakistan, these are over- and inappropriately prescribed by physicians and psychiatrists alike, reaping huge profits for the drug industry. It is not uncommon to find a patient with mental health problems on several psychotropic medications, sometimes more than one of the same class! Patients remain on these drugs for years, experience side effects that go unrecognised, or struggle with withdrawal when attempting to stop.

The important question is this: are we offering treatment, or are we managing distress in the most convenient way? As Moncrieff notes drugs may have a place particularly in acute crisis situations but they should not be presented as correcting an underlying defect or as the default response to social suffering.

For Pakistan, it means addressing the social determinants of mental health that is creating such high levels of distress in our population. It also has crucial implications in the training of doctors to inquire about social factors in patients’ presentations as well as decisions about whether, when and how to use medication. In Pakistan, hardly any patient walks out of a psychiatric clinic without a prescription!

Critiquing the chemical cure myth does not require rejecting psychiatric medication altogether. Moncrieff herself emphasises choice, transparency and proportionality. It means resisting the temptation to medicalise problems that are fundamentally social. No pill can resolve gender violence, economic injustice or political oppression — ills that beset Pakistani society. Treating these realities as chemical disorders obscures responsibility and silencing legitimate anger and grief.

At its core, Chemically Imbalanced is a call for intellectual honesty. It asks us to abandon comforting simplifications and to acknowledge that mental distress does not fit neatly into biomedical categories. We can choose a path that values medication as one tool, not the main or the only tool, among many and use it carefully. Or we can continue to mislead patients and ourselves about the ‘chemical cure’.

As Pakistan struggles to address its mental health crisis, we need to ask ourselves about the overreliance on the biomedical approach to deal with this crisis. The solution will not come from prescribing more pills but recognising that distress is as much a social and politically driven issue as it is a medical one. Only by moving beyond the myth of the chemical cure can we begin to build a mental health system that truly serves the people it is meant to help.

The writer is Professor Emeritus, Psychiatry, Aga Khan University.

mmkarticle@gmail.com

Published in Dawn, April 11th, 2026

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