It’s often the case that an entire belief system is spawned from a single story, experiment or case study. This is certainly the case with the neurochemical model of behavior. While neurotransmitters like serotonin and norepinephrine were discovered in the 1950s, the profound effects these chemicals have on human behavior weren’t proven until 1961, when an injection of L-DOPA — a dopamine precursor — drastically reduced a Parkinson’s patient’s tremors. A slew of studies attributing other mental disorders to chemical imbalances followed. Soon, it seemed evident that our behavior, mood and personality were determined by these same chemicals.
While this model has helped treat millions of people, it has also come to restrict our understanding of human behavior and mental health. This restriction has led to a general disregard for basic human needs, a reduction of agency and the overprescription of psychiatric drugs.
I think the concept of an Identified Patient can define the limits of the neurochemical model, as well as introduce a new way of thinking about human behavior — just as the L-DOPA experiments limited the use of psychoanalysis and helped invent modern psychiatry. The clinical term Identified Patient describes an individual whose natural reaction to a toxic home environment is pathologized by the family. Labeling one member of the family as “crazy” deflects blame from the family’s dysfunctional dynamics.
The Identified Patient phenomenon can serve as a metaphor to describe the neurochemical model’s misapplication. In this case, instead of a toxic family labeling one of its members as mentally unwell, a dysfunctional culture deflects blame away from itself by overestimating the prevalence of mental illness. In many cases, societal issues prevent an individual from meeting minimum requirements for well-being, the individual becomes unhappy. This unhappiness is conceptualized as a chemical imbalance by a psychiatrist and the patient is prescribed psychiatric drugs.
I hope this article can paint a realistic — and at times harrowing — picture of this transmutation from individual to patient that has happened in our country, which exhibits an incredibly high per-capita consumption of psychiatric drugs.
The reasons for unhappiness in the United States, as they are in any society, are myriad. I would immediately point to the increasing rarity of third places such as libraries or churches, the extensive use of technology and increasing financial pressures. If you want a more extensive list of some contemporary American stressors, I would refer you to Celeste Cariker’s recent op-ed. Unfortunately, the neurochemical model’s monopoly over the diagnostic process prevents these exterior factors from being appropriately weighed.
The insistence that neurochemical interactions are somehow more fundamental to reality than immediately observable phenomena is beginning to creep into everyday speech. I frequently hear people say “they need a little dopamine hit” when they’re craving dessert. Sometimes impulses much more fundamental to the human experience are conscripted into the service of a neurochemical.
Last week, I received an email from Pomona College promoting a concert. The flyer attached immediately cited the fact that music “can trigger the release of dopamine and endorphins.” While this is correct, the statement’s prominence on the flyer suggests that music’s value derives from its ability to modulate neurotransmitter production. This statement almost feels sacrilegious, given music’s profound, spiritual valence and importance in defining the human experience. My aim isn’t to critique the rhetorical decisions made in the poster, but to explain how pervasive and limiting the neurochemical model of behavior can be.
The use of overly psychiatric language reveals the neurochemical model’s secret ambition to extend its list of diagnostic criteria until we are all patients, reducing an experience that was once spiritual and profound into a medical regimen. This kind of logic makes moving through your day seem like swallowing a series of pills: 5 mg of adderall for dopamine, 30 minutes of sunlight for serotonin production and a short jog for the endorphins.
This devaluing of the human experience is reflected in how frequently psychiatric interventions result in the elimination of core human capacities. I immediately think of my friend who quit playing the piano after being prescribed an SSRI, stating that all the notes sounded the same on the medication. Many SSRI users report a similar flattening of their emotional and perceptual experience. SSRIs are also known to significantly alter a user’s sex life. In studies, nearly 90% of all SSRI users have reported sexual dysfunction. I initially felt compelled to explain why this statistic is so disturbing, and then realized my attempt to do so was just as misguided as the wellness poster’s attempt to explain why music is valuable. Orgasms are good. This fact should be self-evident and does not need to be supported by its relation to a specific neurochemical or study.
The administration of psychiatric drugs can sometimes have much more disastrous effects. Oftentimes, Bipolar 1 individuals are misdiagnosed as suffering from depression. When they are prescribed SSRIs, they are liable to experience a manic episode. If their dose is high enough and their case of Bipolar 1 is severe, these manic episodes can result in hospitalization. Misdiagnosing or misprescribing a patient is incredibly common. I was told by a psychiatrist in college that I needed to be on a mood stabilizer and stay away from drugs that could prompt episodes of mania, such as amphetamines. Ironically, a psychiatrist recommended I take an amphetamine (adderall) to manage my ADHD symptoms in high school. While it is theoretically possible that I have both ADHD and Bipolar 2, taking Adderall without the presence of a mood stabilizer could be potentially disastrous.
This isn’t to suggest that psychiatric drugs aren’t incredibly useful for many people. Psychiatric drugs treating neurodegenerative disorders have added years to people’s lives and my friend credits antipsychotics with saving his life. However, the majority of psychiatric drugs are prescribed to treat anxiety and depressive disorders, which are oftentimes qualitatively different than their more severe counterparts.
My primary issue with the neurochemical model is that it directs attention away from systemic issues that need to be addressed. By placing blame on a specific chemical, we are liable to ignore the environmental conditions leading to our unhappiness or anxiety. If you have been diagnosed with a mental illness or have been advised to pursue medication, I highly suggest you pause for a second. Avert your gaze from the neurochemical world and inspect what is immediately evident to you. Make note of everything that harms your general well-being. Find the items you can reasonably change or eliminate. Understand that there are few things as drastic as chemically altering your mind, and make your lifestyle adjustments accordingly.
Liam Riley PO ’26 is trying his best to hopemaxx.