Everything you thought you knew about mental health is wrong | Joanna Moncrieff
Joanna Moncrieff challenges the dominant view in psychiatry over the last 40 years – that mental illness is a result of a chemical imbalance in the brain.
Is the chemical imbalance theory the biggest myth in medicine?
With a free trial, you can watch Joanna debate the promise and dangers of psychedelic drugs NOW at https://iai.tv/video/out-of-our-minds?utm_source=YouTube&utm_medium=description
We tend to think that depression and other mental illnesses are medical conditions caused by problems in the brain, and that framing them this way reduces stigma and leads to better treatment. However, Joanna Moncrieff argues that this is deeply mistaken, and that medicalising mental distress can actually increase stigma, undermine hope of recovery, and distract us from what really helps. Drawing on science, philosophy, and the history of pharmaceutical marketing, join Joanna in the search for a new and better model of mental health.
#psychology #mentalhealth #science #neuroscience
Joanna Moncrieff is a British psychiatrist and academic. She is Professor of Critical and Social Psychiatry at University College London and a leading figure in the Critical Psychiatry Network.
The Institute of Art and Ideas features videos and articles from cutting edge thinkers discussing the ideas that are shaping the world, from metaphysics to string theory, technology to democracy, aesthetics to genetics. Subscribe today! https://iai.tv/subscribe?utm_source=YouTube&utm_medium=description&utm_campaign=joanna-moncrieff-medicalization-of-mental-illness
00:36 What are the consequences of treating mental health conditions as medical issues?
02:38 What is the evidence for mental illness not being a matter of brain dysfunction?
04:34 What do you make of the expectation that a relationship should exist between mental health and the brain?
06:59 How would we improve the condition of people suffering from mental health difficulties under the non-medical view?
08:55 How do you explain the occurrence of depression in objectively positive circumstances?
10:38 Would you give a similar account of other mental health conditions like schizophrenia?
12:24 Would it be accurate to say that mental disorders are just ways of behaving that strike us as unusual?
12:47 How would you respond to the risk that this view stigmatises mental health disorders?
15:16 Should the courts deal differently with people who have committed crimes who have mental disorders?
15:54 Is there a way to avoid taking a moralistic line with your positive account of what mental health is?
17:05 Could you describe how the pharmaceutical industry has played a role in the medicalisation of mental health?
18:53 Has your own work been suppressed by these vested interests?
19:30 Have you always been critical of the dominant model of mental health?
20:43 Have you found it useful to interact with philosophers when it comes to your thinking in psychiatry?
For debates and talks: https://iai.tv
For articles: https://iai.tv/articles
For courses: https://iai.tv/iai-academy/courses
44 Comments
Do you still have faith in the pharmaceutical industry?
With a free trial, you can watch Joanna debate the promise and dangers of psychedelic drugs at https://iai.tv/video/out-of-our-minds?utm_source=YouTube&utm_medium=pinned-comment
🦆🦆🦆
She forgets to include the context of the society, inequality, power imbalance, miss information, uncertainty, gas lighting, etc
If pharma has medicalised mental health then she is depoliticising it.. from what im hearing.
I think that in general there are spiritual and psychobiological approaches to treating mental disorders and depression in particular. The spiritual approach presupposes an awareness of one's own responsibility for the illness and the need to change the entire order of one's previously habitual life and thinking. In contrast the psychobiological approach presupposes a state of innocence and victimhood in the face of circumstances, people, stories, the past and so on, and the need for active external therapeutic intervention. It seems to me that the spiritual method is always aimed at final healing, while psychobiological therapy can be a way of temporary help, correction, support and pushing the patient towards the spiritual path of healing.
Mental Ill Health is Entirely down to "Childhood Trauma". Treatment for Mental Ill Health is extremely Poor. Talk Therapy and Their Modalities "Don't Work"!! Execrice, Meditation, Healthy Eating etc. Only "Manage" the Symptoms, they are Not a Cure and they Don't Rewire the Brain. It seems that by the age of 5 or so, if you had a traumatic or a Less than "Good Enough" Childhood, you will have to deal with the repercussions for the rest of your life. Currently there is "NO CURE" for Mental Health Disorders, all you can do is "Manage" the symptoms.
P.S. The "LIE" of a "Chemical Imbalance" causing Ill Mental Healthy is "Purely" made up by "GREEDY" Pharmaceutical Companies. Which has caused So Many People "Unnecessary Suffering"! These "Disgraceful" Companies should be held Accountable for their "Grossly Immoral Behaviour"!!
This is potentially a very dangerous opinion
5:06
A medical treatment driven by a profit motivated business model…..👺
Personally I think there might be stigma when it comes to “mental illness” vs mental health
So many women I talk to use medical terms to describe their otherwise normal behavior with a bit of depression or anxiety, just as bad sex is often elevated to sexual assault. Safe spaces and trigger warnings drive more mental anguish and more childlike reaction rather than being a free adult.
This isn’t even “either – or”, not a strictly binary question nor answer. Even up until mid 90’s, depression could be diagnosed on a spectrum from ‘reactive’ to ‘endogenous’. A decade later, only the latter remained.
Individualism is structural to our (western) culture, even when we deliberate matters with clear social or societal contexts. As said in the video, we have internalized individualisation of failure – even when something beyond an individual’s agency fails.
That narrative caters for recurrent and chronic depression, whether the dynamics behind the symptoms are internal or external – or likely a complex of both.
4:58 It is just a matter of information exchange.
I heard of a mother being trapped into a severe war trauma. She was Jewish. And kept having dreams or imaginations (past memories) of being in a dark cellar with the family. While loud foodsteps and shouted commands sounded above. Before the hatch was removed and Nazi uniforms appeared holding machine guns pointing at them. While now they were in the light.
Revealed fear. Trauma.
While in fact this never could have happened. Because she was there and never went to a camp.
What had happened was she went into hiding and met a Catholic man hiding her, she later married with. But who also appeared to be in the resistance.
So all of this (conflict) only made things worse for her.
Because now apart from difference in religion, there was a big chance he could be trapped and she with it.
It brought everything closer again. And never went away.
They even had a son later who was diagnosed crazy. He was very intelligent. But made things that bad they even removed him from their passports. Did not want to be responsible anymore.
So is that a matter of a damaged brain? Or genes?
Or just pure experience. Secundly for him the transformation of consiousness already present. She might have been very scared to bring a child into this world.
I do not know whether they ever tried drugs on him. If so it apparently did not work. And he was too clever to be impressed by a psychiatrist. He just fooled them.
They also had a daughter who kept an affair with two men at the same time while they knew it. They all three went on holiday together.
The returning split personality. Pleasing 'two men' at the same time.
I also have known a bipolar lady closely. Who was the middle daughter of three.
And while the first one got all the attention from the father (the mother was beautifull but weak: a follower character).
She got very upset and wanted to attract his attention. Proving she was actually the best.
Later on in life she only fell for married men. And at the same time never trusted them. Because there had been like in her experience another woman at play. She as a child could not defeat.
This is the Oedipus complex for women. Not wanting to kill their mother.
But to outcompete her by winning the heart and mind of the father. Narcica perhaps?
She later on became a single mother. To have it her way.
Still under heavy drug use at the time. Suppressing the bipolar disorder which later became obvious.
She also had the tendency of wanting to really kill a collegue. So she could not work anymore.
And got a benefit for life ;-).
All of this really happened.
She first was only manic. And later was told to be diagnosed manic depressive.
Although that was not bad because Churchill also was. She was kind of proud if it.
Really?
They did not really look underneath the hood.
Radio waves can be used to alter chemical structures, we are bombarded with radio waves which are altering our chemical structures. Fm and Am, to be at ease we need to work on our frequency manipulation and our amplitude manipulation or start communicating face to face and get rid of the things that keep us apart. Technology will be our downfall, not our rise to greatness.
thanks great show
6:45 Thank You 🫶
This is exactly what I am thinking , it is the very normal human response
She is describing an ideal world.
According to this lady, the idea is to exercise and dance, and that's the end of the problem. The first thing I would ask her is, has she ever had any of these illnesses? It seems very easy to give such a stupid prescription.
I work with holistic health care, herbal medicine and art therapy. Interesting interview and I should agree but I don’t. I’m a biologist as well and we understand the universe better than the human body. And in perfect circumstances people might heal from trauma or tough situations through therapy or whatever. But we don’t live in a society where people get that treatment for free (because that would be the option?). And we live in a world where unfortunately most people will get themselves in reality tough situations. So most people would eventually need therapy? Sometimes we just need a pain killer to get through the day or something to make us sleep. Yes, it’s symptom reduction. But when did that become the new evil? And in this I even turn on my peers. I made the same promise as a doctor. To reduce suffering. Herbalism isn’t magic. It’s as much symptom reduction as modern medicine. But when we can we strive to find the underlying cause and heal that. If it’s possible. But many times it’s not. I wish all of you well.
If she wants to say we experience a mental health crisis because we are in very shitty circumstances, she is right. To correct those circumstances would be the correct way to deal with it. But it wouldnt be a small change, since we had to change basically our complete modern western lifestyle.
We have been socialized to believe that health is physical & the norm only; and that mental illness/mental health is abnormal-therefore there must be something "wrong" with your mind/brain. This in turn created a separation of our body and mind;
good health versus bad/wrong
Symptoms are our body's language communicating, protecting and alerting us to slow down, rest/care for mind/body, stop, ask for help.
Each of us can become ill in many different ways, and we can become healthy. We needs to maintain/sustain our whole health.
Unfortunately, profit superceeds whole health
Heeey thank you for sharing this, is there a link to the full video ?
When we can't even accurately measure the amount of serotonin someone has, how can GPs and Psychiatrists feel comfortable prescribing treatments that influence it?
I'm treatment resistant, I have had a MyDNA test and that has confirmed it but it keeps being ignored/forgotten by my doctors. I have had negative mental health outcomes with CCBs and ACE inhibitors which were used to treat my other health issues, but they cross the blood brain barrier and have caused toxicity.
This issue goes far beyond just mental health medication and into the truth that without individual DNA tests, regular accurate measurements with baselines, and Dr's who are capable of providing this level of support to most people we are just playing darts in a hurricane blindfolded.
I'm not anti-medication, I'm against the lack of investment in mental health support, testing, and tools.
When I received a very late diagnosis for AuDHD (plus extras) it didn't include a parachute for the traume, or even an explanation of what it would mean. Years later I'm still trying to untangle or accept my traumas, but on top of this I'm now realising the both the medical supports and medication I've been given for years are totally insufficient, and even inappropriate.
There is no reason this lady should be on a show that has anything to do with science.
I suppose what I am more interested in understanding is why she didn't draw the parallel between how the inside influences the outside and vice versa — how we are both participants and shaped by our environment.
Supposedly, the homelessness crisis, childhood abuse, sexual violation, poor relationship history, and the strain under capitalism all impact our mental chemistry and the synaptic connections we form, because we develop and adapt based on the attachments we have in the world. That influences our brain, which then interprets external signals to match our pre-existing ideas of what the world looks like, or a schema, right? To have a confirmation bias and thus become trapped in a specific thought process, right? It's both internal and external, isn’t it?
I'm surprised she didn't state that we create our environment; our environment creates us — rather than seeing it as dualistic. It’s non-dual. There is no separate 'us' and 'environment'; these are just scaffolds we've constructed to codify our ego, right? We are not our ego, nor the bodies we inhabit, nor our brains. We are everything in between. I think I would have preferred something more complex and phenomenological.
Szasz was right.
The medicalization of everyday life is one of the greatest scandals in human history. Thoughts are not diseases as Szasz said in the 1950s. The ancient Stoics knew that negative emotions were reactions to adverse circumstances. The modern “therapeutic” paradigm is still trapped in the medicalization model. The most effective psychological “therapy” is cognitive behavioural therapy (CBT) and guess what? CBT is based on Stoicism. The pharmaceutical industry has moved in, and continues to ply its propaganda on the world. Joanna Moncreiff is clearly influenced by Szasz but does not go far enough – and we need a revival of his ideas.
The medicalization of everyday life is one of the greatest scandals in human history. Thoughts are not diseases as Szasz said in the 1950s. The ancient Stoics knew that negative emotions were reactions to adverse circumstances. The modern “therapeutic” paradigm is still trapped in the medicalization model. The most effective psychological “therapy” is cognitive behavioural therapy (CBT) and guess what? CBT is based on Stoicism. The pharmaceutical industry has moved in, and continues to ply its propaganda on the world. Joanna Moncreiff is clearly influenced by Szasz but does not go far enough – and we need a revival of his ideas.
If there isn’t a blood test for something then medicine has no business in it.
Change your environment and your habits, you will change.
The diet for your senses shape you.
How can you feel good if you torture yourself?
Existing in this failed civilization is what causes depression and all other mental health problems. Working for a living is unfufilling and soul crushing. Depression is a result of having to play a game you know is rigged against you
Personally, when I took birth control pills, they affected my mood and led to depression. The depression returned during menopause, and I realized it was due to my hormone levels. I also developed trigeminal neuralgia, which I'd never had before. Both disappeared with hormone replacement therapy. As a psychologist, I've learned the tremendous importance of biology in our mental and emotional states, so now I also exercise, follow an anti-inflammatory diet, and go for a walk every day to see the light of day. I try to respect my sleep and maintain a supportive relationship with others. HRT has made a huge difference in my neurological inflammation caused by the reduced amount of extrogens in my body, without I would still suffer, sincerely. Without my response to difficult situations was definitely less resiliant.
It's fantastic we are having this debate. I'm no anti-capitalist tin-foil hat wearer, capitalism has made many great things possible, but like everything when the tail wags the dog we have a problem. Greed is a sinister shape-shifter and can undermine truth for decades.
This video just reinforces my view that psychiatry is a very woolly and unscientific discipline. The amount of times she says "we may never know" or "we can't say for sure" is very disconcerting for someone making such big claims. One of the biggest problems with psychiatry is that diagnoses of anxiety and depression almost exclusively rely on self-report, which is highly problematic given that a patient is usually at their lowest ebb when they meet a psychiatrist for the first time and might not be able to properly articulate how they're feeling. By contrast, if I have kidney disease or thyroid problems or psoriasis, my doctor can do blood tests to establish firstly whether the patient has the illness, and if so, the severity of it. Psychiatrists have no lesion or biomarker they can point to and confidently say "you're suffering from X, Y or Z."
I'd agree with her that a lot of mental illness can be traced back to childhood adversity, and that has been demonstrated by Dr Vincent Felitti's ACE (adverse childhood experiences) study, which showed a dose-response relationship between childhood trauma and health conditions in later life. However, life history has already happened, so the question remains regarding what to do to treat the downstream health issues it causes.
To her credit, her umbrella review of the serotonin literature was a legitimate and methodologically sound contribution — the chemical imbalance story was always more marketing than science. But that's a narrower claim than the one she's making here, and I'm glad the interviewer pushed her on schizophrenia, because it exposes the epistemic overreach of her broader argument. She didn't really answer the question. There are conditions like ADHD and addiction where medication demonstrably works, as blunt an instrument as it may be. There's also strong evidence that OCD results from serotonergic dysfunction in the cortico-striato-thalamo-cortical circuit, and that high doses of SSRIs can meaningfully improve patients' quality of life.
Finally, it's all well and good recommending therapy, but mental health clinicians are scarce, have long waiting lists even for private patients, and are prohibitively expensive for all but those who can afford health insurance or are willing to wait years to be seen publicly. It's also a bit on the nose to tell someone who's very ill with depression to go dancing or go to the gym when they can hardly get out of bed.
15:08 Disappointed by the quality of this guest – do we really want to be speaking in terms of “proper” brain disease?
Ultimately whether treated with pharmaceuticals or not the centre of this is the person. There is no either/or when it comes to lifestyle/therapy/chemical treatments for mental health disorders. To suggest otherwise is a false dichotomy that is itself as damaging as demonising any particular kind of treatment.
i agree on some general points. But how can you say absolutely its not to do with physiological causes that are not related to life circumstances? ie. many side effects of drugs can cause depression and alter mood. How do you square this? Geneuinely curious
Everything you thought you knew about everything is wrong.
Fromm warned how destructive commercial psychology would be become. That was 75 years ago, the field had 75 years to avoid becoming the most socially destructive academic force to ever exist.
Our emotions interact with lots of types of 'things'. Such as our environment, our hormones (and all sorts of body mechanisms) and our relationships, sun, diet etc. It's unbelievably complex, because each 'thing' influences all the others
Only someone who hasn‘t experienced an anxiety disorder can say something like that it‘s a „normal variant of emotions“. That“s like saying being paralyzed is a normal variant, no need for wheel chairs. Regular panic attacks feel like torture. I’m so relieved now that I have found a medication to treat that condition. I can finally lead a normal life.
It‘s a medical condition if people suffer from it. Period. It‘s a good thing to prescribe medications if they help patients. It‘s the subjective experience that counts. Acting crazy is no disease if you enjoy it. But suffering from emotional instability definitively is.
The new Serenity as well ce Mr Burns and Sterling
Depression is real
food and microbiome
Mental illness is treated with chemical drugs. But mental illness as a result of common industrial and household chemicals and unnatural food additive chemicals are not associated with mental illness? Every generation for the last 100 years is saturated with mind and hormone disrupting drugs passed off as harmless necessary chemicals in our food, water and air. I’m sick of all these credited experts and book writers who willfully resist to definitively identify the root causes. I watched the effects between my great grandmothers generation and my parents. I’ve always felt I was witnessing something profound happening. I’ve made it a point to be informed and question all medical trends that doctors try to sell. Western medicine is snake oil to cover the symptoms caused by circumstances. A spiritually dysfunctional culture founded on rebellion, revenge, violence, escapism, lies and fake love. Mental illness is caused by circumstances.
Here's what she gets seriously wrong. Persistent childhood trauma affects the brain in structural ways. In many cases, in order to get to baseline functioning a chemical intervention is needed. I've been taking an anti depressant on and off for most of the last 30 years because I"ve given this very question a great deal of thought. I am sure that there are many people who are given an anti depressant for what are normal stages of grief and having to endure negative environments. But there are many like myself. This message gets recirculated every few years and will probably continue to.