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A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances

Simon Sobo, M.D.

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The assumption that the etiologies of DSM-IV disorders are fundamentally related to "chemical imbalances" is challenged. While the chemical imbalance model may eventually be empirically shown to be unequivocally accurate in specific disorders, this is not presently the case for any disorder. The attempt to correct chemical imbalances through medication is at the heart of modern
psychiatric treatment, as are evidence-based protocols which follow from the establishment of an accurate diagnosis. There is much to be said for this approach, but the downside is that other medication treatment strategies are rendered illegitimate. Instead of correcting imbalances, it is argued that pharmacological agents may be viewed as inducing particular psychological states
which though not specifically related to diagnosis, are nonetheless the basis for the usefulness of the medication. This perspective provides justification for using medications in clinical situations that may not even be DS! M-IV defined. To properly use medications in this way, patients must more often be viewed in the complexity usually associated with psychotherapy. A case is made against the widespread use of medications by non-psychiatrists as well as the 15-minute, once-a-month medication visits that have become standard psychiatric practice, both the product of the chemical imbalance model

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