Skip to main content

‘The Explanation You Have Been Looking For’: Neurobiology as Promise and Hermeneutic Closure

Abstract

The biomedical aspiration of psychiatry has fundamentally reoriented clinical practice since the DSM-III in 1980 and reverberated in the public sphere. Over time, lay public understanding of the causes of mental suffering has increasingly endorsed biological conceptions. In this paper, I explore the sources from which a neurobiological model for mental suffering reaches ordinary people, and investigate its rhetorical appeal, personal appropriation, and consequences. Drawing on interviews and other data, I show that these sources—physicians, popular media, and advertising—share common ontological and moral assumptions. These assumptions, in turn, influence how people take up neurobiological explanation to account for their suffering, and how, paradoxically, they join it to their projects of self-determination. I conclude by considering how, from a phenomenological perspective, a neurobiological account fails to enhance self-knowledge or determination but leads to a hermeneutic dead end.

This is a preview of subscription content, access via your institution.

Notes

  1. American Psychiatric Association, “What is Mental Illness.” https://www.psychiatry.org/patients-families/what-is-mental-illness.

  2. Studies of mental health professionals find a similar tendency to separately classify patient symptoms or conditions as biogenetic or psychosocial and to view treatments accordingly, with psychotherapy regarded as significantly less effective when they believe that patient symptoms are caused by biogenetic factors (Lebowitz and Ahn 2014).

  3. Psychotherapists, in turn, also recommend the use of medication. According to a study of national trends, published in 2010, more than two-thirds of those who received psychotherapy also received a psychiatric medication (Olfson and Marcus 2010).

  4. Further, according to the website, the drug “is thought to work by affecting the levels of … two brain chemicals [serotonin and norepinephrine], both thought to play a role in depression.” https://www.pristiq.com/faqs (accessed Feb. 9, 2021). See a very similar idea at the website for the antipsychotic medication Rexulti, one of the most highly advertised drugs on TV in recent years and marketed as an adjunctive treatment for depression symptoms. https://www.rexulti.com/us/mdd/why-rexulti (accessed Feb. 9, 2021).

  5. Research studies find that the endorsement of biogenetic beliefs is associated with the belief that medication will be effective (Kemp et al. 2014; Lebowitz and Ahn 2014). Conversely, biological attributions of problem origin reduce the perceived effectiveness of psychotherapy (Iselin and Addis 2003; Schreiber and Hartrick 2002).

  6. Curiously, Karp, when speaking of those he actually interviewed, observes that: “Visiting a doctor and then filling a prescription for antidepressants is normally a weighty affair…” (2006: 12).

  7. Phenomenology represents one form, British and Euro-American, of what anthropologists call an ethnopsychology, a “cultural repertoire of conceptions, explanations, emotions, and strategies … for how to experience and to interpret the world” (Jenkins 2015: 97). For an alternative ethnopsychology from Uganda, see the powerful paper by China Scherz and colleagues, “Not You,” this issue.

  8. Interviewees who took medication but did not explain their suffering in terms of neurobiology interpreted medication differently. Those who spoke positively, spoke of medication’s benefits in practical terms, such as increased emotional regulation, better sleep, and more mental focus. Under this interpretation, insight-oriented work remained an open possibility.

References

  • Addis, Michael E., Paula Truax, and Neil S. Jacobson 1995 Why Do People Think They Are Depressed: the Reasons for Depression Questionnaire. Psychotherapy: Theory, Research, Practice, Training 32: 476–483

    Google Scholar 

  • Aho, Kevin 2019 Contexts of Suffering: A Heideggerian Approach to Psychopathology London: Rowman and Littlefield

    Google Scholar 

  • Aikin, Kathryn J., John L. Swasy, and Amie C. Braman 2004 Patient and Physician Attitudes and Behaviors Associated with DTC Promotion of Prescription Drugs—Summary of FDA Survey Research Results. Washington, DC: U.S. Department of Health and Human Services (November 19).

  • Angermeyer, Matthias C., Anita Holzinger, Mauro G. Carta, and Georg Schomerus 2011 Biogenetic Explanations and Public Acceptance of Mental Illness: Systematic Review of Population Studies. The British Journal of Psychiatry 199: 367–372

    Google Scholar 

  • Bann, Carla M., Corette B. Parker, Jacques Bradwejn, Jonathan R.T.. Davidson, Benedetto Vitiello, and Kishore M. Gadde 2004 Assessing Patient Beliefs in a Clinical Trial of Hypericum Perforatum in Major Depression. Depression and Anxiety 20: 114–122

    Google Scholar 

  • Browne, Tamara Kayali 2018 Depression and the Self: Meaning, Control and Authenticity Cambridge, UK: Cambridge University Press

    Google Scholar 

  • Carlat, Daniel J. 2010 Unhinged: the Trouble with Psychiatry—A Doctor’s Revelations about a Profession in Crisis New York: Free Press

    Google Scholar 

  • Carlat, Daniel J. 2015 Response to Lacasse and Leo. The Behavior Therapist 38: 262

    Google Scholar 

  • Carpenter-Song, Elizabeth 2009a Caught in the Psychiatric Net: Meanings and Experiences of ADHD, Pediatric Bipolar Disorder and Mental Health Treatment among a Diverse Group of Families in the United States. Culture, Medicine and Psychiatry 33: 61–85

    Google Scholar 

  • Carpenter-Song, Elizabeth 2009b Children’s Sense of Self in Relation to Clinical Processes: Portraits of Pharmaceutical Transformation. Ethos 37: 257–281

    Google Scholar 

  • Clark, Lee Anna, Bruce Cuthbert, Roberto Lewis-Fernández, William E. Narrow, and Geoffrey M. Reed 2017 Three Approaches to Understanding and Classifying Mental Disorder: ICD-11, DSM-5, and the National Institute of Mental Health’s Research Domain Criteria (RDoC). Psychological Science in the Public Interest 18: 72–145

    Google Scholar 

  • Clarke, Juanne, and Adele Gawley 2009 The Triumph of Pharmaceuticals: the Portrayal of Depression from 1980 to 2005. Administration and Policy in Mental Health 36: 91–101

    Google Scholar 

  • Cohen, David, and Shannon Hughes 2011 How Do People Taking Psychiatric Drugs Explain Their ‘Chemical Imbalance?’ Ethical Human Psychology and Psychiatry 13: 176–189

    Google Scholar 

  • Comaroff, Jean 1982 Medicine: Symbol and Ideology. In The Problem of Medical Knowledge: Examining the Social Construction of Medicine P. Wright, and A. Treacher, eds., Edinburgh: Edinburgh University Press.

    Google Scholar 

  • Conrad, Peter and Joseph W. Schneider 1980. Deviance and Medicalization: From Badness to Sickness. St. Louis, MO: C. V. Mosby.

  • Cushman, Philip 2002 How Psychology Erodes Personhood. Journal of Theoretical and Philosophical Psychology 22: 103–113

    Google Scholar 

  • Davis, Joseph E. 2010. Medicalization, Social Control, and the Relief of Suffering. In The New Blackwell Companion to Medical Sociology, edited by William C. Cockerham, pp. 211–41. Malden, MA: Blackwell Publishers.

  • Davis, Joseph E. 2020. Chemically Imbalanced: Everyday Suffering, Medication, and Our Troubled Quest for Self-Mastery. Chicago: University of Chicago Press.

  • Deacon, Brett J., and Grayson L. Baird 2009 The Chemical Imbalance Explanation of Depression: Reducing Blame at What Cost? Journal of Social and Clinical Psychology 28: 415–435

    Google Scholar 

  • Demasi, Maryanne, and Peter C. Gøtzsche 2020 Presentation of Benefits and Harms of Antidepressants on Websites: A Cross Sectional Study. The International Journal of Risk and Safety in Medicine 31: 53–65

    Google Scholar 

  • Dumit, Joseph 2012 Drugs for Life: How Pharmaceutical Companies Define Our Health Durham, NC: Duke University Press

    Google Scholar 

  • Ehrenberg, Alain 2010 The Weariness of the Self: Diagnosing the History of Depression in the Contemporary Age Montreal and Kingston: McGill-Queen’s University Press

    Google Scholar 

  • Fosgerau, Christina Fogtmann, and Annette Sofie Davidsen 2014 Patients’ Perspectives on Antidepressant Treatment in Consultations with Physicians. Qualitative Health Research 24: 641–653

    Google Scholar 

  • France, Christopher M., Paul H. Lysaker, and Ryan P. Robinson 2007 The ‘Chemical Imbalance’ Explanation for Depression: Origins, Lay Endorsement, and Clinical Implications. Professional Psychology: Research and Practice 38: 411–420

    Google Scholar 

  • Fuchs, Eberhard, Boldizsár Czéh, H.P. Maarten, M.H. Kole, Thomas Michaelis, and Paul J. Lucassen 2004 Alterations of Neuroplasticity in Depression: the Hippocampus and Beyond. European Neuropsychopharmacology 14(Suppl 5): S481–S490

    Google Scholar 

  • Fullagar, Simone 2009 Negotiating the Neurochemical Self: Anti-Depressant Consumption in Women’s Recovery from Depression. Health 13: 389–406

    Google Scholar 

  • Gadamer, Hans-Georg 1996 The Enigma of Health: The Art of Healing in a Scientific Age. Translated by Jason Gaiger and Nicholas Walker. Stanford: Stanford University Press.

  • Gardner, Caleb, and Arthur Kleinman 2019 Medicine and the Mind—the Consequences of Psychiatry’s Identity Crisis. The New England Journal of Medicine 381: 1697–1699

    Google Scholar 

  • Goldberg, Joseph F 2018 The Psychopharmacology of Depression: Strategies, Formulations, and Future Implications. Psychiatric Times 35.7 (July 31). http://www.psychiatrictimes.com/special-reports/psychopharmacology-depression-strategies-formulations-and-future-implications.

  • Goldstein, Benjamin, and Francine Rosselli 2003 Etiological Paradigms of Depression: the Relationship between Perceived Causes, Empowerment, Treatment Preferences, and Stigma. Journal of Mental Health 12: 551–563

    Google Scholar 

  • Gutheil, Thomas G., and Robert I. Simon 2003 Abandonment of Patients in Split Treatment. Harvard Review of Psychiatry 11: 175–179

    Google Scholar 

  • Harrington, Anne 2019 Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness New York: W.W. Norton

    Google Scholar 

  • Haslam, Nick 2005 Dimensions of Folk Psychiatry. Review of General Psychology 9: 35–47

    Google Scholar 

  • Herzberg, David 2009 Happy Pills in America: from Miltown to Prozac Baltimore, MD: Johns Hopkins University Press

    Google Scholar 

  • Horwitz, Allan V. 1982 The Social Control of Mental Illness New York: Academic Press

    Google Scholar 

  • Hyman, Steven E. 2018 The Daunting Polygenicity of Mental Illness: Making a New Map. Philosophical Transactions of the Royal Society B Biological Sciences 373: 20170031

    Google Scholar 

  • Iselin, Marie-Geneviève., and Michael E. Addis 2003 Effects of Etiology on Perceived Helpfulness of Treatments for Depression. Cognitive Therapy and Research 27: 205–222

    Google Scholar 

  • Jenkins, Janis H 2010 Pharmaceutical Self and Imaginary in the Social Field of Psychiatric Treatment. In Pharmaceutical Self: the Global Shaping of Experience in an Age of Psychopharmacology Janis H. Jenkins, ed., Santa Fe, NM: School for Advanced Research Press.

    Google Scholar 

  • Jenkins, Janis H. 2015 Extraordinary Conditions: Culture and Experience in Mental Illness Oakland, CA: University of California Press

    Google Scholar 

  • Jones, Nelson F., Marvin W. Kahn, and John M. Macdonald 1963 Psychiatric Patients’ Views of Mental Illness, Hospitalization and Treatment. Journal of Nervous and Mental Disease 136: 82–87

    Google Scholar 

  • Jutel, Annemarie Goldstein 2011 Putting a Name to It: Diagnosis in Contemporary Society Baltimore, MD: Johns Hopkins University Press

    Google Scholar 

  • Karp, David A 2006 Is It Me or My Meds? Living with Antidepressants Cambridge, MA: Harvard University Press

    Google Scholar 

  • Keller, Evelyn Fox 2007 Whole Bodies, Whole Persons? Cultural Studies, Psychoanalysis, and Biology. In Subjectivity: Ethnographic Investigations João. Biehl, Byron Good, and Arthur Kleinman, eds., Berkeley: University of California Press.

    Google Scholar 

  • Kemp, Joshua J., James J. Lickel, and Brett J. Deacon 2014 Effects of a Chemical Imbalance Causal Explanation on Individuals’ Perceptions of Their Depressive Symptoms. Behaviour Research and Therapy 56: 47–52

    Google Scholar 

  • Khalsa, Shabad-Ratan., Kevin S. McCarthy, Brian A. Sharpless, Marna S. Barrett, and Jacques P. Barber 2011 Beliefs about the Causes of Depression and Treatment Preferences. Journal of Clinical Psychology 67: 539–549

    Google Scholar 

  • Kleinman, Arthur 2008 Rethinking Psychiatry New York: Free Press

    Google Scholar 

  • Lacasse, Jeffrey R., and Jonathan Leo 2005 Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. PLoS Medicine 2(12): e392.

  • Lacasse, Jeffrey R., and Jonathan Leo 2015 Antidepressants and the Chemical Imbalance Theory of Depression: A Reflection and Update on the Discourse. The Behavior Therapist 38:206–213

    Google Scholar 

  • Lafrance, Michelle N. 2007 A Bitter Pill: A Discursive Analysis of Women’s Medicalized Accounts of Depression. Journal of Health Psychology 12: 127–140

    Google Scholar 

  • Larkings, Josephine S., and Patricia M. Brown 2018 Do Biogenetic Causal Beliefs Reduce Mental Illness Stigma in People with Mental Illness and in Mental Health Professionals? A Systematic Review. International Journal of Mental Health Nursing 27: 928–941

    Google Scholar 

  • Lebowitz, Matthew S 2014 Biological Conceptualizations of Mental Disorders among Affected Individuals: A Review of Correlates and Consequences. Clinical Psychology: Science and Practice 21: 67–83

    Google Scholar 

  • Lebowitz, Matthew S., and Woo-kyoung Ahn 2014 Effects of Biological Explanations for Mental Disorders on Clinicians’ Empathy. Proceedings of the National Academy of Sciences of the United States of America—PNAS 11: 17786–17790

    Google Scholar 

  • Leo, Jonathan, and Jeffrey R. Lacasse 2008 The Media and the Chemical Imbalance Theory of Depression. Society 45(1): 35–45.

  • Link, Bruce G., Jo. C. Phelan, Michaeline Bresnahan, Ann Stueve, and Bernice A. Pescosolido 1999 Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance. American Journal of Public Health 89: 1328–1333

    Google Scholar 

  • Lock, Margaret 2004 Medicalization and the Naturalization of Social Control. In Encyclopedia of Medical Anthropology (Vol. 1). C.R. Ember, and M. Ember, eds., New York: Kluwer Academic/Plenum.

    Google Scholar 

  • Luhrmann, T.M 2000 Of Two Minds: The Growing Disorder in American Psychiatry New York: Alfred A. Knopf

    Google Scholar 

  • Malla, Ashok, Ridha Joober, and Amparo Garcia 2015 "Mental Illness Is like Any Other Medical Illness”: A Critical Examination of the Statement and Its Impact on Patient Care and Society. Journal of Psychiatry and Neuroscience 40: 147–150

    Google Scholar 

  • Malpass, Alice, Alison Shaw, Debbie Sharp, Fiona Walter, Gene Feder, Matthew Ridd, and David Kessler 2009 ‘Medication Career’ or ‘Moral Career’? the Two Sides of Managing Antidepressants: A Meta-Ethnography of Patients’ Experience of Antidepressants. Social Science and Medicine 68: 154–168

    Google Scholar 

  • McHugh, R. Kathryn., Sarah W. Whitton, Andrew D. Peckham, Jeffrey A. Welge, and Michael W. Otto 2013 Patient Preference for Psychological Vs Pharmacological Treatment of Psychiatric Disorders: A Meta-Analytic Review. Journal of Clinical Psychiatry 74: 595–602

    Google Scholar 

  • Meloni, Maurizio 2014 Biology without Biologism: Social Theory in a Postgenomic Age. Sociology 48: 731–746

    Google Scholar 

  • Metzl, Jonathan Michel 2003 Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs Durham, N.C.: Duke University Press

    Google Scholar 

  • Miller, Greg 2010 Is Pharma Running out of Brainy Ideas? Science 329(5991): 502–504

    Google Scholar 

  • Mojtabai, Ramin, and Mark Olfson 2008 National Trends in Psychotherapy by Office-Based Psychiatrists. Archives of General Psychiatry 65: 962–970

    Google Scholar 

  • Olfson, Mark, and Steven C. Marcus 2010 National Trends in Outpatient Psychotherapy. American Journal of Psychiatry 167: 1456–1463

    Google Scholar 

  • Parry, Hugh J., Mitchell B. Balter, Glen D. Mellinger, Ira H. Cisin, and Dean I. Manheimer 1973 National Patterns of Psychotherapeutic Drug Use. Archives of General Psychiatry 28: 769–783

    Google Scholar 

  • Pescosolido, Bernice A., Jack K. Martin, J. Scott Long, Tait R. Medina, Jo. C. Phelan, and Bruce G. Link 2010 ‘A Disease like Any Other’? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence. American Journal of Psychiatry 167: 1321–1330

    Google Scholar 

  • Pies Ronald W 2011a Psychiatry’s New Brain-Mind and the Legend of the ‘Chemical Imbalance.' Psychiatric Times (July 11). http://www.psychiatrictimes.com/couch-crisis/psychiatrys-new-brain-mind-and-legend-chemical-imbalance.

  • Pies Ronald W 2011b Doctor, Is My Mood Disorder Due to a Chemical Imbalance? Psychiatric Times (August 12). https://www.psychiatrictimes.com/view/doctor-my-mood-disorder-due-chemical-imbalance.

  • Pies, Ronald W 2019 Debunking the Two Chemical Imbalance Myths, Again Psychiatric Times 36, no. 8 (August 2). https://www.psychiatrictimes.com/depression/debunking-two-chemical-imbalance-myths-again.

  • Prins, Marijn A., Peter F.M.. Verhaak, Jozien M. Bensing, and Klaas van der Meer 2008 Health Beliefs and Perceived Need for Mental Health Care of Anxiety and Depression—the Patients’ Perspective Explored. Clinical Psychology Review 28: 1038–1058

    Google Scholar 

  • Read, John, Claire Cartwright, Kerry Gibson, Christopher Shiels, and Lorenza Magliano 2015 Beliefs of People Taking Antidepressants about the Causes of Their Own Depression. Journal of Affective Disorders 174: 150–156

    Google Scholar 

  • Roberts, Robert C 2003 Emotions: an Essay in Aid of Moral Psychology Cambridge: Cambridge University Press

    Google Scholar 

  • Rose, Nikolas 2007 The Politics of Life Itself: Biomedicine, Power, and Subjectivity in the Twenty-First Century Princeton, NJ: Princeton University Press

    Google Scholar 

  • Rose, Nikolas, and Joelle M. Abi-Rached 2013 Neuro: The New Brain Sciences and the Management of the Mind. Princeton. NJ: Princeton University Press.

  • Ross, David A., Michael J. Travis, and Melissa R. Arbuckle 2015 The Future of Psychiatry as Clinical Neuroscience: Why Not Now? JAMA Psychiatry 72: 413–414

    Google Scholar 

  • Rüsch, Nicolas, Andrew R. Todd, Galen V. Bodenhausen, and Patrick W. Corrigan 2010 Biogenetic Models of Psychopathology, Implicit Guilt, and Mental Illness Stigma. Psychiatry Research 179: 328–332

    Google Scholar 

  • Schomerus, G., C. Schwahn, A. Holzinger, P.W. Corrigan, H.J. Grabe, M.G. Carta, and M.C. Angermeyer 2012 Evolution of Public Attitudes about Mental Illness: A Systematic Review and Meta-Analysis. Acta Psychiatrica Scandinavica 125: 440–452

    Google Scholar 

  • Schreiber, Rita, and Gwen Hartrick 2002 Keeping It Together: How Women Use the Biomedical Explanatory Model to Manage the Stigma of Depression. Issues in Mental Health Nursing 23: 91–105

    Google Scholar 

  • Schroder, Hans S., Jessica M. Duda, Kirsten Christensen, Courtney Beard, and Thröstur Björgvinsson 2020 Stressors and Chemical Imbalances: Beliefs about the Causes of Depression in an Acute Psychiatric Treatment Sample. Journal of Affective Disorders 276: 537–545

    Google Scholar 

  • Svenaeus, Fredrik 2018 Heidegger’s Philosophy of Technology and the Perils of Medicalization. In Existential Medicine: Essays on Health and Illness Kevin Aho, ed., London: Rowman & Littlefield International.

    Google Scholar 

  • Stepnisky, Jeffrey 2007 The Biomedical Self: Hermeneutic Considerations. Social Theory and Health 5: 187–207

    Google Scholar 

  • Taylor, Charles 1985 Self-Interpreting Animals. In Human Agency and Language: Philosophical Papers I, pp. 45–76. Cambridge: Cambridge University Press.

  • Tomuletiu, Sanda 2012 Listening to Language in Gadamer’s Hermeneutics (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1288.

  • Voorhees, Van, W. Benjamin, Joshua Fogel, Thomas K. Houston, Lisa A. Cooper, Nae-Yuh. Wang, and Daniel E. Ford 2005 Beliefs and Attitudes Associated with the Intention to Not Accept the Diagnosis of Depression among Young Adults. Annals of Family Medicine 3: 38–46

    Google Scholar 

  • Wall, Terri N., and Jeffrey A. Hayes 2000 Depressed Clients’ Attributions of Responsibility for the Causes of and Solutions to Their Problems. Journal of Counseling and Development 78: 81–86

    Google Scholar 

  • Weinstein, Raymond M., and Norman Q. Brill 1971 Social Class and Patients’ Perceptions of Mental Illness. Psychiatric Quarterly 45: 35–44

    Google Scholar 

  • Whooley, Owen 2019 On the Heels of Ignorance: Psychiatry and the Politics of Not Knowing Chicago: University of Chicago Press

    Google Scholar 

  • Wilson, Mitchell 1993 DSM-III and the Transformation of American Psychiatry: A History. American Journal of Psychiatry 150: 399–410

    Google Scholar 

  • Wynne, Brian 1991 Knowledges in Context. Science, Technology, and Human Values 16: 111–121

    Google Scholar 

  • Zola, Irving Kenneth 1975 In the Name of Health and Illness: on Some Socio-Political Consequences of Medical Influence. Social Science and Medicine 9: 83–87

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joseph E. Davis.

Ethics declarations

Conflict of interest

The author declares that he/she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Davis, J.E. ‘The Explanation You Have Been Looking For’: Neurobiology as Promise and Hermeneutic Closure. Cult Med Psychiatry 46, 76–100 (2022). https://doi.org/10.1007/s11013-021-09737-2

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11013-021-09737-2

Keywords

  • Psychiatry
  • Neurobiology
  • Chemical imbalance
  • Self
  • Narrative
  • Account