Stop Making Serotonin Jokes

How medicalized mental health is making you sicker and how to escape it

To Meme or Not To Meme?

Every single social media platform is overrun by mental health memes. Although I’ve previously been willing to chalk this up to my personal algorithm, it’s becoming increasingly clear that a majority of internet users are coping with mental health struggles through memes. This isn’t a harmful phenomenon in its basic form but I’m here to deliver an unpleasant truth: you need to stop making and sharing serotonin jokes. As a mental health professional and researcher, I have avoided having this difficult conversation on the internet, but the time is up. You don’t know what you’re talking about, and it is causing real harm to you and your digital comrades. In this piece, I’m going to explain the issues with “serotonin theory” and how it harms us. Then, I will provide a variety of practical techniques for better mental health. I won't hold you if you don’t want to stick around. So, if you want the goods, skip to the “What Now?” section. 

As early as 2012, other reporters resorted to begging y’all to end this trend. As time has passed and the answer hasn’t changed, I’ve decided to try my hand at breaking down how this is part of a much larger issue: the reliance on the medical model of mental health. The medical model is an approach or a paradigm that explains mental health as a biological issue related to neurotransmitters (like serotonin), physiology, and genetics. One of the early medically based hypotheses spawned the origins of what we now carry as the myth of serotonin. I can confidently write “myth,” as we have known since the early 2000s that serotonin is not the cause of depression. Which makes very simple sense when you realize that there are no biological tests that can confirm mental health disorders.

Researchers and reporters claim that psychiatrists or textbooks have never claimed that chemical imbalance theory is the cause of depression. However, I know that people I know personally and many of you readers have heard this myth pervasively throughout American culture. We cannot know how many people have heard the idea that depression is caused by a chemical imbalance in their brain or who the specific culprits were. However, the direct-to-consumer advertising from drug companies have been known to slip in chemical imbalance when they can. What we do know is that the idea that you have a “chemical imbalance” is now being considered only a metaphor to help explain depression, not a medical belief. 

I am not claiming that your antidepressants (or SSRIs, specifically) do not work for you! I am definitely not recommending that you stop taking them. Research shows that the safe estimate is that about 15% of people have a meaningful effect from antidepressants. We just cannot say that it is because of serotonin. For example, research has even tried intentionally lowering people’s serotonin, and they did not become depressed. 

My concern isn’t related to semantics and rhetoric. The risk with these memes…

…is the perpetuation of a larger reliance on medicalized explanations for mental health problems. By making medical solutions (or definitions) for mental health the new trendy meme, you are weaving the communal narrative in the drug companies’ favor. Even more worrisome, you are reducing the chances that you will see your mental health as changeable. In this setup, your wellbeing ends up as the butt of the joke.  

The Diagnostic and Statistical Manual (DSM) does not provide references to research within its pages and is formed through expert panel discussions. Even after the dictionary of mental disorders is formed, the American Psychological Association has to test it for its accuracy in diagnostic assessments. The hope is that even if the criteria for the diagnoses are formed through a piece-meal of expert opinion, it can still be verified scientifically. However, even for depression, the testing of our most recent DSM could not meet acceptable levels of reliability or validity in diagnosis for the disorders tested. In fact, there are between 200 and 10,000 different sets of symptoms that can qualify you for Major Depressive Disorder (MDD). 

The most reliable diagnoses are PTSD, ADHD, borderline personality disorder, and alcohol use disorder. These are considered reliable by the APA’s standards, which were statistically lowered from the scientific standard when they published their results. Only having four somewhat accurate diagnoses should be even more concerning when you realize there are almost 300 possible diagnoses in the DSM-V. Even people who worked to develop the DSM-V have critiqued the strict definitions of mental illness that do not recognize that these disorders are social constructs. 

It is important that we recognize that suffering is real, but the APA's language does not reflect a biological, intractable, scientific reality. Many people grasp that the DSM-V only reflects a social reality easily when discussing that homosexuality used to be a mental disorder in three editions of the book. However, when it comes to anxiety, depression, or schizophrenia, the same paradigm feels too uncertain. American culture is terrified by the perceived severity of disorders like schizophrenia. Although fear alone doesn’t create or define our mental health diagnoses, social and cultural perceptions do. 

Our American cultural influences, like individualism, are holding us back in mental health. What many people think they know about mental health are simply narratives that fit neatly into the rest of our worldview. If you’re skeptical, maybe some counterexamples will help. What if I said that even for severe symptomology like hallucinations, culture has misled our experiences and our treatment? People in collectivist nations experience playful and benign hallucinations compared to the violent or threatening hallucinations that many in the United States experience. Additionally, a community-model of treatment for schizophrenia has been tested. The Soteria Model used medication only as a last resort, but its communal living and social treatment provided relief and remission for many. Despite potential skepticism, research has even found that social treatment of schizophrenia achieved equal (or better) results than medication-based approaches.  

Unfortunately, our desire for easy answers drives a lot of our mental health system. Even mental health professionals feel that the authority of the medical model influences their worldview despite knowing the importance of psychosocial factors. We even created a medical test to try to see which mental health medications will work best before you take them! Unfortunately for us, gene testing for medications does not lead to better outcomes in treatment. Each time we look toward medical answers for social questions, such as fMRI brain scans, we reach a wall of limitations that stall our mental health progress. Most tragically, blind faith in “science” has historically led to the eugenics of numerous marginalized groups. Repeatedly, we’ve defined the “undeserving” poor, “criminal,” or unpleasant as mentally ill for political, not emotional, benefits. There is plenty of material for a piece on modern eugenics. However, today, I want to focus on the everyday problem of how many of us are contributing, through memes, to our own downfall. 

What’s the Harm?

Not only are serotonin myth memes factually incorrect, but they are directly harmful to the way we think about our own mental health. Through this piece, you’ve now seen the wobbly chair legs of our mental health system; the medical model is a weak answer to the questions of our suffering. Even The Onion is laughing at our belief in the chemical imbalance myth. I say these things because I want you to feel better, and antidepressants may actually worsen your condition long-term. I know that we lean on the simple “magic bullet” answers because we don’t like that the alternative answer is so damn tedious. Especially when the answers are things like, “exercise is one of the most reliable effective treatments for depression.” I don’t like that answer either. 

Outside of specific medications, the mindset we are perpetuating is harmful. These memes reinforce that biological conditions are the cause and that medication is the answer. When we believe that medication is meant to cure a biological problem, and it doesn’t, we blame ourselves. On occasion, so do doctors and researchers, saying that we’re “complex patients.” This is awful, considering that people with depression are more likely to blame themselves and feel shameful to begin with. In our individualistic society, do we need another system saying that you are the problem? 

Research across 19 studies has found that how much control you think you have in your mental health determines whether your coping skills are healthy or unhealthy. Feelings of empowerment have an impact on your mental health recovery; yes, even for schizophrenia! Now, I hope you’re not twisting my words. I am not telling you to choose to be happy and mentally well. Especially when we know that the current environment and social systems 

Even psychiatry can compromise with a biopsychosocial model that acknowledges that there are biological, psychological, and social factors that influence our mental health. What I want us to achieve is the understanding that you have some control. You are likely in a situation (financially, emotionally, romantically, traumatically, etc.) that warrants stress. You may also have symptoms that don’t make sense for where you’re at in your life that pose challenges that seem insurmountable. But believing that you can get better is always a better alternative to feeding your (or others’) feelings of hopelessness. Let’s pledge today to reinforce the growth mindset in recovery rather than sharing memes that reinforce the view that you need a pill, or ketamine, or that you just cannot get better. Focusing on  “soft treatment” like community-building or self-confidence can have better effects for everyone, from college students to older adults or even people experiencing psychosis. 

Now What?

In my usual fashion, I’m not trying to sell you something like a video game to work on your mental health. I want to start with just you, with minimal tools, for $FREE.99. 

The most unfortunate part of mental health recovery is the trial and error that is required to find out what coping skills work best for you. Although I believe that most of us could list a handful of things that put us in a better mood, I think there’s an additional hurdle; we have to believe that we are deserving of relief. Many of the people I speak to who struggle with anxiety, depression, or general unnamed misery, are hyper-concerned with being a good person. I think these things go hand in hand. Tell me, do these statements apply to you?

1. I try really hard to be nice to other people, and I find that I am constantly worried about doing something wrong or inconveniencing someone. 

2. I don’t want to hurt others, but I often tolerate others hurting me because it’s important that my friends enjoy being around me.

3. I feel like I deeply understand myself and why I feel like I do, but I can’t stop feeling terrible when I get stuck.

4. I spend a lot of my time trying to avoid feeling worse, but nothing helps. 

5. I know that I am overthinking things, but I just can’t seem to let them go. 

6. I find myself feeling guilty for things that other people don’t seem to think twice about doing, saying, feeling, or thinking.

7. I can immediately tell when someone around me is upset, even when they do not say anything; it’s like a superpower. 

8. I find it hard to take compliments, even if I know the praise I’m getting is accurate.

9. I often deny myself what I want for the benefit of others.

10. I often talk myself out of things I want, activities I’ve planned, or things I want to say to people. 

If these statements apply, you are probably: 1) suffering more than anyone knows, 2) doing it quietly, and 3) exhausting yourself more each day. I won’t tell you that feeling better will be easy but I will tell you that the work to feel better isn't as painful as the mental suffering you’re dealing with right now. It’s difficult only because of the practice it takes. Although mental wellness looks different for everyone, I can build you a basic foundation that can be used in conjunction with other treatment, lifestyle, or personal choices. Getting better starts with acknowledging that lots of things aren’t working, and then rebuilding what you can. 

Coping, Not Just Journaling

The safest bet when you’re trying to rebuild your mindset, emotional regulation, and automatic thoughts to be more healthy, is something that you’ve heard before. So, forgive me but I always recommend practical coping skills first. Now, unlike others, I’m not just going to say “do mindfulness” and “journal.” I’m not going to leave you empty handed. Dialectical Behavioral Therapy is a modality of treatment that is typically used for “more severe” or challenging patterns of behavior. However, as a mental health professional, it is one of my favorites to pull from for any emotional struggles. The reason for this is that the modality focuses on a lot of practical management and coping skills. I consider it a large toolbox of skills more than anything. The good news is there’s a WONDERFUL SITE that provides many of these emotional regulation tools for free, self-guided practice. 

Perspective Shifts

Now, the mindset that comes with the statements above often requires some perspective shifting. We know that your thoughts, feelings, and behaviors include rumination, suffering, and mental stress. So, let’s turn off some mental alarm bells and look at how to make your internal narrative a bit more pleasant. DBT skills also include a Bill of Rights that explains the things that you are inherently worthy of and that are the rights of being human. Now, you may look at these and think, “yeah these are obvious!” If so, then, great! But do you treat yourself like they are obvious for you? Many people who struggle with anxiety and depression do not treat themselves the way they think it is obvious to treat others: kindly. What this looks like is that you will both graciously cheer up your friend with non-judgment and kindness when they do something embarrassing but then berate yourself mentally when you do something uncouth. This Bill of Rights helps you internalize the rules of being a person that you’re allowed to stop thinking about. I recommend starting with this but I encourage you to add your own as you learn more about your recovery practices. 

I’ll give you some science-y stuff on the importance of our viewpoints in case you’re stubbornly safe-hating. There are two kinds of “locus of controls” in psychology. Internal locus of control means that you believe you have personal control over your own behavior. This is an important key to self-efficacy, confidence, and motivation, so it is usually positive. However, a complete belief in an internal locus of control can lead to shame and guilt for behaviors that are typically forgivable. If you believe that everything that happens to you is controlled by the way you act, you may be terrified to do anything. An external locus of control means that you believe that what happens to you is a result of fate, the universe, or authority figures. This is also harmful if it’s your complete worldview. 

Healthy mindsets require that you are able to pivot between these, or experience both in moderation. One way to do this is to make lists, or circles, that identify in stressful situations what you can and cannot control. Most difficulty, you must give yourself permission to let go of what you can’t control. One recommendation for this is to assign yourself a “Worry Hour” each day at the same time where you are allowed to worry as much and as severely or irrationally as you want. This helps confine it to a limited time frame (1 hour) compared to every minute of every day.  

Another strategy is simple but effective. I call it the “Happy Folder.” If you are reading this then you have either a phone, iPad or a computer. Let’s build a folder of evidence that you have good qualities instead of whatever your negative thoughts say. This is simple because it’s exactly what it sounds like: a folder of photos of things that make you happy. For me, my happy folder includes mainly texts between me and my friends where they make me feel worthy of love. This technique requires that you actually check the folder when you are having negative thoughts about yourself. 

I have developed a starter strategy that I call the “Mirror Check” technique. When you’re driving a car, you naturally cycle between checking each of your side mirrors, review mirror, and back window, and the road ahead. An important place to start is by checking your psychosocial and emotional mirrors. This technique means that every half hour you check-in with yourself regarding the following questions: 

1. What am I feeling in my body? Can I name each sensation?

2. What is making me uncomfortable? Can I stop, change, or minimize it? 

3. When is the next moment that I can do something that makes me happy?

4. What was I just thinking about before? What is something this week that made me happy?

5. How could I make today more meaningful even in a small way?  

The key to this check-in is that when you find something actionable like reducing an unpleasant stimulus, doing something that makes you happy, or changing your environment, that you do it as soon as you can. Although I recommend a check-in like this every 30 minutes, any other standardized amount of time that you can manage works. Remember, anything is better than nothing, even if you don’t notice a difference at first.

One of my favorite techniques is, “Facts Only.” People often “play both sides of the chess board” so to speak. This is where, instead of waiting to reach to a situation or another person, you chose your action based on the reaction that you already expect. Example: your friend texts you to invite you to a gathering but the way they text makes you think that they could be in a bad mood. Without hearing first from this friend that they are feeling irritable, you text them with extra niceties, you show up to help them set up for the party, or do other things that you think will help the situation. If you notice yourself feeling anxious, upset, or uncomfortable because you think they are upset (when they haven’t said) then it’s time to play facts only. What was explicitly said or done? Ignore your brains evidence for your hypothesis, and stick only to what is FACTUAL. You’re going to make your decisions based on taking anything literally. Acting on subtext will exhaust you and often takes away from other people’s autonomy. For example, when you don’t tell your partner that you want to watch a show you like because you assume that they don’t want to watch it because it’s late, you’re taking away their opportunity to express their wants - you made a decision for them. Stop playing the other side of the chessboard. Allow others to act and speak up and then react. That is all anyone can ask for. Go back to your Bill of Rights if you find yourself thinking otherwise.

Similar to facts only is the simple technique, “Best, Worst, Most likely case.” When you find yourself getting anxious and worrying about a situation, ask yourself what is the 1. best case scenario 2. the worst case scenario, and 3. the most likely case. This is used so that if you are spending most of your time thinking about the worst case scenario, you have to spend equal time on the best case scenario too. Hopefully, you land on a more reasonable and less concerning most likely case. However, the benefits are beyond just the moment. This will allow you to spend more time, on average, thinking about positive outcomes. Especially if you typically find yourself constantly thinking about worst cases, this is an improvement. Over time you will train your mind to think more reasonably and spend less time worrying. 

Anxiety and depression are often concerned with things that will or might happen. One of the techniques that I hold closest is “Setting Your Consequences.” People often find themselves stressing, feeling guilty, or demeaning themselves for anything  and everything possible. If you set the consequences that you are allowed to care about, you free yourself from needing to evaluate every single action and situation to see if you’re actually a bad person. The four consequences that I recommend are if your action could cause harm to you or your loved one’s 1) health, 2) life, 3) financial security, or 4) can cause incarceration. These do not have to be yours, but I found these made the most sense to start with. Most consequences that are outside of those four can be reasonably managed. This is a challenging skill to internalize, though, as it can be easy to slip into old worries. I recommend having someone that you can share this technique with who can hold you accountable if they hear you worrying outside of those consequences. 

All of these techniques require that you learn how to identify when you are upset, distressed, anxious, or feeling especially negative. This is when journaling might come in handy. If you have to start from figuring out what most regularly makes you anxious or what your worry feels like then start with the Mirror Check technique. Keep a list of 1) what anxiety feels like in your body, 2) what actions, situations, or environments often make you anxious, and 3) anything that makes it better. Check in for these things as often as possible. Start where you can. 

The key goals as steps

1. Identify what makes you anxious

2. Learn what boundaries are important to you

3. Set your personal value code

4. Set consequences you care about that you are right to worry about 

5. Internalize your personal rights

6. Practice any helpful skills as often as possible

This may seem simple but it can be the foundation for a better you and a healthier life. Not radical but refreshed.