Psychiatric Drugs: Two Stories About How They Work
Why a Drug-Centered Lens Matters

For decades, the dominant story about psychiatric medication has sounded reassuringly simple: “You’re depressed because of a chemical imbalance. This medication will correct it—like insulin for diabetes.”

This is what British psychiatrist Joanna Moncrieff calls the disease-centered model of drug action. It presents psychiatric drugs as precise treatments for underlying brain disorders.

A strikingly similar story dominates around children said to be “born in the wrong body,” equally reassuring in its simplicity: “You’re distressed about your body because it doesn’t match your brain. These medications and surgeries will correct your body — like insulin for diabetes.”

Just as there is a far more nuanced and therapeutic way to understand gender distress, there is also another way to understand psychiatric drugs—one that fits more appropriately with what we actually know from research and clinical practice: the drug-centered model.

To fully understand our re-psychopathologization campaign, this distinction is crucial. It aligns with how we think about diagnosis, medication, and proper psychotherapeutic care. We follow the framework developed most clearly by psychiatrist Joanna Moncrieff, outlined below.

The Disease-Centered Model vs.The Drug-Centered Model

In the disease-centered story — currently the mainstream view — psychiatric medications are understood as treatments for discrete biochemical pathologies.

Depression is framed as a serotonin deficit; psychosis as a dopamine problem; attention difficulties as a dopamine and norepinephrine imbalance. Medication is then described as acting directly on this underlying fault —“correcting” it in the same way antibiotics target bacteria or insulin replaces what the pancreas cannot produce. The beneficial effects of a drug are seen as the result of its ability to restore normal physiological functioning by directly addressing the cause of the disorder.

This model has been extraordinarily successful at shaping public belief and guiding clinical practice. But its scientific foundation is far shakier than most people realize. Chemical imbalance theories have repeatedly failed to find robust, independent evidence, even while they continue to circulate in patient education and marketing materials.

Clinically, the disease-centered model locates the problem inside the individual’s biology, narrowing the lens on their distress. Trauma, family dynamics, social context, and meaning are easily relegated to background noise. The same is true with how our medical and psychological organizations locate the problem of gender distress inside the individual’s brain biology—rather than on a complex interplay of biopsychosocial factors.

In the drug-centered model — currently the alternative view — drugs are understood as substances that induce altered physiological or psychological states. The effects of the drug come from the state it produces—such as sedation, emotional blunting, motor slowing, altered sleep, appetite or libido, or general dampening of arousal—which in turn can counteract or mask the symptoms of a disorder or of mental distress.

Here, the drug doesn’t “normalize” brain function; it creates a drug-induced state that may be incompatible with the expression of certain symptoms. For example, an antipsychotic might reduce agitation and psychotic symptoms not by curing an underlying dopamine imbalance, but by producing a general dampening effect on neural activity. A drug that blunts emotional intensity may make despair or rage feel more bearable, because very little is felt with full force. A stimulant may improve school performance in an over-stressed child simply by boosting energy and focus.

In this view, the drug’s therapeutic effect does not come from rectifying a defect. It comes from the interaction between the altered state the drug creates and the person’s existing difficulties. A similar process is taking place when cross-sex hormones induce a desired effect. This effect does not come from rectifying a defect in the body, but from the interaction between the drug’s altered physical and mental states—clitoral enlargement, facial hair, fat redistribution, lowered voice, and boosted confidence, assertiveness and sexual drive—and the person’s existing maladaptive desire for those altered physical and mental changes.

Moncrieff’s influential paper on antidepressants in PLOS Medicine makes the former point sharply: antidepressants may “create abnormal brain states” that can sometimes relieve depressive symptoms, but that is not the same thing as normalizing a faulty serotonin system.

Two Models, Two Implications

Focusing on the contrast between these two models as they apply strictly to psychotropic drugs, we can summarize as follows:

In the disease-centered model, drugs are understood as cures or partial cures: they target a disease process and bring the person’s biology back toward normal.

In the drug-centered model, drugs are understood as tools that generate altered states. These states may mute or obscure distress and may also introduce new problems.

Crucially, the drug-centered model does not deny that biology matters. It simply refuses to pretend that we have pinned down clear, specific “imbalances” that medications reliably correct. It asks us to look honestly at what the drug does to this person’s feelings, thoughts, relationships, body and functioning; whether those changes fit with the life they are trying to build; and what gets missed if we treat a psychoactive state as a cure.

A More Human Framework for Talking About Meds

We find the drug-centered model far more compatible with a relational and developmentally-informed understanding of suffering—the kind of framework Genspect is trying to restore. Instead of asking, as the disease-centered model does, “Which drug corrects your biochemical imbalance?” we instead consider:

What are you experiencing and how did you come to feel this way?
What systems (family, school, social, culture) have impacted you—and how?
If you are on or considering medication, what state or changes do you notice the drug creates for you?

From here, five key insights follow.

1. Complexity Over Reductionism

People’s distress and suffering rarely boil down to a single broken mechanism. It arises from the tangle of temperament, developmental history, attachment patterns, cumulative stress, discrimination, trauma, and cultural messages about what is “normal,” “desirable” or “acceptable.”

The drug-centered model refuses the reductionism of magic-bullet thinking. It doesn’t require us to pretend that every panic attack, meltdown, or shutdown is the symptom of a discrete brain disease awaiting a matching molecule. It places suffering in the context of the interplay of factors described above, and does not confuse normal life struggles, challenges, and suffering with that which reaches the level of mental illness and true psychopathology–such as suicidality, eating disorders or the fixation on medically and surgically altering a healthy body.

2. Acknowledging Trauma and Adapted Responses

When we interpret alarm, withdrawal, or dissociation as mere evidence of inner defect, we risk pathologizing what are often adaptive responses to very real harms.

Within a drug-centered lens, the question becomes: “If a drug blunts your fear or numbs your grief, what happens to the story of what you went through? Does the medication create enough safety and stability to process it—or does it simply quiet the alarm while the underlying wound remains unaddressed?”

That is a psychosocial, meaning-focused question—exactly the kind of question re-psychopathologization insists must remain central so that normal, human responses to emotional pain are not misunderstood as psychopathology and vice versa.

3. The Limits of Medical Intervention

The drug-centered model makes clear that psychotropic medications alter states rather than resolve complex human experiences. It keeps psychotherapeutic work, relational healing, and the full context of a person’s life in view.

The drug is not the solution. It is often a blunt instrument, and its effects can sometimes complicate rather than support the psychological work that healing requires.

This is very different from a disease-centered logic that implicitly says: “Your biology is the main problem; get the right drug and all will be well.”

4. The Multifaceted Effects of Substances

A drug-centered perspective also makes it harder to downplay side effects as unfortunate but secondary. Sexual dysfunction, weight gain, emotional flattening, cognitive fog, agitation—these are not minor footnotes. They are integral parts of the drug-induced state.

If we are honest that medications create abnormal states rather than restoring a normal one, we cannot dismiss these changes as irrelevant. We must ask whether the overall state is compatible with development, intimacy, and agency, especially for young people.

This is particularly relevant to Genspect’s concerns about over-medicalization: young people who are already struggling with identity, embodiment, and belonging may be especially vulnerable to long-term psychoactive states that flatten feeling and complicate self-understanding.

5. The Absence of Informed Consent

Genuine informed consent requires accurate information. The drug-centered model exposes how rarely patients receive it.

We reject the message millions are told: “This drug corrects your imbalance; you need it for life.” We reject the parallel claim in gender medicine: “Your brain doesn’t match your body.” Neither has found robust scientific support.

Patients deserve conversation, listening, and psychological care that respects them as more than a diagnosis. Instead, they have been placed on lifelong psychiatric medication based on a misrepresentation of what these drugs actually do. The same dynamic now funnels a growing number of individuals, many of them young people, toward irreversible hormonal and surgical interventions under a similarly unsupported rationale.

Re-Psychopathologization and the Future of Drug Talk

Re-psychopathologization is not about re-stamping people as “broken” or focusing on psychiatric labels. It is about re-centering psychological meaning, development and context in how we think about suffering, and how we determine when maladaptive coping crosses into psychopathology.

The drug-centered model of psychiatric medication supports that aim. It pierces the comforting simplicity of the chemical-imbalance story and replaces it with the truth:

• Psychiatric drugs are mind-altering substances.
• They may provide temporary symptomatic relief, but can also cause serious harm.
• They never tell the whole story of why someone is suffering—or what they need to heal.

The drug-centered model aligns with our re-psychopathologization campaign because it explains that chemical substances do not fix but rather alter natural physiology. It also aligns with our commitment to understand human experience in its full complexity and to engage in an honest, informed discussion about the nature and consequences of these interventions.

Key Sources and Further Reading

Joanna Moncrieff, “Models of drug action” (blog, 2013) – concise explanation of disease vs drug-centered models.
https://joannamoncrieff.com/2013/11/21/models-of-drug-action

Joanna Moncrieff & David Cohen, “Do Antidepressants Cure or Create Abnormal Brain States?”, PLOS Medicine (2006).
Open-access article: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030240

Joanna Moncrieff, The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment (book).
Publisher page: https://link.springer.com/book/10.1007/978-0-230-58944-5

Joanna Moncrieff, “Research on a ‘drug-centered’ approach to psychiatric drug treatment,” Epidemiology and Psychiatric Sciences (2018). https://pubmed.ncbi.nlm.nih.gov/29022518/

Genspect, Re-psychopathologization Campaign, Policy Statement: Restoring Clinical Clarity on Gender Distress

A licensed psychotherapist and writer, Evelyn Ball helps families, adolescents, and adults explore identity, build resilience, and foster authentic connection. More of her work can be found on Substack at Evelyn Ball.

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