I wrote in another comment to another post how imagining we know anything about why psychoactive substances do what they do is mere hubris, and it is. This argument is misguided, comrade. At best, it's utopian thinking. What is happening in practice is maximal suffering, with no benefit to public health (or positive outcomes on the individual level!) - how do we change society? Inventing a world where deprescription as it has been and is actually implemented ceases to exist somehow is utopian.

There's no contradiction between rejecting the chemical imbalance theory (which was originally a marketing scheme for Zoloft) and supporting the use of psych meds for those who benefit from using them.

I'm going to try and go a different direction here since other commenters have already said everything I'd like to say: psychiatry is extremely faddish, and deprescribing has been gaining some powerful friends the same way other interventions have in the past. As such it deserves to be treated with the same critical eye as any other trend in the field. Deprescribing is hot now because there is a way to profit from it. Any benefit or risk that accrues is incidental to the further commidification of disability and disabled people. Other people have written at length about this, if you're disabled you've probably seen it yourself: what drives trends in treatment is what treatment is available and who can monetize it. If it weren't profitable we wouldn't be seeing such a push for deprescription now, the same way we wouldn't have seen anxiety become depression become bipolar disorder (merely changing the name for the same underlying phenomena as different medications come on or off patent).

Benzodiazepines were considered largely benign until the manufacturer of Buspar decided to salt the literature to make space in the market for their "non-addictive anti-anxiety medication". MDD and GAD got redefined in the DSM as SSRIs emerged as alternate "serenics" or "anti-depressants". Social anxiety as a diagnosable nosological entity distinct from other anxiety disorders only exists because Paxil needed a new indication to extend its patent life. PMDD as a distinct nosological entity distinct from what had existed before but been coded as PMS or PMT (non-billable) is a thing because Prozac was going off patent and the manufacturer reformulated fluoxetine as a pink tablet to keep their rate of profit up. BPAD got fuzzed to include "has moods" as the market for "mood stabilizers" appeared around the turn of the century.

There have been no real advances in psychopharmacology since the introduction of the SSRIs and SGAs in the 1980s. We've been running on fumes and recombining old treatments for decades, creating prodrugs (Vyvanse/Elvanse) of 100 year old drugs, or turning ketamine into a single-enantiomer nasal spray. There's no money to be made in psychopharmacology now. Everything is generic, there's no marketing teams creating the pressure that there was 20, 30, 40 years ago.

The failure of nosology to account for human experience has nothing to do with whether somebody benefits from a medication or not. Force-tapering people is violence, but there's money in violence. There's metrics to create and hold prescribers to! We can further enclose and extract rent from the human experience and from human suffering in ways that don't differ from forced prescribing (or overprescribing, whatever) at all. Medication has no moral valence by itself but the choice to prescribe or deprescribe (and the necessity of a prescription to access certain medications in the first place) does.

And lastly, there is the whiff of disability-as-moral-failing and disability-as-contagion to this reasoning. Whether the cluster of experiences we call ADHD is nosologically coherent or not doesn't change the fact that there exist drugs that improve executive function and quality of life for certain people, and those people (myself among them) should have access to the medication they need without judgement or gatekeeping. "If we could treat the underlying causes then disability would cease to exist" is ahistorical. It's the same argument RFK is making, ultimately.