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Sunday, February 08, 2015

Stigma and the Biological Model of Mental Illness

For many years, the psychiatric profession has been pushing the idea of mental illness as biological illness, despite the fact that there is no blood test or other biological test for any psychiatric condition. The National Alliance on Mental Illness says on its web site: "Mental illnesses are biologically based brain disorders. They cannot be overcome through 'will power' and are not related to a person’s 'character' or intelligence." NAMI thus invokes the biological theory of mental illness as a way to counter the stigma that so often accompanies mental illness. But what if a belief in biological models actually worsens stigma or degrades people's belief in a positive prognosis?

A 2001 study by John Read and Niki Harré (and I quote) "confirmed previous findings (contrary to the assumption on which most destigmatisation programmes are based) that biological and genetic causal beliefs are related to negative attitudes, including perceptions that 'mental patients' are dangerous, antisocial and unpredictable, and reluctance to become romantically involved with them."

A small but interesting 2007 study by D.C. Lam and P.M. Salkovskis reported:
Anxious and depressed patients (n=49) were randomly allocated to three experimental conditions. Prior to watching a video of a person suffering from panic disorder, participants were told either that research indicated that panic was caused by biological factors, by psychological factors or the cause was unclear (control condition). Those in the biological condition were significantly more pessimistic about the patient's prospects for recovery and rated risks as higher compared to those in the psychological condition. The results call into question the widely accepted practice of promoting biological/disease explanations of mental health problems.
In 2009, Brett J. Deacon and Grayson L. Baird replicated the Lam & Salkovskis results using a group of 90 undergraduates who were were asked to imagine feeling depressed (and seeking help from a doctor who diagnosed them with major depressive disorder), then received either a chemical imbalance explanation or a biopsychosocial explanation for their symptoms. The students then filled out surveys to rate each explanation’s credibility and provide information on stigma, prognosis, and treatment expectancies. The upshot:
Compared to the biopsychosocial model, the chemical imbalance model was associated with significantly less self-stigma but also significantly lower credibility, a worse expected prognosis, and the perception that psychosocial interventions would be ineffective. The chemical imbalance explanation appears to reduce blame at the cost of fostering pessimism about recovery and the efficacy of nonbiological treatments.
Sheila Mehta and Amerigo Farina (1997) found that college students delivered electric shocks of higher intensity and duration to an allegedly mentally ill confederate when the person’s symptoms were described as caused by biological rather than psychosocial factors. While allegedly mentally ill confederates were held less responsible for their performance on a learning task when their disorder was attributed to biological as opposed to psychosocial factors, nevertheless a biological explanation did not improve the likeability, perceived dangerousness of the confederate, or willingness of the observer to engage in a social relationship with the confederate.

Studies of these sorts provde suggestive evidence that the biological model, whether it's a valid model or not, does little to mitigate stigma and may actually worsen attitudes toward recovery. As the authors of a 2014 paper in Psychiatry Research said: "A growing body of studies shows that although biogenetic explanations reduce blame, they tend to reinforce prognostic pessimism and harsher treatment of people with schizophrenia." If these studies are correct, it indicates that NAMI, NIMH, the APA (with its "biological" revision of the DSM), and other groups are potentially doing harm to the very people they intend to help.

My 384-page mental illness memoir, Of Two Minds, goes into depth on issues surrounding depression, schizophrenia, drugs, and therapeutic alternatives, with 300+ footnotes to the literature and countless personal narratives to shed further light on these and other issues. Please join the mailing list to get updates. Thanks!

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