One of the leading organizations in the fight against stigma regarding mental illness is the National Alliance on Mental Illness (NAMI). It stresses that mental illnesses are medical conditions: “Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.” Similarly, we mental health practitioners often counsel patients that their conditions are not their fault–that these are biologically-based, often hereditary, conditions and nothing to be ashamed of.
Unfortunately, such statements are sometimes interpreted to mean that a) There’s nothing I can do about it and b) The only viable treatment is medication. Indeed, pharmaceutical industry advertising often promotes such thinking. But between the lines is the logical error of either/or thinking: Psychiatric disorders are either mental or physical, either psychological or biological.
And hanging in the balance seems to be the individual’s self-respect: If it’s biological, then it’s valid, real and acceptable. If it’s “just” psychological, well….
But is this mind/body distinction valid? Does it make sense scientifically to maintain that human problems are either psychological or biological? Consider the following research findings, all published in prestigious scientific journals in recent years:
- When volunteers are exposed to the virus for the common cold, the best predictor of who will become ill is stress.
- Clinical depression is associated with risk of heart attack comparable to that of cigarette smoking.
- People who smoke are at significantly increased risk for suicide relative to nonsmokers.
- A few sessions of training in meditation-based stress management substantially improves functioning of the immune system.
- Among patients with a genetic predisposition for schizophrenia, a powerful predictor of who will actually develop schizophrenia is family environment.
- Depressed patients treated with placebo pills showed many of the same changes on positron emission tomography PET scans of the brain as patients treated with antidepressant medications.
- Psoriasis patients who listened to mindfulness meditation tapes during phototherapy improved significantly more quickly than those receiving phototherapy alone.
- One session of Acceptance and Commitment Therapy combined with education resulted in superior diabetes status three months later compared to education alone.
- Cognitive-behavior therapy (CBT) equals and sometimes beats antidepressant medications in treating anxiety disorders and depression.
- Abnormalities on the brain images of patients with obsessive-compulsive disorder disappeared after treatment with behavior therapy.
- A few weeks of CBT alone reduces relapse of major depression as well as maintenance treatment with antidepressant medications.
- CBT is superior to sleep medications in the treatment of insomnia.
Perhaps mind and body aren’t as separable as is sometimes supposed! Indeed, in a recent review article in American Psychologist titled, “How the Mind Hurts and Heals the Body,” distinguished researcher Oakley Ray summarized, “As we change our minds (thoughts), we change our brains and therefore our bodies.”
It’s not all about biology
None of this is to suggest that biological factors are unimportant in the development or treatment of emotional and behavioral disorders. To the contrary, genetic and neurobiological research shows that Hippocrates and Galin were right centuries ago to suspect that abnormal behavior might reflect an underlying physical cause. However, research also tells us that biology does not exist in a vacuum, but rather operates in a complex system along with one’s learning history, psychological factors and social environment in a process of reciprocal influence.
The bottom line: there are more elegant ways of combating stigma than attributing psychiatric disorders to purely biological causes. By using a bio-psycho-social model–one that takes into account the roles and interactions among biological, psychological and environmental processes–we dramatically increase treatment options and enable patients to employ greater flexibility in managing their lives. At the same time, we must stand firm against any suggestion that because psychological factors are involved, people are therefore to blame for their disorders; this is no more appropriate than blaming a person for his or her psoriasis. In a future post, we’ll take a look at the important distinction between blame and responsibility.