Does reframing mental illnesses as brain disorders reduce stigma?

by Jon G. Allen, PhD on February 26, 2014 · 2 comments

in mental illness

brain disorders or psychiatric disordersPsychiatry is moving gradually toward characterizing “mental illnesses” as “brain disorders.”

This movement is consistent with increasing understanding of the contribution of brain functioning to psychiatric disorders. This biological contribution includes genetic factors as well as alterations in brain chemistry, activity and structure.

But research in neuroscience also shows that genetic makeup is not destiny: Environmental and psychological stress influence gene activity as well as patterns of brain activity. Moreover, extensive research attests to the fact that stress and health-related behavior play major roles in general medical conditions. Furthermore, psychological and behavioral interventions, such as stress management, are effectively employed in the treatment of general medical conditions as well as psychiatric disorders.

Psychology and neurobiology – mind and matter – are inextricable. All this knowledge blurs the boundaries between “mental” and “physical” illness and suggests some arbitrariness in this distinction.

Stigma and psychiatric disorders

Greater stigma has been associated with psychiatric disorders than with general medical conditions. Accordingly, it is reasonable to hypothesize that reframing mental illness as physical illness would reduce stigma. Yet critics of this hypothesis raise concern that the disease model points to a deep-seated and defining “essence” that could solidify stereotypes and prejudice. Fortunately, we now have a growing body of research that has put these competing views to the test.

Erlend Kvaale, Nick Haslam and William Gottdiener amalgamated all available research data bearing on the question as to whether we reduce stigma by characterizing psychological problems as diseases with biogenetic causes.

Appreciating the complexity of stigma, they addressed four different facets:

  1. blame of the individual for problems,
  2. pessimism about prognosis for recovery,
  3. perceived dangerousness and
  4. desire to maintain social distance.

Combining data from various studies yielded large samples for each of these four facets of stigma, ranging from 1,207 to 3,469 participants.

Research results

The results are mixed. The disease perspective is associated with less blaming attitudes, but it also is associated with greater pessimism about prognosis. There was inconclusive evidence that the disease model is associated with higher perceived dangerousness. Notably, there is no evidence that the disease model affected social distancing, for better or for worse.

The authors of the study concluded that we should be skeptical of the view that regarding psychological problems as brain disorders will abolish stigma. Although the disease model decreases blame, this shift comes with a cost: It increases pessimism about recovery and might also contribute to perceived dangerousness.

With the current furor about mental illness in relation to gun control, this problem of perceived dangerousness certainly merits further study. Moreover, the authors point to rejection and discrimination as the key consequence of stigma, which is manifested in social distancing; these most pernicious social attitudes are not ameliorated by the disease model. Here is their conclusion:

Explanations that invoke biogenetic factors may reduce blame but they may have unfortunate side-effects and they should not be promoted at the expense of psychosocial explanations, which appear to have more optimistic implications.

Technology and personhood

In a previous post, I protested the current trend toward “biomania,” by which I meant excessive enthusiasm for an exclusive focus on neuroscience in the field of psychiatry. In part, this protest is associated with a concern about patients’ increasing reliance on medication compared to psychotherapy.

I also have expressed concern about the movement from a more humanistic to a more technological focus in our work and the emphasis on neuroscience is taking technology to new heights. At worst, this technological emphasis could be dehumanizing.

I firmly believe that we must pursue vigorously knowledge of the neurobiological basis of mental illness and that improved treatment will result from this endeavor. I also believe that neurobiological understanding can facilitate our empathy with the daunting challenges of recovering from mental illnesses. Patients can’t just change their mind by some force of will; they are ill in every sense of the word.

Yet, in embracing this burgeoning knowledge about genetics and brain functioning, we should not lose our minds and lose sight of the personhood of those who are ill. Nor should those who are ill lose sight of their personhood. With treatment, persons with psychiatric disorders heal, in concert with their brains.

Reference

Kvaale, E.P., Haslam, N. & Gottdiener, W.H. (2013). The ‘side effects’ of medicalization: A meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33, 782-794.

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