Depression, schizophrenia, and other psychiatric conditions increasingly are linked to findings in the brain and in our genes. Many professionals believe these developments hold the key to better treatments and their enthusiasm spreads. The public now endorses biogenetic (biological and genetic) explanations for mental health problems much more so than we did in previous decades.
One possible desirable side effect of these developments is a reduction in stigma. If the cause of psychiatric misery is in our brain chemistry or our DNA, then the miserable cannot be blamed for their symptoms. Advocates argue stigma will diminish if we come to see mental health problems as biologically-caused illnesses, no different from diabetes or cancer.
This is an appealingly optimistic view, linking scientific advance to social progress.
Unfortunately, it may also be wrong. Many writers argue seeing mental health problems as biogenetically-caused diseases increases the stigma associated. Believing a person has a deep-seated biological defect may lead us to see “them” as unpredictable, incurable, and categorically different from the rest of us.
These studies examine several forms of stigma: Some consider whether people are blamed and held responsible for their conditions. Some assess the belief “they” are unlikely to recover. Some measure the desire to keep away from “them.” Finally, some measured the perception people with mental health problems are dangerous or unpredictable.
Our findings indicate biogenetic explanations are decidedly mixed blessings. People who attribute mental health problems to brain disease or heredity tend to blame the affected people less. However, these people also tend to be more pessimistic about recovery, more willing to socially exclude the affected people, and more likely to see “them” as dangerous.
One notable example of a biogenetic explanation is the “chemical imbalance” view of depression.
The belief this condition is caused by unbalanced brain chemistry is now widespread.
A recent Australian study found 86% of people believe “chemical imbalance” is a likely or very likely cause of depression, and is the most frequently mentioned cause Americans named in another survey.
Seeing depression as being caused by a “chemical imbalance” accords with evidence that abnormalities in brain chemicals accompany the condition. It is also intuitively plausible because medications that alter brain chemistry can be effective treatments. Indeed, the chemical imbalance view fits hand in glove with the growth of antidepressant prescribing.
A recent study suggests the chemical imbalance view of depression has troubling implications. The researchers interviewed 3,642 German adults and presented them with brief descriptions of a person with depression or two other conditions. They rated how much the person’s problems were caused by ten different factors, including a chemical imbalance, a brain disease and heredity. They also rated how much fear and anger they felt toward the person and how much they would socially accept them.
People who endorsed the chemical imbalance explanation had consistently more negative reactions to the depressed person than those who did not. They were more fearful, angrier and less socially accepting. The same negative pattern held for people who endorsed the brain disease and heredity explanations.
The negative implications of the chemical imbalance view of depression may adversely affect depressed people themselves. A recent study recruited adults who had experienced an episode of depression.
Because there is no test for “chemical imbalance,” these people were given a bogus lab test purported to determine whether or not their depression is caused by a chemical imbalance. A saliva sample was taken and purportedly assayed for levels of serotonin, a neurotransmitter.
Half of the experimental participants were told their depression was caused by low serotonin levels and shown an official-looking bar-graph to prove it. The other half, a control group, were told their depression was not the result of a chemical imbalance and given test results to match. All participants then rated themselves on a series of questionnaires.
Participants in the chemical imbalance group blamed themselves as much as their control group peers. They were also more pessimistic about their chances of recovery and less confident of their ability to manage their depression.
Further, only participants in the chemical imbalance group believed pharmacological treatment to be more appropriate and effective than psychotherapy.
In sum, the chemical imbalance view leads people to feel less hopeful and capable in the face of their problem,s and more disposed to use medication.
Biogenetic explanations are ascendant in psychiatry. Writing on a new biomedical makeover of psychiatric classification, the head of the United State’s powerful National Institute of Mental Health said as much, recently declaring “mental disorders are biological disorders.”
This statement is true in the same way “humans are biological organisms” is true: correct on one level, yet also fundamentally incomplete.
As this revolution gathers force, we need to be mindful biogenetic explanations for mental health problems can and will have troubling implications for the myriad people who suffer them.