These days, calls to end the stigmatization of mental illness have become routine. And who could argue with that? People with serious mental illness are by definition suffering. Why would we want to add to that by deeming them disgraceful as well?
So goes the thinking behind an effort to change mental illness attitudes through “Mental Health Literacy” — essentially teaching people to recognize and understand mental illness as a biological or genetic condition rather than a psychosocial one in order to, we’re told, reduce the burden of stigma.
Problem is, I can find no solid evidence this reduces stigma.
John Read, a professor of clinical psychology at the University of East London, reviewed the literature a decade ago to determine the effect of this approach on the perception of schizophrenia and those who have it. Mr. Read and his co-authors found that, in fact, a belief in “bio-genetic” explanations for schizophrenia and the necessity of pharmaceutical management for it leads to increased pessimism in the chances of recovery and a greater desire to avoid contact with persons so labeled.
These points have been replicated in study after study regarding a host of mental illnesses in at least 16 different countries. The first meta-analysis on the subject, by researchers at the University of Melbourne, demonstrated in 2013 that acceptance of bio-genetic explanations for mental illness was positively correlated with a greater perception of dangerousness regarding the mentally ill.
Moreover, the few studies that have assessed public attitudes toward the mentally ill over time have shown these attitudes have actually gotten worse as acceptance of bio-genetic theories of mental illness has increased.
A German study found that between the years 1990 and 2001, the number of respondents who attributed schizophrenia to hereditary factors increased from 41 percent to 60 percent. The same study found an increase in the number of respondents who would not want a person suffering from schizophrenia as a tenant, co-worker, neighbor or child caregiver; would not view such a person as a desirable addition to one’s family or social circle and would not recommend such a person for a job.
In this country, the General Social Surveys of 1996 and 2006 found increasing acceptance of neurobiological or genetic explanations for mental illness — and also an increase in the number of respondents who were unwilling to accept a mentally ill person as someone to work closely with, have as a neighbor, socialize with, make friends with or have marry into one’s family.
There are essentially two ways of looking at those conditions called “mental illnesses.” We could regard them as more extreme versions of the despondency, fear, wrath or confusion that we all experience, and as perfectly understandable reactions to overwhelming abuse and trauma. Or we could regard them as brain diseases, probably genetic in origin, requiring the sufferer to take powerful mind-altering drugs, quite likely for the rest of her life.
One approach emphasizes our common humanity, and the other seems to regard the sufferer as a mere biological specimen. One approach invites us to consider the societal and economic factors that lead individuals to feel despondent, fearful, wrathful or confused, and to think about ways of changing them, while the other seems to regard society as basically sound, but unfortunately plagued by those individuals with faulty genes or faulty brains who can’t fit in.
Which approach is more stigmatizing? A German study from 2016 suggests the latter. The study subjects were presented with information texts on schizophrenia. One of these texts emphasized bio-genetic explanations, while the other emphasized the continuity between the experiences of those labeled “schizophrenic” and those of “normal” people, along with information about the role of stress in the genesis of this condition. The subjects who received the continuum information actually reported less fear of, and less desire for distance, from those labeled schizophrenic, than those who read the bio-genetic information.
“Although biogenetic beliefs have been shown to reduce the blame given to persons with schizophrenia, they tend to increase discrimination and stereotypes such as dangerousness and unpredictability,” the study concluded.
Teaching people that mental illness is an illness like any other makes attitudes toward it worse, Professor Read, of the University of East London, told me. “These approaches are not evidence-based. They are ideologically based. It’s not an accident that a lot of them are funded by drug companies.”
In addition, the toxic effects of so-called “antipsychotic” drugs — obesity, drooling, uncontrollable movements — are themselves stigmatizing, a point the proponents of “Mental Health Literacy” and pharmacological treatment never seem to consider.
Many of those who adopt this approach undoubtedly do so believing it’s in the best interests of those with a serious mental illness. But available evidence suggests they might be doing more harm than good.
Patrick D. Hahn is an affiliate professor of biology at Loyola University Maryland and a freelance writer. He can be reached at firstname.lastname@example.org.