Monday, 11 December 2006

Biological accounts of mental illness may dent patients’ hope and increase stigma

Mental illnesses are biologically based brain disorders” - that's the bold proclamation made by The National Alliance on Mental Illness and many other campaign groups. No doubt, one intention of such proclamations is to reduce the stigma associated with mental illness – to show that mental illnesses are not “all in the mind”, but are as real as any physical illness. However, Danny Lam and Paul Salkovskis report that such arguments may in fact do more harm than good, increasing stigma, and causing patients to feel pessimistic about their chances of recovery.

Forty-nine participants suffering from depression or anxiety were played a ten minute assessment video featuring a woman who suffers from panic attacks and agoraphobia. Crucially, before watching the video, some participants read an information sheet that explained panic attacks are caused by psychological processes, whereas others read a version that said panic is a biological condition caused by a chemical imbalance. A control group read that the causes of panic disorder are unknown.

After watching the video, the participants rated the woman’s chances for the future. Those who’d read that panic was a biological condition predicted the woman’s treatment would take longer than the other participants did, and regarded her as having a higher risk of harming herself and others. By contrast, the participants who read that panic is a psychological condition rated the woman’s chances of recovery as significantly better than the other participants did.

Together with prior research, the researchers said these findings suggested “biological explanations of mental health problems may increase public, professional and patient perception of harm (self-harm and harming others) and result in more negative predictions regarding prognosis, whilst psychological accounts may have the opposite (destigmatising) effect.”

Lam, D.C.K. & Salkovskis, P.M. (2006). An experimental investigation of the impact of biological and psychological causal explanations on anxious and depressed patients’ perception of a person with panic disorder. Behaviour Research and Therapy, 45, 405-411.

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.


Jeff Ezell said...

As a clinical psychologist with 25 years practice experience in the USA and now working in the UK for the last couple of years, I wonder how specific these results may be to a UK population sample. While I am unaware of comparable research in the US, my experience tells me that Americans are significantly more optimistic about medications in general, and psychopharmacology in particular, than are residents of the UK. I would predict that Americans would have a greater tendency to see a biological explanation of psychiatric symptomatology as good news, with the implication that the "chemical imbalance" might potentially be rectified efficiently through psychopharmacological means. Further, my guess is that a random, stratified sampling of Americans would find greater pessimism in the face of a purely psychological explanation for psychiatric symptoms, with the concomitant implication of a need for psychotherapy (with the likely expectation that this might take years or not be all that effective). As we used to say, there's a dissertation in there somewhere!

Mark Hardiman said...

Perhaps another perspective on these results is that there is still a perception that mental health problems are 'all in the mind' and can be snapped out of.

Reading accounts that the reasons for panic attacks are either psychological or unknown does nothing to remove these perceptions. Reading about a biological explanation may help to overcome this initial perception and allow the condition to be viewed as a more 'genuine' illness needing more work to recover from.

The fact that the participants where themselves suffering from a mental health issue does not necessarily mean they would not hold such initial views of mental health conditions. In fact it is quite possible they had heard such opinions expressed to them at some point by third parties.

Keiron said...

This research in no way affects whether biolgical factors are involved in the etiology of mental illnesses. If biological factors are found to be involved should patients be decieved?

Anonymous said...

The same can be said of people in AA who are told if they drink, they will die, that theirs' is a disease of the soul only cured by a higher power. What if that higher power isn't enough for abstinence? Still your own fault. The power of suggestion is mighty and the guilt of those 95% who don't last a year in AA, not to mention the drinking with reckless abandon often to the point of death. After 20+ years of trial and error in AA, I'm finally sober. But that hasn't meant I can't have a drink now and then. I wasted all those years fulfilling those prophesies.

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