Monday, 12 January 2015

Psychologists and psychiatrists feel less empathy for patients when their problems are explained biologically

The idea that mental illness is related to brain abnormalities or other biological factors is popular among some patients; they say it demystifies their experiences and lends legitimacy to their symptoms. However, studies show that biological explanations can increase mental health stigma, encouraging the public perception that people with mental illness are essentially different, and that their problems are permanent. Now Matthew Lebowitz and Woo-young Ahn have published new evidence that suggests biological explanations of mental illness reduce the empathy that mental health professionals feel towards patients.

Over two hundred psychologists, psychiatrists and social workers were presented with vignettes of patients with conditions such as social phobia, depression or schizophrenia. Crucially, some of these vignettes were accompanied by purely biological explanations focused on factors like genes and brain chemistry, while other vignettes were accompanied by psychosocial explanations, such as a history of bullying or bereavement. Next, the mental health professionals reported their feelings by scoring how far a range of adjectives - such as "sympathetic", "troubled" and "warm" - fitted their current state.

Vignettes accompanied by biological explanation provoked lower feelings of empathy from the clinicians, and this was true regardless of their specific profession. Both biological and psychosocial explanations triggered similar levels of distress, so the reduced empathy associated with biological explanation was not simply due to psychosocial explanations being more upsetting. The mental health professionals rated the biological explanations less clinically useful; biological explanation also prompted them to have less faith in psychotherapy and more confidence in drug treatments.

Similar results were found in a follow-up study in which clinicians and social workers were presented with vignettes and explanations that reflected a combination of psychosocial and biological factors, but with one approach more dominant than the other. The idea was that this would better reflect real life. In this case, explanations dominated by biological factors prompted lower empathy from clinicians.

Lebowitz and Ahn suggest biological explanations provoke reduced empathy because they have a dehumanising effect (implying patients are "systems of interacting mechanisms") and give the impression that problems are permanent. With biological approaches to mental illness gaining prominence in psychology and psychiatry these are potentially worrying results. A silver lining is that both medically trained and non-medical clinicians and social workers in the study saw biological explanations as less clinically useful than psychosocial explanations.

A weakness of the research is the lack of a baseline no-explanation control condition - this means we can't know for sure if psychosocial explanations increased empathy or if biological explanations reduced it. Also, as the researchers admitted, the vignettes and explanations were greatly simplified. Nonetheless, the findings may still give reason for concern. Lebowitz and Ahn suggest reductions in empathy may be avoided if clinicians understand that "even when biology plays an important etiological role, it is constantly interacting with other factors, and biological 'abnormalities' do not create strict distinctions between members of society with and without mental disorders."


Lebowitz, M., & Ahn, W. (2014). Effects of biological explanations for mental disorders on clinicians’ empathy Proceedings of the National Academy of Sciences, 111 (50), 17786-17790 DOI: 10.1073/pnas.1414058111

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


Research Digest said...

I know a link isn't an endorsement...but I thought Christian debunked the speculative claims about mirror neurons as featured in that article within his own book?

Research Digest said...

hi Jane, which article are you referring to?

Research Digest said...

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Research Digest said...

This seems to contradict the well known result that people hold better views of homosexuality (although this is no illness) when they think it has biological causes. And even if the trend shown in this study is true, it has no bearing on the question whether illnesses ARE actually caused by biological factors.

Research Digest said...

I think the study conclusions are questionable. I read through the original paper and found many of the vignettes for psychosocial explanations of illness were descriptions of victimization where a person had been severely abused or betrayed. Perhaps the study should have asked if victims of abuse or betrayal elicit more empathy than those who have not had such experiences. I think the study results make more sense when interpreted in this way.

Research Digest said...

The whole point of psychology is that talking therapies can heal a person so why would they empathize with the biological/chemical theory it goes against their training. They believe people can change with the right help. Also most behaviour is learnt. They cant find where these parts are in the brain so how can they give medication to solve something that cant be found in practice. All chemicals do is suppress feelings and really feelings need to be felt. What medication does is make the troubled person more manageable for the rest of society.

Research Digest said...

The study's finding sums up the malaise throughout the current dog-and-pony-show approaches in psychotherapy, where:

- Efforts to treat symptoms are maximized, and approaches to treat causes are minimized;
- The therapist is in charge, not the patient;
- The thinking brain is the all-in-all, while the feeling and instinctual parts of the patient’s brain that drive behavior are suppressed.

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