While this post wasn’t intended to be an opinion or commentary, I would like to preface it by sharing a recent encounter online. Someone had anonymously shared her struggles with depression in a post and had received plenty of supportive and helpful comments validating her experiences, and advising her to seek professional help. One comment stood out in particular – a well-meaning commenter tried to explain the poster’s depression as (to paraphrase) ‘the body’s inability to regulate neurochemicals’. I reckoned that his comment had hoped to alleviate self-blame and stigma by explaining the poster’s depression as a biological illness. As an advocate of accurate and evidence-informed knowledge and information, I thanked the commenter for his good advice of asking the poster to seek professional help, while informing him (and linking him to online resources that explain) that the chemical imbalance theory of depression is inaccurate and outdated despite its widespread popularity. What followed were a series of thoughts that lingered on my mind. I started to wonder if:
- Non-biological models of conceptualizing mental illnesses increases stigma; while
- Biological models of conceptualizing mental illnesses decreases stigma?
While it appears some people do endorse the first statement, to quote from a research paper published in 2009 that “the biopsychosocial concept, in hinting that biology is distinct from psychology, indirectly re-enforces the stigma that psychiatric diseases patient suffer from are volitional and not medical issues“, today’s Wassup’ post seeks to specifically evaluate statement number 2.
In the article by Loughman & Haslam (2018), researchers conducted a meta-analysis of 19 correlational and 7 experimental studies investigating the impact of neurobiological explanations of mental illnesses on stigma. From their analysis of the included experimental studies, they found that:
- Individuals who endorsed neurobiological explanations did not attribute more or less blame to sufferers of mental illnesses compared to non-neurobiological explanations; however,
- They desired to be more socially distant from sufferers of mental illnesses, thought of them as being more dangerous, and were more pessimistic about their recovery outcomes.
That is to say, while individuals who thought mental illnesses had neurobiological underpinnings did not blame sufferers more, they thought that they were more dangerous, were less likely to recover, and were more unwilling to enter social relationships with them.
When the correlational studies were analysed, the researchers did not find any significant overall effects between neurobiological explanations and blame, dangerousness, and social distance. However, when the analyses were conducted for individual mental illnesses (in contrast to an overall aggregate), the study found:
- Small but significant positive correlations between neurobiological explanations and social distance for Depression, Schizophrenia, and other mental illnesses; and
- A small but significant positive correlation between neurobiological explanations and perceived dangerousness for those who suffer from mental illnesses other than depression and schizophrenia.
Simply put, people who endorsed neurobiological explanations of mental illnesses such as the chemical imbalance theory more strongly were more unwilling to be in social relationships with people who have depression, schizophrenia, or other non-specific mental illness. They were also more likely to hold views that those with non-specific mental illnesses were more dangerous.
Based on the meta-analysis, the researchers unfortunately concluded that “People who tend to explain psychiatric conditions as brain diseases or as products of chemical imbalances may be especially likely to avoid sufferers and are just as likely as others to blame them for their problems. People who are given a neurobiological explanation of a psychiatric condition tend to see sufferers as more dangerous and less likely to recover, and are more likely to distance themselves from them, than people who are not.“
For all its promise of destigmatizing mental illness, it would appear that attributing mental illnesses to biological bases does more harm than good. Not only is the chemical imbalance theory of mental illness inaccurate and outdated, the current meta-analysis also suggested that these harmful views perpetuate stigma. So the next time a well-intentioned person tries to offer ‘helpful advice’ by attributing depression to the body’s inability to regulate neurochemicals, perhaps it’s time we take a step back and consider the true implications of our words.