Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness (2)

3 October, 2019

While it seems logical, even intuitive, that adopting Western beliefs about causation of mental illness (ie, that it is biological, genetic, treatable with drugs) would result in less stigma, research shows that there are many nuances: these biodeterminist explanations of causation can result in erroneous beliefs about essential defects and inherent dangerousness in those diagnosed; prognostic pessimism; and a desire to maintain more social distance from those diagnosed. This research has been going on for some time, and there are meta-analyses available which show these nuanced outcomes. Also, there are other ways to conceive of MI than biogenetic v. cursed/punished. In fact, most cultures and groups have beliefs about socio-economic and socio-political associations with many behaviors that we might call “psychiatric diagnoses”. While a bio-psych-social framework is always proposed in theory, much of Western psychiatric care tends to focus on the bio. The need to include Societal Determinants of Health is emerging for MH and wellbeing.

I have included links to two recent analyses about results of bio-genetic/neurological explanations on stigma in MI (with excerpts.) Both full text articles are freely available through the links. There are other models to promote wellbeing in LMIC: Friendship benches in Zimbabwe, conversation cafes in Nigeria, etc.

Eileen McGinn

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/

Assessing Mental Illness Stigma: A Complex Issue

Front Psychol. 2018; 9: 2722.

Published online 2019 Jan 11. doi: 10.3389/fpsyg.2018.02722

PMCID: PMC6336735

PMID: 30687177

EXCERPT:

However, despite these theoretically-based premises, these campaigns sponsoring a bio-genetic cause of mental disorders did not produce the desired effect in reducing stigmatizing attitudes. Indeed, the result of these social interventions was a mixed and contradictory pattern of both negative and positive emotions and cognitions, such as: higher levels of negative stigma as well as a higher endorsement of professional MI treatments and MI scientific literacy (Angermeyer et al., 2011 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B4>; Kvaale et al., 2013 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B28>). Indeed, these strategies didn't consider that bio-genetic causal beliefs are associated to the perception that people with MI are considered dangerous, uncontrollable, and antisocial (Read and Law, 1999 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B52>). Proclaiming a “*wrong”* brain functioning as a cause of mental disorders strongly increase the dangerousness perception of such individuals, due to the possible unawareness of their behaviors (Read and Harré, 2001 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B50>; Dietrich et al., 2004 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B15>; Angermeyer and Matschinger, 2005 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B5>). These results suggested that encouraging biological models as explanation of mental

disorders is not useful to reduce stigmatization as well as social distance (Walker and Read, 2002 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B67>; Angermeyer et al., 2011 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336735/#B4>).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/

Cogn Res Princ Implic. 2018 Dec; 3: 43.

Published online 2018 Nov 14. doi: 10.1186/s41235-018-0136-1

PMCID: PMC6234201

PMID: 30426319

*Neuroscientific explanations and the stigma of mental disorder: a meta-analytic study *

EXCERPT:

Neurobiological explanations were positively associated with desire for social distance in both meta-analyses (only marginally for the correlational analysis) and they were unrelated to blame in both meta-analyses. Neurobiological explanations were significantly associated with greater perceived dangerousness in the experimental meta-analysis and although there was no significant relationship in the correlational meta-analysis the trend was in the same direction. As there were no correlational studies of prognostic pessimism, consistency with the significant positive relationship between neurobiological explanation and this stigma dimension could not be assessed. Despite the overall consistency, it must also be noted that the experimental meta-analyses yielded much stronger evidence for relationships between neurobiological explanation and stigma than the correlational meta-analyses, despite including fewer primary studies. This difference may reflect the many confounding factors and moderator variables present in correlational studies of stigma (e.g., Kvaale & Haslam, 2016 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/#CR30>) that may hamper the detection of relationships. In view of the superiority of experimental designs in detecting causal relationships, the stronger evidence for the adverse effects of neurobiological explanation on stigma in the experimental meta-analyses is a reason for confidence in those effects.

The findings also accord well with the prior investigations of Kvaale, Gottdiener, and Haslam (2013 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/#CR29>), and Kvaale, Haslam, and Gottdiener (2013 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/#CR31>), whose focus was on the broader set of biogenetic explanations (i.e., including genetic explanations in addition to neurobiological explanations). The only discrepancies between past and present meta-analyses point to somewhat more adverse implications of neurobiological explanations in the present study.

Biogenetic explanations were associated with reduced blame in Kvaale, Gottdiener, and Haslam (2013 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/#CR29>) and Kvaale, Haslam, and Gottdiener (2013 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/#CR31>), but neurobiological explanations had a null relationship with blame in the present analyses. Kvaale, Haslam, and Gottdiener (2013 <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234201/#CR31>) found a null relationship between biogenetic explanations and desire for social distance in experimental studies, but the present study found a positive relationship in such studies, which provide the best evidence that neurobiological explanations have a causative effect in psychiatric stigma.

HIFA profile: Eileen McGinn is a Consultant in USA. qedeileen AT aol.com