Much of the information about mental illness promoted to the public over many years tells a story in which mental illness is a lifelong disability, incurable and hopeless. The mentally ill are fundamentally different from everyone else. They act strangely. They can be dangerous.
The fundamental difference, we have been told, is that the mentally ill have brains that are chemically unbalanced. It is just the way they are. When they take special drugs to restore the balance they can appear normal, but they are not really.
Research in several countries has shown worsening public attitudes towards people who are mentally ill in recent years, as the story that the mentally ill are fundamentally different from normal people has become more widely believed. This fundamental difference story is known as the ‘neurobiological’ explanation of mental illness — a mentally ill person’s brain is broken in some irreversible way.
The neurobiological explanation contrasts with the explanations of mental illness used by psychotherapists. For example, in CBT the explanation is that mental illness is the result of circumstances and life events — it can happen to anyone at any time, and it is completely reversible. CBT therapists demonstrate this over and over again in their work with patients, in which treatment rarely lasts more than a matter of months.
The truth is that mental illness does not generally indicate a permanent defect in brain chemistry. Like a broken leg, a disordered mind can heal itself remarkably quickly and completely. Mental illness is almost always a temporary condition if treated competently.
A sociological study recently published as “A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence, found that:
In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996.
Over the same period, it found, the proportion of the public who said they would socialize with someone with major depression fell from 35% to 30% (Table 1).
These results were obtained from reactions to vignettes (fictional stories) that did not include diagnostic labels.
A false belief
That study came to the attention of Robert Whitaker, an American author and journalist who explains the rise of the neurobiological explanation of mental illness as the result of storytelling by the psychiatric establishment. In The Successful Creation of a Societal Delusion . . . and the Increase in Stigma It Has Spawned, he summarizes the study’s results:
This is data that tells of an extremely successful propaganda effort. The overwhelming majority of Americans have been led to adopt a false belief.
The false belief is the belief that mental illness is caused by chemical imbalance:
…it is easy to see why the chemical-imbalance story leads to negative attitudes about people struggling with mental illness. It tells the public that people with a psychiatric diagnosis have “broken brains,” and that their moods and behaviors are governed by faulty brain chemistry. This is an understanding that separates the “mentally ill” from the rest of society. The “mentally ill” are different from “us.”
Here in the UK, professor of sociology Frank Furedi, writing last month, suggests that there is a broader tendency in society these days to explain things we fear in ways that emphasize our inability to do anything about them. His article, Fear is key to irresponsibility, explains how:
Worst-case thinking encourages society to adopt fear as of one of the dominant principles around which the public, its government and its institutions should organise their life. It institutionalises insecurity and fosters a mood of confusion and powerlessness.
By popularising the belief that worst cases are normal, it incites people to feel defenceless and vulnerable to a wide range of threats.
Public storytelling in mental health promotes exactly this belief that worst cases are normal, and that people with mental illness, as well as those around them, are defenceless and vulnerable.
The effects of propaganda stories popularizing false beliefs are widespread and destructive. Mental health blogger Dawn Willis interviewed another American writer and journalist, Pete Earley, recently and blogged it in Author Talks About Criminalizing the Mentally Ill. Earley points out how much public money is wasted because of the belief that mental illness is untreatable:
There are 1,200 of [people who are mentally ill] right now in the Miami jail. It costs $100,000 a day. That’s $36 million a year, and they’re not getting any better. For half that, you could put them in affordable housing. You could get them an act team — a team that actually would work with them — and you could actually help them get better.
Even Pete Earley has swallowed the neurobiological story:
…if we honestly say to ourselves, “This person has a biological problem in their brain,” then we realize it could happen to us. We realize it could happen to our children. We realize it could happen to somebody we love. And we don’t want to admit that.
Nevertheless he articulates the problem passionately:
So now we’re in a situation where a large percentage of people are ending up in jails and prisons. We’ve turned it into a criminal justice problem instead of a mental heath problem. It’s costly, it’s wasteful and it’s morally wrong, and we’re depending on jails and prisons, mental health courts, jail diversion programs. We’re depending on law enforcement to solve this problem.
In the NHS
This pervasive neurobiology story affects people in more subtly destructive ways, too. For example, Nurse Converse, a student nurse in the UK, wrote in Challenging Stigma (blatant hypocrisy) last month about the way assumptions about mental health in the NHS harm her:
I believe people should be educated about mental illness, helped to see that people who have MH issues are not scary, or weird, or people to be avoided or gossiped about. That they are just normal people who have had troubles in their life…
Disability discrimination laws are all well and good but frankly, in the NHS they don’t mean a toss.
She met a doctor who is affected, too:
He told me that he had suffered briefly from depression at the age of 18 and now, in his 30’s, he was STILL being hauled in for 6 monthly reviews.
It’s Robert Whitaker who sees how all this can be fixed:
If the psychiatric establishment wants to reduce stigma towards the mentally ill, all they need to do is run a [PR] campaign that — and how else to put this — tells the truth.