Charting the Depths

Reflections on the science of depression.

The Disease Model of Depression Has Not Lifted Depression Stigma

The Enduring Stigma of Depression

Our increasingly dominant conception of depression is that it is a medical illness like any other. The disease model of depression--the view that depression is caused by genetic or brain defects-- is disseminated by psychiatry and by pharmaceutical companies, who have expended enormous advertising resources so that the public will come to see depression as a medical illness. Given that something like 27 million people are taking antidepressants, it is clear that it has become more acceptable to take medications for depression.

Patient advocacy groups have bought into the disease model, often out of the belief that seeing depression as a disease like any other will reduce the stigma associated with depression. This motivation is pure. Historically people who have suffered from depression have tended to suffer in silence and/or not sought treatment because of the shame associated with admitting depression. In the US in the 19th and 20th centuries, virtually every form of mental illness was associated with a moral failing or sign of a weak character.

Previously, I have expressed doubts that a more widespread adoption of the disease model will in fact reduce depression stigma.

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Now the evidence is in: A new large scale research study published in American Journal of Psychiatry has found that despite a greater embrace by the public of neurobiological explanations for depression (and other mental illnesses) there has been no decrease in prejudice and discrmiination towards people who suffer from them.

The researchers analyzed questions posed to a nationally representative sample of adults as part of the General Social Survey (GSS), a survey that involves face-to-face interviews. The scientists tested changing attitudes towards different mental illnessess by presenting vignettes that involved a person who had major depression, schizophrenia or alcohol dependency. Stigma was measured with items that asked respondents how willing they would be to have the person described in the vignette as a close co-worker, neighbor, married into the family, or friend.

From 1996 to 2006, an increasing percentage of  the American public believed that depression was due to biological causes and should be treated by a doctor. By 2006, 67 percent endorsed the biological view of depression and 85 percent endorsed treatment by a physician. Ironically, there was no evidence that holding a biological view of the depression decreased rejection of the person described in the vignettes. For example, in 2006, a remarkably high 47 percent of respondents said they would be unwilling to work closely with the person with depression; this was up from 46 percent in 1996. Furthermore, in all of the surveys and across all vignette conditions, holding a neurobiological conception of mental illness either was unrelated to stigma or tended to increase the odds of a stigmatizing reaction.

The lead author on the paper, sociologist Bernice Pescosolido, summed up the situation perfectly, "Prejudice and discrimination in the U.S. aren't moving..In fact, in some cases, it may be increasing. It's time to stand back and rethink our approach."


Reference: Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., Link, B. G. "A Disease Like Any Other"? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence, American Journal of Psychiatry 2010 0: appi.ajp.2010.09121743

See my previous posts on this topic, here and here

Jonathan Rottenberg is an Associate Professor of Psychology at the University of South Florida, where he directs the Mood and Emotion Laboratory.

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