Generation Meds

How antidepressants cheered us up, let us down, and changed who we are.

When the 'Brain Disease' Model is Bad Medicine

How portraying mental disorders as biological diseases can hinder recovery

Paper: “On the Brain Disease Model of Mental Disorders,” by Brett Deacon, Ph.D., and James Lickel, M.S., The Behavior Therapist 32:6 (Sept 2009): 113-118.

brain art
'Old World Brain,' by Tom McNamee
http://www.flickr.com/photos/mcnamee/445793409/sizes/l/in/photolist-FoNRg-G9PtQ-H9a1G-LpCLT-LuJQs-Mo6zh-Mo7E9-Mo7JU-MvKJE-Pa2Pt-

When I was a freshman in college and a psychiatrist at the school health center wrote me a prescription for antidepressants to treat what—in hindsight—seems like a pretty run-of-the-mill combination of homesickness and heartache, she explained that I was suffering from a biological disorder that required a biological treatment.

As I recalled that year later in my book, Coming of Age on Zoloft, the antidepressants seemed to brighten my mood. But the idea of myself as a person with a brain disease was anything but uplifting. I felt broken, and it seemed to me that anyone else who “knew” I used medication would see me in the same unflattering light.

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For years, proponents of the ‘brain disease’ model of mental illness have argued that if we see depression and other mental disorders as real, physical diseases, people who have them will no longer be stigmatized as they were in the past. The idea is that if the problem is truly biological, it cannot be seen as a flaw in the character or will power of the person who suffers.

It’s a nice piece of reasoning. The problem is not only that it is not scientifically proven that depression, anxiety, and their ilk are biological diseases, but also that defining them in that way is as likely to create stigma as it is to destroy it.

That’s the argument made in a paper by Brett Deacon, a psychologist at the University of Wyoming, Laramie. Noting that Thomas Insel, the director of NIMH, had stated that “mental disorders are brain disorders,” the authors write:

“[W]e are concerned that the enthusiastic promotion of the brain disease model by NIMH and other prominent sources…has far outstripped the available scientific data and may actually be increasing the stigma associated with mental disorders.” 

How could it be doing that? Well, the authors continue:

“Because biological models foster the perception that individuals with mental disorders lack control over their behavior, they may be viewed by others as unpredictable, dangerous, unable to care for themselves, requiring harsher treatment, and fundamentally different from those without mental disorders.”

In fact, there’s a whole literature of studies that find that biological explanations of mental disorder are associated with greater fear of and prejudice toward people who are in mental distress.

Such explanations can also influence the way that people with mental disorders view themselves. In an experiment they conducted at their university, Deacon and his lab members asked undergraduate participants “to imagine seeking help from a doctor who diagnosed them with major depressive disorder and provided either a brain disease or biopsychosocial explanation for their symptoms.”

They found that “[t]he brain disease explanation led to substantially less self-blame than the biopsychosocial explanation, but was associated with a worse expected prognosis, decreased self-efficacy in managing depression, and the perception that psychosocial interventions would be ineffective.”

That experiment and its conclusion rang true to me. Back in college, the biological explanation I was given for my experiences made me see myself more negatively. It made me feel nonsensical and unhinged, a view that gutted my self-esteem. Things didn’t change until years later, when I began to re-define what I’d been through not as a disease or an imbalance, but as a completely understandable interaction between my temperament—the person biology and life experience had made me—and the real stresses I had been under at the time.

Depression certainly isn’t a “flaw in character” or a “lack of will.” But the view that it is a well-defined brain disease is, at best, a leap. The scientific community acknowledges that the biological nature of depression is still not well understood. But Deacon's main point is that besides being iffy science, the brain disorder model isn't always good medicine, either. “It is possible," he writes, "that the brain disease model fosters beliefs about oneself, one’s disorder, and treatment that could interfere with clinical improvement.”

I couldn't agree more. By now, I know that while some people find the brain disease model comforting, others very much do not. Mental health care providers should be aware that this model isn't the all-purpose stigma-eraser it's sometimes presented to be—and they should be cautious about applying it to people whose needs it may not serve.

 

Further Reading:

Angermeyer, M. C., & Matschinger, H. (2005). “Labeling – stereotype – discrimination: An investigation of the stigma process.” Social Psychiatry and Psychiatric Epidemiology, 40, 391-395.

Deacon, B. J., & Baird, G. (in press). “The chemical imbalance explanation of depression: Reducing blame at what cost?” Journal of Clinical and Social Psychology.

Hill, D. J., & Bale, R. M. (1981). Measuring beliefs about where psychological distress originates and who is responsible for its alleviation. New York: Academic Press.

Read, J. (2007). “Why promoting biological ideology increases prejudice against people labeled ‘schizophrenic.’” Australian Psychologist, 42, 118-128.

Katherine Sharpe is the author of Coming of Age on Zoloft.

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