Mad in America

History, Science, and the Treatment of Psychiatric Disorders

The Successful Creation of a Societal Delusion . . . and the Increase in Stigma It Has Spawned

Stigma in the era of "chemical imbalances"

Ever since the revised edition of DSM III was published in 1987, the psychiatric establishment in the United States -- i.e., the American Psychiatric Association, NAMI, the NIMH, and the pharmaceutical industry -- has been telling the American public that it is now known that major mental disorders are "biological diseases," just like "diabetes." The public has been informed that major mental disorders are caused by "chemical imbalances" in the brain, and that psychiatric medications are like "insulin for diabetes."

As this storytelling has occurred, the psychiatric establishment has run anti-stigma campaigns, arguing that if the public understood that mental disorders were brain diseases, then societal "stigma" toward the "mentally ill" would lessen.

A study published in the November issue of the American Journal of Psychiatry, which was led by Bernice Pescosolido at Indiana University, provides an interesting look at how this storytelling effort has worked out.

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As I wrote in Anatomy of an Epidemic (and as others have written, too), the chemical imbalance hypothesis of mental disorders, which arose in the 1960s, basically fell apart in the 1970s and early 1980s. Researchers studying whether people with schizophrenia had overactive "dopamine" systems failed to find that this was so. Similarly, researchers failed to find that people with depression had low levels of serotonin in the brain. These chemical-imbalance investigations continued to sputter along throughout the 1980s and the 1990s, but the bottom-line never changed. As Kenneth Kendler, coeditor in chief of Psychological Medicine, explained in 2005: "We have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them."

However, that scientific finding -- that the chemical-imbalance hypothesis of mental disorders failed to pan out -- was never told to the public. Instead, Prozac came to market in 1988 and the public heard all about "chemical imbalances," and as the study in the November issue of the American Journal of Psychiatry reveals, this PR campaign by the psychiatric establishment was quite successful. In 2006, 87% of the adults surveyed believed that schizophrenia was due to a chemical imbalance, up from 78% in 1996. Eighty percent of those surveyed said that depression was due to a chemical imbalance, up from 67% in 1996.

This is data that tells of an extremely successful propaganda effort. The overwhelming majority of Americans have been led to adopt a false belief.

But -- and this shouldn't be a surprise -- the dissemination of this false belief has not led to a lessening of societal stigma toward people with psychiatric diagnoses. If anything, it has increased it. In their survey, Pescosolido and the other researchers asked a number of questions to flesh out attitudes toward the mentally ill, and in 2006, there was "no significant decrease in any indicator of stigma" compared to 1996. Moreover, "significantly more respondents in the 2006 survey than in the 1996 survey reported an unwillingness to have someone with schizophrenia as a neighbor."

Equally revealing was this: In both the 1996 and 2006 surveys, those who believed in a "neurobiological conception of mental illness" -- i.e., the chemical imbalance story -- were more likely to have a negative attitude toward those with mental disorders than those who did not.

While this finding confounded the researchers' expectations, 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."

Now imagine what societal attitudes might be if the public were told that the biological causes of major psychiatric disorders remain "unknown" (which would be a scientifically accurate message.) That conception of mental illness suggests that it may be possible for anyone -- faced with certain environmental stresses or setbacks in life -- to suffer a severe bout of psychiatric distress. Readers of Shakespeare might sum it up this way: To be human is to have the capacity to go "mad." That is an understanding of "mental illness" that evokes a sense of our common humanity, and a sense of a shared vulnerability to mental suffering.

The lesson to be drawn from this study seems to be this: 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.

 

Robert Whitaker is a journalist who writes mostly about medicine and science; his latest book is Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illnes more...

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