Myth: reframing mental illness as a ‘brain disease’ reduces stigma

A disease like any other?

Various anti-stigma initiatives have advocated for an understanding of mental illness as a biological process: ‘a disease like any other’. ¹² During the late 1990s, both the Canadian Mental Health Association and the National Alliance on Mental Illness in the United States, framed mental illnesses as brain disorders in their anti-stigma campaigns.^13,14

A US study showed that although the public adopted a more biological conception of mental illness in 2006 as compared to 1996, the changes in attitude were not associated with reduced stigma. ¹² Although knowledge about mental illness increased over that period, attitudes of intolerance worsened. A German investigation came to similar conclusions, finding an increase in the desire for social distance from people with schizophrenia in 2001 as compared to 1990, coincident with increasing public acceptance of the biological causes of mental illness. ⁷

So why aren’t mental illnesses diseases like any other? The evidence shows us that while the public may assign less blame to individuals for their biologically determined mental illness, ⁷ the very idea that their actions may be beyond their conscious control can create fear of their unpredictability and thus the perception that those with mental illnesses are dangerous,^8–11,15 leading to avoidance.^7,11,16–18 Biological explanations can also instil an ‘us vs. them’ attitude, defining individuals with mental illness as fundamentally different. ¹⁹ For example, a 2008 survey of Canadians ²⁰ found that: 42% would no longer socialize with a friend diagnosed with mental illness; 55% wouldn’t marry someone who suffered from mental illness; 25% were afraid of being around someone who suffers from mental illness; and 50% would not tell friends or coworkers that a family member was suffering from mental illness.

Similarly, mental illnesses are seen as less responsive to treatment ²¹ and more persistent and serious ²² when framed as biological diseases. This framing may suggest that people with mental illnesses will never recover, which contributes to stigmatizing attitudes. ²¹

It’s not the bio-bio-bio model

So how do we work towards reducing the stigma of mental illness? Despite the recent emphasis on the biological model, research continues to support a bio-psycho-social model, where varied environmental factors interact with life experience and genetic susceptibility to result in mental illness. ²³ Science is broadening our understanding of the significant interaction between genes and the environment, demonstrating that many environmental variables, such as one’s early childhood environment, play a large role in determining how genes are expressed.^24,25

Additionally, factors such as chronic stress, living in an urban area, immigration, traumatic life events, and illicit drug use all can increase one’s vulnerability to mental illness. ²⁶ Presenting mental illness in the context of these psychological and social stressors normalizes symptoms, creating a healthier public perception of mental illness.^21,27 A good example of this in practice is how the Canadian Forces frame mental illness, which refers to depression and post-traumatic stress resulting from war as mental ‘wounds’ and operational stress injuries. ²⁸ The international literature also shows that contact-based education – which involves individuals with lived experience of mental illness sharing their personal stories of illness, stigma and recovery – is one of the most promising practices for reducing stigma.^29,30

Conclusion

Mental illness results from the interplay of genetic, biological, psychological and environmental factors, a concept well accepted and broadly described by the bio-psycho-social model. Anti-stigma initiatives should emphasize the well-researched psychological and social contributors to mental illness in addition to biological factors. This framing provides an accurate and less stigmatizing explanation of the causes of mental illness. Recognizing that people can and do recover is perhaps the most important way to end the stigmatizing ‘us vs. them’ attitudes and behaviours too often experienced by people living with mental illnesses. Working to change these attitudes will help to improve equity and quality of life for people living with mental illness and their family members.

Disclaimer

Mythbusters articles are published only after review by experts on the topic. Canadian Health Services Research Foundation (CHSRF) is an independent, not-for-profit corporation funded through an agreement with the Government of Canada. Interests and views expressed by those who distribute this document may not reflect those of CHSRF.

This issue of Mythbusters is based on an article by the 2012 Mythbusters Award recipient, Dr Joanna Cheek, co-sponsored by the Mental Health Commission of Canada.