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

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The Successful Creation of a Societal Delusion . . . and the

Increase in Stigma It Has Spawned

Stigma in the era of "chemical

imbalances"

Published on

November 4, 2010

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 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.