Stigma and Brain Chemistry

Stigmatising those with mental health problems is a major problem. It impacts in many ways: increasing suffering, reducing the likelihood of people seeking help and costing lives. The Time to Change organisation works to challenge this in the UK.

One of the biggest problems is public understanding of mental health conditions. As doctors we know that conditions such as depression are a result of complex interactions between genetic, environmental, psychological and social factors which interact with brain networks in ways we still don't fully understand. This is not the kind of explanation people like and historically often the explanation has been simplified to one of either social/psychological or biological/brain functioning.

It makes a difference how we explain conditions to patients and to the wider community. As a practicing psychiatrist I spend a lot of time explaining that depression is an illness like any other and that whilst there are things people can do to the help with the condition it is not 'their fault' and they are not 'weak'.

We need to give a bit more than this in our explanations.

We need to give a bit more than this in our explanations.

Over recent years it has become more common to give a very biological explanation in the hope this sends the message that mental health problems are 'true illnesses'. What has the impact been of this on the public understanding.

A group (Kvaale et al) carried out a meta-analysis (a study where you look at all the studies in one area together) about how having a biological / brain functioning understanding impacts on people's views. 

They studied four areas of stigma and found that having a biological view meant people were less likely to blame people for their condition. Unfortunately it also meant they were more likely to view people with mental health problems as 'dangerous' and also see their conditions as unlikely to improve. Interestingly despite the view around dangerousness it didn't make them more or less likely to socially avoid people with mental health problems.

So, what's the answer? Unfortunately there isn't a simple one. We need to give honest explanations which include the interplay between our brain chemistry and the world, whilst also admitting that our knowledge is incomplete. All this complexity does not lend itself to a neat pithy tweet, but Time to Change do try and they are a good example to follow. For your part you can try and discuss these things with those around you: mental health problems are very frequent, people do recover from them and they tend to make people more vulnerable than they make them dangerous. Your help could make all the difference.