If only something were wrong with my body it would be fine, I would rather have anything wrong with my body than something wrong with my head.

                                                                    Sylvia Plath

Layperson Preference

Sylvia Plath was a young promising author and poet said to have had a “mental breakdown” in her early college years.  She wrote about the indignity she felt for her suffering of the mind, “… if only something were wrong with my body it would be fine, I would rather have anything wrong with my body than something wrong with my head.” (1966). Plath committed suicide at the age of 30.  Unfortunately, many who suffer similar experiences share her preference.  The diagnosis of a mental “illness” is not a welcomed label and can be viewed as an added burden, often linked with job loss, relationship breakdown, and social rejection.  A psychological diagnosis often carries a stigma similar to that of AIDS and cancer (Wahl, 1999). Many believe that a psychological problem has an element of personal culpability, implying that a person is weak or has not tried to overcome his problem (Link, Struening, Rahav, Phelan, Nuttbrock, 1997; Wahl, 1999).

Assumed communication difficulties and social non-productivity reinforce the tendency to discriminate against those with mental health problems.   Also, among the general population abnormal behavior is associated with dangerousness.  The rare but widely publicized violent incidents associated with mentally ill patients fuels that fear.  Images of stigma, non-productivity, and violence contributed to the movement among laypersons toward re-classifying mental illness as a physical disease rather than a “character flaw” (Hill, Steinhauer, Zubin, 1986; Astrid, 1998; Begleiter & Porjesz, 1999; Farnham & James, 2000).

The National Alliance for the Mentally Ill (NAMI), a broad-based consumer advocacy group strongly advocates the position that mental illness essentially is a biological brain disorder (NAMI, 2005).  With a paid membership of 80,000 and a website (www.nami.org) that reportedly receives 14,000 hits a day, NAMI’s literature emphasizes that the theory of biological causation is an effective tool in the fight against the stigma of mental illness.  NAMI asserts mental illness is not the result of personal weakness, lack of character or difficult upbringing.  Critics suggest that NAMI, which is comprised mainly of parents of the mentally ill, simply wants to shift the notion that mental illness is a biological brain disorder rather than the responsibility of child-rearing flaws – or even abuse (Donahue, 2000).

Daniel Fisher, MD, who recovered from schizophrenia to become a psychiatrist and now heads the National Empowerment Center, believes that seeing mental illness as a biological disorder is the “easy way out”.  He postulates that blaming the brain is much easier than looking at individual issues, taking personal responsibility or accurately interpreting the realities of social situations and context (1999).

As the divergence between treatment modalities (i.e., biologically based treatments vs. therapy) moves on, a paradoxical scenario results for the consumer.  First, viewing mental illness as biologically based alleviates shame and reduces stigma.  It shifts the responsibility for recovery (and relapse) to the treating physician.  On the other hand, this same process can inadvertently remove the consumer from one important element necessary for regaining or sustaining mental health – a sense of internal locus of control (Michelson, Bellanti, Testa, & Marchione, 1997).

In addition to matters of guilt reduction and personal control, the layperson also is inundated with direct-to-consumer advertising by pharmaceutical companies.  Advertisements often reinforce the message of biological causation.  The billions spent on advertising each year is evidence for its efficacy (Edwards, 2003; Good, 2003, Pharmacy Times, 2003; & Bloice, 2005).  It is a common occurrence for United States television viewers to be subjected to pitches for pharmacological interventions that will ease their “illness”, often encouraging the consumer to, “Be sure to ask your doctor if this medication is right for you.”

Laypersons have little exposure to the empirical evidence about drug efficacy and safety.  They depend on information that amounts to nothing more than drug company promotional material, or at the very least, is information that is filtered and shaped by drug companies (Valenstein, 1998).  A model of direct-to-consumer advertising holds that: (1) advertisement exposure raises consumer awareness of conditions and treatments; (2) increased awareness motivates patients to seek medical care and request drug therapy; and (3) patients’ requests lead to increased prescribing. This leads to the over prescribing of unnecessary, expensive and potentially harmful anti-depressant medications (Kravitz et al, 2005).

The patient’s preference for a non-stigmatizing, responsibility-alleviating, responsibility shifting view of mental illness fits neatly with social influences of the drug industry and has in recent years been magnified by direct-to-consumer advertising.  The downside is that the causes of patients’ abnormal behaviors may be overlooked, at least to the extent that the causes are located in patients’ environmental and learned histories. 

Read more commentary on other issues related to mental health.

 

Donna M. Midkiff, PsyD