The idea that mental illness is related to brain abnormalities or other biological factors is popular among some patients; they say it demystifies their experiences and lends legitimacy to their symptoms. However, studies show that biological explanations can increase mental health stigma, encouraging the public perception that people with mental illness are essentially different, and that their problems are permanent. Now Matthew Lebowitz and Woo-young Ahn have published new evidence that suggests biological explanations of mental illness reduce the empathy that mental health professionals feel towards patients.
Over two hundred psychologists, psychiatrists and social workers were presented with vignettes of patients with conditions such as social phobia, depression or schizophrenia. Crucially, some of these vignettes were accompanied by purely biological explanations focused on factors like genes and brain chemistry, while other vignettes were accompanied by psychosocial explanations, such as a history of bullying or bereavement. Next, the mental health professionals reported their feelings by scoring how far a range of adjectives – such as “sympathetic”, “troubled” and “warm” – fitted their current state.
Vignettes accompanied by biological explanation provoked lower feelings of empathy from the clinicians, and this was true regardless of their specific profession. Both biological and psychosocial explanations triggered similar levels of distress, so the reduced empathy associated with biological explanation was not simply due to psychosocial explanations being more upsetting. The mental health professionals rated the biological explanations less clinically useful; biological explanation also prompted them to have less faith in psychotherapy and more confidence in drug treatments.
Similar results were found in a follow-up study in which clinicians and social workers were presented with vignettes and explanations that reflected a combination of psychosocial and biological factors, but with one approach more dominant than the other. The idea was that this would better reflect real life. In this case, explanations dominated by biological factors prompted lower empathy from clinicians.
Lebowitz and Ahn suggest biological explanations provoke reduced empathy because they have a dehumanising effect (implying patients are “systems of interacting mechanisms”) and give the impression that problems are permanent. With biological approaches to mental illness gaining prominence in psychology and psychiatry these are potentially worrying results. A silver lining is that both medically trained and non-medical clinicians and social workers in the study saw biological explanations as less clinically useful than psychosocial explanations.
A weakness of the research is the lack of a baseline no-explanation control condition – this means we can’t know for sure if psychosocial explanations increased empathy or if biological explanations reduced it. Also, as the researchers admitted, the vignettes and explanations were greatly simplified. Nonetheless, the findings may still give reason for concern. Lebowitz and Ahn suggest reductions in empathy may be avoided if clinicians understand that “even when biology plays an important etiological role, it is constantly interacting with other factors, and biological ‘abnormalities’ do not create strict distinctions between members of society with and without mental disorders.”
Lebowitz, M., & Ahn, W. (2014). Effects of biological explanations for mental disorders on clinicians’ empathy Proceedings of the National Academy of Sciences, 111 (50), 17786-17790 DOI: 10.1073/pnas.1414058111