Biological explanations of mental illness reduce clinicians’ empathy for their patients, according to a new Yale study.
U.S. mental health professionals were given a series of fictitious patients with various mental illnesses that were explained using either biological or psychosocial reasons. Mental health professionals exhibited less empathy after reading the biological explanations. Furthermore, clinicians believed medication, not psychotherapy, to be a more effective treatment when symptoms were explained biologically. The finding comes at a time when there has been a shift to conceptualizing psychiatric disorders as biomedical diseases, according to lead author and psychology graduate student Matthew Lebowitz GRD ’16. There is no doubt that advances in genetics and neuroscience have revolutionized how we see mental health, he added, but it is important to understand their pitfalls, too.
“The conventional wisdom often goes, ‘We don’t blame people for physical diseases like cancer or diabetes because those things are biologically caused,’ and we might expect that by reducing blame, we would increase empathy and reduce stigma,” Lebowitz said. “But the evidence has not supported that.”
Before this study, no one had investigated what impact this increasing reliance on biological explanations of mental disorders had on clinicians. The paper stated that the discovery was alarming because empathy is crucial to a positive relationship between a mental health clinician and their patients.
Co-author and Yale psychology professor Woo-kyoung Ahn cautioned against the trend of studying all mental disorders in terms of biological mechanisms because this increases the social distance between the patient and the mental health professional. The tendency to favor medication over psychotherapy creates a vicious cycle that further pushes the patient away, she said.
Both Ahn and Lebowitz said that they are now searching for a way to present biological explanations of diseases in a less mechanistic way that will discourage clinicians from inadvertently dehumanizing their patients. Ahn noted the difficulty of viewing people as both humans and biological systems at the same time, and she said that we need to figure out how to remind clinicians of this duality.
Director of the Impulse Control Disorders Clinic at Stanford Elias Aboujaoude said he thinks that this preliminary study should serve as a wake-up call. He suggested that the psychiatric profession may have been too quick to embrace the move from mind to brain in interpreting and addressing symptoms.
“While understanding the biological roots of psychiatric illness can reduce the stigma that some patients feel, it would be a net loss if mental health professionals started treating patients less humanely as a result,” he said.
The National Institute of Mental Health is currently developing a new framework for classifying patients with mental illness for research studies. In contrast to current methods of diagnosing patients, which are largely based on clinical observation and self-reporting, the Research Domain Criteria will rely heavily on the results of recent biological research. According to Lebowitz, this is just one example of how strong the current zeitgeist is.
“We want to emphasize that we don’t think that understanding the biological explanation is a bad thing, but we need to know how it impacts social and emotional reaction,” Lebowitz said. “Biology does not exist in a vacuum and does not unilaterally determine people’s destinies and identities.”
He added that human psychological experience is a very complex interaction between many different factors, which includes biology as well as social context, developmental history and day-to-day experience. All these other factors are intertwined, and it does not make sense to separate them and look at biology alone, he concluded.
Noting this, the authors acknowledged that their vignettes were an oversimplification of the myriad factors that interact with each other to cause mental illness. They suggested that clinicians may be able to increase their empathy if they remember that biology is just one explanation of many and that biological differences do not create permanent, fundamental dividing lines between themselves and their patients.
Almost 50 percent of Americans will suffer from mental illness at some point in their lives, according to the Global Burden of Disease study, conducted in 2010.
Correction: Jan. 24
A previous version of this article mentioned only “physicians” and “doctors.” In fact, the study included mental health professionals of all kinds, including some who are not doctors.