More on Neuroessentialism: Theoretical and Clinical Considerations

William Schultz
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Mad in America readers are familiar with the variety of negative effects caused by emphasizing biologically based treatments for psychological disorders. Yet, over the past five years, research has identified another negative consequence which, I think, is less well known: increased prognostic pessimism.

Long story short: numerous studies have found that individuals who more strongly endorse biological etiologies of psychological disorders tend to have increased prognostic pessimism (as well as viewing medications as more effective and psychotherapy as less credible). A prominent hypothesis explaining this phenomenon is that individuals who more strongly endorse biological etiologies seem to endorse “essentialist” views of themselves – meaning they are more likely to view their psychological states as predetermined and outside their influence or control. This is important because clients’ beliefs about their prognosis can have significant effects on their clinical outcomes. Clients who expect to do better typically do better.

The MIA article “More on the Chemical Imbalance Theory” refers to one of the studies I have in mind (Kemp, Lickel, & Deacon, 2014) and suggested that Kemp et al. is “one of the most important pieces of research in this field.” I agree. And I’ve recently published a review article which discusses the research that explores the relationship between individual’s beliefs regarding biological etiologies of depression and their treatment preferences and prognostic pessimism. I believe this is an important area of research which contributes to the case against contemporary mental health professionals’ preoccupation with biological etiologies.

Although my contract with the publisher prohibits me from posting the article on a webpage, I can share the article with individuals upon request. Please contact me at [email protected] if you are interested.

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References:

Kemp, J. J., Lickel, J. J., & Deacon, B. J. (2014). Effects of a chemical imbalance causal explanation on individuals’ perceptions of their depressive symptoms. Behaviour research and therapy, 56, 47-52.

17 COMMENTS

  1. I emailed you. It would be good to make available publicly a longer list of these studies which are finding biologically based views of mental problems to relate to increased problems (and perhaps to worse outcomes, even more damning). This is very important and can be a real weapon to use against (overfocus on) biological research.

  3. “…they are more likely to view their psychological states as predetermined and outside their influence or control. This is important because clients’ beliefs about their prognosis can have significant effects on their clinical outcomes.”

    Absolutely. Thanks for posting this.

    Some say that ‘worry’ is like praying for what we don’t want, because we put so much attention on what we worry about, that we create a self-fulfilling prophecy. After all, we experience that on which we put our attention, because on what we focus is our reality at that moment. Where we choose to focus is, indeed, in our control.

    By the same token, pessimism is purely a focus on negative outcomes. So, by virtue of our creative imaginations, this is what we will create if we continue that focus.

    To believe that our life experience is out of our control and only physically-oriented is the death knell to our quality of life, inner peace, and personal power. One way or another, I think it’s vital to realize once and for all that we influence our own life trajectory with our focus, attitude and outlook. This is how we influence the physical, from a broader perspective.

    When we know this, we are empowered; when we do not, we not only render ourselves powerless, but in addition, we give our power away to those who then have the power to control us, because we unwittingly give them that power.

    Our perspective, focus, attitude, and beliefs make all the difference, and is exactly where we have the power to heal and make changes…or not.

  4. Thank you for the community service of researching the harm of the “medical model.”

    However, I do not believe that it is important to identify “’essentialist’ views” of biological etiologies to directly connect biological etiologies with prognosis pessimism and worse outcomes. A brain dysfunction or disease causes far greater prognosis pessimism than any other etiology.

    I believe that the trouble with mental health care starts with the definition of the problem. Emotional distress is not a “mental disorder” or a “psychological disorder;” no theory of a mental “disorder” is “falsifiable” as per the philosophy of science requisite. I contend that we are describing naturally painful emotional suffering from distressful experiences; extremes of distressful experiences and related emotional pain are unimaginable for most people.

    Best wishes, Steve

    • Steve,
      I agree with you if you are making the Szaszian point that even non-biological medical models like the psychoanalytical medical model
      (which Szasz debunked again and again) are mystifying and harmful. Today people think that biology psychiatry is the only medical model. But as soon as one talks about a mental disorder ot illness one is using a medical model–the root metaphor is “illness.”
      However you write, ” I do not believe that it is important to identify “’essentialist’ views” of biological etiologies to directly connect biological etiologies with prognosis pessimism and worse outcomes.” I don’t understand why you say it is unimportant. Unnecessary perhaps,s but it certainly strengthens the argument for
      using alternatives to drugging–which is today virtually the only “treatment” recommended for people who end up in the “mental health” system.
      Seth Farber, Ph.D.

      • Today people think that biology psychiatry is the only medical model. But as soon as one talks about a mental disorder ot illness one is using a medical model–the root metaphor is “illness.”

        Hell yeah! I was going to make the same point, again, so thanks for saving me the time. Even many anti-psychiatry folks fail to grasp that, as you said, any use of “illness” or disease (or “disorder”) terms constitutes the medical model. There is no medical model of “mental illness”; if you use the term “mental illness” you are employing the medical model.

        • Oldhead,
          Hi. Thanks
          Yes I think that is what Steve Spiegel meant but I don’t think he was clear.
          It goes back to Szasz and “the myth of mental illness” which reigned supreme during the long era of the dominance of psychoanalysis.
          The term’mental illness was always the stigmata inflicted upon those who had extreme experiences and came to attention of the experts. Once the label was applied the long string of violation of constitutional rights followed.
          Seth

  5. I have long maintained that this phenomenon is more damaging than even the drugs themselves can be. Conceptualizing mental health issues as “brain problems” is inherently disempowering. Interestingly, in Harrow’s longitudinal study of those diagnosed with “schizophrenia,” one commonality amongst those who recovered was an internal locus of control – essentially, the idea that they could do something about it rather than waiting for a doctor to cure them. This is the opposite message of what most clients receive. What could be more demoralizing than hearing, “The reason you feel bad is that your brain doesn’t work right. It has nothing to do with your history and life experience, and there isn’t anything you can do to fix it. We’ll give you drugs for the rest of your life that might make it more tolerable, but that’s all we have to offer and it might not work. Good luck!”

    If I weren’t depressed before getting that message, I sure would be afterwards!

    —- Steve

  6. The entire established way of caring for those who experience distress depends on the medical model doing just exactly what this explains. Is this not the cornerstone of creating/strengthening learned helplessness and creating a situation of coercion and an imbalance of power in “treatment” situations?

    I learned some time ago this simple idea; Guilt is response to an action outside of oneself. Shame is something inherently wrong within oneself. One can be resolved and the other can’t because shame indicates defective humanness. Nothing smacks of shame more than DSM diagnosis and the endless cycle it creates. Shame based system spreading shame based lies for control and profit.

  7. When psychiatrists try to convince a person that they have a “life long, incurable, genetic mental illness,” especially given the reality that none of the DSM disorders are known to have any scientific validity or reliability whatsoever, this is actually a form of gas lighting.

    “Gaslighting or gas-lighting is a form of mental abuse in which information is twisted or spun, selectively omitted to favor the abuser, or false information is presented with the intent of making victims doubt their own memory, perception, and sanity.[1][2] Instances may range simply from the denial by an abuser that previous abusive incidents ever occurred, up to the staging of bizarre events by the abuser with the intention of disorienting the victim.”

    “White lies” about “chemical imbalance” theories constitute “false information [being] presented with the intent of making victims doubt their own memory, perception, and sanity.” And psychiatric tranquilization constitutes “the staging of bizarre events by the abuser with the intention of disorienting the victim.”

    Currently our country’s psychiatric industry is technically functioning as a gas lighting industry, not a “mental health” industry.

  8. “Currently our country’s psychiatric industry is technically functioning as a gas lighting industry, not a “mental health” industry.”

    Beautifully succinct. You nailed it, Someone Else. Thank you.

    “We’ll tell you your mentally ill, we’ll prove your mentally ill, and if it doesn’t add up, we’ll make something up, because we want your business and we are always right because you will never be believed.” Gets right to the heart of the civil and human rights issue.

    Especially when I legally challenged authority–gaslighting abounded because they were panicked and wanted to sabotage my credibility. Fortunately, it only made them look bad in front of the mediator, so that was the last time I fell for it. But it did its post traumatic stress damage due to how long I had experienced this before waking up to it, so I did have to take the time and focus to heal from doubting my own reality.

    It’s confusing and disorienting to be gaslighted and knocks people off kilter. In the mental health system, it should be an out and out crime, because it is purposeful and meant to discredit and discriminate, as opposed to supporting and empowering. Exactly what is wrong with the entire system, and how it keeps people feeling chronically ill and dependent, because, in the system, the clients are programmed to doubt their own truth, relentlessly.

    • I agree, Alex, ” in the system, the clients are programmed to doubt their own truth, relentlessly.” Yes, after reading some of my medical records, and confronting my psychiatrist with his many delusions written into them. This psychiatrist declared my entire life a “credible fictional story.” Then he had the gall to have his receptionists ask me to sign a sheet full of clear stickers that stated “I declare this is true” on them. I told them I would, if they’d place them in my medical records where they wanted such confirmation, they declined. Of course, I knew at this point that I was dealing with one of the dumbest, most delusional, and most unethical people on the planet, and I knew I no longer had any respect or need for the “mental health system.”