Biomedical Model of Mental Illness Creates Stigma for College Students Using Services

A study conducted on college-aged students finds strong correlations between biomedical characterizations of mental illness, pharmaceutical treatment, and social stigma.

Tim Beck, PhD
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A recent study, published in the Journal of College Student Psychotherapy, explores how receiving a psychiatric diagnosis and being prescribed psychotropic medication can lead to social stigma for college students. The study draws on earlier research suggesting that biological characterizations of mental illness, especially when tied to pharmaceutical intervention, can produce social stigma by attributing responsibility for experienced distress mainly to the individuals who experience it.

According to the authors of the study, led by Benjamin Johnson, a Ph.D. student in clinical psychology at Marquette University:

“Stigma toward mental illness has been studied extensively, and numerous themes of research have emerged. For example, researchers have examined determinants of stigmatizing attitudes as a function of both the personal characteristics of people holding those attitudes and also of the clinical characteristics of the person or people that are the subject of the stigma”

Going further, they add that:

“[A]n important and frequent attribution about mental illness concerns control and responsibility. Studies have found that people tend to attribute more controllability to mental illness than to medical illness . . . Attributions of responsibility, which is sometimes attributed as personal weakness . . . have been found to be associated with negative emotional reactions (such as fear and anger) and discriminatory behavioral reactions (such as avoidance or unwillingness to hire someone).”

Photo Credit: Pixabay

This is part of a long history of psychiatrists using brain research to explain individual behaviors that appear to deviate from established social norms. This tendency toward a biomedical model of mental health became more pronounced following the publication of the DSM-III, the third edition of the Diagnostic and Statistical Manual for Mental Disorders, in 1980. Since then, there has been an overarching goal to develop operational criteria for mental disorders that can be linked more successfully to pharmaceutical intervention.

And yet, the biomedical model of mental illness has increasingly become a target of criticism by clinical researchers, mental health professionals, and psychiatric survivors/service users. Beyond charges that neurobiological approaches to psychology are based on a set of faulty assumptions, it has been suggested that biomedical approaches to mental health care marginalize the voices and experiences of those receiving services. This phenomenon has been described in terms of contributory injustice, whereby those experiencing distress are not allowed to contribute to discussions about what may or may not be wrong with them.

Johnson et al., the authors of the study, further describe how recent “public education campaigns seeking to reduce stigma have asserted biological causes of mental illness,” and yet “the effect of these campaigns has been mixed and potentially even counterproductive.” As such, while the promotion of biomedical explanations might have lead to a general shift in public perception about individuals’ abilities to “control” their symptoms, such campaigns “do not appear to be successful at reducing other stigmatizing reactions and may actually be enhancing them in some ways.”

The research carried out by these authors looked specifically at how such stigmatizing reactions could play a role in the lives of college students. Focusing on this population is especially important given the ways that mental health services are generally more accessible, with ADHD medications being more available, for them than they are for other groups.

The authors developed the following three hypotheses to test how college students might react cognitively, emotionally, and behaviorally to a peer’s distress when it is characterized in psychiatric terms:

  • “First, based on the expectation that schizophrenia would be more likely to be perceived as being caused by biological factors than would major depressive disorder, it was predicted that participants would attribute more responsibility to the Target Student described as being depressed.
  • Second, based on attribution research, it was predicted that participants would endorse more negative emotional reactions and more stigmatizing behavioral dispositions toward the Target Student with depression.
  • Finally, it was predicted that participants would attribute more responsibility, endorse more negative emotional reactions, and endorse more stigmatizing behavioral dispositions when the vignette included a statement that the Target Student had taken a medication for the illness but then stopped.”

To carry out this research, the authors created four separate vignettes of male college students, half which described “an episode of severe depression” and the other half “an episode of schizophrenia.” Each college-aged participant was given one vignette to read before completing a questionnaire about how such a person might be perceived if encountered.

The survey spanned six different scales of stigma, categorized in terms of responsibility, lack of sympathy, anger, unwilling to help, coercion into treatment, and social distance. Possible attributions participants could select ranged from sentiments like “I would think that his present condition is his own fault” and “society should force him to seek treatment” to “I would feel sorry for him.”

The group of researchers ran several ANOVA statistical analyses to find correlations between these variables. As they explain, the results seem to indicate that when ‘Target Students’ were considered responsible for their actions, there was a higher likelihood for negative emotions or otherwise stigmatizing beliefs expressed towards them. Additionally, stigma increased if a ‘Target Student’ had been prescribed psychotropic medications at some point but had, for whatever reason, stopped taking them.

The participants also responded very differently to cases described as ‘severe depression’ than they did to those described as ‘schizophrenia.’ In general, ‘Target Students’ diagnosed with depression were considered more responsible for their distress, which in turn garnered less sympathy from participants. ‘Target Students’ diagnosed  with schizophrenia, by contrast, were considered “less responsible [but] more sympathetic presumably because of a belief in the biological cause of the disorder.”

And yet, participants were also much more likely to consider ‘Target Students’ diagnosed with ‘schizophrenia’ to be more dangerous (to both self and others) than those diagnosed with ‘severe depression.’ This was likewise associated with the assumption that coercion into medical treatment in cases involving schizophrenia can be not only useful but often necessary when psychotropic medications are not used as prescribed.

Taken at face value, the study seems to suggest that college students who receive mental health services are likely to encounter social stigma from peers in a variety of forms. It also supports earlier research indicating this stigma can be enhanced by popularly held assumptions that a) there are biological causes for mental distress, and b) pharmaceutical treatments are an effective form of psychiatric intervention for distress. Finally, the authors note that stigmatizing beliefs were less likely for participants who had some prior experience with mental health services, either for themselves or with friends/family.  

While the above insights are important, there are noteworthy limitations to keep in mind regarding this research. The vignettes given to participants were, self-admittedly, overly simplistic representations of situations involving mental distress, while focusing exclusively on male individuals. They were also written in ways that intentionally included common stereotypes related to ‘mental illness.’ In fact, given how often the term ‘mental illness’ was referenced throughout the study, it is not clear from the article what an alternative set of assumptions might look like, or how the researchers would propose studying this.

The authors also noted that participants had disproportionately low rates of exposure to mental health services when compared to the general population. Given that the participants were all undergraduate students, and the biomedical model is regarded as the standard approach to mental health care, it could have been worth exploring whether such stigmatizing beliefs and assumptions were reinforced in college courses the participants took themselves.

Nonetheless, the Johnson and colleagues express optimism that their research can, at the very least, serve as a pilot study for further exploration into the ways that stigma related to mental health services affects the lives of college students. Specifically, they hope such research will spur college educators and administrators to reflect more thoughtfully on the ways in which students with a history of receiving mental health services:  

“may face a special burden of expectation—and associated stigma—if they do not take medications, which have been promoted as helpful for several decades. This is especially relevant given that medications do not help all people with depression and, indeed, have been shown to be less effective than psychotherapy in the treatment of depression in adults.”

 

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Benjamin T. Johnson, Peter P. Grau & Stephen M. Saunders (2019): Psychiatric Medications and Stigmatizing Attitudes in College Students, Journal of College Student Psychotherapy, DOI: 10.1080/87568225.2019.1600092 (Link)

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Tim Beck, PhD
MIA Research News Team: Tim Beck is an Instructor in psychology at the University of West Georgia, where he earned a PhD in Psychology: Consciousness and Society. For his dissertation, he traced a critical history of the biomedical model of mental health, focusing on diagnostic representations of autism, and became interested in the power of self-advocacy movements to reshape conventional assumptions about mental suffering. In fall 2019, he will start a new position as Assistant Professor at Landmark College, where he will collaborate with students and faculty at their Center for Neurodiversity.

17 COMMENTS

  1. It seems, from this blog post, with the way the concept “schizophrenia” is wildly thrown around, that it is now obvious what the editorial stance is of MiA.

    It also seems strange, that having one of the major “mental disorders” is not an impediment to attending college.

    What on earth is “an episode of schizophrenia” anyway?

  2. Ironically the bio model can increase prejudice toward those labeled “mentally ill.”

    Once my dorm mom found out I was supposed to be “schizo affective” she grew hostile to me. I was horribly depressed and had drug induced seizures. My mom had a similar reaction. Cause TV shows depicted how wonderful psychiatry is.

    Everyone blamed my grief/loneliness/seizures on not being compliant. Because “meds” magically fix everything. So if your suffering annoys others you must be a naughty patient who deserves to be punished.

  3. Medication for mental health problems has been promoted to be helpful for “several decades”. Ok, since about the year 2000 or even 1990. Are you serious? Before that, it must have been a satanic plot, which it may well still be. What changed 20 or 30 years ago? A new drug? Greed?

  4. The DSM labels create stigma for everyone labeled with those “invalid” and “unreliable” stigmatizations. Goodness gracious, once a person is labeled, they cease to be a person to the psychiatrists, and become the “mental illness.” I know because I’ve read my medical records. I was appalled. I’m a person, not a “mental illness.” How insanely disrespectful can the psychiatrists get?

    “‘Target Students’ diagnosed with schizophrenia, by contrast, were considered ‘less responsible [but] more sympathetic presumably because of a belief in the biological cause of the disorder.’” The problem with this is that there is no known biological cause of that disorder.

    “participants were also much more likely to consider ‘Target Students’ diagnosed with ‘schizophrenia’ to be more dangerous (to both self and others) than those diagnosed with ‘severe depression.’”

    Again, these students have been misled, since psychiatric claims that “schizophrenics” are dangerous are largely untrue.

    “Approximately 40 studies have been published in psychiatric journals since 1990 focusing on the associations between severe mental illness and violence: 30 have focused on the perpetration of violence by mentally ill people and 10 have addressed the likelihood that people with mental illness will become victims of violence. People with schizophrenia are more likely to be the victims than the perpetrators of violence in a community living and mental health setting: one study found that they had a 14 times greater likelihood of suffering violence than of being arrested for a violent act.”

    “This was likewise associated with the assumption that coercion into medical treatment in cases involving schizophrenia can be not only useful but often necessary when psychotropic medications are not used as prescribed.”

    Since the “schizophrenia treatments,” the antipsychotics /neuroleptics, can create both the negative and positive symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome and antipsychotic induced anticholinergic toxidrome.

    https://en.wikipedia.org/wiki/Neuroleptic-induced_deficit_syndrome
    https://en.wikipedia.org/wiki/Toxidrome

    The belief that people should be force treated with the neuroleptic class of drugs is unwise. As you mentioned, it is also unwise to take the antidepressants.

    I’m quite certain “such stigmatizing beliefs and assumptions were reinforced in college courses the participants took themselves,” because that’s what the psychiatrists have been teaching our society for ages. Despite the reality that none of their DSM disorders are even valid disease entities.

    https://www.wired.com/2010/12/ff_dsmv/
    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

  5. James Hillman on the folly of reducing mind to brain.

    From The Soul’s Code by James Hillman, p. 150-154:

    The upshot of genetic studies leads in two (!) directions: a narrow path and a broad one. The narrow road heads toward simplistic, monogenic causes. It wants to pinpoint bits of tissue and correlate them with the vast complexity of psychic meanings. The folly of reducing mind to brain never seems to leave the Western scene. We can never give it up because it is so basic to our Western rationalist and positivist mind-set. The rationalist in the psyche wants to locate causes you can put your hands on and fix.

    Machines provide the best models for meeting this desire. Take them apart, find their inner mechanisms, and then adjust their functioning by modifying their ratchets, enriching their fuel, greasing their connections. Henry Ford as father of American mental health. Result: Ritalin, Prozac, Zoloft, and dozens of other effective products for internal adjustments that we consume in abundance, millions of us, daily or twice daily. The simplistics of monogenic causes eventually leads to the control of behavior by drugs–that is, to drugged behavior.

    Robert Plomin, on whose passionate, prolific, and perceptive writings this chapter has frequently relied, urgently warns against using genetics in a simplistic manner. He states: “Genetic effects on behavior are polygenic and probabilistic, not single gene and deterministic.” I gather from him a warning to psychiatry: Do not capsize your noble vessel under the weight of pharmaceutical, insurance company, and government gold, and do not set your compass toward Fantasy Island, where genetics will define “disease entities in psychiatry.” “We have learned little about the genetics of development [how genes act and interact over time] except to appreciate its complexity.” Therefore we can never arrive at that equation where one defective gene equals one clinical picture (except for true anomalies like Huntington’s chorea).

    These warnings have little effect; simplistic thinking fulfills too many wishes. The heads of Henry Ford and Thomas Edison are carved into the Mount Rushmore of the mind. The monster of mechanism appears in every century of modern Western history and must be watched for by each generation–especially ours, when to hold out for “something else” besides nature or nurture means believing in ghosts or magic.

    Ever since French rationalism of the seventeenth (Marin Mersenne, Nicolas de Malebranche) and eighteenth (Etienne de Condillac, Julien Offroy de La Mettrie) centuries and right through to the positivism of the nineteenth (Antoine Destutt de Tracy, Auguste Comte) in which all mental events were reduced to biology, a piece of the collective Western mind had been yolked like a dumb ox to the heavy tumbrel of French mechanistic materialism. It is astounding how people with such subtle taste as the French and with such erotic sensibility can go on and on contributing so much rationalist rigor mortis to psychology. Every import that arrives from France must be inspected for this French disease, even though it carries the fashionable label of Lacanism, Structuralism, Deconstruction, or whatever.

    Today rationalism is global, computer-compatible every-where. It is the international style of the mind’s architecture. We cannot pin it to a particular flag, unless to the banners of the multinational corporation that can spend big bucks turning psychiatry, and eventually psychological thinking, and therefore soul control, toward monogenetic monotheism. One gene for one disorder: Splice the gene, teach it tricks, combine it, and the disorder is gone, or at least you don’t know you have it. The narrow path leads back to the thirties and forties of psychiatric history, though in a more refined manner and with better press releases. From 1930 into the 1950s, correlating specific brain areas with large emotional and functional concepts provided the rationale for the violence of psychosurgery and the lobotomizing of many a troubled soul at odds with circumstance.

    The narrow path is yet more retro, going back to the skill analysis of Franz Josef Gall (M.D., Vienna, 1795), who settled in Paris and was much appreciated by the French. From him came the “evidence” that skull bumps and declivities could be correlated with psychological faculties (a system later called phrenology). Much as they are today, the faculties were given big names, such as memory, judgment, emotionalism, musical and mathematical talent, criminality, and so on. Refinement in methods over the years does not necessarily lead to progress in theorizing: 1795 or 1995–material location, and then reduction of psyche to location, prompts the enterprise.

    https://footnotes2plato.com/2010/12/14/james-hillman-on-the-folly-of-reducing-mind-to-brain/

  6. I noticed ADHD was also mentioned in the blog by Tim and I made a little study myself. This was in the 80’s and of the 400 hundred or so students at my school at the time, I’ve determined that 0 were afflicted with ADHD or ADD, although some took speed whilst at a concert. However, of the 30 or so teachers, one (the PE teacher, surprise) was a child molester. There you go.

    I’ve also determined that there is a high prevalence of perversion among swimming instructors. The clergy in the Catholic Church is also afflicted with this curse.

  7. Because of the ongoing hoax of Autism-Asperger’s, this biomedical model known as ~neurological difference~, and because of the passivity of the targeted, anyone seen as kind of out of it, in their own space, or otherwise not in submission to heard norms, stands to have their social identity stigmatized, as well to be subjected to invasive procedures such as using magnetic fields to make currents flow through the axons of the nerves in their brains. And then as this type of procedure becomes more well known, it will become common for parents to have this done to their children.

    https://www.madinamerica.com/2019/06/good-actually-means-good/#comment-156982

  8. As far as students using mental health services, I presume that that means psychotherapy.

    They should not be using psychotherapy, they should know better, they should be taught better. Our colleges should not be enabling or supporting psychotherapy in any way shape or form, and this should be a matter of law.

    “The practice of psychotherapy is wrong because it is profiting off of another person’s misery.”

    https://www.amazon.com/Against-Therapy-Emotional-Tyranny-Psychological/dp/0689119291/ref=pd_lpo_sbs_14_t_2/141-0913480-9619008?_encoding=UTF8&psc=1&refRID=R3NMX4CWDTFK0JZZ213E