From Psychiatric Times: “Kendell and Jablensky pointed out already over 20 years ago: ‘Unfortunately, once a diagnostic concept such as schizophrenia or Gulf War syndrome has come into general use, it tends to become reified. That is, people too easily assume that it is an entity of some kind that can be invoked to explain the patient’s symptoms and whose validity need not be questioned.’10
It matters greatly how we conceptualize the problems we are seeking to address. Part of the reason we wanted to call attention to circular causal claims in psychiatry is that they likely have negative consequences for patients, clinicians, and society at large. For one, promoting an understanding of depression as a disease that causes low mood, loss of pleasure, and other symptoms creates an illusion of an independent entity, outside a person’s life, causing the distress and impairment. This can lead to decreased perceptions of agency, as well as other less adaptive beliefs.14 Instead of implying that an external disease entity is causing the symptoms, it is more accurate and more useful to think of depression as a nonspecific symptom, much like a headache, a fever or a cough, or as a functional signal to adverse circumstances in life.14,15 Being clear about what psychiatric diagnoses mean would also help us societally to address the actual causes of the suffering more effectively.
Moreover, if circular claims are presented together with unfounded claims about purported brain mechanisms, they may further bias individuals towards falsely assuming that biological causes and mechanisms have been identified for psychiatric problems. In our study, we identified several concerning examples of causal language being paired with biologically reductionist statements that are unsupported by scientific evidence. For example, ‘[Depression] is a chemical imbalance in your brain that needs to be treated’ (Johns Hopkins University), or, ‘It is believed that chemical changes in the brain are responsible’ (MedlinePlus). It is worrying that such unsupported statements are presented as objective fact by medical authorities.”
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