Medical terminology increases stigma
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11 Jan 2010, 8:46 am
A recent article from the NY Times. It is about mental diseases, rather than things like autism. However the following finding I think is very interesting and possibly applicable to autism as well, especially with the recent attempts to explain it using physical differences in the brain and hence reduce the stigma associated with symptoms:
http://www.nytimes.com/2010/01/10/magaz ... anted=4&em
Quote:
The confederate then stated either that the illness occurred because of “the kind of things that happened to me when I was a kid” or that he had “a disease just like any other, which affected my biochemistry.” (These were termed the “psychosocial” explanation and the “disease” explanation respectively.) The experiment then called for the test subject to teach the confederate a pattern of button presses. When the confederate pushed the wrong button, the only feedback the test subject could give was a “barely discernible” to “somewhat painful” electrical shock.
Analyzing the data, Mehta found a difference between the group of subjects given the psychosocial explanation for their partner’s mental-illness history and those given the brain-disease explanation. Those who believed that their partner suffered a biochemical “disease like any other” increased the severity of the shocks at a faster rate than those who believed they were paired with someone who had a mental disorder caused by an event in the past.
“The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”
In other words, the belief that was assumed to decrease stigma actually increased it. Was the same true outside the lab in the real world?
Analyzing the data, Mehta found a difference between the group of subjects given the psychosocial explanation for their partner’s mental-illness history and those given the brain-disease explanation. Those who believed that their partner suffered a biochemical “disease like any other” increased the severity of the shocks at a faster rate than those who believed they were paired with someone who had a mental disorder caused by an event in the past.
“The results of the current study suggest that we may actually treat people more harshly when their problem is described in disease terms,” Mehta wrote. “We say we are being kind, but our actions suggest otherwise.” The problem, it appears, is that the biomedical narrative about an illness like schizophrenia carries with it the subtle assumption that a brain made ill through biomedical or genetic abnormalities is more thoroughly broken and permanently abnormal than one made ill though life events. “Viewing those with mental disorders as diseased sets them apart and may lead to our perceiving them as physically distinct. Biochemical aberrations make them almost a different species.”
In other words, the belief that was assumed to decrease stigma actually increased it. Was the same true outside the lab in the real world?
Quote:
Researchers hoping to learn what was causing this rise in stigma found the same surprising connection that Mehta discovered in her lab. It turns out that those who adopted biomedical/genetic beliefs about mental disorders were the same people who wanted less contact with the mentally ill and thought of them as more dangerous and unpredictable. This unfortunate relationship has popped up in numerous studies around the world. In a study conducted in Turkey, for example, those who labeled schizophrenic behavior as akil hastaligi (illness of the brain or reasoning abilities) were more inclined to assert that schizophrenics were aggressive and should not live freely in the community than those who saw the disorder as ruhsal hastagi (a disorder of the spiritual or inner self). Another study, which looked at populations in Germany, Russia and Mongolia, found that “irrespective of place . . . endorsing biological factors as the cause of schizophrenia was associated with a greater desire for social distance.”
Even as we have congratulated ourselves for becoming more “benevolent and supportive” of the mentally ill, we have steadily backed away from the sufferers themselves. It appears, in short, that the impact of our worldwide antistigma campaign may have been the exact opposite of what we intended.
Even as we have congratulated ourselves for becoming more “benevolent and supportive” of the mentally ill, we have steadily backed away from the sufferers themselves. It appears, in short, that the impact of our worldwide antistigma campaign may have been the exact opposite of what we intended.
That is, it is possible that people may be more tolerant of mental differences when they are perceived to be differences due to character or traumatic events in the past than if they are perceived to be due to actual physical differences in the brain or biochemical disorders or genetic factors. The increasing attempts to explain things like schizophrenia using biological or genetic factors increases the belief that they are permanently "broken" and possibly not quite human. So attempts to destigmitize things using medical explanations may actually be counterproductive in terms of acceptance.
Most of the article is about how mental disorders actually differ across different cultures.
Quote:
In any given era, those who minister to the mentally ill — doctors or shamans or priests — inadvertently help to select which symptoms will be recognized as legitimate. Because the troubled mind has been influenced by healers of diverse religious and scientific persuasions, the forms of madness from one place and time often look remarkably different from the forms of madness in another.
That is until recently.
For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures.
That is until recently.
For more than a generation now, we in the West have aggressively spread our modern knowledge of mental illness around the world. We have done this in the name of science, believing that our approaches reveal the biological basis of psychic suffering and dispel prescientific myths and harmful stigma. There is now good evidence to suggest that in the process of teaching the rest of the world to think like us, we’ve been exporting our Western “symptom repertoire” as well. That is, we’ve been changing not only the treatments but also the expression of mental illness in other cultures.
The idea being that if a mental disorder is "classified" as having certain symptoms then (1) it is what professionals look for and (2) that the constant talk about the symptoms mean that people with a preposition to have a mental disorder (genetics, stress, etc.) may unconsciously choose those particularly symptoms to act out their preposition. In another culture or time when another certain set of symptoms is widely known then that same person in similar circumstances may choose that disorder instead. That is while the distress and physical effects may be real, the actual symptoms of mental disorders are not necessarily set in stone. Of course this talks about mental illnesses so I don't know how this would apply to something like autism which is not really an illness. One possibility is that those with autistic tendencies in different cultures or times may have chosen to express the symptoms in a different fashion than today in the Western world.
11 Jan 2010, 9:24 am
Quote:
In other words, the belief that was assumed to decrease stigma actually increased it.
What I don't understand is why someone could had think that the "brain disease" explanation would be less stigmatizting than the "traumatic events" explanation. These ideia seems so absurd that I can't imagine the possibel reasoning behiend that.
An analogy: look to a kid who has bad grades in school: what is the less stigmatizating explanation?
A - "The problem with John is that he has problems at home, his family is poor, etc."
B - "The problem with John is that he is inhenritly of low inteligence"
I think that "A" is usually considered the less stigmatizating answer. And, if in most social problems, the "nurture" answers are considered less stigmatizating than the "nature" answers, why should be different in the case of mental problems?
11 Jan 2010, 9:41 am
TPE2 wrote:
Quote:
In other words, the belief that was assumed to decrease stigma actually increased it.
What I don't understand is why someone could had think that the "brain disease" explanation would be less stigmatizting than the "traumatic events" explanation. These ideia seems so absurd that I can't imagine the possibel reasoning behiend that.
An analogy: look to a kid who has bad grades in school: what is the less stigmatizating explanation?
A - "The problem with John is that he has problems at home, his family is poor, etc."
B - "The problem with John is that he is inhenritly of low inteligence"
I think that "A" is usually considered the less stigmatizating answer. And, if in most social problems, the "nurture" answers are considered less stigmatizating than the "nature" answers, why should be different in the case of mental problems?
Well the article says the reasoning behind this was:
Quote:
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility. This was promoted both as a scientific fact and as a social narrative that would reap great benefits. The logic seemed unassailable: Once people believed that the onset of mental illnesses did not spring from supernatural forces, character flaws, semen loss or some other prescientific notion, the sufferer would be protected from blame and stigma. This idea has been promoted by mental-health providers, drug companies and patient-advocacy groups like the National Alliance for the Mentally Ill in the United States and SANE in Britain. In a sometimes fractious field, everyone seemed to agree that this modern way of thinking about mental illness would reduce the social isolation and stigma often experienced by those with mental illness.
11 Jan 2010, 10:08 am
AnnieK wrote:
Well the article says the reasoning behind this was:
Quote:
Mental illnesses, it was suggested, should be treated like “brain diseases” over which the patient has little choice or responsibility.
But both “the kind of things that happened to me when I was a kid” or “a disease (...) which affected my biochemistry” are things "over which the patient has little choice or responsibility".
11 Jan 2010, 10:17 am
While I can understand both points, and it would be logical to assume that an unavoidable natural cause should be less stigmatizing, they're also ignoring the human irrational fear of:
A) Contagion; whether or not the illness is contagious doesn't matter to unreasoning, ignorant people, they can and will see it as contagious, whereas they won't see it as contagious when it's nuture as even superstitious morons know someone else's past can't influence their mind.
B) Incurability; people think that with help, you can "get over anything" even something extremely traumatic in your past, but something that you were born with outside your control is another matter. That might very well be incurable to your run of the mill person.
C) Relation; people can relate to bad experiences in the past, even if their own were not as bad as the ill. They cannot relate to someone with a brain disorder because they were born that way, and the normal person was not.
D) Blame; You can't really place blame on someones genes, but you can blame bad parents/rapists/whathaveyou that caused a traumatic experience.
All of these essentially do the same thing. They keep people who have a disease apart from those without, while those who simply had traumatic pasts can still be part of the group. That's the reason for the stronger stigma against those with a disease, than those with nuture problems.
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