“A Disease Like Any Other”? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence

Abstract

Objective Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice. Method The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma. Results In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection. Conclusions More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.

What does ‘acceptance’ mean? Public reflections on the idea that addiction is a brain disease

“…As Angermeyer et al (2011) have shown, in a number of OECD countries there has been increased public preparedness to accept biogenetic (including neurobiological) explanations of schizophrenia, depression and alcohol dependence. However, trends in the public's acceptance of neurobiological information are not uniform across mental disorders (Schnittker, 2008;Pescosolido et al, 2010;Easter, 2012;Rüsch et al, 2012). Surveys from North America and the United Kingdom show that whereas over three-quarters of the population will label schizophrenia, bipolar disorder and depression as 'mental illnesses', only one-half are prepared to label alcohol dependence or drug abuse in the same way (Pescosolido et al, 2010;Rüsch et al, 2012).…”

“…However, trends in the public's acceptance of neurobiological information are not uniform across mental disorders (Schnittker, 2008;Pescosolido et al, 2010;Easter, 2012;Rüsch et al, 2012). Surveys from North America and the United Kingdom show that whereas over three-quarters of the population will label schizophrenia, bipolar disorder and depression as 'mental illnesses', only one-half are prepared to label alcohol dependence or drug abuse in the same way (Pescosolido et al, 2010;Rüsch et al, 2012). Furthermore, there is incomplete concordance between preparedness to describe conditions as 'mental illnesses' and to accept neurobiological explanations of them (Pescosolido et al, 2010;Rüsch et al, 2012).…”

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“…This trend has been fueled by changes in funding priorities for mental health research, including President Obama's Brain Research through Advancing Innovative Neurotechnologies initiative (4,5). The public's understanding of mental disorders has also become more biological (6).…”

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“…It was a shift from a biopsychosocial descriptive approach to a medically based research model (Wilson, 1993). As the medical model widened, so did the thinking that the mental disorders were brain disorders or chemical imbalances (Pescosolido et al, 2010).…”