The Stigma on Mental Health Issues

This post was submitted by Yorick Peterse, PhD student at the Max Planck Society. Recently, Yorick collaborated on an article about the mental health of German doctoral researchers.

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Arguably the biggest challenge in the field of psychiatry is the lack of insight into the biological mechanisms underlying mental health disorders. As a result, there are no objective biological or medical tests available to assist a clinician in making a diagnosis and selecting the optimal treatment for a patient. Instead, clinicians have to rely on the presence or absence of psychological and behavioral symptoms, and on the frequency and duration of these symptoms. Consequently, patients may end up with the same diagnosis, even if the biological cause for their complaints are completely different. It is not uncommon for two psychiatrists examining the same patient to make different diagnoses, or for a patient who was initially diagnosed with one disorder to better ‘match’ the criteria for another disorder later. Moreover, the criterion of having to suffer from a minimum number of symptoms inevitably creates an arbitrary line between health and sickness. Persons suffering from too few’ symptoms or for ‘too short’ a period are considered healthy, even though they may be impaired in their daily activities. Working with such an arbitrary diagnostic system in turn leads to a non-uniform treatment system, where each patient has to go through a phase of ‘treatment optimization’. At this point, several (combinations) of psychopharmacological drugs are tested, and the dose of these drugs is altered until the symptoms of a patient are under relative control.

Snow-capped Mountains under evening sky
Snow-capped Mountains under evening sky

Given this enormous problem in one of the most debilitating disease categories, a lot of research is being done to understand the biological basis of psychiatric disease. Every subfield of biomedicine is involved, ranging from studying the genome, metabolism, and cell biology, to brain structure and activity in relation to psychiatric disorders. Understanding brain physiology will lead to an understanding of pathology (including mental health disorders) and in turn improve diagnosis and treatment options, but this will take a while.

In the meantime, it is important to also work on the prevention side of mental health issues, which is related to another fundamental challenge in psychiatry: lifting the stigma of suffering from psychological problems. Generally speaking, symptoms of anxiety or depression are considered to be a sign of ‘weakness’. People who experience hallucinations, delusions, or other symptoms related to schizophrenia or bipolar disorder are often labeled ‘crazy’ and people with eating or addiction disorders are deemed ‘lacking self-control’. One in three people are diagnosed with a mental health disorder at some point in their life, and many more experience symptoms related to these disorders, yet most people feel they can not openly say they suffer from psychological issues. A recent survey by the UK-based initiative Time To Change found that only 13% of respondents would open up about mental health illness at work, versus 36% about physical health matters. Think about the ease with which someone would state that he or she receives help from a personal trainer to improve their physical fitness, versus the unease of saying the same for having a psychologist to improve their mental fitness.

The origin for this stigma can partly be traced to the distinction between body and mind, and the intangible nature of mental states. Whereas most physical conditions are either visible or otherwise ‘visualizable’, what goes on in the brain is usually too abstract to understand (with the exception of a tumor or a stroke). Despite this, the relationship between physical and mental states is well known, and the substantial volume of psychiatric research mentioned above has led to many insights of measurable alterations in the brain in relation to mental disorders. For instance, certain psychiatric diagnoses, as well as long periods of stress, are associated with a decreased volume of specific brain areas.

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Mental health stigma has two disadvantageous consequences. First, those who can benefit from psychological help are less inclined to seek it. It is known that suffering from ‘subthreshold levels’ of psychological distress increases the risk for mood and anxiety disorders, and that training in cognitive and behavioral strategies can reduce the risk of developing these disorders. Early treatment is most effective, so providing psychological help to more people earlier on would bring an obvious societal and economic benefit. Second, mental health stigma can exacerbate mental illness, as people who are already suffering are marginalized, for instance, because they are perceived as risks to employers.

With an increased understanding for the causes and consequences, and with a more open communication about psychological suffering, the stigma on mental health issues could perhaps be partly lifted, and more people could be encouraged to seek professional help when needed.

This requires not only more awareness but also a change of professional environments. In this respect, academia has a somewhat ambiguous role. On one hand, in the US, Canada and the UK, academic institutions are among the front-runners of creating more awareness through initiatives such as the Mental Health Awareness Week/Month, although institutions in other countries still need to follow suit. On the other hand, the current postgraduate academic environment certainly seems to be unfavorable for mental health, as highlighted by several publications from recent years. Most recently, a Nature Survey found that 25% of doctoral researchers were concerned about their mental health, but only 12% sought professional help for their issues, confirming the existence of a stigma. Another study from 2017 found that PhD researchers have 2.43 and 2.84 times more risk for having or developing mental health disorders than highly educated persons in the general population and highly educated employees, respectively. Apparently specific aspects of doing a PhD increase the risk for developing mental health issues, which mainly concerns the high level of insecurity in terms of employment duration, finances, and future job prospects, as well as a lack of control over one’s work. Additionally, a work culture where symptoms of psychological distress are normalized, trivialized, or even seen as positive often exists. Someone who is not ‘too busy’ to perform a certain task, who is well-rested or not stressed out, may be seen as not giving their best for their PhD.

Solutions for tackling some of these issues have been proposed elsewhere, including here, here and even on this blog, but it is of fundamental importance that postgraduate students call for a change of the academic work environment themselves, which is one of the reasons why the AMHC is such a great initiative!

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