Many people with mental illness, and their loved ones, still encounter stigma associated with having a behavioral health disorder. In addition to coping with symptoms and effects of their illness, they also encounter stereotypes, prejudice, and discrimination. The Oxford Dictionary (2014) defines stigma as, “a mark of disgrace associated with a particular circumstance, quality, or person”, while the Merriam Webster Dictionary (2014) defines it as “a set of negative and often unfair beliefs that a society or group of people have about something”.
Unfortunately, many misconceptions still exist about people with behavioral health disorders. Stigma can prevent people with illnesses like schizophrenia, alcoholism, or bipolar disorder from accessing employment, housing, and healthcare (Corrigan & Watson, 2002). Imagine someone believing that you are dangerous or permanently impaired because you have an illness—an illness from which recovery is possible. While strides have been made to increase awareness and public knowledge about mental illness, we still have a long way to go. The more we know about what may cause certain behavioral health disorders, the better treatments and support we can offer.
Genetics and the Bio-Psychosocial Model of Illness
Many professionals agree that the Bio- psychosocial Model of illness, first proposed by George Engel in his study of heart disease, can be a helpful way to understand how and why these disorders occur. According to this model, there is not one single cause of a mental illness. Rather mental illness and substance use disorders can be due to social factors (e.g. poverty, environment, access to resources), psychological factors (e.g. emotions and personality), biological factors (e.g. genetics, anatomy, brain chemistry), or a combination of all three of these factors (Smith, 2002).
However, in recent years there has been a great deal of interest in the genetics of mental illness. We now know that genes play a role, although not a decisive one, in a number of behavioral health disorders. While no gene has been found that creates a 100% chance of developing a mental illness, genetics definitely play a part. For example, identical twin studies have demonstrated that if one twin has schizophrenia, there is a 30-50% chance that the other twin will develop it, as well. While if a fraternal twin has schizophrenia, there is only a 15% chance that the other twin will also develop the disorder. Only 1% of the general population will develop schizophrenia in their lifetime, so these studies are evidence of the role of genes in the development of this mental illness (Understanding Genetics, 2014).
Another more recent study funded by the National Institutes of health has found five different major mental illnesses share the same common inherited genetic variations. The genetic connection is strongest between schizophrenia and bipolar disorder, more moderate between bipolar disorder, depression and ADHD. While not quite as strong, there is also evidence of a genetic connection between schizophrenia and autism. Overall, this genetic variation accounts for a 17-28 % risk for developing one or more of these illnesses (New Data, 2013). This research tells us that genetics do play some role in determining if these illnesses will occur within an individual, and what illnesses a person may be more at risk of developing.
Additionally, panic disorder is another mental illness in which genes may play a significant role. Panic can be a very disabling and debilitating anxiety disorder. Approximately 4.7% of the population will experience Panic Disorder, while over 22% of people will experience one or more isolated episodes of panic attacks in their life time. No single gene has been implicated in panic disorder, but research suggests that several genes may play a role. Twin studies of panic disorder demonstrate that if one identical twin develops the disorder, the other twin has a 30-40% chance of also developing the illness, a much higher risk than the general population ((Na, Kang, Lee & Yu, 2011).
In addition to mental illnesses like schizophrenia and panic disorder, there is evidence that genetics plays a significant role in the development of alcoholism. Many people now accept that alcoholism is a disease, rather than the result of a flaw in character or weak will-power. Alcoholism seems to run in families, and research shows that genes are responsible for about 50% of the risk for developing alcoholism. While this means that environment and other factors account for the other 50% of the risk, genes do clearly play a role. Research is also exploring the role genes play in the effectiveness of treatment. For example, the drug naltrexone has been shown to be an effective treatment for some people, but not others. Genes may be at least partly responsible for this difference in treatment effects.
As our understanding of the biological and genetic factors that contribute to the development of these disorders, it becomes easier to see these behavioral health disorders as real diseases—like diabetes or heart disease, which can also run in families. But, how might our relatively recent increased understanding of genetics and biology impact how people with mental illness are perceived and treated in our society? Will this understanding help to decrease stigma, or will it further fuel stigma for people living with behavioral health disorders? There are different perspectives on these questions.
Biology & Stigma
Many studies have found that the public views people with mental illnesses as being responsible for their symptoms. They are somehow to blame for symptoms of depression, psychosis, alcoholism, mania, or anxiety. They believe their symptoms and disability are due to character flaws of moral weakness (Corrigan and Watson, 2004). We might assume that knowledge about the influence of biology on the development of mental illness would lessen negative beliefs about people with these disorders. After all, they did not cause their symptoms to occur. Does education about the biological or genetic component of mental illness help to decrease the stigma associated with these disorders? Knowing that biology plays a role in the development of mental illness should decrease stigma, right? Yes and no.
A study by Corrigan & Watson (2004), found that framing a mental illness, like schizophrenia, as a brain disorder may have limitations when it comes to reducing stigma. It may help us understand why the illness develops, but people may still believe that people with schizophrenia won’t recover and can’t have productive lives. They may not blame people for having symptoms, but they may still not understand the illness or the possibility of recovery. These types of beliefs can also create what’s known as “benevolence stigma”. This is a belief that people with mental illnesses are child-like and need parents or adults to control their lives. This type of stigma can be disempowering, causing people with mental illness to feel like they are different from others, less competent, and less acceptable and friends (Corrigan & Watson, 2004).
Explanations of mental illness that focus too much on biology as a cause may also create beliefs that people with these disorders are fundamentally different, or even dangerous. People may believe that if the illness is biologically based, the person has no control over, thus is more dangerous. While people may be less likely to blame individuals with mental illness for their symptoms, they may actually treat them more harshly because they see them as inherently different (Corrigan & Watson, 2004).
Conversely, models that explain the causes and symptoms of mental illness in terms of not just biology, but also psychology and social factors, may have more success in reducing stigma. We know that there is not one single cause of mental illness, and the disability that often results. Explanations that also include factors like environmental stress, poverty, and trauma have been shown to improve people’s perceptions of those with mental illness (Corrigan & Watson, 2004). People come to understand that symptoms can also be understandable responses to life stressors, possibly increasing empathy.
We must address both biological and psychosocial contributors to the development of mental health disorders of mental illness. Treatments that focus only on medication, without identifying strengths, teaching coping skills, and bolstering health support, are less likely to be effective (Smith, 2002). Additionally, the public must be educated about effective treatments, the relationship between violence and mental illness, and the possibility of recovery from behavioral health disorders (Corrigan & Watson, 2004). This education will help eliminate the stigma and discrimination that limit the quality of life for people living with these disorders.
Corrigan, P. W., & Watson, A. C. (2002). Public stigma. Retrieved August 8, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
Corrigan, P. W., & Watson, A. C. (2004). At Issue: Stop the Stigma: Call Mental Illness a Brain Disease. Schizophrenia Bulletin, 30(3), 477-479. doi: 10.1093/oxfordjournals.schbul.a007095
Definition of stigma in English:. (2014). Retrieved August 9, 2014, from http://www.oxforddictionaries.com/us/definition/american_english/stigma
Genetics of Alcohol Use Disorders. (2008). Retrieved August 11, 2014, from http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders/genetics-alcohol-use-disorders
Na, H., Kang, E., Lee, J., & Yu, B. (2011, May 18). The genetic basis of panic disorder. Retrieved August 10, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102861/
New data reveal extent of genetic overlap between major mental disorders. (2013, August 12). Retrieved August 9, 2014, from http://www.nimh.nih.gov/news/science-news/2013/new-data-reveal-extent-of-genetic-overlap-between-major-mental-disorders.shtml
Smith, R. C. (2002, April). The biopsychosocial revolution. Retrieved August 9, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495036/
Stigma. (2014). Retrieved August 9, 2014, from http://www.merriam-webster.com/dictionary/stigma
Understanding genetics. (2014). Retrieved August 9, 2014, from http://genetics.thetech.org/ask/ask112