“If you had diabetes, would you take insulin?” This was the question I was trained to ask any patient who was on the fence about taking prescription medication for a mental health issue. Equating a mental illness with a physical one was intended to persuade the person that there was a straightforward biological explanation for their symptoms and a simple remedy.
Looking back, I realize that the-brain-is-broken-and-medication-can-fix-it argument may not have been the most effective message. For starters, it completely ignores psychological and social factors such as homelessness, isolation, family dynamics, and poverty that can trigger mental illness. It also overlooks the role of lifestyle factors such as diet, sleep, and physical activity that buffer and boost mental health.
In his book Healing, former director of the National Institute of Mental Health, Tom Insel discusses what he believes to be the most important contributors to recovery: people, place, and purpose. In other words, having people who support you, having a sanctuary to heal, and discovering a purpose or mission. A psychiatrist friend summed it up this way: mental health is having someone to love, somewhere to live, and something to do. A woman who is depressed because she is in an abusive relationship doesn’t need Prozac, she needs a safe haven.
Happiness is not all in your head
When we talk about a mental disorder using the biological model and equate it with physical illness, we ignore context. We also overlook a key contributor to mental health: the role of personal agency. Having a sense of agency means that you feel like you are in the driver’s seat, that you have a say over your actions, that life is not just happening to you. Being told you are governed by neurochemical abnormalities is the opposite of empowering. Research shows it can also promote negative social attitudes. However well intended, the biological model may inadvertently promote a defeatist attitude and feelings of powerlessness:
“Biological explanations appear to lead to certain forms of so-called psychological essentialism in which mental disorders are seen as having unique, immutable essences—located in the brain or DNA—that produce the symptoms and behavior of patients. This view, in turn, can yield the belief that people with mental disorders are categorically dissimilar from so-called normal people, and the perception of such strict social boundaries between groups of people can lead to more negative intergroup attitudes. It can also exacerbate the perception that mental disorders are relatively permanent and difficult to overcome or treat effectively, which is known as prognostic pessimism.”
Messaging matters
A few years ago, I remember a patient’s sense of relief when I told him he was in the midst of a major depressive episode. The word “episode” helped him see his symptoms as time limited, rather than permanent and pervasive. The problem with the biological model is that it promotes a fixed mindset about mental illness–that it’s stable and innate. Promoting a growth mindset–the belief that it is changeable and that the person has agency–is a healthier message.
A recent study published in the Journal of Clinical Psychology found that when college students read messages on social media that promote a growth mindset about mental health challenges, they were more optimistic about getting better. Even subtle differences in wording was enough to sway people’s beliefs about depression and anxiety and their treatment.
Participants were divided into three groups. Some viewed a series of tweets on X that conveyed a fixed mindset. For instance, one tweet said, “I can’t wait for my seasonal depression to be over so that I can get back to my regular depression.” A second group read tweets that emphasized a growth mindset. These messages emphasized the fluid nature of mental health and the ability to take control over it. For example, one of these tweets read, “I got this” to a meme that read “telling those anxious thoughts who’s really in control.” A third group read tweets that did not touch on mental health at all.
Participants who read the fixed mindset tweets had more pessimistic views about mental illness and saw it as more permanent and that there was little a person could do to manage it. Participants who read the growth mindset tweets were more likely to see depression and anxiety as temporary conditions that people can take steps to alleviate.
Bottom line
There are many reasons a person might experience mental distress, including biological, psychological, and social ones. If we only address the biological factors, we risk undermining optimism and key contributors to mental health: people, place, and purpose.
I wish you all the best,
Dr. Samantha Boardman
