Since the 1970s, psychiatrists have often depicted mental disorders as diseases. We’ve all heard the expressions: “Depression is like diabetes.” “Schizophrenia is like cancer.”

Many thought that the disease metaphor would reduce the stigma surrounding mental illness. That’s because it doesn’t see depression or delusions as moral failures or character defects. It sees them as due to chemical imbalances.

But does the disease metaphor actually help people with mental illnesses? A growing body of evidence suggests that framing mental illness as a disease doesn’t so much alleviate stigma, but replace one stigma for another.

While the disease metaphor can reduce blame, it can also increase the perception that people with disorders are dangerous and can’t be cured. People who accept biological explanations tend to have lowered expectations about their ability to get better.

An alternative paradigm sees depression as nature’s evolved “signal” that not everything is well with my relationships or plans. It’s designed to push us to reflect on our lives and make the necessary changes.

 

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Framing Depression as an Adaptation

A groundbreaking new study, recently published in Social Science and Medicine, provides evidence that the purpose paradigm might actually promote healing. It was led by Hans Schroder, a Clinical Assistant Professor of Psychiatry and clinical psychologist at the University of Michigan.

Schroder has long thought that depression could be evolution’s signal that something in one’s life needs attention. The question he poses here is how that framing impacts recovery.

He and his collaborators recruited over 800 participants with experience with depression and divided them into two groups. Each group watched an informational video and then completed a series of self-evaluations.

The first group watched a series of videos of a clinician presenting depression as a “disease like any other,” somewhat like cancer or diabetes.

The second group watched a series of videos of a clinician presenting depression as a signal that serves an adaptive function. It’s your mind’s way of telling you that “something in life needs more attention.”

Schroder’s work was inspired in part by the concept of mindset—that our expectations and attitudes have a profound influence on mental health.

3 Measures of Well-Being

Schroder and his team found that people in the second group made greater strides on three measures: “offset efficacy,” “depression adaptability,” and “self-stigma.”

First, people exposed to the design framework felt less helpless about their depression (“offset efficacy”). They believed that their personal efforts were crucial to healing.

Second, people presented with the design framework felt that their depression had a useful function, for example, that it leads to new insights (“depression adaptability”).

Third, the design framework led people to feel less stigma about their condition (“self-stigma”). For example, they were less likely to think they needed to hide their depression from others.

Schroder and his collaborators point out that one reason the study is so important is because of the sheer dominance of biological explanations of mental illness in the public sphere.

For example, 90 percent of licensed social workers surveyed in a recent study often use the “chemical imbalance” metaphor of depression with their clients. And nearly half of all YouTube videos about depression present biological causes, rather than environmental or social ones.

The authors point to the role of pharmaceutical advertising, public health campaigns, and technological innovations in explaining how disease framings became so widespread.

In light of this new research, the question of whether to keep using the disease metaphor has become a profound moral problem. If framing depression as a dysfunction or disorder can obstruct recovery, what justification is there for continuing to use it?