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Bridging the Gap on Mental Health

More Americans recognize the value of mental health, but there’s still a social stigma. Finding common ground in treatment could help increase understanding.

Despite all of the advancements in medicine, technology, and treatment, the human brain still remains largely a mystery.

That is perhaps why mental illnesses are so difficult for people to understand. The symptoms don’t present the same way as physical diseases, and there’s not always a clear protocol for treatment. There are no blood tests, and no biological markers to diagnose a mental illness, such as depression, anxiety, or schizophrenia. That means medical professionals are entirely reliant on symptom descriptions for diagnosis.

It also makes mental illness something difficult for society to accept as a critical component of overall health, although one in four people suffer from a mental health condition.

“These are often invisible conditions,” says Paolo Del Vecchio, director of the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services. “If someone breaks their leg, we know about that, and there are clear ways of setting and treating it.”

And while a larger portion of the American public is recognizing the importance of mental health, there’s still a significant social stigma around mental illnesses. The American Foundation for Suicide Prevention Survey, for example, revealed that 90 percent of Americans value physical and mental health equally. The same survey revealed that young adults (between ages 18 and 24) are becoming more comfortable with seeking help for mental health.

But according to Del Vecchio, mental health professionals also continue to see data that indicates a degree of social distancing. People tend to react negatively to questions about whether they would want a person with a mental illness to be a co-worker, or to marry into their family, he says.

“In fact, we have seen increases in those negative responses, particularly as it relates to the myths about violence and mental illness,” Del Vecchio says.

Del Vecchio also says part of the negative perception around mental illness because television and film media often stigmatize those with mental disorders as violent. Take movies like “Psycho”, “Basket Case”, and “Texas Chainsaw Massacre,” for example. Those types of films send the message that psychosis goes hand in hand with violent behavior. But just a small fraction of violent incidents in the United States are attributable to mental illness, according to Del Vecchio.

“One really clear message that we need to continue to enforce to the American public is that recovery is real and that people can receive effective treatment and go on to live happy and full lives in their communities,” Del Vecchio says. Research around public attitudes indicates only about a quarter believe recovery can happen, he says, but “the vast majority can and do recover.”

Part of the social stigma also comes from a lack of understanding about how the brain functions, how mental health disorders arise, and what is the best course of treatment. There’s even a divide in the medical community about how to approach diagnosis and treatment for mental illnesses, according to Ken Duckworth, medical director at the National Alliance on Mental Illness.

“We don’t know that much about the brain, so we have a weakness in terms of our diagnostic framework,” Duckworth says. “We don’t have a biological marker for this condition. That’s no one’s fault. The brain, it turns out, is a lot harder [to understand] than anything else.”

Some scientists and medical professionals believe diagnosis and treatment should only go based on what is already well-established and known from research. There’s also work to identify biological markers associated with certain mental illnesses. The Broad Institute of MIT and Harvard, for example, earlier this year identified one chromosome – Chromosome 6 – has a gene on it that is overrepresented in people who have a diagnosis of schizophrenia.

“This is not a panacea,” Duckworth says. “It is, however, the most meaningful neuroscience data we found to tell us what’s going on here.”

Still, finding a biological connection with different mental illnesses and developing treatment based on those discoveries could be many years away. That’s why other mental health professionals have taken a different path, and advocate more for early intervention and psychological therapy, such as cognitive behavioral therapy – a type of treatment that explores the connection between thoughts, feelings, and behavior, and how to identify and avoid self-destructive or negative thoughts and behaviors.

“In heart disease, we intervene with high blood pressure decades before people have heart attacks,” Duckworth says. “Why wouldn’t we do the same thing with psychosis?”

One variation of cognitive behavioral therapy, though less established in evidence, is biofeedback, the idea that a person can be taught to control seemingly involuntary physical behaviors. Neal Elgar Miller was a pioneer in developing biofeedback as a form of therapy, demonstrating that patients could increase their blood pressures by watching their vital signs. Today, some use biofeedback as a form of therapy for a range of mental disorders, including anxiety and depression.

Ideally, though, combining the benefits of neuroscience and psychotherapy treatments could lead to better outcomes for mental health patients. Ann M. Graybiel, a recipient of the National Medal of Science, has said it’s important to understand exactly how and why “talk therapy” can help individuals with mental health disorders, particularly because they affect such a large portion of the population.  

Ann Graybiel receives the 2001 National Medal of Science from President George W. Bush for her pioneering contributions to understanding brain function

“Neuroscience is shedding light on how to modulate emotion and memory, habit and fear learning. But psychological understanding and treatments have, as yet, profited much too little from such developments,” she wrote in a 2014 article in the journal Nature, along with Emily Holmes of the University of Cambridge, and Michelle Craske of UCLA.

“It is time to use science to advance the psychological, not just the pharmaceutical, treatment of those with mental-health problems.”

Part of the problem, they wrote, is a “culture gap” between neuroscientists and clinical scientists. Even within the medical field, for some people, “psychological treatments still conjure up notions of couches and quasi-mystical experiences,” they wrote. “That evidence-based psychological treatments target processes of learning, emotion regulation and habit formation is not clear to some neuroscientists and cell biologists. In our experience, many even challenge the idea of clinical psychology as a science and many are unaware of its evidence base.”

Creating an umbrella discipline of mental health science, the article said, could bring together the best of both worlds, and help generate new and more effective forms of treatment. And a sense of cooperation could lessen the competition for a limited source of funding between two fields that are working toward a common goal of helping those with mental illnesses.

SAMHSA’s Del Vecchio also says that the most effective way to combat negative attitudes toward mental illness is through disclosure and interpersonal contact, which happens when people share their own experiences, often in therapy.

“We know discrimination is still real and that people can risk their jobs and livelihoods because these negative attitudes continue to fester,” Del Vecchio says. “But the more people do feel comfortable and safe in revealing their mental health histories, that will be the answer in terms of how we clearly shift the public view on mental health.”