Misrepresentations of Biological Psychiatry: A New Report

A new report published earlier this month in the Harvard Review of Psychiatry suggests that research in biological psychiatry is often misrepresented to the public, leading to popular misconceptions about the nature of mental illness. The paper, titled "Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences" begins like this:

Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated (Dumas-Mallet & Gonon, 2020, p. 395).

Source: Public domain

The authors, affiliated with the Institute of Neurodegenerative Diseases at the University of Bordeaux in France, contend that the misrepresentation of psychiatric knowledge has various causes: overt falsification of data by researchers, or "p-hacking"; preferential publication of positive results by academic journals (e.g., journals are more likely to publish papers showing exciting new biological findings than those demonstrating no such findings); misleading pharmaceutical company marketing; and the embellishment of neuroscience findings by the news media.

The authors provide the following as an example of misrepresentation:

A study reported that treating children with ADHD with a psychostimulant does not improve their reading performance and does not decrease their risk of early school dropout. On the sole basis of a slightly lower grade-repetition rate, however, the authors concluded that this treatment improves their academic performance in the long term. Indeed, on 21 September 2007, the Washington Post wrote: "This is the first study that shows that taking stimulants for ADHD improves long-term school performance" (Dumas-Mallet & Gonon, 2020, p. 397).

The authors also point out a common error in biological research: the tendency to suggest that a correlation between a pathology and a risk factor is, in fact, a causality. They write, "Structural changes in certain brain areas are not necessarily the cause of mental disorders" (Dumas-Mallet & Gonon, 2020, p. 397), pointing out that changes in hippocampal size in depressed patients, for instance, are not observed in patients diagnosed with a first depressive episode. In other words, it is possible for changes in brain structure to be the consequence rather than the cause of the disorder.

Dumas-Mallet and Gonon (2020) go on to describe the consequences of misrepresenting biological psychiatry. These include bolstering the public attitude that mental disorders are primarily biomedical diseases rather than complex biopsychosocial disorders; an emphasis on biological treatments to the exclusion of social or psychological ones; and implications on public policy, such as selective funding of medication-driven programs rather than comprehensive care for the severely ill.

The paper concludes by endorsing the biopsychosocial model in psychiatry, echoing sentiments expressed by the great American psychiatrist Allen Frances. Dumas-Mallet and Gonon (2020) write, "The psychosocial understanding of mental disorders is at least as important as the biological one to guide mental health professionals. Public information about mental health should reflect this view" (p. 401).

The paper can be accessed for free on PubMed by clicking here.