Explaining Away Empathy – Mental Illness and Reduced Compassion




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Empathy is critical for health care providers. Especially in mental health care, empathy and compassion improve outcomes and enhance overall patient well-being. Thanks to innovative explorations into the way the brain works, mental illness is increasingly defined by biological mechanisms. But, new research claims that these biological explanations lead to less empathy for patients.

A recent trend in mental health has focused on offering biological and genetic mechanisms for mental illness. Experts believed that such explanations would decrease the blame that patients receive for their illnesses since genes, cells, and chemicals are named as culprits. Feelings of compassion should increase for the patients since the illnesses are not their faults, right?

Wrong.

In a series of studies, clinicians expressed less empathy and compassion for patients when symptoms of mental illnesses were explained with biological mechanisms. The authors of a recent analysis indicate that biological explanations do decrease patient blame but, albeit unintentionally, also dehumanize patients. The biological explanations for mental illness seem to enhance the perception that patients are abnormal or deserving of social exclusion. In additional studies, clinicians indicated that they believed psychotherapy would be less effective and medication would be more effective when mental illness was explained by biological mechanisms instead of psychosocial reasons. (Most mental health experts agree that psychotherapy is effective in many mental illnesses, despite the cause of the illnesses.)

Biological explanations also affect the perspectives of the patients themselves. Patients who attribute their conditions to biology are more pessimistic about their prognosis than patients who accept psychosocial explanations for their illnesses.

Many questions still remain about causes, predictive factors, and prognosis of mental illness, and biological features should not be ignored as one piece of the mental health puzzle. The biological conceptualization of many conditions is a significant step toward the safe and effective treatment of mental illness. But, like patients with any other condition – cancer, autism, asthma, or even high blood pressure – patients with mental illness deserve respect and compassion. Treatment for all patients and all diseases should focus on the whole patient and consider biology, psychosocial, and emotional factors.

References

Ahn WK, Proctor CC, & Flanagan EH (2009). Mental Health Clinicians’ Beliefs About the Biological, Psychological, and Environmental Bases of Mental Disorders. Cognitive science, 33 (2), 147-182 PMID: 20411158

Kvaale EP, Gottdiener WH, & Haslam N (2013). Biogenetic explanations and stigma: a meta-analytic review of associations among laypeople. Social science & medicine (1982), 96, 95-103 PMID: 24034956

Kvaale EP, Haslam N, & Gottdiener WH (2013). The ‘side effects’ of medicalization: a meta-analytic review of how biogenetic explanations affect stigma. Clinical psychology review, 33 (6), 782-94 PMID: 23831861

Lebowitz MS, & Ahn WK (2014). Effects of biological explanations for mental disorders on clinicians’ empathy. Proceedings of the National Academy of Sciences of the United States of America, 111 (50), 17786-90 PMID: 25453068

Lelorain S, Brédart A, Dolbeault S, & Sultan S (2012). A systematic review of the associations between empathy measures and patient outcomes in cancer care. Psycho-oncology, 21 (12), 1255-64 PMID: 22238060

Schlier B, Schmick S, & Lincoln TM (2014). No matter of etiology: biogenetic, psychosocial and vulnerability-stress causal explanations fail to improve attitudes towards schizophrenia. Psychiatry research, 215 (3), 753-9 PMID: 24485063

Shashikumar R, Chaudhary R, Ryali VS, Bhat PS, Srivastava K, Prakash J, & Basannar D (2014). Cross sectional assessment of empathy among undergraduates from a medical college. Medical journal, Armed Forces India, 70 (2), 179-85 PMID: 24843209

Speerforck S, Schomerus G, Pruess S, & Angermeyer MC (2014). Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: is the concept of a chemical imbalance beneficial? Journal of affective disorders, 168, 224-8 PMID: 25064807

Image via Gio.tto / Shutterstock.

Jennifer Gibson, PharmD

Jennifer Gibson, PharmD, is a practicing clinical pharmacist and medical writer/editor with experience in researching and preparing scientific publications, developing public relations materials, creating educational resources and presentations, and editing technical manuscripts. She is the owner of Excalibur Scientific, LLC.
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