A Disorder by Any Other Name...

John M. Grohol, Psy.D.
October 1996; Reviewed: February 2004

After spending 9 years of my life pursuing a dream of earning a doctoral degree, I seem to have missed an important class or two. It seems that while I was in school studying away and spending countless hours in-between library stacks, pouring through research journals ad nauseum, the scientific community had discovered that all serious mental disorders are actually brain disorders, also referred to affectionately as neurobiological disorders. With this re-naming of mental disorders, we have apparently cured not only the stigma of mental disorders, but also arrived at the logical (and didn't we suspect this all along?) treatment choice -- medication.

All of this really happened while I was still in college, though. Because in 1988, the National Alliance for the Mentally Ill (NAMI) adopted a mission statement, which reads, in part, that "mental illnesses are no-fault, biologically based, treatable, and may eventually be curable." Everything in this statement is true, if one is careful how one reads it. If biology is interested in the scientific study of life and all living things, then a disorder which is "biologically based" pretty much encompasses everything we, as humans, do. To say that the foundation of mental disorders is life is to state the obvious. But I suspect that this isn't what NAMI really means to say, as their literature expands on this point of view.

In their literature, NAMI refers to mental disorders as "mental illnesses" and states, "Neurobiological disorders, neurobiological brain disorders (NBD), and mental illness are terms used for a group of brain disorders that cause disturbances in thinking, feeling, or relating." They list not only the expected mental disorders, such as schizophrenia, but also a few unexpected ones, such as panic disorder, borderline personality disorder, and major depression, among others. They suggest a consultation with the DSM-IV, rather than a trained mental health professional, for people to discover if they have one these "neurobiological brain disorders." That's akin to suggesting that you should consult Gray's Anatomy to find out if that pain in your chest is a heart attack or heart burn.

NAMI is an excellent organization started in 1979 with noble goals: to educate people about mental disorders and reduce the stigma of them in society. I suppose early on in their thinking, someone said, "Hey, people don't feel guilty about getting cancer, and society doesn't stigmatize these individuals. So why don't we compare mental disorders as similar to other medical problems?" This kind of thinking likely led to the adoption of a medical model of mental disorders, long before there was much research to support their position. The organization is composed mostly of people with mental disorders and family members, although it is open to all. Little of their literature provides research citations for their statements and conclusions, so it is difficult to gauge the intent and accuracy of the organization.

NAMI tries to make a ludicrous distinction in some of their literature, however, between "obvious" neurobiological brain disorders (NBD) and emotional problems brought about by a major stressor. I say "ludicrous" because research to this point has shown that there is little difference in how people perceive their distress when caused by external (as opposed to internal) factors. It much more greatly depends on a person's individual makeup and personality, which is the sum of a combination of developmental and environmental factors. I'm not sure what the intent of this distinction is, other than to suggest that there are two groups of individuals who suffer from some of these disorders. It allows them an alternative explanation to responses such as, "Well, psychotherapy did wonders for me and I did it without medications." NAMI could then respond by suggesting that the person really didn't have a NBD in the first place. It was just an emotional problem.

NAMI's goals are worthy, but their direction and focus is counter to the accepted understanding of mental disorders by the majority of mental health professionals today (across all the major disciplines, including psychology, psychiatry and social work). As I have written in the past, most mental health professionals accept a bio-psycho-social model of mental disorders. This model suggests that there are three, equally important components of most mental disorders:

  • Biological - This is what happens inside the body, most often to the brain, when a person suffers from a mental disorder. Why are serotonin levels implicated in many very different mental disorders? And why did they change in the first place inside a person's brain?? Obviously there is more to understanding the brain and biological factors than our current knowledge allows. Genetics are also included in this category. While there are genetic influences to many mental disorders, the links aren't all that strong.

  • Psychological - What is the specific makeup of an individual's personality. How come some people can go through horrible experiences and be mentally healthy, but others suffer from the effects for the rest of their lives? What developmental factors are important in a child's early years? How do you cope with stress?? Healthy expression of one's emotions, such as anger, hurt, etc. might also be covered in this category. How does a person learn to react, think and behave they way they do?

  • Social - What environmental and relationship factors are influencing a person's life. This would include work and family relationships, as well as peer relationships. Some of this is psychologically-based as well. Are their occupational factors or poverty which strictly limit a person's capabilities or normal functioning?

All of these factors are equally important, without a doubt. Research has shown this. The only research summaries you'll find on NAMI's Web site, though, are those related to medications and the medical model. They support their arguments with a very biased reading of the entire research literature, filtering in only those articles which support them. For example, you won't find any mention that the placebo effect alone can account for up to 50% of the positive effects in treatment. Only 27% of the effects of the medication were attributed to the actual pharmalogical effects of the active ingredients. If all serious mental disorders were so neurobiologically-based, this effect should not occur. It speaks volumes to the benefits of psychological and social factors in mental disorders, and often many medical illnesses as well. Psychological factors simply should not and cannot be ignored.

Changing the name of mental disorders to something else (no matter what that something else is), is not the answer. It's not even an adequate response, serving only to muddy the issues and confuse people further. If people with mental disorders want to say they have a neurobiological brain disorder, then people with headaches or stroke victims could very well do the same.

Mental disorders are serious. And they should be taken seriously and treated seriously. People who suffer from them should be treated with respect and dignity. They should not be told a simplistic and inaccurate explanation for their disorder when the answer is anything but simple. Research on this issue implicates multiple factors for most mental disorders. This simple fact is overlooked by NAMI and advocates like NAMI (who also, by the way, suggest that electroconvulsive therapy, or ECT [aka "shock therapy"], is an appropriate treatment for some of their neurobiological brain disorders). NAMI should seriously re-examine its agenda and the means it goes about propagating this agenda.

I may have indeed missed a few important items in my education and training. But there is one thing I did not miss -- learning all we know about the causes and appropriate treatments for mental disorders. People want the simple, plain facts. The truth remains to this day, as I learned, that we simply do not know what causes mental disorders.

It's not about a name. It's about people and the truth they suffer.

Reference
Grohol, J.M. (Oct 1996). A disorder by any other name.... [Online].

Last reviewed: By John M. Grohol, Psy.D. on 6 Jan 2008
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