Science Over Stigma: Education and Advocacy for Mental Health

A new book argues it’s time for psychiatrists to let the public know that mental illness is common, real, serious, and treatable.

BOOK REVIEW

Science Over Stigma: Education and Advocacy for Mental Health

by Daniel B. Morehead, MD; American Psychiatric Association Publishing, 2021

198 pages; $38.23 (paperback)

Reviewed by Ronald W. Pies, MD

In the July 2021 issue of the American Journal of Psychiatry, Stephen R. Marder, MD, describes the struggle to eliminate the stigma associated with schizophrenia. Marder notes that “the negative attitudes and beliefs about schizophrenia have detrimental effects, including discrimination in housing, employment and social opportunities.”1 Now comes Daniel B. Morehead, MD, with a book whose title hopefully proclaims, “Science over Stigma.” This is an outcome devoutly to be wished—but can it be achieved, given so many entrenched prejudices regarding both psychiatric illness and those of us who treat it?

To his credit, Morehead believes the answer is yes. This, despite the fact that, as Morehead notes, “blame, shame, and guilt have always been the grim fellow travelers of mental illness.” Importantly, he speaks not only as a clinician and educator, but also as “…a close family member of several people with mental illness.”

Morehead’s book consists of 10 succinct chapters, covering (among many other issues) the nature of mental illness and its prevalence; the wrongheaded notion that mental illness is a myth, and the overwhelming evidence that, alas, it is all too real; the serious consequences of mental illness; the issue of who is to blame for mental illness (nobody); the many effective treatments for mental illness; and how those who suffer from mental illness can gain and convey what he calls “deep wisdom about life.”

Among the most valuable sections of Morehead’s book is chapter 5 (“Mental Illness is Real”), which provides a richly detailed review of the numerous biological abnormalities associated with psychiatric illness (a term I intend as roughly synonymous with mental illness). Morehead elegantly summarizes the abundance of data demonstrating that “mental illness is medical”; ie, that “mental illness is true biological dysfunction.” He presents a brief, focused review of structural and functional imaging studies, as well as of genetic and neurobiological factors in mental illness. But Morehead is circumspect in his claims. He notes that, “…we know a vast amount about the biology of mental illness, [but] we also don’t know a vast amount” about it. Furthermore, “…we do not know precisely how each mental illness works or how it can be cured.” (This is true, of course, in much of general medicine and neurology.2)

To be clear: Dr Morehead is far from advocating a purely biological approach to understanding psychiatric illness. Rather, he makes a strong case for a viewing mental illness as the outcome of biological, psychological, and social factors, arguing that “there is no difference between the biological and the psychological in regard to mental illness and its treatment…they do not exclude or compete with each other.” Nor does Morehead neglect the spiritual dimension of mental health and illness, understood as the belief that “…we are part of something much greater than ourselves [and] that life has purpose and meaning beyond our individual existence…” He cites data showing that, for the most part, religious and spiritual practices have a positive effect on body and brain.

Finally, the subtitle of Morehead’s book is critical to understanding his aims in writing it; i.e., his emphasis on “education and advocacy.” Morehead is, in the first place, intent on breaking down the barrier between those with mental illness and everybody else. He argues that “…people with mental illness are not ‘those people,’ they are ‘us people,’ because there is no meaningful social group that does not contain people with mental illness.” Rather, mental illness “…is part of being human, of having a body and a brain, and of getting sick.”

Furthermore, Morehead argues, psychiatrists and other mental health professionals need to be more active in defending what we do and why we do it; and yet, “…we rarely see anyone explaining the entire edifice of mental health diagnosis and treatment, much less defending it.” One tragic result of this lack of advocacy is that “…treatment of severe mental illness in this country constitutes a scandal and a human rights disaster…” such that “…individuals with severe mental illness are more likely to be jailed than treated…” as E. Fuller Torrey, MD, and others have argued for many years.3

For Morehead, our charge, as psychiatrists, is to explain that mental illness is common, real, serious, and treatable. This means, among other things, making the scientific case for psychiatric treatment to the general public. As Morehead puts it, “…they need to see the science for themselves. They need to look at the numbers, the graphs, the [brain imaging] photos, and even some of the studies for themselves.”

Morehead’s book should serve as a wake-up call to both mental health professionals and the general public. Few readers will agree with everything in this book, but fair-minded and objective readers should come away persuaded of its principal arguments and values. I believe that for this reason alone, Morehead has performed a valuable service for both our profession and our patients.

Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and Editor in Chief emeritus of Psychiatric TimesTM (2007-2010). He is the author of The Levtov Trilogy and Just Take it One Miserable Day at a Time.

References

1. Marder SR. Changing the face of schizophrenia. Am J Psychiatry. 2021;178(7):584-585.

2. Pies RW. Why Thomas Szasz did not write The Myth of Migraine. Psychiatric Times. July 29, 2021. Accessed August 11, 2021.

3. Torrey EF, Kennard AD, Eslinger D, et al. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. US Department of Justice. May 2010. Accessed August 11, 2021.