Jthere is no doubt that public attitudes towards mental health have already turned a corner. Just consider the slew of public figures — from Robbie Williams and Lady Gaga to Baroness Davidson — who have opened up about their struggles.
According to an analysis of English newspapers, the number of articles stigmatizing mental illness fell by around half between 2008 and 2016, while those challenging this stigma roughly doubled over the same period. And it seems to have a positive impact on everyday experiences of prejudice – people with mental illness now report significantly less discrimination from family, friends and colleagues than just a few years ago.
Despite this progress, some myths about mental illness are still widely shared, including false claims about the effectiveness of treatments. Here are six of the most common beliefs and the truth behind them.
Mental illnesses are overdiagnosed
Let’s start with the idea that people confuse everyday distress with a clinical disorder. The claim is a favorite of TV personalities and newspaper columnists, who periodically claim that the increased focus on mental health reduces people’s autonomy, so they turn to interventions. medical care rather than addressing the issues in their lives.
In reality, there is very little hard evidence that overdiagnosis is the serious problem that some claim. Surveys of depression in Western countries, for example, have not found a surge in diagnoses as people jump on the “mental health bandwagon.” “The evidence points to stability,” says Professor Johan “Hans” Ormel of the University of Groningen in the Netherlands. He suggests doctors are just as likely to miss real cases as they are to misdiagnose someone who is simply experiencing transient distress.
time is a healer
Related to the claim that doctors medicalize everyday distress, it is suggested that many people who think they have depression should be more resilient and simply wait for time to cure their ailments. If they are just suffering from temporary sadness, after all, then surely the problem should go away on its own?
To find out if that was really the case, Australian researchers looked at data from 16 clinical trials, in which a control group of patients were placed on a “waiting list” before receiving treatment. They found that only one in eight of these patients went into remission while awaiting treatment, while the rest continued to show symptoms over the three-month period.
Antidepressants don’t work
It’s not just the diagnostic process that has inspired medical myths; treatments used to help patients are often the subject of misinformation.
A common belief is that a common class of antidepressant drugs, called SSRIs (selective serotonin reuptake inhibitors), are ineffective and work no better than a placebo. The idea recently gained attention following the publication of an article that raises serious questions about the proposed mechanism of these pills.
SSRIs, which include Prozac, were thought to correct a “chemical imbalance” in the brain, correcting levels of serotonin, a neurotransmitter thought to be involved in regulating mood, among other functions. The recent paper, however, reviewed the evidence to date and concluded that there was no clear link between serotonin levels and depression.
But there are many other ways they can help relieve symptoms – by reducing inflammation, which is another potential contributor to depression, for example. Importantly, a recent meta-analysis in the Lancet, considering several clinical trials, have confirmed that SSRIs are effective in alleviating depression. Although they don’t work for everyone, they are about 50% more likely to produce a response than placebo pills. According to Professor Cathryn Lewis of King’s College London and Professor Andrew M McIntosh of the University of Edinburgh, the clinical benefits are now “beyond reasonable doubt”.
‘Happy Pills’ Just Numb People’s Feelings
Other myths concern side effects. You’ll see many articles, for example, claiming that antidepressants “dull” people’s emotions. There is apparently a good basis for this idea: many patients report concerns that their medications have smoothed out the ups and downs of life, leading to numb feelings.
Until recently, however, few studies have investigated the causes of emotional blunting, and it now appears that feelings of numbness may be a residual symptom of depression. It makes sense: depression is often accompanied by apathy and an inability to feel pleasure. SSRIs took away the most salient feelings of hopelessness – but they don’t necessarily increase positive emotions and motivation, says Professor Guy Goodwin of the University of Oxford, who conducted the recent study: “The emotional dullness is real, but it’s not caused by medication.
Mental illness makes people more creative
Perhaps the most persistent myth is the idea that mental suffering is a source of artistic genius – from Virginia Woolf to Kanye West. But any evidence supporting the link between creativity and mental illness is extremely tenuous, says Professor James C Kaufman of the University of Connecticut.
“Historiometric” analyses, for example, have probed the biographies of notable artists. Although these studies seem to suggest that mental illness is more prevalent among creative personalities, any post-hoc, text-only diagnosis should be treated with great caution. “They’re not super objective,” Kaufman says. “Very few creativity researchers believe there is a strong connection.” And the idea that mental anguish can inspire great art certainly shouldn’t be grounds for avoiding treatment for serious illness, he says.
Schizophrenia is incurable
Despite changing attitudes towards other mental illnesses, schizophrenia still carries a huge stigma, says Marjorie Wallace, founder and chief executive of mental health charity SANE. “Schizophrenia is still a ‘forgotten disease’ because it has been squeezed out of all these anti-stigma campaigns, which have focused on stress, depression and anxiety.” This means most people have only a vague understanding of the condition, despite the lifetime prevalence being around 1.5% in the UK.
A big misconception is that schizophrenia is simply “incurable.” However, with the right medications and talking therapies, 45% of people with schizophrenia go into remission after one or more psychotic episodes, while 35% experience mixed patterns of remission and relapse. The belief that there is no chance of a cure can be a cause of great despair for people who have been diagnosed with the disease and their families. (Activist and filmmaker Jonny Benjamin described the diagnosis as a life sentence.)
In general, early interventions are more effective. But a chronic lack of resources in health services means many people with schizophrenia fail to get help in the early stages of a crisis, Wallace says, reducing their chances of recovery. They may be turned away from hospitals or mental institutions, and it is often the police who end up caring for the patient. The worsening of their condition in these cases only adds to the perception that it is impossible to treat, but the person could have done much better if they had had access to treatment earlier.
The Expectancy Effect: How Your Mindset Can Transform Your Life by David Robson is published by Canongate (£18.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply
Medications Don’t Work (and Other Mental Health Myths)