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Biological psychiatric problems garner less empathy

(Reuters Health) - Given more information about the biology of a mental disorder, doctors and therapists react with less empathy for the patient, a new study finds.

The study didn't involve real patients - only short descriptions of fictional cases. Still, it found that psychiatrists, psychologists and social workers expressed less empathy for patients with conditions explained as biological rather than psychological.

The findings challenge the notion that biological explanations of mental illness boost compassion for millions of Americans who suffer from psychological conditions.

"Our study demonstrates an example of the downside of the trend toward increasingly biological conceptualizations of mental health," lead author Matthew Lebowitztold Reuters Health.

"Overemphasizing this idea that people with mental disorders have something fundamentally wrong with their brains can be dehumanizing," he said.

Lebowitz, a psychology graduate student at Yale University in New Haven, Connecticut, and his colleagues asked 343 U.S. clinicians to read fictional stories about mental health patients paired with explanations based wholly or partly on either genetics and neurobiology, or on childhood experiences and stressful life circumstances.

The vignettes described people with social phobias, schizophrenia, depression and obsessive-compulsive disorder.

In one, for example, the biological explanation for a college student's crippling shyness was that her mother and brother also were shy, and an MRI technician found a part of her brain involved with fear was more active than normal. The psychosocial explanation instead offered details of the shy student's history of childhood bullying.

Overall, the clinicians responded with less empathy for stories with symptoms based on biological factors and more empathy for stories based on psychosocial factors, the researchers reported in the Proceedings of the National Academy of Sciences.

All clinicians reacted with less empathy to biological explanations and with more empathy to psychological explanations of symptoms. But medical doctors reported significantly less empathy overall than other clinicians, the study found. The authors could not explain why.

The study authors called the results "alarming."

"One of the benefits often touted for the biological explanations of mental disorders is that they can reduce blame and personal responsibility for their symptoms," Lebowitz said. "But there are some problems with that. Biological explanations can start to dehumanize patients."

The authors note that the vignettes they presented were oversimplified and failed to capture the complexity of the etiology of mental disorders. The study cannot say whether clinicians facing patients with real problems would react the same way.

If true, however, they caution that the findings may lead clinicians away from proven psychotherapy treatments. The study found biological explanations were tied to clinicians believing less in psychotherapy and more in medication.

James Tabery, a professor at the University of Utah School of Medicine in Salt Lake City, said he found the study findings "worrisome." But he told Reuters Health he hoped the research would be used as a training tool to teach aspiring clinicians about the complex interplay between genetics, biology and environment in the development of psychiatric conditions.

"The study does raise a troubling implication - the thought that the patient-physician relationship is compromised by these biological explanations. I would hope we could use this information to educate aspiring clinicians so that they don't (fall) victim to that trend, to bring it to their attention so they can actively combat it," he said.

Tabery wrote a 2014 book titled Beyond Versus: The Struggle to Understand the Interaction of Nature and Nurture. He was not involved in the current study.

"There's increasing effort among the scientific community to find biological explanations for depression, social phobias," he said. "The researchers have uncovered one potential cost of this development."

Tabery and Lebowitz both see mental health conditions as resulting from a combination of genetics, neurobiology and life experience.

"To reduce it all to one is to miss that complex story," Tabery said.

SOURCE: Proceedings of the National Academy of Sciences, online December 1, 2014.