Examining the Consequences of Biogenetic Causal Messaging in Major Depressive Disorder
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By ​Esther Yu

​In today’s realm of psychopathology, clinical psychologists and medical doctors alike often describe mental illnesses as being biological, so as to decrease stigma of the illness and deflect blame from the patient. This tendency is referred to as biogenetic causal messaging, which attributes the primary causes of a disorder to biological or genetic factors (Angermeyer, Holzinger, Carta, & Schomerus, 2011). At first blush, messages emphasizing abnormal brain functioning, chemical imbalances, and genetic susceptibility may seem helpful in deflecting blame from the patient due to the stigma that stems from mental illnesses being any less legitimate than physical illnesses. However, recent work suggests that these biogenetic causal explanations may also have unintended negative consequences. The effects of biogenetic messaging on patients diagnosed with Major Depressive Disorder (MDD) have only recently been translated in clinical and psychological contexts, but the literature has already begun to shed light on the unintended consequences of biogenetic causal messaging (Deacon & Baird, 2009). It is important to better understand the physiological and psychological consequences of biogenetic causal messaging and to modify, accordingly, how mental health professionals describe MDD’s etiology to patients with MDD. The overarching goal of this paper is to inform and improve messaging about the origin of psychiatric problems to maximize MDD patient motivation and learning potential.

Integrating Clinical and Social Psychology

Examining biogenetic causal messaging from two different subfields (clinical and social contexts) is crucial due to how closely intertwined the clinical and social spheres are in the realm of psychopathology. Aside from the notion that externalized stigma against MDD is still largely prominent in today’s society, internalized stigma can prevent people from seeking mental health treatment (Miller, 1985). Furthermore, integrating the clinical and social subfields can provide more well-rounded answers due to the considerable amount of research that has been conducted in both realms. 

Examining Biogenetic Causal Messaging in a Clinical Context

In previous studies, experiments have involved giving research subjects falsified genetic feedback (i.e., “you have a gene for depression”) to assess how people diagnosed with MDD respond to biogenetic causal explanations. In a review examining the effect of biogenetic causal explanations, Lebowitz (2019) focuses on how biogenetic causal explanations influence “prognostic pessimism,” or the patient’s belief that he/she will not recover from their mental illness(es). To test this effect, the studies that Lebowitz (2019) assessed provided falsified biogenetic feedback to patients via a faux saliva test and tested prognostic pessimism via a modified version of the Negative Mood Regulation Scale (a scale measuring one’s ability to modify and control one’s negative mood states). Lebowitz’ (2019) review indicated that although biomedical explanations appear to reduce blame, they can also enhance the impression that MDD is innate or unlikely to remit.     

Along similar lines, a study conducted by Salem, Winer, Jordan, and Dorr (2019) examined another variable that plays a major role in treatment outcomes: willingness to accept treatment. Recruiting college students (ranging from healthy to unhealthy) from a large Southern university, this study provided bogus MDD screening results to participants. After receiving this feedback, the subjects were given the option to accept treatment for MDD. The results suggest that those given biogenetic causal explanations for their MDD were relatively unwilling to accept either treatment, while those given psychosocial explanations (which attribute the causes of a disorder to social factors/individual thoughts [Deacon, 2013]) were more willing to accept therapy as treatment. In the realm of depression, seeking treatment or help is often a challenge in itself, especially with stigma against mental disorders. The findings of the aforementioned studies are crucial to better understanding how causal explanations could encourage or discourage patients from seeking mental health treatment. 

Examining Biogenetic Causal Messaging in a Social Context

Studies that examine biogenetic causal messaging from a social perspective often assess internalized/externalized stigma by utilizing questionnaires. These findings prove to be significant, not only because self-reported measures and levels of subjectivity are key measures of stigma, but also because externalized/internalized stigma play important roles in how patients perceive their own illnesses, as well as in whether patients seek treatment for, or trust the treatment for, their illness (Nieuwsma & Pepper, 2010).
 
In a meta-analytic study, Kvaale, Haslam, and Gottdiener (2013) explored how biogenetic messaging affects social stigma. The researchers used data from 28 separate studies and analyzed 4 meta-analyses to analyze the unintended consequences of biogenetic causal beliefs on stigma. According to their findings, although biogenetic causal beliefs did increase the perception that people with mental health issues are dangerous, such messages also helped reduce stigma against mental illnesses--presenting the other side of the debate and supporting the use of biogenetic causal messaging in everyday use. 

On the other hand, research that sheds light on the dangers of using biogenetic causal explanations exists as well. Rusch, Todd, Bodenhausen, and Corrigan (2010) examine the role that biogenetic causal feedback plays in reducing social stigma against psychopathology. In their study, 85 people with serious mental illness and 50 members of the public were administered the Brief Implicit Association Test (a behavioral task that assesses non-conscious cognitive associations between biogenetic models and perceived responsibility). The results showed that, among those diagnosed with mental illnesses, endorsement of biogenetic causal beliefs was correlated with more self-blame--supporting the notion that biogenetic explanations may be problematic when it comes to internalized stigma. 
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Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness (Angermeyer, Holzinger, Carta, & Schomerus, 2011). These conclusions, in addition to those of Rusch, Todd, Bodenhausen, and Corrigan (2010), highlight the duality within the social subfield of research. These contradictions are exactly what makes this realm of research so complex and multi-faceted. 

Conclusions
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Overall, the evidence to date supports the notion that biogenetic causal messaging can have unintended negative consequences on those diagnosed with MDD. Although biogenetic explanations may help to reduce stigma, the harmful clinical effects of using such messages may outweigh these social effects. Furthermore, the findings summarized in this paper show that biogenetic causal explanations can be effective in reducing individual and societal stigma, but can also lead to prognostic pessimism. 

All things considered, there is clearly no singular way to reduce social stigma, cure MDD, and motivate patients all at once. The answer to the current research question is not black-and-white: the notion that biomedical explanations cannot coexist with psychosocial ones reflects mind–brain dualism, and it is this nature versus nurture thinking that inevitably leads to common misconceptions about the causes of MDD in the first place. Instead, it may be more effective to clarify the notion that biogenetically-caused disorders are just as malleable and treatable as psychosocially-caused illnesses. Regardless of the cause, treatment outcomes depend heavily on variables like patient motivation and perceived mood controllability. And although the literature has outlined that biogenetic causal explanations can increase the legitimacy of mental illnesses and help reduce blame, it is important to normalize psychopathology and encourage people to seek treatment when they need it. 

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About the Author
Esther Yu is a junior at Harvard College concentrating in Neuroscience.

​References
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