The drugs don't work (and other mental health myths) | Mental health
There can be little doubt that public attitudes to mental health have already turned a corner. Just consider the sheer number 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 roughly halved between 2008 and 2016, while those challenging that stigma roughly doubled over the same period. And that seems to be having a positive impact on day-to-day experiences of prejudice – people with mental illness now report markedly less discrimination from family, friends and colleagues compared to just a few years ago.
Despite this progress, some myths about mental illnesses are still widely shared, including false claims about the efficacy of treatments. Here are six of the most prevalent beliefs, and the truth behind them.
Mental illnesses are overdiagnosed
Let's start with the idea that people are mistaking everyday distress for a clinical disorder. The claim is a favorite of TV personalities and newspaper columnistswho periodically claims that the increased focus on mental health is reducing people's self-relianceso that they turn to medical interventions, rather than addressing the problems 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 instance, have failed to reveal a large uptick in diagnoses as people jump on the "mental health bandwagon". "The evidence points at stability," says Prof. Johan "Hans" Ormel of the University of Groningen in the Netherlands. He suggests that doctors are just as likely to miss real cases as they are to wrongly diagnose someone who is simply experiencing transient distress.
Time is a healer
Related to the claim that doctors are medicalizing everyday distress, there is the suggestion that many people who think they have depression should show more resilience and simply wait for time to heal their woes. If they are simply suffering transient sadness, after all, then the problem should surely go away on its own?
To find out if this was really the case, researchers in Australia examined the data from 16 clinical trials, in which a control group of patients had been placed on a "waiting list" before being given a treatment. They found that just one in eight of these patients went into remission as they waited for therapywhile the rest continued to show symptoms during the three-month period.
Antidepressants don't work
It's not just the diagnostic process that has inspired medical myths; the treatments used to help patients are often the subject of misinformation.
One common belief is that a common class of antidepressant medications, called SSRIs (selective serotonin reuptake inhibitors), are ineffective, and work no better than a placebo. The idea recently attracted widespread attention following the publication of a paper that raises some serious questions about the proposed mechanism of these pills.
SSRIs, which include Prozac, were thought to address a "chemical imbalance" in the brain, by correcting levels of the neurotransmitter serotonin that is thought to be involved in mood regulation, among other functions. The recent paper, however, examined the evidence to date and concluded that there was no clear link between levels of serotonin and depression.
But there are many other ways that they may help relieve symptoms – by reducing inflammation, which is another potential contributor to depression, for example. Importantly, a recent meta-analysis in the Lancetconsidering multiple clinical trials, confirmed that SSRIs are effective at relieving depression. While they do not work for everyone, they are about 50% more likely to produce a response than placebo pills. In the words of Prof Cathryn Lewis of King's College London and Prof Andrew M McIntosh of the University of Edinburgh, the clinical benefits are now "beyond reasonable doubt".
'Happy pills' simply numb people's feelings
Other myths concern side-effects. You will see many articles, for example, claiming that antidepressant pills “blunt” people's emotions. There is a seemingly good basis for this idea: many patients do report concerns that their medications have muted life's ups as well as its downs, resulting in numbed feelings.
Until recently, however, few studies had questioned the causes of the emotional blunting, and it now seems that the 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. The SSRIs have taken away the more salient feelings of hopelessness – but they don't necessarily increase positive emotions and motivation, says Prof. Guy Goodwin of the University of Oxford, who conducted the recent study: "The feeling of emotional blunting is real, but it isn't caused by the drugs.”
Mental illness makes people more creative
Perhaps the most persistent myth has been the idea that mental suffering is a source of artistic genius – from Virginia Woolf to Kanye West. But anyway evidence supporting the link between creativity and mental illness is extremely tenuous, says Prof James C Kaufman at the University of Connecticut.
"Historiometric" analyses, for example, have plumbed the biographies of notable artists. While these studies seem to suggest that mental illness is more prevalent in creative personalities, any post-hoc diagnoses, based purely on a text, have to be treated with great caution. "They are not super objective," says Kaufman. "Very few creativity researchers believe there is a strong connection." And the idea that mental anguish may inspire great art certainly shouldn't be grounds for avoiding treatment for a serious condition, he says.
Schizophrenia is untreatable
Despite the changing attitudes to other mental illnesses, schizophrenia is still subject to a huge amount of stigma, says Marjorie Wallace, the founder and chief executive of the mental health charity HEALTHY. "Schizophrenia is still a 'forgotten illness' because it has been squeezed out of all these anti-stigma campaigns, which have emphasized stress, depression and anxiety." This means that most people have only a vague understanding of the condition, despite the fact the lifetime prevalence is around 1.5% in the UK.
One big misconception is that schizophrenia is simply "untreatable". With the right medications and talking therapies, however, 45% of people with schizophrenia go into remission after one or more psychotic episodes, while 35% show mixed patterns of remission and relapse. The belief that there is no chance of recovery can be a cause of great despair for people who have been diagnosed with the disease, and their families. (The campaigner and film-maker Jonny Benjamin famously described the diagnosis as feeling like a life sentence.)
In general, earlier interventions are more effective. But a chronic lack of resources in the health service means that many people with schizophrenia fail to get help in the first stages of a crisis, says Wallace, which reduces their chance of recovery. They may be turned away from hospitals or psychiatric facilities, and often it will be police officers who end up dealing with the patient. The escalation of their condition in these cases only adds to the perception that it is impossible to treat, yet the person may have fared much better if they had earlier access to treatment.
The Expectation 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