Messaging in Biological Psychiatry: Misrepresentations, Their Causes, and Potential Consequences

Abstract

Most experts in the field of psychiatry recognize that neuroscience advances have yet to be translated into clinical practice. The main message delivered to laypeople, however, is that mental disorders are brain diseases cured by scientifically designed medications. Here we describe how this misleading message is generated. We summarize the academic studies describing how biomedical observations are often misrepresented in the scientific literature through various forms of data embellishment, publication biases favoring initial and positive studies, improper interpretations, and exaggerated conclusions. These misrepresentations also affect biological psychiatry and are spread through mass media documents. Exacerbated competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings. Moreover, journalists are unaware that initial studies, even when positive and promising, are inherently uncertain. Journalists preferentially cover them and almost never inform the public when those studies are disconfirmed by subsequent research. This explains why reductionist theories about mental health often persist in mass media even though the scientific claims that have been put forward to support them have long been contradicted. These misrepresentations affect the care of patients. Indeed, studies show that a neuro-essentialist conceptualization of mental disorders negatively affects several aspects of stigmatization, reduces the chances of patients’ healing, and overshadows psychotherapeutic and social approaches that have been found effective in alleviating mental suffering. Public information about mental health should avoid these reporting biases and give equal consideration to the biological, psychological, and social aspects of mental health.

Towards a more relational psychiatry: a critical reflection

“…A third way in which the two differ is that critical psychiatry is more prepared to engage with research evidence about the aetiology and treatment of mental health problems. Methodological bias leads to exaggerated claims for the neuroscientific basis of mental health problems (Dumas-Mallet 2012) and for the effectiveness of psychotropic drugs (Fisher 1997). For example, unmasking (‘unblinding’) in clinical trials can lead to placebo amplification, meaning that any statistically significant difference in trials could be an artefact.…”

Languaging psychopathology: neurobiology and metaphor

“…Still, reductive biological explanations remain prevalent. This fits the biomedical model that mental disorders are brain disorders which are therefore correctable with targeted medications, a concept that in recent years has come under increased scrutiny (6). Though novel nosological efforts to better characterize psychopathology are in active development, such as the Hierarchical Taxonomy of Psychopathology (7), they are not widely adopted by clinicians or scientists compared to the dominant neurobiological paradigms.…”

“…Meaningful explanation is found by holding multiple truths in a manner that includes both clarifying and poetic aspects of language use. 6 We have argued that mechanistic terminology recruited by contemporary advances in neurobiology cannot be simply transposed as convenient descriptors of complex mental processes or individual subjective experience. As so eloquently suggested by philosopher and poet Jan Zwicky in the opening epigraph, our nonmetaphorical languagethat is, the language of neurobiologyis arguably the necessary foil to facilitate metaphorical reasoning that embodies the human art of medicine.…”

The first appearance of EEG evidence in a UK court of law: a cautionary tale

“…14 Sharing new technologies and their results with the popular press also continues to be fraught with difficulties, a recent journal article observing that, quite apart from reporter error or deliberate exaggeration, 'competition, hyperspecialization, and the need to obtain funding for research projects might drive scientists to misrepresent their findings'. 15 In March 1939, when this trial occurred, Walter was about to move to a new permanent post, as scientific director of the Burden Neurological Institute in Bristol, a new venture funded by a bequest from a Reverend Burden, a local healthcare entrepreneur. 4 Far from enhancing his reputation, and that of the EEG, Walter's appearance in court lead to embarrassing articles in the national and regional press and a near arraignment for contempt of court.…”