Mental health stigma and the mind-body problem: Making the case for strategic collusion

To the Editor

In a recent Letter to the Editor, Thomas (2013) engages our discussion of mind-body dualism and its contribution to mental health stigma among health professionals. He insightfully points out that our suggestion to educate health professionals on the biological correlates of mental disorders to assist them in overcoming the ‘functional vs. real’ divide does not successfully break down this dualist paradigm but rather works within it. Thomas is correct: we are colluding with the dualist mindset. Although counterintuitive, we are doing so purposefully and strategically.

Thomas (2013:1) suggests that a more useful way to respond to the problem of mind-body dualism would be to ‘conceptualis(e) distress in terms of interactions between biological, emotional, cognitive, behavioural and environmental factors’. We agree that a more sophisticated understanding of mental disorders can be achieved by humanising the experience of mental distress. As we argue, educating professionals about the organic correlates of mental disorders should not be taken at the expense of other ingredients already known to be successful at reducing stigma among health professionals, like contact-based education and a focus on recovery (Ungar and Knaak, 2013:2).

But we still need providers to see mental disorders as real and treatable in the first place. This is where working with and leveraging the existing knowledge paradigm of health professionals is likely to be more productive than working against it. It has been our experience, for example, that among physicians in particular, anti-stigma interventions that focus on humanising mental disorders (through contact-based approaches, for example) tend to have low levels of participation unless they also include a component that teaches about mental disorders and what physicians can do to help. To this end, presenting physiological information about mental disorders may help to ensure the necessary buy-in among physicians in the first instance, while also providing the humanising component.

Cultural knowledge schemas are deeply entrenched structures, resistant to change. Fields such as human factors and design thinking focus on improving health-care quality within a framework accepting of human limitations, and encourage design affordances (i.e. designing around human limitations) as a way to provide more efficient and effective pathways to the desired result (Brown and Kātz 2008; Vicente 2006). Working from an emic perspective also finds support in cultural psychiatry. Inasmuch as we know that different cultural groups have different ways of explaining and making sense of mental disorders, anti-stigma efforts are likely to be more successful if they acknowledge, understand and seek change from within one’s existing cultural schema (Haslam et al., 2007; Kleinman, 1980).

Ultimately, we agree with Thomas (2013) that educating health-care providers about the biological correlates of mental disorders may not, in itself, overcome mind-body dualism. Strategically colluding with the existing knowledge paradigm of health-care providers may, however, allow us to accomplish a more immediate and practical goal – improving the quality of care of patients with mental disorders, reducing stigma and improving the experiences that patients with mental disorders have in their encounters with health-care professionals.