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frizzy-hoot · 3 years

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Neuroessentialism and mental health

Hi!

Time for a little rant about neuroessentialism.

The aim of this post is to provide the opportunity to be conscious of the things that influence us when it comes the way we think about mental health and to challenge stigma around mental health.

First off, I’m not a doctor and the information here cannot serve as medical advice. Always consult your doctor before changing your medication or treatment approach.

Secondly, a lot of the information I present here is elaborated on and further discussed in an episode of the Psychiatry and psychotherapy podcast called “Free will in psychotherapy and psychiatry Part 3” and while I will link to as many things as I can, you can also find a lot of the source material on the website for the podcast. https://www.psychiatrypodcast.com/psychiatry-psychotherapy-podcast/2020/7/22/free-will-in-psychiatry-amp-psychotherapy-part-3

So, I see a lot of people talking about mental health on here through a neuroessentialist perspective in memes or text format and I don’t think they’re aware of it so. I’d like to talk a bit about it.

First, I’ll offer a definition of neuroessentialism:

" Neuroessentialism is the view that the definitive way to explain human psychological experience is by reference to the brain and its activity from chemical, biological and neuroscientific perspectives. For instance, if someone is experiencing depression a neuroessentialistic perspective would claim that he or she is experiencing depression because his or her brain is functioning in a certain way.” - Schultz, W. (2018)

I see people talk about, for example, depression in this way often: in memes when people say "I have a literal neurotransmitter deficiency, Karen." or " God forgot to add serotonin when he made me".

Now, why can this be problematic?

Before I get into the issues with this perspective, I will first acknowledge that one of the reasons this view has become so prominent lately is because it aims to reduce stigma around mental health issues.

In the podcast episode mentioned above they point out that “Efforts to reduce stigma should be praised, but they should also be critically analyzed to determine if they meet their goal.”

And that’s the thing neuroessentialism, while aiming to reduce stigma and shame it only does so short term and ends up contributing to stigmatizing attitudes about mental health.

I want to say that it's great to see people fight back when it comes to stigma around mental health. That's what I see people do in these memes. But the effects of neuroessentialist perspectives end up othering people; making them inherently “bad”, “defect” or “helpless”.

Here the deterministic aspect of neuroessentialism comes up - it tells us that there’s something wrong with our brain that we can’t change. It alienates people because it chips away at their and our belief in their ability to change. If you believe that someone's mental issues are rooted exclusively in brain biology, you're less likely to believe that they can control their behavior and so it is less worth the effort of getting them better. This brings about more stigma.

Another thing that’s important to talk about is how neuroessentialism is an extremely simplistic perspective on mental health. And that’s also one of the reasons it has become so big- because it offers a simple explanation to very complicated illnesses.

Here, I want to add a quote by Psychiatrist and psychotherapist Dr. David Puder:

“There are prominent theories out there that we know just aren’t true anymore and that get propagated because they are simplistic ways of explaining things; for example, depression is because you have low serotonin in your brain. That’s just not true. It’s a whole lot more complicated than that.

You could probably show 20 or 30 things that are going on in the brain during depression. Inflammation. Like initially I thought ‘oh depression is inflammation!’

Well, it turns out not all depression has inflammation. Maybe, only one third [of patients with depression] have inflammation markers in the brain.”

We have been looking to neuroscience for an explanation when it comes to mental health and been satisfied with the idea of a simple "chemical imbalance" but truth is that there are many more neurotransmitters which significantly affect our brains when we talk about depression – it’s so far from just serotonin.

Another example of how neuroessentialim can oversimplify mental health is with brain scans. So, in the podcast episode mentioned above, Dr. Puder talks about how he was really interested in emotions and especially studying anger and he was looking at all this research on the different areas in the brain involved in anger. After a while, he says, he began to understand that it’s really complex and you can’t just point at one area and say that’s the area that’s involved in the emotion anger. There are several areas involved in just that one emotion and different studies show different things.

The truth is that the manifestation of mental illness in the body is a very new area of research and we haven’t found physical manifestations for most mental illnesses and the important thing to note here is that despite this we still do have ways of treating all of them.

Alright, all this can seem quite removed from us so how does neuroessentialsim affect us?

In the episode the guest star, Mathew Hagele, further discusses the article which provided the definition on neuroessentialism above: “Shultz looked at studies investigating how patients viewed their own prognosis and later the same with professionals.

The study found that biochemical or genetic attribution scores were a significant predictor of longer expected symptoms duration and lower perceived odds of recovery.” (Lebowitz et al., 2013, p. 523).

Now, this means that the more a patient attributes symptoms of their psychopathology to genetic (inherited disorderes) or biochemical (serotonin deficiency for example) factors, the longer they expected to struggle with their disorder and the smaller the belief that they can recover.

If a person doesn’t believe they can be helped or get better they’re a lot less likely to try and a lot more likely to feel scared and hopeless.

The other side of this coin is the effect the neuroessentialist narrative has on clinicians which Matthew Haegel dives into in the next part of the quote:

“Another study shows that clinicians believe psychotherapy to be less effective when shown biological descriptions of mental health pathologies...

They took a couple different disorders that these clinicians were looking at and one group had a biological explanation and the other did not- had a different type of explanation. And [in] the results that were across disorders, the biological explanation yielded significantly less empathy than the psychosocial explanation. They also did some additional analysis and they found that biological explanations yielded less empathy than the psychosocial explanations among both MD’s and non-MD’s…..”( Lebowitz, M. S., & Ahn, W. K. (2014). )

So, in these studies we see that a neuroessentialist perspective lowers empathy for the patient in medical health professionals and people who weren’t medical health professionals.

Okay, so how does this perception of the patient’s illness affect the patient’s treatment?

I’ll start with a quote where Hagele elaborates further:

“…and finally, that clinicians perceive psychotherapy to be significantly less effective when symptoms were explained biologically than psychologically…[ Lebowitz, M. S., & Ahn, W. K. (2014). ]

basically, linking the idea that the diminished importance of psychotherapy among mental health professionals ascribing to the concept of neuroessentialism is doubly harmful when considering the multiple contexts in which psychotherapy matches or outperforms pharmaceutical interventions.”

What Hagele points out here is the way neuroessentialism can lead to a less effective and ethical treatment of mental illness. It makes us approach an issue in one manner only- fix the brain, fix the behavior. But sometimes what can treat he issue in the brain is, working on the behavior. This can be talked about in terms of meds vs. psychotherapy.

So, seeing mental health from a neuroessentialist perspective, completely excludes the effects of psychotherapy. A classic example is CBT (cognitive behavioral therapy) in which we have “Cognitive restructuring”: a psychotherapeutic process in which a person learns to recognize maladaptive or distressing thoughts and teaches their brain to consider other perspectives or different thought pattern. This is an example of “work on behaviour to better brain” rather than “working on brain will fix behavior”. According to strict neuroessentialism therapy shouldn’t work as well as it does but there is a really big body of science backing psychotherapeutic intervention and its efficacy compared to psychopharmacological intervention.

I feel I should address the discussion of Meds vs. therapy before I continue, (it is a whole topic worthy of a post on its own) but to be brief, they work best together and if you’re weighing one against the other psychotherapy has more long-term effects and barely any side effects compared to medication. There are other factor affecting what would be the most effective treatment approach that further nuances this discussion.

Now this is all a pretty big picture but how is this seen every day?

Well, its seen in the downplaying of the importance of therapy. Often, I see this as people normalize behavior where they kind of devalue the importance therapy or put off working on their issues in therapy with the excuse that it’s only for “crazy” people or not something worth the effort.

Therapy then increasingly is seen as this unimportant, extra thing rather than, in most cases, the most effective and safe treatment. And the less crucial therapy is considered, the less accessible it’s going to be – in the U.S. it can often be easier to get your insurance company to cover for a doctors visits where the treatment would be for your GP to prescribe you an antidepressant than an inpatient or outpatient treatment with a mental health professional.

Another point I wanna put out there is that that neuroessentialist narrative is incentivized by pharmaceutical companies. Dr. Puder talks about his own experience in the podcast episode and makes sure to stress that practitioners are humans too and will of course be biased towards something if that something writes them a check or pays some of their expenses. In the episode they discuss a way in which we have seen the neuroessentialist narrative progress:

“Second, there is evidence that the significant increase in direct-to consumer (DTC) advertising for antidepressants is related to rising prescription rates (Park & Grow, 2008). Such advertisements portray depression as a biological medical condition that can successfully be treated with medicine (Lacasse & Leo, 2005; Leo & Lacasse, 2008)” (613).

Now, medicine is an important tool in psychiatry and there is a lot of unnecessary stigma around medication for mental health conditions. I am under no circumstances arguing that medication is bad and therapy is the only right way to treat mental illness. That would be an extreme simplification and invalidation of human experiences. I also wanna acknowledge that being able to go to therapy in many places in the world is a matter of privilege. Therapy simply isn’t accessible for everyone and people can choose an “only medication approach” for many valid reasons. And if that’s the only treatment that was accessible to you I’m really proud of you for taking care of yourself and doing what you can.

If your doctor has prescribed you a medication please take it and know that the purpose is to help you and that you are worthy of help and good health care. The situation where I would suggest to be a tad critical is when people come in with disorders and issues that they have dealt with for years and most of their life and they are just prescribed an antidepressant and sent home. That simply isn’t effective and ethical care. In that case it is worth investigating getting access to a mental health practitioner as well as continuing with medicinal treatment.

I could talk about this for hours but the last thing I wanna get across is that this is a societal problem. I don’t suggest we turn away from pharmaceutical intervention which saves thousands of lives and helps people get better, rather that we work to make psychotherapy (which can be and is crucial for long term remission and recovery) more accessible for when it’s appropriate.

When your doctor tells you that this invisible illness is because of your biology most people feel validated and experience less shame. The fact that people feel like they need to have a tracible biological “anomaly” in their brains to be worthy of treatment and care speaks to an invalidation that many feel. But the issue here is that we're taught to invalidate invisible illness in society which in the end makes people delay critical treatment or blocks access to ethical and effective care.

We also have to acknowledge that with the technology we have now we are not able to know whether all mental illness manifests in the brain in a way we can see so hinging our worthiness of help and care on the definition is in the end harmful.

TL;DR

Neuroessentilism can validate a patient and bring relief of shame short term but ends up contributing to stigmatizing attitudes and thus doesn’t help reduce stigma overall.

The neuroessentialist narrative can downplay the efficacy and criticalness of psychotherapeutic intervention

Neuroessentialist perspectives foster lower empathy levels for patients in medical providers and non-providers alike.

Neuroessentialist perspectives of a patient significantly increases levels of prognostic pessimism which leads to worse treatment outcomes

Neuroessentialism arose because of a real invalidation people feel around their mental health and it is a societal issue we need to work on

We can combat neuroessentialism and stigma by working to make psychotherapy more accessible and talking about our experiences openly as well as giving each other kindness and empathy.

#i tried to make this a readable as possible but shoot me a message if i missed soemthing #neuroessentialism #rant post #mental health struggles #recovery data #psychiatry #medication #psychotherapy #therapy #psychology

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fixomnia-scribble · 3 years

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Citations On Tap!

For those asking for forensic anth & forensic arch references for assessing skeletal remains as transgender, by traditional methods and using new techniques. Under cut because LOOOONG. This is the list I used for a two-term thesis. The reference lists in these pubs can provide many more suggestions. While most of these are unfortunately behind academic access walls, there should be plenty of abstracts to read that are public.

ETA: Ha! All the qual research and interviewing refs are still in there too. Well, if they’re useful, have at it.

Assessing Transgender Skeletal Remains

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3. Barrouquere, B. (2019). Under attack. Southern Poverty Law Center Intelligence Report (Spring 2019), 19-24.

4. Berg, G. (2013). Determining the sex of unknown human skeletal remains. In: Tersigni-Tarrant, M. & Shirley, N. (eds). Forensic Anthropology: An Introduction. Boca Raton: CRC Press

5. Bersatos, A., Papageorgopoulou, C., Valakos, E., & Chovalopoulou, M. (2018). Investigating the sex-related geometric variation of the human cranium. International Journal of Legal Medicine, 132(5), 1505-1514. https://doi.org/10.1007/s00414-018-1790-z

6. Blair, E. (2015). A reflexive exploration of two qualitative data coding techniques. Journal of Methods and Measurement in the Social Sciences, 6(1), 14-29. doi:10.2458/jmm.v6i1.18772.

7. Boyer, Y., Odeyemi, A., Fletcher, E., and Fletcher, J. (2019). Vulnerable Targets: Trans Prisoner Safety, the Law, and Sexual Violence in the Prison System. Canadian Journal of Women and the Law, 31(2), 386-412. doi: 10.3138/cjwl.31.2.07

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#forensic anthropology #forensic archaeology #tumblr archaeology #archaeology #transgender #transgender skeleton #bones #anthropology #bioarchaeology

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arco-pluris · 4 years

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Know your gender essentialisms to know how to debunk them:

Bioessentialism — belied that gender is determined by biology, and that it is immute, unchangeable, permanent, and innate. (Subtypes include neuroessentialism, chromosomal essentialism, genital essentialism)

Theo-essentialism —- belief that Gender is determined by God or **natural law**, and that it is immutable, unchangeable, permanent, and innate(Subtypes might include Christo-essentialism, Islamo-essentialism, Judeo-essentialism, etc.)

Juris-essentialism — belief that gender is determined by recognition of a state authority (for example, through law, or drivers license gender markers), is immutable, and *innate* in a sense, though based on changing precedent and policy.

Socio-essentialism — belief that gender is determined by conditions pertaining to the social contract between an individual and their society (e.g. determined the government, or by demands of the “sexual marketplace”), is immutable, unchangeable, permanent, and innate.

Linguistic essentialism —belief that gender is determined by constraints of language, is immutable, unchangeable, permanent, and innate.

Psychological essentialism — belief that gender is determined by essential psychological types, is immutable unchangeable, permanent, and innate.

I'm basically archiving this thread terms. Determinism might also another word for essentialisms. There are many ways of being aligned with a gender, specially the binary, since for some people gender has binarized essences and senses.

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geneticoreboostmale-blog · 6 years

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Tonaki Tinnitus Protocol Review : Side Effects,Benefits And Where to buy?

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Are there any setbacks?

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