As the saying goes, all good things must come to an end. For more than eight years, we have authored this column on facts and fictions in mental health, an opportunity for which we are profoundly grateful. Nevertheless, because of growing commitments and other pursuits, we have decided that this will be our last column.
We have written these articles for a simple reason: we live in a world in which mental health literacy is more important than ever. According to survey data published in 2010 by psychiatrist Mark Olfson of Columbia University and psychologist Steven Marcus of the University of Pennsylvania, about 3 percent of Americans are in psychotherapy, with most of them also receiving medication. Moreover, as psychiatrist Thomas Insel, director of the National Institute of Mental Health, observed in a 2014 strategic plan, the incidence of a number of mental health conditions, including autism spectrum disorder and major depression, has soared in recent years, although the significance of these rising rates remains a matter of controversy.
Despite its pervasiveness, many people are woefully misinformed about mental illness. This fact is worrisome because inaccurate notions about mental illness can be harmful. For example, the erroneous belief that people with schizophrenia are prone to violence can lead to unjustified stigma [see “Deranged and Dangerous?”; July/August 2011]. And the unsupported assumption that antidepressants are more effective than cognitive-behavior therapy for the long-term treatment of depression can dissuade individuals from seeking the most beneficial interventions for their illness [see “The Best Medicine?”; October/November 2007].
In this concluding column, we look back at our past contributions and extract some of their most important lessons. We hope to leave readers with a user-friendly kit for sorting fact from fiction about mental health and illness.
A misunderstanding mind
Several common errors of reasoning make all of us susceptible to certain misconceptions about psychological health. For instance, the availability heuristic is a mental shortcut by which we gauge the frequency of an event by the extent to which it is fresh in our mind. For example, the mistaken belief that most children of divorced parents display poor psychological adjustment probably stems from the fact that when a child experiences serious problems after a divorce, we often hear about it. Conversely, when a child adapts well to a divorce—as most do—his or her resilience is almost never discussed. As a result, we may think of divorce as more closely tied to psychological problems than it actually is [see “Is Divorce Bad for Children?”; March/April 2013].
Another common logical error is post hoc, ergo propter hoc, meaning “after this, therefore because of this.” Our minds are continually on the lookout for connections between incidents, which may lead us to conclude that an event preceding the emergence of a psychological condition caused the condition. For instance, many people continue to believe that childhood vaccines (especially those containing the preservative thimerosal) cause autism because the usual time for vaccinating children—soon after they turn one—comes just before the first signs of autism typically become evident. This connection in time is apparently more persuasive to many than the multiple, large epidemiological studies that have debunked the link [see “Autism: An Epidemic?”; April/May 2007].
In addition, many misconceptions about mental illness contain a kernel of truth that can lead us to false conclusions. For example, just because dogs, horses and some other domesticated animals provide emotional warmth that can temporarily relieve anguish does not mean that animal-assisted therapy alleviates the main symptoms of major mental disorders such as autism, schizophrenia and anorexia nervosa [see “Can Animals Aid Therapy?”; June/July 2008].
Misled by the messenger
As information becomes increasingly abundant and accessible, the ability to evaluate articles, books and Web sites grows more crucial. About 3,500 self-help books appear every year, but few are based on research or are subjected to scientific scrutiny [see “Do Self-Help Books Help?”; October/November 2006]. Likewise, many psychology Web sites are replete with misinformation. In a 2012 survey of the sites of eight national autism associations, special education professor Jennifer Stephenson and her co-authors at Macquarie University in Australia found that most of them provided misleading information about the effectiveness of interventions. For example, of 33 autism treatments suggested on these sites, solid empirical support exists for only three. (Those three are grounded in the principles of behavior modification, a technique that reinforces adaptive activities.)
The mainstream media can also spread distortions, whether because of mistakes rising from deadline pressure, misunderstanding of source material or an overzealous desire to appeal to the public. As psychologist Thomas Gilovich of Cornell University observed in his 1991 book, How We Know What Isn't So, reporters almost always sharpen the central point of an article and leave out peripheral details. They also routinely exaggerate claims in the service of a good story. On October 7, 2013, the front page of The Sun, a popular British tabloid, trumpeted: “1,200 killed by mental patients.” The headline implied that psychiatric patients had murdered 1,200 people in the U.K. Yet that figure included not only patients in the mental health system but also individuals who were judged retrospectively by researchers to be experiencing symptoms of mental illness, a judgment that is highly subjective.
Even when a story is more nuanced, the headline may still hold sway in people's minds. Psychologist Ullrich Ecker of the University of Western Australia and his colleagues collected data last year showing that deceptive headlines, such as “Fears of Fluoride in Drinking Water” (which topped an article emphasizing the safety of fluoride in water), can provoke biased inferences about the story, leading to misconceptions. Thus, readers must not only continue past the headline but must also carefully encode any details in a story that contradict or add nuance to its title. We should beware, too, of misguided attempts to create balance in stories. Journalists sometimes feel obligated to present both sides of an issue even when the scientific consensus is clearly on one side.
We hope that this column and the more than 50 that came before it have helped educate readers about psychological health in ways that matter for both individuals and society. The tips and analyses we have offered over the years are hardly panaceas, but they can serve as a guide through the increasingly complicated maze of claims about mental health.
