How do biases affect decision making in mental health?
Bias in treatment recommendations is a problem health care in general. The focus on my research looks specifically at the biases in mental health care. In this field we find literature that suggests certain disorders are viewed as more “psychological” in nature and others are viewed as more “biological” in nature, and to some degree, there is evidence for this distinction (for example, see Ahn et al., 2009). However, this thinking can be problematic for two reasons: (1) mental health clients with a disorder that is viewed as more psychological in nature than biological in nature are seen to be more at fault for having their illness (Miresco & Kirmayer, 2006); and (2) holding someone accountable for his or her illness is associated with recommending psychotherapy for treatment rather than medication (Miresco & Kirmayer, 2006; Ahn et al., 2009). Perhaps this seems logical, if the cause is psychological then psychotherapy should be the best treatment choice, and when the cause is biological then medication should be the best treatment. However, this implies dualistic thinking. That is, when considering that psychological symptoms are best treated by medication it implies that there is a separation between the psychological and the biological self. Dualism assumes that our mind is non-material and therefore separate from our physical beings. The current paradigm in psychology rejects this notion and teaches materialism. According to the materialist paradigm our mind and body are both made of matter and therefore are not to be treated as separate parts of the person that need to be treated different. This is confirmed from our knowledge that changing our cognition can change the physical aspects of our brains, and also that medication can change our cognition. Additionally, we know that psychotherapy and medication both affect the brain (Kandel, 1998). Therefore, the bias that distinguishes psychological and biological causes of disorders can negatively affect the way we view individuals with mental illness and the treatment that is recommended for them.
In the current literature we see that when people are held responsible for the cause of their illness, whether it is a physical or mental illness, they are stigmatized (i.e. Crisafulli, von Holle, & Bulik, 2008). My current research seeks to understand whether the treatment choice of clinicians (and opinions of laypeople) differs when the client is clearly to blame for the causes of his/her mental disorder compared to when the client is not at blame for the causes of his/her mental disorder. One prediction of my research is that explicitly ascribing blame to the client will influence treatment choices such that those at blame are more likely be prescribed psychotherapy over medication for treatment.
To fully understand the influences of attitudes and biases in clinical decision making it is imperative to examine the biases themselves, the nature of the biases, and how they affect decision making and client care. Researching what biases exist in mental health care is important to further understand how these biases develop and the impact they might have in the mental health field. It is also imperative to look for ways to reduce biases in practice, either by awareness, training, or use of decision making aids.
Ahn, W., Proctor, C., & Flanagan, E.H. (2009). Mental Health Clinicians’ Beliefs About the Biological, Psychological and Environmental Bases of Mental Disorders. Cognitive Science (33), 147-182.
Crisafulli, M. A., Von Holle, A., & Bulik, C. M. (2008). Attitudes toward anorexia nervosa: The impact of framing on blame and stigma. International Journal of Eating Disorders 41(4), 333-339.
Kandel, E. R. (1998). A new intellectual framework for psychiatry. American Journal of Psychiatry (155), 457-469.
Miresco, M. J. & Kirmayer, L. J. (2006). The persistence of mind-brain dualism in psychiatric reasoning about clinical scenarios. American Journal of Psychiatry (163), 913-918.