It is fair to say that the public perception of the field of psychiatry, like mental illness itself, is generally not positive. The stigma surrounding mental disorders seems matched by the public’s suspicion of psychiatric practitioners and psychiatric science.
Most of what the public learns about our profession comes from the popular print and electronic media coverage of mental health—coverage that is often technically accurate but negatively biased. The old dictum “If it bleeds it leads” still determines what is considered newsworthy. For example, a representative survey of 70 major U.S. newspapers found in 2005 that 39% of all stories about the mentally ill focused on dangerousness—the single largest area of all mental health coverage (1).
Likewise, media coverage of psychiatric treatments often highlights the negative. For example, the reported link between selective serotonin reuptake inhibitors and elevated risk of suicidal symptoms received prominent media coverage, but the public learned little, if anything, about the fact that the risk of antidepressant treatment is dwarfed by the risk of actual suicide in untreated major depression. In the same vein, the serious metabolic effects of the new atypical antipsychotic drugs have been covered in depth, but there were no front-page stories about patients whose lives have been improved or even transformed by the positive effects of these same drugs.
Given these circumstances, is it surprising that the public has a negative impression of psychiatry and little understanding that we have a range of effective and empirically proven treatments for the major mental disorders?
My experience over the years as a regular contributor to the New York Times, where I write on behavior for the science section, has taught me that it does not have to be this way. There is much that the psychiatric profession can do to engage and educate the public about what we are working on, what psychiatrists actually do, and where the field is headed.
The public is intensely curious about human behavior and the psychiatric profession. At the New York Times, pieces about behavior are consistently among the most widely read and e-mailed in the paper. For a week last January, I did a blog for the science section on mental health (2). My editor wanted to send me just a selection of readers’ questions, but I was curious to read all of them.
While it cannot be considered a representative survey of the public’s interest in mental health, a few recurring themes emerged from the several thousand e-mails I read. Perhaps the most common question focused on what was the optimal treatment for a given mental disorder. Readers wanted to know how they could judge the quality of their own treatments. There was also a lot of concern about the long-term safety of psychotropic medications and skepticism about the validity of psychiatric disorders in general. Many readers raised issues of trust related to stories they had read in the popular press about the self-serving relationship between psychiatric researchers and the pharmaceutical industry.
I spent many hours that week considering how to connect with a faceless but curious audience. How much detail would suffice? Should I cite studies? Should I correct readers’ misperceptions? I tried to do all of these.
What was clear from this experience is that physician-writers, and psychiatrists in particular, have a potentially important role to play in educating the public about the current state of the psychiatric field. Given their unique perspective as clinicians who treat patients, physician-writers have to wrestle with the implications of new findings in day-to-day medical practice. Unlike most journalists, who have to rely on second-hand accounts or expert opinion, physician-writers can weigh in directly with their advice, opinions, and expertise.
Beyond just making relevant information about mental illnesses and their treatments available to the public, one can also speculate about the broader implications of new findings that go beyond current data to consider new treatments that may lie ahead. The question of how far to go is not so easy to answer. For example, I wrote a column about the possibility of designing biologically personalized treatments for depression (3). I speculated, from an intriguing animal study, about identifying human genetic polymorphisms that might predict differential response to antidepressant drugs. Because depressed patients often have to endure multiple empirical trials of different antidepressants before achieving a satisfactory response, the possibility of predicting individual drug response has great appeal.
The reaction to my column was immediate and overwhelming. Many patients called to ask where they could get this “new genetic test,” despite my attempt to make it clear in the piece that this was just a future possibility. Likewise, several colleagues told me of patients who had asked them why they did not know about this test and felt I had raised false hopes in the column.
I can understand my colleagues’ concern. Speculation about the therapeutic implications of new research findings is commonplace in peer-reviewed journals, where a professional audience sees it for what it is. In a newspaper, which is read by many sick and even desperate patients, enthusiastic speculation may unwittingly lead to false optimism, despite qualifications and disclaimers, because this is generally a vulnerable population; those who are ill and searching for effective psychiatric treatment do not always have the luxury of detached analysis.
Perhaps, but I still think the public is capable of critical thinking, even when presented with conflicting data or speculation. I have heard repeatedly from readers who distrust unqualified and blanket assertions by members of our profession about the safety and efficacy of our treatments. For example, when the U.S. Food and Drug Administration required that antidepressants carry a black-box warning about an increased risk of suicidal symptoms, many readers expressed anger at clinicians who brushed aside this data. As one patient put it succinctly in an e-mail, “Tell me the pros and cons. I can make up my own mind.” My impression is that people want more, not less, information and that they appreciate nuance and complexity, so long as we communicate clearly and without jargon.
The fact is that if we do not take a more active role in presenting and explaining our field to the public, others will do it for us. The Internet, which has eclipsed the print media as an information source, has done much to blur the distinction between information and expertise. With little or no editorial filter, anyone can appear to be an expert. Thus, blogs and chat rooms abound with misinformation about the nature of mental disorders and their treatments, something that must be familiar to all clinicians who hear about it from their patients.
In contrast, reliable and authoritative web sites, like that of APA, offer useful general information and resources, but they could do much more to provide guidance on issues of the day that concern the public. News coverage of our field will inevitably raise more questions than the popular media has the space or expertise to answer. We should seize the opportunity to engage the public directly in print and electronic media and explain the broad implications of our new research and clarify current controversies within our field that come to public attention. The public is very interested in what we are thinking about and working on and what it might mean for them in their everyday lives.
1.Corrigan PW, Watson AC, Gracia G, Slopen N, Rasinski K, Hall LL: Newspaper stories as measures of structural stigma. Psychiatr Serv 2005; 56:551–556
2.Friedman RA: A new you: Dr Richard A Friedman on mental health. New York Times, Jan 14, 2008 (http://science.blogs.nytimes.com/2008/01/14/a-new-you-dr-richard-a-friedman-on-mental-health)
3.Friedman RA: On the horizon: personalized depression drugs. New York Times, June 19, 2007 (http://www.nytimes.com/2007/06/19/health/psychology/19beha.html)
Address correspondence and reprint requests to Dr. Friedman, Weill Cornell Medical College, 525 East 68th Street, Box 140, New York, NY 10065; firstname.lastname@example.org (e-mail). Commentary accepted for publication February 2009 (doi: 10.1176/appi.ajp.2009.08121847).
Dr. Friedman reports no competing interests.