Fixable or fate? Perceptions of the biology of depression

Mental disorders are increasingly construed in terms of their biology, revolutionizing the conceptualization of psychopathology. Depression provides a compelling example of this conceptual shift: In 2006, 80% of Americans endorsed “a chemical imbalance in the brain,” as a cause of depression, while 64% endorsed “a genetic or inherited problem”—both figures representing double-digit increases from just ten years earlier (Pescosolido et al., 2010). Unfortunately, studies have found that attributing mental disorders (e.g., depression) to such biological causes is associated with prognostic pessimism—a belief that mental health problems are relatively permanent and difficult to cure or treat effectively (Bennett, Thirlaway, & Murray, 2008; Deacon & Baird, 2009; Phelan, 2005; Phelan, Yang, & Cruz-Rojas, 2006). This association appears to stem from the belief that mental disorders have immutable essences (e.g., genes and neurobiology)—assumptions known as “genetic essentialism” and “neuroessentialism” (Dar-Nimrod & Heine, 2011; Haslam, 2011; Medin & Ortony, 1989). Popular media accounts of scientific advances often reinforce these essentialist biases by portraying genetic and neural influences as deterministic and immutable (Dar-Nimrod & Heine, 2011; Haslam, 2011). Importantly, essentialist accounts contradict current understandings of genetics and neurochemistry. Neuroplasticity in the human brain persists throughout adulthood and is important for recovery from mental disorders, including depression (Brunoni, Lopes, & Fregni, 2008). Moreover, despite significant heritability, there is no “gene for” any psychiatric illness (Kendler, 2005), and epigenetics and gene-by-environment interactions show that experience can modulate genetic effects (Lau & Eley, 2010). The notion that biological explanations of mental disorders denote immutability is thus a misperception that should be corrected. The present studies have two aims. First, they examine whether biochemical and genetic attributions for depression are associated with prognostic pessimism among individuals with depressive symptoms. Although considerable research has documented such an association in the general public (Haslam, 2011), the impact of biological attributions on people who actually have mental health problems has scarcely been examined. In one recent exception, genetic attributions for mental disorders were associated with implicit guilt among diagnosed individuals, but this research did not examine prognostic pessimism. Understanding how biological attributions relate to symptomatic individuals’ prognostic beliefs is clinically important, as depressed individuals’ prognostic expectancies can significantly affect their actual prognoses (Rutherford, Wager, & Roose, 2010). The second goal is to examine whether psychoeducation about neuroplasticity and the malleability of gene effects can reduce prognostic pessimism among symptomatic individuals. Given the increasing prevalence of biological explanations for psychopathology, ways of presenting them without increasing prognostic pessimism are urgently needed, but research to date has not focused on this need. For this aim, we drew inspiration from previous research that has used educational interventions to dispel perceptions of immutability and promote the concept of malleability in domains like intelligence and social belonging (Aronson, Fried, & Good, 2002; Blackwell, Trzesniewski, & Dweck, 2007; Walton & Cohen, 2011).