Well...in fact I'm going to start with biopsychosocial....no...wait...let me drop in another big word and massive concept...spirituobiopsychosocial model of mental health.
The last part was about the biomedical model. This is a model of thought - a way of thinking about stuff which involves well defined concepts - which is dominant in psychiatry. Psychologists and other professionals have other ideas but they don't hold the power in the system the same way psychiatrists do, but this is always changing.
One commonly found alternative which is percieved as the alternative to the biomedical one is the psychosocial paradigm of mental health.
The biomedical one percieves the problem purely as a factor of biological cause and this is what brings the idea of a medical illness. This also means treatments are physical, for example drug treatments.
The psychosocial one is a lot more complicated. Often people have different intepretations and the majority, in my experience, favour weighting the psychological perspective over the sociological one.
The psychosocial idea strings together two important perspectives: individual psychology and the impact of society and conditioning, e.g. parents.
Therapists often explain to their clients that their parents were the reason for their problems whereas psychiatrists are more likely to suggest there's something wrong with an individuals brain. This is how this abstract theory I'm rambling about boils down to clinical practice.
Once a diagnosis is made there is treatment. The choice of treatment is important as are the explanations. The explanations psychiatrists give would be varied but generally skewed to a biomedical paradigm whereas psychologists' responses would be skewed to their frame of reference, the psychosocial paradigm of mental health problems.
Those big words just explain that some people believe one thing about mental health just as others believe other things. It's sort of like football. They're all playing the same sport but people play for different sides.
The psychosocial paradigm has battled for recognition in the Uk. It battles against the dominance of psychiatry. Few people know the hidden battle because we all use the same word - mental health - to describe these different concepts. I think of Eskimos and their words for snow. They have lots of words for snow but we have one. They have lots of snow I guess.
Psychosocial explanations offer a new way of understanding. They're not wholly aligned with psychiatric ones in what they do. They explain the same thing - mental health - but the concepts are different.
The bringing together of psychology and sociology will be a new field of debate but currently the former dominates. People become who they are. Their types are psychiological types and talking therapies can ease their suffering. People are different but have commonalities which psychologists can decern. Certain triats are predictable.
Also...people can be treated. Unlike medication a psychologist uses talking and approved technqiues to turn a person into someone who doesn't have mental health problems.
They don't follow the idea of biological cause nor treatment. The understanding is that people become disordered in their thinking or they think wrongly because of other factors than biology.
I'm holding back for stating what psychologists believe because I don't know enough and, perhaps more importantly, I don't think they do either. I've read enough to know the psychosocial paradigm is not truly innovative. It is just an alternative but too heavily dependent on the medical model and what it provided.
The psychosocial model is heavily biased towards the psychologists perspective and not enough to sociologoical concerns. It says there is still something wrong with the individual. It explains the individual as a series of bad experiences or influences irrespective of biology which cause them to be who they are, specifically to be labelled as mentally ill.
Treatment works to change the individual and that's where it doesn't align itself fully with the sociologist's perspective, I.e. that things other than the individual need to be change, but it does use this occassionally.
I've left out defining the psychosocial paradigm most of all because I don't agree with the consensus defintion which is used far too easily by people who don't spend their days and nights trying to drill down to the pure concepts.
It is more complex, to me, than the biomedical paradigm. People may have a type or something ingrained within them but this can be produced by what happens to them in life. What happens to them in life is just not life experiences, it is the stuff which happens around diagnosis.
What I mean is explained in an example. In Hong Kong psychiatrists had their own way to diagnose anorexia. They didn't use the reference criteria because it didn't present in this way in Hong Kong. My assumption is they understood the negative outcomes of very low calorie intake but it didn't present in the same way as the reference criteria asked.
One day an anorexic dropped dead in the street in Hong Kong. There was a big media story. Journalists went to find out what anorexia was using what most now use. They used Google. When they did that they came across definitions from ICD and DSM, the symptoms which local psychiatrists rarely found. These became published along with the other information on the young woman's death.
After the media report local psychiatrists found more people presenting with the Western symptoms in the diagnostic manuals, the symptoms which are published on sites like Wikipedia.
A media story changed the presentation of anorexia and the case is documented in the book The Americanisation of Mental Illness by Ethan Watters.
This is a weak example of the sociological part of mental illness. Here is a simple example of symptoms changing though, for anyone else interested in mental health, it is a significant example.
Let's explore a better one. Its one of my favourite things to talk about when conveying the complexities of mental health to the uninformed.
The vibrator was invented as a mental health treatment.
Hysteria was an epidemic in days gone by. Today the diagnosis is represented by conversion disorders and, in a small part because of misdiagnosis, disorders of sexual function specifically related to women orgasming.
In bygone times the diagnosis had an unusual treatment. The physician would give a woman an orgasm....or try to at least. Some women required a lot of effort and physicians arms got tired. This was the age of mechanisation and so one bright spark decided to invent a machine. And so the steam powered orgasm inducing machine was born as a health treatment.
This amusing piece of pub banter leads to a thought I find interesting. Did the vibrator heal hysteria? The prevalence of conversion disorders is small in comparison to the hysteria epidemic.
Was it the treatment or did something else change? Was it society and the sexual revolution in the 20th century which washed away much of the old values. Was it an acceptance by the people of women's behaviour? Or did psychiatric diagnosis change? Or something else entirely.
These are all questions outside pure psychology. They're also questions which don't relate to modern treatments, not in the sense that treatment accepts the idea that society has an influence and this is changeable.
The new frontier is not ways to change the individual, to normalise them and force their fit inness or homogeny. The psychosocial is the paradigm of progress but it forgets the -social part too easily when we come to consider treatment.
Social treatment may provide a real new frontier because it sidesteps the problem of domination over choice. Homosexuality was demedicalised because of a social movement. Suicide will be too but our judgemtns about suicide are temporal, just as they were with homosexuality.
I should probably start writing about suicide now but my battery is low.
Sent from my smartphone
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