Psychosocial paradigm

It's difficult. For many reasons. One is meeting the practioners and their lack of conceptual knowledge. For all the ills of psychiatrists there's at least that saving grace: they know their stuff. They have to of course. They're experts and powerholders.

The psychosocial paradigm has battled to find purchase. It has public support, especially with the use of the distress continuum, but in the echelons of power it is still fighting for dominance. This is changing in recent times as psychiatry's biomedical options face the onslaught of evidence.

The psychosocial paradigm as a concept is poorly understood. This is the key problem. Without the crystalised concepts it is just another dogma rather than pursuit of scientific pursuit.

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What is mental health? Psychosocial

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.

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I feel like I've misused language

I was thinking about the last two pieces I've written for the book I'm trying to write. One was more web format and more communicative but used fewer big words. The other was about something I feel less confident about. As I explored the concept I used big words. I tried not to but I was in an area where I feel inept to communicate properly. I switched to the language I read but which doesn't help in communicasting stuff to all people.

I'm avoiding using big words but in the last piece I may have used a lot or whipped up concepts which are still abstract in the minds of many readers.

This is a technique of authority. Big words, like glasses, make a person seem smart. People listen to smart people without thinking. They assume they're right.

If I ever fail in this discourse it is when I stop you thinking. I'm not smart. I just read a lot. And drink and stuff. I'm not any smarter than you.

What I hope is readers read and comprehend and think. The last bit it the most important. My examples may oversimplify but they comminicate the important bit and, most of all I hope, get a good mind thinking.

Slipping into an authority mode by a switch of language from lay to professional or specialist is not a technqiue I wish to use in what I write here though I'm afraid to admit I do do it in my personal life.

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What is mental illness ? - the illness paradigm

That's a fair tirade I've just written. It's somewhat antipsychiatry which, I admit, I am too.

But I must balance the argument. I've picked certain examples which I hope provoke an internal debate in the reader. This is meant to be mind expanding stuff. This is all about concepts and I've avoided getting bogged down in the language.

Now let me write for psychiatry. This is also one of the facets of the machine which is the mental health system. It is a good thing, one borne of compassion.

Before psychiatry existed there were just the problems of what society did to the disadvantaged. The Industrial Revolution saw many human types get a better quality of life but the inequality gap widdened. Those who were worst off became so much more worst off.

A social problem came to exist. The mad and what to do with them. Madness is as complex a concept as mental illness but it had a terrible price in those days. The reality was many of the mad were outcast, excluded, homeless, living in poverty and total pariahs in mainstream culture as the Industrial Revolution took hold.

Society had explanations and systems to deal with madness. The Church provided them. Its power waned during the Industrial Revolution and the systems replaced the function with psychiatry but in the inbetween stage there were many ills wrought upon the mad.

The mad ship...or ship of fools?...I've never known in that term relates to the boat the forefathers of America sailed on...the Mayflower or something. The mad ships is what I'm talking about. Towns would get the mad together then put them on a boat and push them out to sea with little care for their lives. Those mad ships lucky enough to make it to the next town would have more mad people crammed onboard before they were once again pushed out to sea.

Exclusion was a far greater problem. The mad did worse than even the untouchable Indian sub caste, a caste at the cultural hierachy which sat at the bottom of Indian culture.

Psychiatry's inception was a bless, though perhaps the blessing is one in disguise or perhaps "into the frying pan and into the fire" are better descriptions.

Before psychiatry fully came into existence there was a series of laws which aimed to help the poor and outcast. These created the asylum system. A lot of old leper colonies became used to house the mad.

The word mad is not a popular one, at least for those who have no mad pride, but it relates to a concept. The concept is broad but it relates to a group of people initially unified by concepts such as exclusion, poverty and a subjective temporary social judgement of abnormality. The judgement is the severity or nature of the degree of abnormality.

Before the psychiatric labels there was the result of mental illness. The result is the prognosis. Here's what I mean. Back then a person who was intensely miserable was difficult to handle. There was no explanation of mental illness.

Let's say they didn't wash nor take care of themselves, though sad thoughts, didn't eat much, had few friends and was incurably unhappy. After a while people would stop caring about them. There was no idea of mental illness so it was left to unadulterated human compassion and sadly is in short supply. The depressed person - to use today's term - would be jobless and hard to put up with. Without mental healthcare or welfare they may end up homeless and starving to death on a street corner.

This is what was happening before the asylum system and psychiatry came into being. The outcast became looked after in the institutions and the caretakers of these instituions, eventually, became psychiatrists.

It was the first prepsychiatrists who brought together the idea that the mad were not mad. They were ill. It was an illness which caused their being to be judged as abherrant and abnormal. It was just like dementia. Dementia was already established to be an organic brain illness and it was associated with a change in behaviour to one which was considered undesireable. The mad exhibited undesireable behaviour and so they must be ill too. Their behaviour was a result of a biological illness - a true medical illness - which had certain symptoms.

With the removal of choice from the individual by using the idea that their actions were the result of a biological illness created something important: the privilege of the invalid. A lot of people may not like this phrase and I'm sure there's a better one. I happened across the concept, and the term, when dipping into the work of Thomas Szasz.

Mental illness comes with many things. One of them is the forgiveness and compassion. As I explained the idea of mental illness is fundamentally based on biological differences and a prognosis.

The prognsosis forms part of the privilege of the invalid. The root of the privilege of the invalid and the root of the medicalisation of behaviour is strongly rooted in the biological, specifically the biomedical, paradigm. What I mean is the strict adherence of mental illness to biological causes is where the modern privilege of the invalid is extended to the mentally ill. They're ill. That's the point. Other paradigms require different understandings to hijack and formalise the aspect of the privilege of the invalid.

I've not spoken about the psychosocial paradigm of mental illness...or perhaps mental health problems is a more appropriate term to use to align the concept with the lingua franca. And I'm not going to. I'm going to talk about something which I'm afraid to admit I know little about.

In fact I don't know much about much. My meanderings in mental health are meant to be points to consider and debate. I do know a lot more about mental health than the average person but in a sense I don't, in a far higher sense.

What I understand least well is the prognosis aspect of the medicalisation. This is defined by a negative outcome or life course on measures of clinical outcomes and social outcomes. I'm not sure if social outcomes is merely analogous or fully synonymous with social disability.

It's the aspect of social disability rather than the bastardised psychiatric measures I'm most interested in but the consensus understanding is poorer clinical and social outcomes are a bad thing which advances in mental health practice seek to remedy.

I'm talking about the exlusion and discrimination and stigma and reduced life expectancy and high rates of poverty and unemployment and all sorts of other bad things which are associated with mental illness.

These are bad things. These are things an advanced society would wanto to protect citizens from. This is what psychiatry does for the mentally ill. For all its bad things mental health treatment, in theory, is meant to affect those outcomes. It is, in theory, meant to reduce the burden of disability the individual has to suffer.

Severe mental illness is shit. It is a life of shit. About 5% of people diagnosed with schizophrenia kill themselves because life is shit. They account for 20% of the completed suicide rate. This is the impact of the burden of disability and it's why schizophrenia and other severe mental illnesses are considered akin to severe physical disabilities.

This measure of disability and the work to overcome it is a good thing. It makes things better for the worst off. It saves lives. It keeps people out of poverty.

It doesn't do it for everyone though. The privilege of the invalid is extended to the mentally ill just like those with physical disabilities but there are still poor and disadvantaged people who are not extended this privilege. They are on state welfare rather than the higher rate for medical welfare. If the non-mentally kill or do any other serious crime then they will not have the privilege of the invalid to protect them either.

Let's work through a simple example. A child who spends time in a childrens home or foster home is likely to do less well in life. Some may be diagnosed mentally ill and others won't. They still suffer the same prognsosis. Or most of them do. I'm doing a bit better than most of them. My time was short though. Others have spent large parts of their childhood without a family.

These children who are looked after by the state are not automatically labelled mentally ill. They're supported to adulthood through the social services system but only those labelled mentally ill are assigned any extra treatment.

About three years after I was briefly looked after in a childrens and foster home(3-4months in total. Not much more) I was programming for a European Space Agency project, admittedly at a very junior level.

My outcomes might be different and for those labelled with mental illness and given the privilege of the invalid they would get more social support which would hopefully boost their life outcomes. Those who don't get a label but survive the trauma of being looked after by the state and all the things which might lead to the situation...in adulthood they're left to fend for themselves.

The privilege of the invalid is an interesting concept.

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What is mental health? Choice.

I've described different continua. Now I should be writing about weirdness. Being different. Hard to understand. Abnormal and mentally healthy. Another dark topic and concept built into this uberconcept termed mental health and illness.

But I'm not going to. I'm going to go off on one about choice. Mental health and human liberty are not bedfellows.

Drapteomania is the famous example of mental health and its relationship to things which doctors should not be part of. This is the psychiatric diagnosis given to black slaves who kept on running away.

Much could be said about this diagnosis. I'm going to peer at it looking at the element of free will and what the paradigm of illness means.

A black slave who repeatedly ran away was considered insane. White psychiatrists at the time couldn't understand this behaviour. It needed to be dealt with too. Thus a person who runs away from their slave life is mentally ill. Their free choice is their illness as equally as their behaviour and actions become as the judgements of psychiatry take hold.

A black slave who keeps on running away doesn't get to chose their life, not once the label of mental illness is applied. They can chose many other things in life but the psychiatric system will treat them to stop them running away. Their treatment is to make their free will in line with the expectations of normal slaves.

Slaves who were lazy were also diagnosed as mentally ill. Treatment boosts their productivity. This is the same as modern arguements used by Lord Layard for improving access to psychological therapies for depression and anxiety.

The power of labelling as an illness means it must be treated away, and this is all backed by the authority and respectability of the medical profession.

The public far too easily forget or never even hear of diagnoses like negritude. Negritude is the medical illness all Africans had. It's what made them black. Treatment was to turn their skin colour white.

Skin colour is not a choice but behaviour, emotion, experience of consciousness and other facets of the human condition are often about choices.

The medicalisation of homosexuality and arguments about whether patients who are gay but want to be treated should be allowed to be treated or deemed mentally ill. They're examples of how choice is dismissed using the application of the label of mental illness.

This is nothing to do with science. Science is used to give authority to psychiatric dogma but it is pseudoscience when it is applied by psychiatrists.

I see individual choice and psychiatry's power in a similar way to the Church's power before the Industrial Revolution. Religion layed down rules of behaviour and emotion and choice. It also gave explanations and treatments or punishments based on the symptoms and the label. Sinner, witch, etc.

Priests were where people went to solve their life problems and misery. Their truth was the truth of god's word. Now the truth of science is misued by psychiatrists and therapists to replace the role of religion in the post-Industrial Age.

The treatments are generally more humane than some of those used before psychiatry's inception though they're about as effective in high quality, placebo controlled trials. Even electro-convulsive therapy is only as good as the sham treatment on followup.

In one regard they're doing the same thing as religion did. The system is used to overcome choices. One last example to further elucidate the point is that of unmarried mothers.

Unmarried mothers at the turn of the 20th century could be locked up and have their children taken away because they were mentally ill. Their only symptom was being poor and being an unmarried mother. It was often 'repeat offenders' who were incarcerated even though being an unmarried mother was not a crime. The wealthy might be able to support their child but those that couldn't could face the same punishment of a label of mental illness.

The justifications and the prcesses leading to the inception of a psychiatric diagnosis are as complex as the workings of the Vatican. Once they've been established psychiatric science goes about justifying the existence of the diagnosis using modern psychiatric techniques. The public and patients, in the main, then assume that it's all true until history shows it not to be.

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No one gives a shit about me

It's been repeating in my head since it was said. Oh how a parent can
mess up a psyche.

I'm dealing with it as I always do but it's really brought me down a
lot, especially now it's become a repeating thought.

Perhaps I'm looking at things glass half empty but I can't say he's not
right. I've thought about what's wrong with me such that he'd be right
to say no one cares for me. There are conscious and unconscious forces
involved.

Right now I need to reassert my balance and get back on the path to
feeling better, a path that was starting for me until my dad chose to
use those words. I should be grown up enough to ignore it but it's
cutting through me like a knife freshly pulled out of a forge.

C'est la vie. I'll get over it somehow.

Calculating the lifetime prevalence of mental disorder

Its not fucking 1 in 4 in a lifetime you bunch of cunts. Right. Now. I've got that out the way...

The lifetime prevalence is not established for the UK. The lifetime prevalence of what is an important question.

What I mean is the lifetime prevalence of mental distress or common mental disorders or mental health problems needs to be accurately defined before the question can be answered.

The rest is easy. Well...almost.... the easy bit is then turning into a research question. Have you ever felt a prolonged period of distress or have you ever had a mental health diagnosis or whatever ever in your life. The perfect way would be accurate medical records and the imperfect but practical way is a census question.

The realistic proposal is an accurately age stratfied sample of sufficient size which is otherwise randomised.

There is still the problem of recall of information and other reasons for lack of reporting a positive hit for the research question. This could be partially measured by comparing responses with available medical records. This element finds the multiplying factor between the reported and actual experiences of mental distress, if by definition the question asks for a medical diagnosis and treatment which is recorded correctly in the medical records.

It is something better than nothing to improve the accuracy of the estimate. A functional proxy is the reciept of services - a service user - but a broader definition would include more people. For example if the question was asked - have you ever felt emotionally unwell for two weeks ever in your life would garner a much higher response rate.

There would be significant debate about whether this is a suitable research question or simply something to be used for mental health charity PR. The epidiemology of human suffering is not currently considered a subject worth studying nor is the treatment because all psychiatric research is based on measures of psychopathology rather than specifically distress or even self report of unwellness.

I kid you not. Anyway, science and measures and concepts and my chocolate salty balls.

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