Models of Mental Health Asclepius Course March 28th at 10 am

It’s widely accepted that individuals can be disturbed or troubled of mind.  What is controversial is how we should understand this. 

Asides psychiatrists, many professional disciplines work and research in the field of mental disorder.  Each discipline approaches the subject from their own viewpoint, using their own conceptual model to explain what they find before them. 

Alas there is no single model that has complete explanatory power.  To fully understand an individual’s difficulties it is often necessary to borrow from several.  This would be the favoured approach from an eclectic practitioner.  In practice it’s easy to favour a pet model which most closely fits one’s world view and defend this against those supported by others. 

The on-going debate about the merits of drug treatments versus talking therapy can be viewed as a clash of models: biological versus psychodynamic/cognitive.

The disease or biological model

This model holds that any dysfunction that effects mental functioning can be regarded as ‘disease’ in a similar way to dysfunction that affects other parts of the body.

In the disease model, a disorder affecting mental functioning is assumed to be a consequence of physical and chemical changes which take place primarily in the brain.  Just like any other disease a mental disease can be recognised by specific and consistent signs, symptoms and test results.  These distinguish it from other diseases. 

Psychiatrists who adhere to the disease model are often referred to as ‘biological psychiatrists’ (as in ‘he’s very biological’).
With a biological approach comes a preference for physical treatment methods, primarily drugs, but also ECT. 

This model best applies to schizophrenia

The psychodynamic model

The central tenet of the psychodynamic model is that a patient’s feelings have lead to problematic thinking and behaviour.  These feelings may be unknown to the patient and have formed during critical times in their life, due to interpersonal relationships. 

These unknown (or unconscious) feelings are uncovered during therapy.  Therapy can take place over a large number of sessions and over a time period of a year and beyond. 

During therapy a relationship builds up between therapist and patient.  The emotions that the patient attaches to the therapist are collectively known as ‘transference’, and those the therapist attaches to the patient collectively as ‘counter transference’.  By understanding these feelings a patient may gain an understanding that they can take with them to future relationships.
This model is applied broadly, but has limited applicability to the most severe mental disorders. 

The behavioural model

The behavioural model understands mental dysfunction in terms theory emerging from experimental psychology.

Symptoms, as understood by the behavioural model, are a patient’s behaviour.  This behaviour has come about by a process of learning, or conditioning.  Most learning is useful as it helps us to adapt to our environment, for example by learning new skills.  However some learning is maladaptive and behaviour therapy aims to reverse this learning (counter conditioning). 

This model best applies to phobias.

The cognitive model

The cognitive model understands mental disorder as being a result of errors or biases in thinking.  Our view of the world is determined by our thinking, and dysfunctional thinking can lead to mental disorder.  Therefore to correct mental disorder, what is necessary is a change in thinking. 

This model will be familiar to anyone who has trained or undergone cognitive behavioural therapy (CBT).  CBT aims to identify and correct ‘errors’ in thinking.  In this way, unlike psychodynamic therapy, it takes little interest in a patient’s past.
This model is widely used, but classically applies to depression and anxiety.

The social model.

The social model regards social forces as the most important determinants of mental disorder.  The social model takes a broader view of psychiatric disorder than any other model.  It regards a patient’s environment and their behaviour as being intrinsically linked. 

In some ways it is like the psychodynamic model, which also sees patients as moulded by external events.  However whereas the psychodynamic model sees mental disorder as highly personalized and its determinants not immediately recognizable, the social model sees mental disorder as based on general theories of groups and caused by observable environmental factors. 

Example

For someone who develops persistent depression following the death of a close relative :

“This can be perceived in several ways by psychiatrists.  One sees the depression as a pathological event that is directly due to the biochemical changes occurring in the brain of someone who is predisposed to pathological depression through an accident of illness.  Another sees the depression as a reactivation of unresolved childhood conflicts over an early loss.  Another regards the depression as part of the normal mourning process that has got out of control because the person’s thoughts become fixed in a negative set which sees everything in the most pessimistic light.  Yet others conclude that the mourning response has been exaggerated primarily by society or see it as an abnormal form of learning which is no longer appropriate for the situation but is receiving encouragement from some quarter (positive reinforcement)”