Mental Health and Well-Being

Alternatives to the Medical Model

Neil Thompson

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351123884
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Mental Health and Well-Being provides a sound foundation for understanding alternatives to the medical model of mental health. Students and professionals alike will find an easy to understand overview of critiques of the dominant medical model of mental health and well-being, both longstanding and more recent, and will come away from the book with a more theoretically sound, holistic conception of mental health and well-being. Written by an experienced mental health expert and replete with practical anecdotes, exercises, and examples to help readers apply the book's material, this book offers an essential foundation for developing more humane mental health practices.

Part I
Constructing Mental Illness

Introduction

Despite the current dominance of a medicalized approach to mental health problems, it was not the original way of conceptualizing what we would today call mental health problems. In this first of four parts we concern ourselves with the historical development of social perspectives on the subject.

This is not a history book, and so I will not be presenting a detailed historical analysis or drawing on primary sources. Rather, my aim is more modest than that, namely to provide a basic overview of some of the key ideas that helped to shape current thinking and thereby pave the way for the discussions that follow in Parts II to IV.

Through these first four chapters certain themes will emerge that will prove to be significant in later chapters, and so some of the points made in Part I will be revisited and further developed in the context of the subject matter of later chapters. In this way, the complex nature of mental health problems will be exemplified and clarified. This will lay the foundations for Part IV where the emphasis is on practical responses to the challenges mental health problems give rise to.

1 From Demons to Drugs

Introduction

This chapter presents a historical overview of conceptions of madness, from demons and witchcraft to “illnesses” that need (drug) “treatments.” My aim is to show how “mental illness” is socially constructed (that is, shaped by social forces) and has been understood differently at different times in history. Gender is used as an example of the need to develop a broader, more sociologically informed approach to mental health problems.

In addition, the chapter briefly explores how alcohol-related problems have also come to be construed in narrow medical terms.

Madness Then and Now

Porter argues that the notion of mental illness dates back to at least the days of the Ancient Greeks:

Ever since the Ancient Greeks, insanity has been deemed a disease and claimed by medicine. But it has remained shrouded in mystery. Whereas complaints such as measles involve clearly delineated physical symptoms, the manifestations of madness, by contrast, though often flamboyant and bizarre, can be fleeting and fantastically labile – cries and gestures, moods and movements that commonly produce no lasting perceptible physical change, nothing discernible even in a post-mortem.

(1991, p. 34)

This is an important passage for two reasons. First, it shows that a medicalized understanding of mental health problems is not by any means a recent development. Second, it highlights that, even in such early times, there was a problem in reconciling such a view with any firm evidence to back it up.

Practice focus 1.1

Karen was looking forward to her time on the psychiatric ward as part of her nurse training, as she was keen to broaden her understanding of nursing in all its forms. However, she found her time on the psychiatric ward confusing and unsettling. She struggled to see what positive difference she could make to the patients. For the most part they were heavily sedated by their medication and no one seemed too interested in finding out what had led to their problems. She had read about innovative approaches to mental health, but she could see no sign of any such work being done here. The major focus seemed to be managing the medication regime, but she could not see any sign of anyone improving under that regime. She was very disappointed, as this was so different from what she had encountered on other wards dealing with physical illness issues.

Although such a view has a long-standing basis, it is only at a much later date that this becomes the predominant way of thinking. Over the millennia there have been other conceptions of madness and related matters that have vied with the medical model. It is an overview of some of these key ideas that we shall be focusing on here.

I find it helpful to think of the history of madness in terms of three different frames of reference. These are not being presented as objective or definitive epochs, but, rather, simply as a helpful way of mapping some key issues in the historical development of current ways of thinking.

Pre-Enlightenment Thinking

“The Enlightenment” is a term used to refer to a period of over 200 years, beginning towards the end of the seventeenth century. It describes the shift in thinking away from the largely superstitious and irrational thinking that was the norm towards a more rational, scientific outlook on the world and what goes on within it. It represented a move from what was regarded as primitive thinking to a more modern approach, hence the use of the term “modernity” to refer to the period that followed the Enlightenment and “modernism” to refer to the type of thinking it reflected.

As far as madness and related matters were concerned, pre-Enlightenment thinking was characterized by very simplistic beliefs. Given how disturbing, frightening and unsettling encounters with mental health problems could be and how, for the most part, such encounters would be out of the ordinary and far removed from people’s sense of what is “normal” behavior, it is understandable that they would want to try to make sense of the phenomena they were witnessing. Given that the idea of “possession by evil spirits” (or demons) was part of the common belief system at that time, it is not surprising that this came to be a way of conceptualizing madness – someone who was displaying the bizarre and unfathomable behavior that today would be called psychotic would be labelled as “possessed,” a label that would fit, to a certain extent, what onlookers were seeing in the context of the dominant beliefs at that time.

This was linked to the idea of the role of the Devil as the master of evil and how he could take over people’s souls in certain circumstances. Madness was therefore conceived of not as an illness of the body or mind, but as a malady of the soul.

This in turn was linked to witchcraft, in the sense that this was a means of trying to explain what were perceived as phenomena that were not only “unnatural,” but also threatening or unsettling in some way. Being a witch, like being mad, was explained as the operation of evil forces acting on human souls.

Although the medical model subsequently involved a very different perspective by relocating the problem in the body – specifically the brain and nervous system – rather than the soul and replaced evil with medical pathology, there were also continuities. For one thing, the emerging medical model was equally monocausal, rather than holistic – that is, it was offering a simplistic level of explanation that focused on there being “something wrong” in how the body functioned without reference to wider or deeper factors. Another continuity was the gender bias involved in both approaches. It was witches, not wizards, who were perceived as unnatural and threatening. And, within, the medical model the gender bias remains to this day. For example, as Ussher explains:

As the outspoken, difficult woman of the sixteenth century was castigated as a witch and the same woman in the nineteenth century a hysteric, in the late twentieth and twenty-first century she is described within patriarchal psychiatric discourse as “borderline,” or having PMDD. All are potentially stigmatising labels. All are irrevocably tied to what it means to be a “woman” at a particular point in history.

(2018, p. 76)

Voice of experience 1.1

I had expected switching from a men’s prison to a women’s prison to be different in a number of ways, but I hadn’t appreciated just how profoundly different the two set ups were. In particular, the approach to mental health was nothing like I had experienced before. It was as if there were two mental health systems, one for men and one for women.

Sandy, a prison officer

It is beyond the scope of this book to look in detail at the relationship between mental health and the prison system – see Thompson (2010) for an interesting perspective on this.

The question of gender is a highly significant one in relation to mental health, and it is one to which we shall return later in this chapter and, indeed, in subsequent chapters. For now, though, I want to highlight some of the continuities that remain, despite the major change from a so-called “irrational” pre-Enlightenment understanding to a “rational,” scientific post-Enlightenment one.

Post-Enlightenment Thinking

The Enlightenment was brought about largely by the rise of secular philosophies that emphasized and promoted rational approaches as a better option than uncritical acceptance of irrational dogma. This was to be the dawning of modernity and the age of science – a distinct move from the irrational to the rational. This approach was to be seen as a more “enlightened” one, and one that would herald great progress through the positive developments that science and rationality could bring.

In relation to mental health problems, this was to be the early stages of the current medicalized approach. One significant development in this regard arose from the pioneering work of Philippe Pinel, a French physician who, towards the end of the eighteenth century, became involved in the mental health system and introduced what he called “moral” treatment which involved moving away from a custodial approach (in institutions that simply housed people with mental health problems, often in chains) towards a more therapeutic approach geared towards helping people with their problems. This was to be a major shift in approach (from an oppressive custodial one to a more humanitarian therapeutic one), but the latter approach was none the less narrow in its focus, with the major emphasis on medical pathology.

Towards the end of the nineteenth century, a German psychiatrist by the name of Kraepelin published what was to become a highly influential textbook of psychiatry that was firmly rooted in a biomedical model of mental health problems, drawing direct parallels with physical illnesses. The notion of “diseases of the brain” was what his approach was based on (Bentall, 2004). His work was to be a further major plank in the establishment of psychiatry as a medical specialism and thus mental health problems as medical conditions best treated by medical interventions.

Contemporary Thinking

The emphasis on rationality and science has persisted to this day, not only in the mental health field, but across the board. However, it has not been without its critics. We shall explore in more detail in Chapter 8 the significance of such critiques when we examine the “flawed science” school of thought that has joined the ranks of other critics over the years. But, for now, I want to emphasize the point that the continuing predominance of scientific thinking has not been without its challengers, especially in the mental health field.

Practice focus 1.2

What also struck Karen while she was working on the psychiatric ward was that she had read a great deal about the “scientific” basis of mental health care, but, apart from the biochemistry involved in the medication, she could find little evidence of science being used. It was as if the medication was being used to suppress the symptoms in the hope that, once the symptoms had gone, the underlying condition would no longer be a problem. It went totally against what she had been taught about health care being much more than just symptom management. She could see that the nurses and assistants on the ward were all kind and caring people, so had no qualms about that, but she failed to see what benefit the overall regime brought.

Some commentators have spoken of an era of “postmodernity” (that is, an age that goes beyond the belief in human progress associated with modernity and the Enlightenment) and the associated thinking as “postmodernism.” I have written elsewhere (Thompson, 2018a) of my concerns about the theoretical problems associated with this line of thinking, but it remains the case that an uncritical reliance on rationality and the scientific method as the only valid basis of understanding has been heavily criticized from various quarters. It is important to stress, though, that it is not science per se that has been criticized, but, rather, the tendency to...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Table of Contents
• Preface
• Acknowledgments
• About the Author
• Introduction
• Part I Constructing Mental Illness
• Part II Deconstructing Mental Illness
• Part III Theorizing Mental Health and Well-being
• Part IV Promoting Mental Health and Well-being
• Conclusion
• Epilogue
• Glossary
• Guide to Further Learning
• References
• Index