Models of mental illness

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.

Social Model

 Social models of mental change health regard social forces as

influential in the development of mental disorders.
 Social model is concerned with the wider issues such as family,
culture and the community.
 Environmental factors such as economic pressures.
 Social change could have an impact on the individual’s personal
experience.
 The meaning attached to the situation is also recognized as part of
social context
 Research shows that : Effects

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)”

Health Belief Model

The Health Belief Model (HBM) is a tool that scientists use to try and
predict health behaviors. It was originally developed in the 1950s, and
updated in the 1980s. The model is based on the theory that a person's
willingness to change their health behaviors is primarily due to the
following factors:

 Perceived Susceptibility
 People will not change their health behaviors unless they believe
that they are at risk.
 Example: Those who do not think that they are at risk of
acquiring HIV from unprotected intercourse are unlikely to use
a condom. Young people who don't think they're at risk of lung
cancer are unlikely to stop smoking.

 Perceived Severity
 The probability that a person will change his/her health behaviors to
avoid a consequence depends on how serious he or she considers
the consequence to be.
 Example: If you are young and in love, you are unlikely to avoid
kissing your sweetheart on the mouth just because he has the
sniffles, and you might get his cold. On the other hand, you
probably would stop kissing if it might give you Ebola. Similarly,
people are less likely to consider condoms when they think STDs
are a minor inconvenience. That's why talk about safe sex increased
during the AIDS epidemic. The perceived severity increased
enormously.

 Perceived Benefits
 It's difficult to convince people to change a behavior if there isn't
something in it for them. People don't want to give up something
they enjoy if they don't also get something in return.

 Example: Your father probably won't stop smoking if he doesn't

think that doing so will improve his life in some way. A couple might
 not choose to practice safe sex, if they don't see how it could make
their sex life better.

 Perceived Barriers
 One of the major reasons people don't change their health
behaviors is that they think that doing so is going to be hard.
Sometimes it's not just a matter of physical difficulty, but social
difficulty as well. Changing your health behaviors can cost effort,
money, and time.
 Example: If everyone from your office goes out drinking on Fridays,
it may be very difficult to cut down on your alcohol intake. If you
think that condoms are a sign of distrust in a relationship, you may
be hesitant to bring them up.

One of the best things about the Health Belief Model, is how realistically it
frames people's behaviors. It recognizes the fact that sometimes wanting
to change a health behavior isn't enough to actually make someone do it.
Therefore, it incorporates two more elements into its estimations about
what it actually takes to get an individual to make the leap. These two
elements are cues to action and self efficacy.

Cues to action are external events that prompt a desire to make a

health change. They can be anything from a blood pressure van being
present at a health fair, to seeing a condom poster on a train, to having a
relative die of cancer. A cue to action is something that helps move
someone from wanting to make a health change to actually making the
change.

In my mind, however, the most interesting part of the Health Belief Model
is the concept of self efficacy. This is an element which wasn't added to
the model until 1988. Self efficacy looks at a person's belief in his/her
ability to make a health related change. It may seem trivial, but faith in
your ability to do something has an enormous impact on your actual
ability to do it. Thinking that you will fail will almost make certain that you
do. In fact, in recent years, self efficacy has been found to be one of the
most important factors in an individual's ability to successfully negotiate
condom use.
Medical model

A term coined by psychiatrist R.D. Laing, in The Politics of the Family and
Other Essays (1971), a medical model is a "set of procedures in which all
doctors are trained."

The medical model's school of thought is that mental disorders are

believed to be the product of physiological factors. Simply stated, the
medical model treats mental disorders as physical diseases whereby
medication is often used in treatment.

When it comes to mental illness, the medical model, which is more widely
used by psychiatrists than psychologists, treats these disorders in the
same way as a broken leg.

However, there are many schools of thought about the medical model in
the psychiatry world. Supporters of the medical model usually consider
symptoms to be telltale signs of the inner physical disorder and believe
that if symptoms are connected, it can be characterized as a syndrome.

Medical Model Assumptions

 The biological approach of the medical model focuses on genetics,

neurotransmitters, neurophysiology, neuroanatomy etc.
Psychopathology says that disorders have an organic or physical
cause. The approach suggests that mental conditions are related to
the brain's physical structure and functioning.
 Symptoms' of mental illness, such as hallucinations, can be
categorized as syndromes caused by the disease. These symptoms
allow a psychiatrist to make a diagnosis and prescribe treatment.

The Use of Medication in Treatment Based on the Medical Model

Based on the medical model, mental illness should be treated, in part, as

a medical condition, typically through the use of prescription medications.

Medications for mental illness change brain chemistry. In most cases,

these medications add or modify a chemical that is responsible for
problems with mood, perception, anxiety, or other issues. In the correct
dosage, medication can have a profoundly positive impact on functioning.

References

https://www.verywellmind.com/health-belief-model-3132721

https://www.verywellmind.com/medical-model-2671617