SEMINAR ―MODELS OF MENTAL ILLNESS‖Chairperson : Dr. K. S. SengarPresentee : Sudarshana Das GuptaDiscussant : Jaishankar PatelVenue : Conference HallTime : 2:30 pmDate : 02.08.2012
Presentation will be under the following headings: Introduction Concept of Health Mental Health Concept of Mental Illness Mental health, Mental Ill-health and Mental Illness History and significance of Mental Health Perspectives of Mental Health Criteria for Mental Health Models of Mental Illness Conclusion
W.H.O.s definition of Health:"A state of complete physical, mentaland social well-being and not merelythe absence of disease or infirmity."
Mental Health is defined as―A state of well-being in which every individualrealizes his or her own potential, can copewith the normal stresses of life, can workproductively and fruitfully, and is able to makea contribution to his or her community.‖
Mental Illness is defined as―Mental illness can be seen in purely sociologicalterms, as a deviation from socially approvedstandards of interpersonal behaviour, or as aninability to perform one’s sanctioned social roles. Insocial science literature it is generally agreed thatthe mental illness refers to dysfunctionalinterpersonal behaviour, judged to be dysfunctionalin terms of the norms and values held by theobserver‖ (International Encyclopedia of Psychiatry,Psychology, Psychoanalysis & Neurology, 1992).
Mental Illness (Cont.)―An illness with psychological or behavioralmanifestation and/or impairment in functioning,due to social, psychological, genetic, physical orbiological disturbances.‖ (American PsychiatricAssociation).―Mentally ill person means a person who is in needof treatment by reason of any mental disorderother than mental retardation‖(Indian MentalHealth Act, 1987).
Mental health, Mental Ill-health and Mental Illness It is a commonplace to view the relationship between health and illness — and, therefore, mental health and mental illness — as two ends of the same Trent (1992), The Canadian Ministry of National Health and Welfare (MNHW),1988 Downie et al (1990) Groder, (1977)
History In the mid-19th century, William Sweetzer was the first to clearly define the term "mental hygiene", which can be seen as the precursor to contemporary approaches to work on promoting positive mental health An important figure to "mental hygiene", would be Dorothea Dix (1802–1887), a school teacher, who had campaigned her whole life in order to help those suffering of a mental illness, and to bring to light the deplorable conditions which they were put it in. This was known as the "mental hygiene movement". At the beginning of the 20th century, Clifford Beers founded the National Committee for Mental Hygiene and opened the first outpatient mental health clinic in the United States of America.
Significance Evidence from the World Health Organization suggests that nearly half the worlds population is affected by mental illness with an impact on their self-esteem, relationships and ability to function in everyday life. ―There is growing evidence that is showing emotional abilities are associated with prosocial behaviors such as stress management and physical health‖ (Richards, Campania, & Muse-Burke (2010). The importance of maintaining good mental health is crucial to living a long and healthy life.
Perspectives Sense of Responsibility Sense of Self-reliance Sense of Direction A Set of Personal Values Sense of Individuality Mental Well-Being Lack of a mental disorder Cultural and religious considerations
Maria Jahoda (1963) proposed the followingsix characteristics of the mentally healthyindividual — Environmental mastery Undistorted perception of reality Integration Autonomy Growth, self-development and self-actualization Attitude towards Self
Models of Mental Illness Spiritual Model Moral Character Model The Statistical Model The Disease/ Medical/ Biological Model — Genetics — Neuroimaging — Neurobiology Psychological Models — Psychodynamic Model — The Behavioural Model • The Cognitive-behavioural Model — Existential / Humanistic Model The Social Model Psychosocial Model — The Social Learning Model Family Therapy Model Biopsychosocial Model
Spiritual ModelThe first and oldest explanatory system for mental illness is spiritual.From a traditional spiritual perspective, consciousness is seen asresulting from or deeply connected to some supernatural force.Usually, there is a religious narrative that explains that there aregood and bad forces in the world, and that suffering is a function ofeither being possessed by the bad, or through the idea that theafflicted have fallen out of favor with the good. This generally occursbecause of sin or related concept of immoral behavior that leads tosome form of badness or contamination.
Moral Character ModelThe second explanatory system for mental illness is moralcharacter. In a nutshell, the position of moral character is thatthere are virtues which one must learn, such as courage andfortitude, honesty and integrity, compassion and grace thatenable on to live the admirable life.
The Statistical ModelDerived more from mathematics than from psychology, thestatistical model concentrates on the definition of abnormality.According to this approach, abnormality is any substantialdeviation from a statistically calculated average. Those who fallwithin the ―Golden mean‖ i.e. in short, those who do what mostpeople do, are normal, while those whose behaviour differs fromthose of the majority are abnormal.
The medical model attributes mentalabnormalities to physiological, biochemical,or genetic causes and attempts to treatthese abnormalities by way of medicallygrounded procedures such aspsychopharmacology (drug therapy),electroconvulsive therapy (ECT), orpsychosurgery (brain surgery).Genetic models of mental disorder suggestthat psychopathology is inherited fromparents, and there is certainly evidence forthe familial transmission of many disorders.
The Medical Model (Cont.) Neuroimaging This system explains causation of mental illness in terms of structural changes in different parts of brain. It suggest that in various mental illness certain ventricular atrophy, volumetric changes, reduction in cortical volume can be seen which may be one of the various contributory factors behind the causation of illness.
The Medical Model (Cont.) Neurobiology • Here the belief is that the human is an organism that consists of natural functions designed by nature (i.e., natural selection operating on genetics) and mental illness is the breakdown of such functions. Thus, just as a heart attack is a biological disease characterized by the breakdown of the functioning of the circulatory system, mental illness stems from malfunctioning neurophysiological processes.
Psychological Models An important explanatory system for mental illness is psychological in nature. The general model here is that the individual develops along a path and attempts to adapt to their environment. However, if the individual fails to learn certain crucial elements or learns the wrong responses to new situations or adopts short term solutions that have long term maladaptive consequences, then suffering and dysfunction result. Psychodynamic Model The Behavioural Model The Cognitive-behavioural Model Humanistic / Existential Model
Psychodynamic Model The core assumption of this approach is that the roots of mental disorders are psychological. They lie in the unconscious mind and are the result the failure of defence mechanisms to protect the self (or ego) from anxiety. Problems are determined by the history of a person’s prior emotional experiences, especially the childhood ones or to be more specific, the negative childhood experiences.
The Behavioural ModelThis system believes that, only the study of directly observablebehavior, the stimuli and reinforcing conditions that control itcould serve as a basis for understanding human, behaviour,normal or abnormal. The behavioural perspective is organizedaround a central theme: the role of learning in human behaviour. The Cognitive-behavioural ModelThe cognitive model understands mental disorder as being aresult of errors or biases in thinking. It explains how thoughtsand information processing can become distorted and leads tomaladaptive emotions and behaviour. Our view of the world isdetermined by our thinking, and dysfunctional thinking can leadto mental disorder. Therefore to correct mental disorder, what isnecessary is a change in thinking.
Humanistic / Existential ModelThe humanistic model sees mental health problems as asignal that an individual is failing to reach his or her potentialand that psychological growth has stopped.The humanisticperspective views human nature as ―basically good‖. Itemphasizes present conscious processes – paying lessattention to unconscious processes and past causes – andplaces strong emphasis on each person’s inherent capacityfor responsible self-direction. Its emphasis is thus on growthand self-actualizing rather than on curing diseases oralleviating disorders. The humanistic model does not believein labeling people by diagnosing them as having specificmental disorders.
The Social ModelThe social model suggests that the ways in which societies areorganized, not just biological and psychological characteristics ofindividuals, must be considered as causal factors in mental illness. Itdoes not argue that people should not be held responsible for theirbehaviour because they are victims of ―society‖, but they do suggestthat social structure imposes restrictions on behaviour as surely asbiological inheritance and that the effects of social conditions onmental illness need to be understood, to explain both individualdistress and how that distress might be related to larger forces. Thesocial model regards social forces as the most important determinantsof mental disorder.
Psychosocial ModelThis model explains the causation of mental illness due to theeffect of interaction of psychological and social factors.Psychosocial factors are those developmental influences thatmay handicap a person psychologically, making him or herless resourceful in coping with social events.
Psychosocial Model (Cont.)There are four basic categories of psychosocialcausal factors: Early deprivation or trauma Inadequate parenting styles Marital discord and divorce Maladaptive peer relationship The Social Learning Model:
Family Therapy ModelLaing & Esterson (1964) were among the first British writers to express the viewthat individuals with mental illness were the victims of a pathological familyprocess. Family therapy usually begins by an approach that encourages allmembers of the family to work together in resolving the conflict. The process isdesigned to identify and change relationships where necessary. Attention is paidto family interactions, especially to alignments and discord and the engagementand disengagement of the different group members. Double Bind Schisms and Skewed Families Pseudomutual and Pseudohostile Families Expressed Emotion
Biopsychosocial Model Integration of: Biological Social Psychological (Esp. cognitive & behavioral) Abnormality caused by: Interaction of these factors – no one cause Relative importance of each factor depends on individual and environment
Biopsychosocial Model Feedback Loops Psychological Biological Emphasis on Emphasis on psychological biological factors, such as early processes (e.g., childhood genetics) experience and self- conceptFeedback Loops Feedback Loops Social Emphasis on interpersonal relationships and social environment
Biopsychosocial Model (Cont.) Explanations of mental illness: Diathesis / Stress Physiological, sociocultural or genetic predisposition to develop disorder Stressor that triggers manifestation of disorder
Conclusion Current trends in delivery of care emphasize a collaborative team approach The diverse explanations provide a range of models that influence and direct current approaches in the treatment and management of people with mental health problems. The dominance of the biomedical model is increasingly being challenged by other professional groups.