Part 1 of 3
So let’s unpack some mental health discourse
Psychiatry – mostly medical model in practice since the seventies or even not until the eighties, it was partly psychoanalytical before the 50’s (despite the history of the bio-medical model going back to Kraeplin and Bleuler and the private hospital mad doctors prior to 1848) and the arrival of chloropromazine but even then it took until decarceration and care in the community for the paradigm. The medical model has a level of discursivity that stems from a neurological condition to distress/ trauma models, but most see medication as the key treatment.
Pscyhoanalysis/ psychotherapy – from Freud to Integrated counselling, the basis that a person can talk out their own symptoms through transference (therapeutric relation) to a safe significant other.
Cognitive behaviourism – The argument that personal insight and narrative (gained through talking therapies) can only take us so so far and adjustments from psychological expertise based on behavioural norms that have been studied through objective observation is sometimes required.
Positive psychology model – at its simplest the focus on the individual as source of recovery (if not always cause of mental distress), from adjusting behaviour, self-conception, negative thoughts, through to lifehacks. Whilst few would deny any individual responsibility in recovery (others argue it is automatic, mental distress being unpleasant) at its extreme form, denying any outside affects from significant others to structural affects, positive psychology can victim blame those it is aimimg to treat.
Neuroscience – the study of the brain, there is a lot of knowledge gained from studying loss of function due to brain damage. It gives sustenance to the medical model but like any science can also criticise core assumptions through falsifying received wisdom with evidence. so the key to a critique of say the dopamine model of schizophrenia may in fact be a systems theory argument of the interaction of all the neurochemicals. There is also room to measure the long term effects of psychotherapy and evidrence test the competing patradigm, but there are limits to this. Neuroscience is however a basic science and is not psychiatry.
Trauma model – That mental poor health stems from previousa trauma and the display that sometimes leads to distress and non-normative bhaviour is caused by the mind and body working through the trauma, not always successfully.
Pathological communication model – that poor mental health and distress can come from early pathological communication that triggers distress in adult life when repeated and/or becomes a form of trauma that needs working out not always successfully. It can work with the trauma model either as a trauma in itself, or in an inability of significant others to support or even to worsen the experience of working through previous trauma. Can be individual pathological communication or group nexus.
Spiritual crisis model – This is at its simplest level the belief that a mental breakdown is a spiritual breakdown. It has roots that go back to the Quaker’s and the Tuke work cure. but the modern version fits well with the trauma model. It was largely behind the humanist model until the advent of modernism at the dawn of the 20th century and was replaced with a more materialist but still humanist model.
Materialist model -This is not just opposed to the spiritual model, but also some atheist secular dualist models (where mind or consciousness are separate from each other), for this model there mental distress is located in the body (the brain or mind is part of the body – it is also opposed to idealism as a philosophy but that is more complicated). With regards religion it requires at least a deist theology (where God is transcendental and unknowable, earthly matters are material and fallible – but it can be accepting of a materialist conception of mental distress eg Spinoza).
Social model – the interaction of the person struggling with their mental health based on whatever paradigm of above mental health models with their man-made social and economic environment (sometimes called ‘second nature’) that during the period of distress puts them at a disadvantage with regards normative interaction at a human rights level, or similar justification, entitles them to support whether structural, personal or economic.
Ideological model – One version is a variation of the social model, at its most naive, utopian and worst (possibly a straw man), madness is an ideological condition that will disappear with full communism. The more realistic version is that there are iatrogenic effects that stem from the economy that exacerbate existing conditions, impede recovery and trauma such as homlessness can lead to a form of trauma itself. A robust social model combined with a critique of capitalism is required to combat these issues. There is also a version that sees ideological propaganda as adding to pathological language (this might include that used by say medical psychiatry, positive or cognitive psychology that puts too much responsibility (that should be met either by others or structurally) on the individual with mental distress. this language is driven by capitalist ideology at a discursive level. there are also the iatrogenic effects of unequal power disparities at a class level and the attrition effect it has on everyday life.
The other version I include has its worst version as a complete denial of mental illness, that those who suffer are malingerers and need some corrective therapy or a work cure to pull themselves up by the bootstraps. The milder versions accept a level of mental distress but see narrow corrective therapy and sanctions as sufficient policy. This includes views on work as cure and views on benefit dependency as a obstacle to recovery.This sometimes includes the anti-meds and anti-diagnosis lobby where the social model and other structural realities such as a diagnosis for sick notes is denied.
Embodied model – For the most part the embodied model is a materialist conception of mental health. Centred as it is on the body. At its simplest it is a relation of the body to trauma and the need of the body to deal with traumatic events over time. However as it is the embodied model not the ‘body’ model, it assumes that the body afgfects and is affected by the rest of the world as such it has a bodily relation to the world, so most embodied theories accept also the communicative model (especially linguistically) and the social model. Those that have relations to what is called biopolitics have a relation to the ideological model (biopolitics in its simplest form is the body’s relation to governance and its attempts to resist dominating powers centred on that body).
Recovery model – the idea of recovery from mental distress has a long history, from shamans through to Tuke and Pinel (even Bleuler saw schizophrenia as a disease it was possible to recover from – contra Kraeplin), through the early years of psychoanalysis (its early success with trauma victims from WWI), to the humanistic asylum policies of the early 50’s and ’60s (before the medical model took hold), to anti-psychiatry. The term recently, since the 90’s, has had a narrower focus, in its simplest form it is a counter to the disease based model, a model that states that people can recover from severe mental health. However in the last 10 or so years it has come to also refer to a form that capitalises on such possibilities of recovery whilst denying that austerity measures have adverse effects contra the social and ideological model, narrowing the model to more positive cognitive models combined with sanctions. More humanistic recovery models still exist, and few professionals have ‘forgotten’ them, but in the current policy environment they get less funding and the more punitive sanctioning model has taken precedence at structural levels (if not always in the minds of professionals, survivors and service users).
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