From: drarwingnuttephd@gmail.com   
      
   Why We Need to Abandon the Disease-Model of Mental Health Care   
      
   By Peter Kinderman    
   November 17, 2014   
      
   The views expressed are those of the author and are not necessarily those of   
   Scientific American.   
      
      
      
   The original English version of the DSM-5 as well as the French version of the   
   DSM-IV-TR. (Credit: F.RdeC via Wikimedia Commons)   
      
   The idea that our more distressing emotions such as grief and anger can best   
   be understood as symptoms of physical illnesses is pervasive and seductive.   
   But in my view it is also a myth, and a harmful one. Our present approach to   
   helping vulnerable    
   people in acute emotional distress is severely hampered by old-fashioned,   
   inhumane and fundamentally unscientific ideas about the nature and origins of   
   mental health problems. We need wholesale and radical change, not only in how   
   we understand mental    
   health problems, but also in how we design and commission mental health   
   services.   
      
   Clarity without diagnosis   
   Even mainstream medical authorities have begun to question the creeping   
   medicalization of normal life and criticize the poor reliability, validity,   
   utility and humanity of conventional psychiatric diagnosis. It is important   
   that we are able to define,    
   identify and measure the phenomena we are attempting to study and the problems   
   for which people seek help. But we obfuscate rather than help when we use the   
   language of medical disease to describe the understandable, human and indeed   
   normal response of    
   people to traumatic or distressing circumstances. So there are ethical and   
   humanitarian reasons to be skeptical of traditional psychiatric diagnosis. But   
   there are scientific reasons too. It’s odd but hugely significant that the   
   reliability statistics    
   for the American Psychiatric Association’s influential DSM franchise have   
   been falling steadily over time. It is difficult reliably to distinguish   
   different “disorders”, but also difficult to identify specific biological   
   etiological risk factors.    
   Indeed, Thomas Insel, director of the National Institute of Mental Health,   
   recently suggested that traditional psychiatric diagnoses had outlived their   
   usefulness.   
      
      
      
       
   A Prescription for Psychiatry, book cover.   
      
      
   Understanding rather than etiology   
   It’s all too easy to assume that mental health problems — especially the   
   more severe ones that attract diagnoses like bipolar disorder or schizophrenia   
   — must be mystery biological illnesses, random and essentially unconnected   
   to a person’s life.    
   But when we start asking questions about this traditional disease-model way of   
   thinking, those assumptions start to crumble.   
      
   Some neuroscientists have asserted that all emotional distress can ultimately   
   be explained in terms of the functioning of our neural synapses and their   
   neurotransmitter signalers. But this logic applies to all human behavior and   
   every human emotion and    
   it doesn’t differentiate between distress — explained as a product of   
   chemical “imbalances” — and “normal” emotions. Moreover, while it is   
   clear that medication (like many other substances, including drugs and   
   alcohol) has an effect on our    
   neurotransmitters, and therefore on our emotions and behavior, this is a long   
   way from supporting the idea that distressing experiences are caused by   
   imbalances in those neurotransmitters.   
      
   Many people continue to assume that serious problems such as hallucinations   
   and delusional beliefs are quintessentially biological in origin, but we now   
   have considerable evidence that traumatic childhood experiences (poverty,   
   abuse, etc.) are associated    
   with later psychotic experiences. There is an almost knee-jerk assumption that   
   suicide, for instance, is a consequence of an underlying illness, explicable   
   only in biological terms. But this contrasts with the observation that the   
   recent economic    
   recession has had a direct impact on suicide rates, a rather dramatic (and   
   sad) example of how social factors impact on our mental health.   
      
   Neural activity and chemical processes in the brain lie behind all human   
   experiences, and it’s undoubtedly helpful to understand more about how the   
   human brain works. However, this is very different from assuming that some of   
   those experiences (   
   psychosis, low mood, anxiety, etc) should be classified as illnesses. The   
   human brain is not only a complex biological structure; it is also a   
   fantastically elegant learning engine. We learn as a result of the events that   
   happen to us, and there is    
   increasing evidence that even severe mental health problems are not merely the   
   result simply of faulty genes or brain chemicals. They are also a result of   
   experience — a natural and normal response to the terrible things that can   
   happen to us and that    
   shape our view of the world.   
      
   Stigma & empathy   
   Traditionally, the idea that mental health problems are illnesses like any   
   other and that therefore people should not be blamed or held responsible for   
   their difficulties has been seen as a powerful tool to reduce stigma and   
   discrimination.   
      
   Unfortunately, the emphasis on biological explanations for mental health   
   problems may not help matters because it presents problems as a fundamental,   
   heritable and immutable part of the individual. In contrast, a more genuinely   
   empathic approach would be    
   to understand how we all respond emotionally to life’s challenges.   
      
   But things are changing. Over the past 20 years or so, we’ve seen a very   
   positive and welcome growth of the user and survivor movements, where people   
   who have experienced psychiatric care actively campaign for reform, and signs   
   of more responsible    
   media coverage. We are just starting to see the beginnings of transparency and   
   democracy in mental health care. This has led to calls for radical   
   alternatives to traditional models of care, but I would argue that we do not   
   need to develop new    
   alternatives.
We already have robust and effective alternatives. We just   
   need to use them.   
      
   Therapy   
   Clinicians have raised concerns about the relative benefits of psychiatric   
   medication and there is increasing evidence for the effectiveness of   
   psychological therapies such as cognitive behavioral therapy. Indeed, even for   
   people with very serious mental    
   health problems, such as those leading to a diagnosis of schizophrenia, and   
   even for those choosing not to take medication, such therapies have great   
   promise.   
      
      
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