A Psychological View of Mental illness

While recent evidence points to a biological cause for many types of mental illness, the causes of these conditions is not yet fully understood. The medical model view of mental illness described above would suggest that mental illness is caused by structural abnormalities in the brain which result in patterns of maladaptive behavior. Understanding mental illness as a condition which has psychological roots stems back to the eighteenth century when mental illness was seen as a condition which caused individuals to engage in "irrational thinking". The psychological viewpoint of mental illness therefore suggests that individuals with mental illness are not "ill" but have developed a series of maladaptive behaviors beased on an irrational pattern of thinking and perceiving. The focus in a psychological approach to mental illness tends to be on what it feels like to be different and how society deals with people who are different.

The psychological view of mental illness does not exclude a biological etiology. However, the psychological approach differs in the amount of attention the biological factors receive in the resulting treatment models. A variety of psychological theories have attempted to explain abnormal behavior. Some of these theories would focus on the "feeling" issues involved in abnormal behavior, some the behavioral aspects and how to change maladaptive patterns, and others focus upon patterns of thinking which are seen as characteristic of dysfunction. A brief comparison of these approaches can be found in the Reference Room In a section entitled Psychological Frameworks for Viewing Mental Illness.

In general, however, the psychological approach could be said to define mental illness (or abnormal behavior) as:

A pattern of behaviors which are.....

Bizarre and extreme

Result in.....

A Disturbance of others,

Self-distress,

and.....

An Interference with daily functions.

(Darley, Glucksberg, Kamin, and Kinchla, 1981)

In our previous lecture, we examined the story of Consuela. It is obvious from the example that the degree of "abnormality" in her behavioral pattern is impacted by the norms of the group or society in which the behavior is occurring. Individuals are both contributors to and recipients of a set of "rules" which defines what is "OK" in any given situation.

ILLUSTRATION

In a social or cultural view of mental illness, an individual is seen as "ill" when:

The modern day awareness of the impacts of individual culture on the ability of an individual to fulfill societally acceptable roles is important to fully understanding the combination of dynamics which influence the consumers we deal with. The cultural roots of an individual effect the development of personality characteristics, the worldview of an individual, and the value base of the individual.

More information on the impact of culture on the development if individuals is included in the Reference Room in a section entitled "Cultural Factors in Psychiatric Rehabilitation". We will also revisit this issue in our class discussions over the next couple of weeks. Reread Consuela's story and DeCole's descripition of "Norma" which has been summarized and placed in the Reference Room.

What does all of this mean to the treatment process of individuals with psychiatric disabilities?

The definitions of mental illness described above are interesting points of contrast but in and of themselves tell us little about how we ought to be dealing with people who are experiencing severe, long term mental illness. It should be clear that legal definitions have great impact on who gets services and how many service one can get. Biological definitions suggest that medical interventions hold great promise in improving the symptoms and course of severe mental illness. Psychological approaches allow us to begin to address the behavioral and emotional issues effecting the individual him(her)self. Social definitions draw attention to the variety of outside factors which impact the individual and are impacted by the behaviors of the individual. Finally, a cultural view of mental illness allows us to recognize the role of personality and culture in the production of patterns of adjustment or maladjustment.

However, modern approaches to Psychiatric Rehabilitation are most effective when they follow a

BIOPSYCHOSOCIAL APPROACH

That is a combination of a viewpoints concerning mental illness.

Let's look at a combination of interventions springing from a combination of the biological, psychological, social, and cultural models which illustrate an effective treatment approach to severe, long term mental illness.

A COMPREHENSIVE APPROACH TO TREATMENT OF INDIVIDUALS EXPERIENCING A SEVERE MENTAL ILLNESS

Attention to the Biological Issues:

Attention to the Psychological Issues:

Attention to the Social Issues:

Attention to Cultural and Contextual Issues

Food for Thought:

How are all of these issues addressed by the services your agency provides?

Which of these issues are addressed by other service providing agencies?

Look at Case Study in the Reference Room. This is the story of Dottie. If you were working with Dottie, how might you begin to address the issues mentioned above in her situation?

Our next Lecture will focus in more depth on the biological issues of severe, long term mental illness. We will be discussing the diagnosis, assessment, and classification of mental illness in preparation for a discussion on medication and their use in treating severe, long term mental illness.