Models of Mental Health: A Critique and Prospectus

"You, your joys and your sorrows, your memories and your ambitions, your sense of personal identity and free will, are in fact no more than the behavior of a vast assembly of nerve cells and their associated molecules"

"the scientific theory of health is not objective as it claims to be, but rather influences and is influenced by human values and practices"

"the entire modern biological approach to mental illness - the so-called Medical Model - fosters the same delusory hope, equating sickness of the soul with a neurological glitch, and promising patients an easy chemical normalization without their ever having to confront the existential crisis that is at the center of their pain"

1. The "medical model": strengths and limitations

   The "medical model" has its strengths in some arenas, particularly those in which there is substantial consensus among humans as to what constitutes a "problem" and such problems reflect situations involving fairly simple cause-effect relationships. In other arenas, of which mental health is a significant example, the "medical model" has clear limitations. Among these are an over-reliance on "categories", "ideals", and "objectivity" a failure to appreciate the significance of internal experiences lack of appreciation for diversity and for the essential role played by individuals in their own evolution lack of appreciation for the role of culture in mental health

 

2. Expanding the view: the "biological/neurobiological/cultural model"

   The broader perspective ... offers a common framework within which a variety of people approaching issues in mental health from different professional backgrounds might comfortably share existing insights and work together toward additional ones. Among the important distinctive features ... is attention ... to individual diversity as well as to ongoing individual change and the role of individuals themselves in that process. And the highlighting of bidirectional interactions between individuals and the cultures in which they live. the primary objective of mental health professionals ought to be not to "fixing problems" but rather to encouraging and facilitating the potential inherent in each individual to be continually shaping and reshaping their own lives.

 

3. Further directions ...

   It is an appealing possibility that a serious commitment to enhancing the capability of individuals to shape and reshape their individual lives would as well be a contribution to this sort of reshaping of culture, and that cultural changes along those lines would contribute to making it easier for individuals to engage in the process. A similar motivation would operate coherently and with mutually reinforcing effects at both individual and cultural levels. the medical model (like all perspectives) has limits to its usefulness that have become particularly clear in the context of many challenges in the area of mental health. We believe the appropriate response to those limitations is ... to be aware of the limitations of existing perspectives and to seek in a synthesis of these a wider perspective having more general applicability. Drawing on aspects of biology, neurobiology, and cultural studies ... we have offered as an example of such a synthetic perspective, the "biological/neurobiological/cultural model". We believe it to provide a wider and more useful perspective in the mental health arena, but recognize that it too is of course limited and have suggested some additional area that might usefully be considered in efforts to achieve a still broader perspective. We invite others to contribute their own thoughts in the ongoing process of "getting it less wrong" in the mental health arena.