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Mental Health — A BioPsychoSocial Perspective
A Praxis Course at Bryn Mawr College Spring 2002
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Mental Health Paper 2

Ngoc Tran

My placement is a microscopic sample of how the biological, the psychological, and the social arena would come together in real life. I believe this is why I was impressed during my orientation. Indeed, although the placement is a small wheelchair community for the severely and chronically disabled, it has spaces for residents to cook, to dine, to shop, to wash, to worship, to learn, to entertain, to travel, to work and to receive care as needed. Within the community, residents have access to medical doctors, therapists, psychiatrists, psychologists, social workers, administrators, nurses, and staffs. As if it wasn't impressive enough for me, I learn that the greatest mission is to help residents to transition out of the community and move into independent living in accessible housing. In fact, I did have the opportunity to speak, the week after the orientation, with a resident who succeeded in transitioning out of the community and still comes back to visit on occasion. I couldn't help but be eager when the other visits come around.

It is unquestionable that my perspective of the community has been changed since the day of my orientation. Of course, to a certain extend, there are truths to what I learn and what I see on that particular day. Those truths, however, are idealized, superficial and limited. Although I still think this community represents a version of the biopsychosocial model, I no longer view it without flaws. It is true that effort to have and to make care available for biological, psychological, and social needs, alone, can profess to the awareness of the importance of the biopsychosocial model. How successful and effective the model work, as I learn, is a whole other question to be examined.

The examination will have to begin here in the classroom where we believe in looking at mental health and mental illness through the biological, psychological, and social lens. Our discussion, more often than not, work with the assumption that the coming together, the union of these perspectives, will allow us to come to a more wholesome understanding of the complexities found in mental health and mental illness. In many ways, learning to examine mental health and mental illness through these perspectives do let us arrive at a better picture of these complexities. In other ways, I believe we forget to be realistic in our assumption and our enthusiasm for the biopsychosocial model and its prospective achievement. It is critical to identify this realism because it has the potential to either prolong, diminish, and/or server our hope and optimism in different direction.

For the first few weeks, I was more than hopeful and optimistic with my participation within the community. The independence that residents achieve and the struggle that residents overcome never cease to amaze me. Nevertheless, the longer I spend at the placement and the more learn about the community, the more layered problems I recognize and the more flaws I find possible in the biopsychosocial model. While families of residents believe that individuals will receive the best of care from facilities, that which held a high standard of meeting the physical, mental, and social needs, in reality, individuals and the community, as a whole, are constantly challenged. To begin with, individuals are taken out of their familiar settings where they may have been receiving care from families, friends, and or relatives. Being away from familiar care can lead to feelings of sadness, homesick and even rejection. Recognizing familial support as an important factor in the social arena, the community does try to introduce to residents a "different" form of social support from professionals, staffs, and volunteers in addition to family visits. Unfortunately, for the most part, the pictures on the wall, the familiar objects in the room, and the weekly visits are not enough to fulfill the social needs in the biopsychosocial model. Taking individuals out of an inadequate context (such as home care) into what seemed like a more ideal context (such as this wheelchair community) may work as a gain and loss situation rather than a win win situation.

R, for instance, is a young resident who has been part of the community for six months. During his six months stay, he wishes his family had remained as involve in his life as they had been while he was still at home. He tells me that things would be different if they were. I ask him how and he explains that unlike nurses and staffs, who would take care of his physical and personal needs, his family would get things going. In other words, his family can help him to get through the day with more efficiency. The nurse would bath, dress, and transfer him to his wheel sometime during the day but not early enough for him to attend his GED class despite his effort to request the nurse's presence earlier in the morning. The lack of efficiency is due largely to the ingenuine care and lack of communications among those who serve and those who receive care.

R, however, is very appreciative of his opportunity to become a member of this community because he, like many others, too, realize the community do offer an invaluable opportunity for him to acquire a mentally and physically healthful life despite his disabilities. Those who succeed at transitioning out of the community, which I believe R would someday, are few. In fact, majority of residents have been residents in the community for over twenty years, and for most of these residents, they may not have a choice but to be there for the rest of their lives. This, then, presents a paradoxical instance. I said paradoxical because in the process of providing individuals a better life, a life where they will receive well-rounded care to meet their biological, psychological, and social needs, the community is also, at another level, isolating these individuals indeterminately from the society. The few trips to the bowling ally, the shopping mall, and any other places once or twice a month won't make up to the fact that the residents are bounded to this little community where they need not to go beyond the community space to find what they need.

It is undeniable that while this biopsychosocial model brings many benefits to residents, it also offer many challenges. Such challenges have to do with the isolation and the unsatisfaction residents felt as a result of being separated from their family and being bounded to limited community spaces. Nonetheless, I still have great hope and optimism in community's mission.

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