Models of madness – why does the media still frame mental health in medical terms?

As part of this month’s theme, Philip reflected on his experience at a preview session from the Health Promotion Agency’s National Depression Initiative and his own common and unique experience of depression and anxiety.

Philip talked about his objections to the idea that depression is “an illness, not a weakness” because, in his view, the causes of depression and anxiety are often social factors – and that these problems (and other mental health concerns) need a “social model” rather than a medical one.

As a person who has experienced my own battle with depression, as well as someone who now works with people experiencing depression, anxiety, addiction and a range of other issues, I have my own unique perspective.

changes-and-mental-wellbeingFirstly, like Philip I can see why someone would classify anxiety or depression as “an illness, not a weakness”.  I agree that no mental health problem comes about as the result of a weakness of character and that anyone, anywhere, at any time, can experience these kinds of problems (and indeed, one in five New Zealand’s do in their lifetime).

I think that experiences like depression and anxiety get called “illnesses” as a way of signalling the vast difference between someone when they feel mentally “well”, compared to when they don’t.  Indeed, most of the diagnostic criteria for mental “illnesses” include the fact that the symptoms either cause significant distress to a person, or significant impairment in their day-to-day functioning.

So my take is that “illness” is perhaps used as an inadequate shorthand for “not functioning in the way that I do when I’m feeling whole, connected, supported, complete and satisfied with my life – I’m struggling, help!”

But I agree too, that “illness” also does not feel like quite the right term.  Philip suggests that depression, anxiety and other mental health concerns can be valid emotional responses when a person is struggling with the state of their life.  As both a therapist and a person who has experienced significant depression, I completely agree.

Philip goes on to suggest that rather than a medical model, we need a “social model” of mental illness.  The thing is, that is exactly what we have and use in mainstream mental health.  We base most modern, evidence-based mental health intervention on what is called the “bio-psycho-social” model of mental illness.  I’ll break this down briefly, with examples.

The “bio” part of the model refers to the fact that we are pretty sure that some mental health problems have a genetic component.  Now this doesn’t mean that if you have a particular gene you are guaranteed to get a particular disorder, rather that your brain chemistry might just be a little bit more vulnerable to developing one, given the right life circumstances.  It’s a bit like heart disease.  Two people can have the same healthy (or not so healthy) diet.  One, who has a particular genetic marker in their family, may have a heart attack; while the other goes on to live a long life with no heart problems.

“Bio” also refers to the fact that experiences like anxiety and depression do affect your physical body just as much as your mental health.  In terms of treatment, many people will find that particular medications help (others don’t, and that’s okay too).  We also know things like getting enough sleep and exercising a little can help people manage these problems too.

The “psycho” part refers to your internal functioning – your mind, mental and emotional experience.  When I was growing up, I learned particular ways to think about and manage my emotional experiences, that didn’t really serve me so well as an adult (for example, thinking “negative” emotions like sadness or anger are a bad thing and should not be experienced or expressed…that’s a pretty common right across Kiwi culture, I think).

Part of my recovery involved learning a different way of understanding and managing my emotions.  This is generally where therapy can be the most helpful (and heaps of other things can help in this area too!)

The last is the “social” part of the model.  This is the acknowledgement of the idea that crappy life experiences or a not-so-great situation can significantly contribute to mental health concerns.  Again, treatment often involves helping someone to get themselves into a better or more stable environment, and connecting to good support.  I’ve had many clients realise they needed to do things like end relationships, quit a job or move house, as I did myself, to help improve their mental health.

Now, our mental health system is far from perfect.  There is a massive shortage of resource and funding, as well as an ongoing battle with stigma and discrimination, amongst other issues.  But, for better or worse, that’s a super short summary of the model that the majority of mainstream mental health support services are based on.

So given that we are supposed to be acknowledging, integrating and working with all the parts of a person and their situation – why is it that the message is still out there in the media that mental health problems are a medical, not a social issue?  Is it short-hand, a simplified way of raising awareness that mental health problems are common, and not a character flaw?  Or is it is lack of understanding as to how mental health problems develop, and how we treat them?  I’m really not sure on this one – but I’d love to find out.

What’s your perspective on the way that we view mental health in New Zealand?  Why is the media image so different from the one that services are based on?

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