“Why We Need to Abandon the Disease-Model of Mental Health Care”

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In a guest blog for the Scientific American, Peter Kinderman takes on the “harmful myth” that our more distressing emotions can best be understood as symptoms of physical illnesses. “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.”

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6 COMMENTS

  1. Below are some more points to contemplate in addition to what is presented in the Kinderman article:

    – Despite decades of research, scientists have not been able to find any structural or other brain differences between patients who present with mental illnesses and healthy individuals. If mental illnesses are a result of biological abnormalities, it should be possible to detect these mental illnesses just like any other disease (like detecting diabetes).

    – Because there are no differences between the brains of patients who present with mental illness and healthy individuals, various labels (naming of mental illnesses) are based entirely on doctor’s subjective evaluations. There are no objective tests at all – there are no blood tests, no tissue tests or X-rays, etc. Diagnosis made this way also fails to meet the Virchowian standard of disease.

    – The discovery of neuroplasticity (the mind’s ability to change brain structure) seems to be often ignored. Mind-related interventions (such as mindfulness interventions and psychotherapy) have shown that such interventions not only result in healthy structural changes in the brain but even bring about changes in genetic expression (see: http://psycnet.apa.org/index.cfm?fa=buy.optionToBuy&id=2010-25386-001 ; http://www.ncbi.nlm.nih.gov/pubmed/26106351 and http://pps.sagepub.com/content/6/6/537.abstract .

    – Individuals who are ‘diagnosed’ (using subjective criteria as explained above) with mental illnesses, are often given a label. Since many of these labels have complicated names and often end with the term ‘disorder’, these labels have a permanent feel to them. When a label is received, having the label itself leads to thinking that one is mentally ill permanently, ‘doomed for life’, ‘why me’, etc. This will lead to excessive mental proliferation, worry, rumination, etc., and could in turn aggravate mental illness (many psychological studies have shown that rumination, worry, etc., lead to mental illness). A label can also increase stigma, affecting how others treat the person, further aggravating the situation. All this mental proliferation, worry, rumination, would also gradually result in adverse structural changes in the brain (neuroplasticity).

    – In conducting research for treatments for mental illnesses, currently, the main focus is to analyze the brain to understand the mind (bio-medical model of mental illness). As a result of this focus, the aim is to develop a drug for every ‘ailment’. But if we pause and try to understand the mind/brain correspondence, people completely forget that it is the mind that talks about the brain. Brains do not talk about themselves. The mind thinks about the trees outside, about our body structures such as the digestive system, nervous system and even the brain. An ancient model of the mind can help us understand this further – see: http://sgo.sagepub.com/content/5/2/2158244015583860

    – Skeletal muscles waste away if they are not exercised regularly. We know this as a causal fact – so, we do not focus our energies on developing a drug to prevent muscles from wasting away. Likewise, less activity in the mind (such as when engaged in an intellectual activity or when engaged in meditation) is linked to less activity in the default mode network of the brain. Less activity in the default mode network of the brain leads to favorable structural changes in the brain (neuroplasticity). High activity of the default mode network (e.g. proliferation, worry, rumination, etc.) leads to mental illness as well as adverse structural changes in the brain.
    Giving a label for mental illnesses (based on DSM criteria) add to the already existing rumination, worry, etc., and that itself can make matters worse for the patient. Instead of giving labels to mental illnesses, it would be best to simply focus on the symptoms of a patient (such as stress, worry, hearing voices, a habit, etc.) and direct attention on treating those specific symptoms.
    Considering the causal pathways discussed above, except for a very small minority of patients, alleviating symptoms should be done using psychological interventions.