How the Psychosocial Approach Provides an Alternative to the Biomedical Model

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Trauma is situational. The situation in which a human being is unable to wind down for a long time because it has been continuously subjected to aversive circumstances is likely to result in distress. There is a growing body of literature that supports this thesis today. Yet the biomedical concepts of mental distress still seem to prevail in the public discourse. This kind of discourse, however, ignores the situatedness of the mental distress in the social context in which it exists, despite a large body of evidence of that link.

Macro photo of thumbtacks holding strings in a network on a blue backgroundResearch has found that wide range of social determinants influence mental health. A meta-analysis of 51 prevalence studies, 5 incidence studies and 4 persistence studies mostly from high-income countries has shown that there is a strong association between depressive states and less advantaged socioeconomic position. Financial disadvantage, unemployment, low income, low education or low material standard of living directly impacts mental health.

Childhood trauma and further adverse events in adulthood such as bullying, social discrimination or exclusion, migration or visibly marginalized status may, for example, increase risk of developing what is then labeled as psychotic disorder. Furthermore, research points towards financial difficulties and low income as barriers towards recovery once a person is already manifesting symptoms. These are just a few studies displaying the clear link between mental distress and social determinants, but there are countless others.

How can mental and emotional suffering be approached in a more constructive manner?

The answer lies in the psychosocial approach. The psychosocial approach addresses mental health in the context of the community. It deals directly with the social determinants of mental health and puts emphasis on the lived experience of people who encounter mental distress. However, the institutional power of various proponents of the biomedical role is an institutional barrier when it comes to the spread of psychosocial model.

Consequently, resources offering a psychosocial perspective on emotional distress are still not sufficiently available to the wider public or dominant in the public discourse. Often, in order to research these resources one has to first have epistemological knowledge – to understand how knowledge is constructed socially with power relations being in-built into the concepts. In other words, in order to find other kinds of frameworks one has to first know that the prevailing biomedical framework is just that—a framework. Thus it can be argued that what I will call conceptual tools are needed to understand alternatives to biomedical approach. The psychosocial framework is one such tool. It situates the mental distress within power-operating social environment and understands it as linked to social structures, identifying barriers to recovery and focusing on a way forward towards new orientations instead of the challenges.

There are many psychotherapies that work within psychosocial framework. To have access to them or to acquaint oneself with them, however, requires financial resources. Often, people struggling with mental health issues may be have restricted financial resources, or may suffer social isolation, making it hard for them to have access to these kind of resources. Simultaneously, in the 2021 Mental Health Atlas of the WHO it was found that only 49 countries, which is equivalent to 31% of responding countries or 25% of WHO Member States, reported the integration of mental health into primary care including the provision of psychosocial interventions. Thus barriers to access to psychosocial support are also often institutional and geographical.

In this kind of context, the psychosocial framework is still hard to access for lot of people, both in terms of understanding (epistemologically) and financially, as well as due to its limited availability.

This is why it is particularly important to clearly outline and spread the psychosocial narrative that can offer new ways of understanding of mental distress. It constitutes a conceptual resource—a tool that offers another kind of understanding that is not confined to the malfunction-perspective often emphasized within the biomedical paradigm, which has the danger of functioning as a self-fulfilling prophecy.

Mental distress, within this view, is conceptualized as a reaction to enduring an experience that overpowers the capacities of the organism or exposure to such an experience without adequate support or resources to process it. This can consequently turn into a set of challenging orientations towards the world in which trust, basic safety or the sense of ontological security are hard to access for people suffering. When distress is conceptualized in this manner it is a narrative that opens space towards its symbolic processing.

There is, however, another reason why this kind of narrative is also important. However hard and complex, symptoms are also often a direction sign. Solely focusing on numbing them down, although sometimes or necessary in order to reduce suffering, will not necessarily remove the original source of their emergence. Like in a system of connected vessels, they might reappear once the original symptom has been silenced, but the underlying cause has not been solved. This is why it is sometimes important to also listen to what they are pointing towards. As psychotherapist Branka Jakelić noted in her book, Searching for Oneself, on self-growth and psychological crisis, a crisis can actually be an “enticement towards deeper cure and a step towards oneself”.

So, for example, what is labelled as depression can also be thought of as shutting down of the organism which has either functioned too long in a situation of insecurity or scarcity and/or which does not know how to get out of the cycle of scarcity and/or not seeing options. It might be excruciating and seem like the collapse of organism that comes out of nowhere. However, if it is researched, usually subjective negative experiences are found that were not acknowledged or not listened to. Further, questioning the above mentioned link of the scarcity within the social context is also important. It is important to educate people on how to process the pain in a constructive manner, how to give oneself more options or how to find more options in scarce circumstances.

Further, it is important to understand states of anxiety as states of being caught in the tension of trying to suppress emotions and feeling them. Emotions erupting in the face of solving what seems unsolvable can result in the inability to breathe. When the human being does not have resources to process them in adequate manner, he or she will often compartmentalize emotions and when they rise this might result in shaking and trembling or a loss of breath. It is important to understand this is pointing towards something that is not attended to and it should be because it has emotional significance for the person. States of anxiety should also be examined within the frameworks of power, particularly institutional ones, or the socioeconomic circumstances people live within.

It also has to be understood that mania can be explained by the overly reactive fight-flight mechanism and stress response of the organism and how adequately addressing the perceived source of stress that one sometimes hides from oneself or not letting oneself feel feelings because of fear might be connected to its regulation. How can recognizing the winding up of the organism and attending to its well-being contribute to regulation in these initial phases of the emergence of this kind of state?

Symptoms of psychosis can be a reaction linked to distressing or traumatic events during a person’s childhood that affects the way in which person experiences things as an adult. People who are sensitive enough and have had adverse or traumatic experiences in childhood are at significant risk to develop different ways of engaging the world or reactions to stress. It is important to raise the awareness that there is a way of “making sense of voices” in some areas offered within hearing voices networks. People can also be educated on how to recognize the early onset of stressful situations that make them prone to the emergence of voices.

Then there is complex PTSD, which can be due to the lack of attunement from caregivers in the developmental phase or shock which is overwhelming for the organism that is unable to process it, resulting in a hypervigilance, problems with safe attachment or arousal regulation due to the compromising of neurobiological systems which are involved. Within this context it is necessary to teach people about re-training of their neurological mechanisms and feelings of safety and how to work with their triggers and process unprocessed emotions.

This is just a brief overview of some of the states and how they can be thought of alternatively. It is important to note the empowerment that this approach brings. The idea is not to underemphasize the challenges of mental distress, but the emphasis is also not put on the solidifying of states into an unchangeable block, as it is in the biomedical paradigm.

The emphasis is instead put on detection of challenging orientations towards the world, their disentanglement into smaller blocks which are understandable, explorable and in which there exists a possibility of working with them or their processing. The work can also consist of re-training of the organism towards new orientations. It also involves thinking of the social context and power relations.

It is important on multiple levels to put an effort into promoting and teaching this kind of alternative psychosocial aetiology and conceptual framework. It gives people conceptual tools to understand and name their experiences, so-called mentalization—the sense-making of one’s own experience. This simultaneously gives room for the processing of emotional suffering. It also provides an orientation towards meaning. If this epistemological conceptual framework and interventions following this framework could be scaled to be widely accessible, it is likely this could also mean a difference for the sustainability of the mental health system.

Namely, this kind of approach can offer a sense of agency for the person suffering. Instead of a helpless position where interventions lowering distress come only from an outside position of power (built into the very premises of the biomedical model), the psychosocial approach puts an emphasis on equality between the help-seeker and the help-provider, and thus the co-creation of the process. This brings with it a sense of agency and ownership of the process which could, it is safe to assume, result in a different kind of motivation for finding new orientations.

Thus, having this kind of conceptual tool at our disposal could mean a difference for the person encountering mental distress, but also for the mental health support system as a whole.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

14 COMMENTS

  1. I was thinking about a similar thing this morning, and came up with the following way of putting it:

    As alternatives to the disproven chemical imbalance theory, how about the following “imbalance theories”:

    Great Reset fourth industrial revolution holocaust social credit score slave system imbalance theory

    Oligarchs trying to destroy food imbalance theory (example: glyphosate in our food imbalance theory)

    Oligarchs poisoning water with fluoride like the Nazis imbalance theory

    Oligarchs poisoning people with medicines and vaccines imbalance theory

    Mass murderers in medicine going off scot-free imbalance theory (see Brandy Vaughn’s videos where she talks about Vioxx for one example of the horrible corruption here)

    Doctors being lied to throughout medical school and their practice imbalance theory (examples: psychiatry, vaccines, many more)

    Heroes like Julian Assange and Edward Snowden being imprisoned for exposing crimes like people at the UN sexually abusing kids (https://wikileaks.org/wiki/United_Nations_confidential_reports) while criminals like Eric Schmidt cover up these crimes by lying imbalance theory

    Big Tech attacks on humanity using cybernetics weaponry imbalance theory (examples: Facebook, Twitter, Google, YouTube, et cetera)

    Propaganda attacks agaisnt humanity imbalance theory (for example, did you know Warren Buffett’s company Berkshire Hathaway bought up tons of local newspapers right before the plandemic attack? He’s also on the Board of Trustees of the Bill and Melinda Gates Foundation and a key player there)

    Bill Gates-Jeff Epstein-MIT relationship that “haunted” Melinda Gates and led to their divorce imbalance theory (this was even reported in a Newsweek article)

    Tons of hate being stirred up in our world imbalance theory

    and many more, unfortunately

    Hopefully we can stop all this evil. Thank you for your loving work.

    In the spirit of Martin Luther King Jr., Jesus Christ, St. Francis of Assisi, Peter and Ginger Breggin, and all good, Heavenly beings, Amen.

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    • I learned a lot from your post but some of it I already knew. Your theories are excellent and spot on. Thank you for enlightening me moreso and for putting the information out there so others may realize these “theories” themselves.
      Why I ask myself almost everyday… why is there so much evil in this world…mass shootings, more really young people being violent and so disrespectful towards others such as their parents, siblings, teachers, strangers? I wonder why…what caused this downward spiraling of our society?

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    • Hi, I’m just correcting an error I noticed upon re-reading my comment. I had written that both Julian Assange and Edward Snowden were imprisoned for their heroic actions. However, only Julian Assange was imprisoned; Edward Snowden was driven into exile and denied a fair trial.

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    • I respect this very long article, and I completely disagree. My life has been ruined by mental illness and I have of course been in contact with a lot of mentally I’ll persons. They were all from different backgrounds, and their psycho social element did nothing to explain their illness, that I saw. If this were true, all siblings would be affected alike, or all the persons from the same neighborhood or the same social class. This is far from being the case. The individuality is impossible to deny and goes much further than these simplifications. It seems to function like collectivism, with hard and authoritarian divisions. It is my belief that this might never go very far, because it has a simplistic vision of the human being. And to conclude, if I may I have not heard any denial of the chemical thinking by any of the specialists I have to see regularly. If everyone adhered to the psychosocial theory, I would not see psychiatrists and therapists anymore. As for my psychosocial origin, ,I have a sibling who is extremely different and whose life is miles away from mine. The Lady who quotes the name of Doctor King is very well intentioned, but I cannot see any link between this theory and Doctor King or Mother Teresa

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      • “If everyone adhered to the psychosocial theory, I would not see psychiatrists and therapists anymore.”

        Maybe that’s the reason you haven’t heard any denial of the chemical thinking by any of the specialists you’ve been seeing.

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  6. I don’t know how they can leave out a person’s social reality, or circumstances.
    Stigma, can be very damaging.
    A mistake can have serious consequences, in someone’s life.
    Missed opportunities, or other differences with others, can matter, too.
    It seems cruel, to drug people (with disabling drugs), to more resemble others, if they are not the others, they want them to be!
    Better, to really help them with their problems.
    The problems other people have with them…advocacy? Help, in arranging their life, so they have a chance (with their permission and cooperation).
    Safety and well being (as much as possible), with all concern.
    Peace.
    Life us short, and it’s sad to spend it, fighting (defensive), or stressed out.
    This would be a nicer way of using our resources in a more benign way. ✌

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  7. “Mental distress, within this view, is conceptualized as a reaction to enduring an experience that overpowers the capacities of the organism or exposure to such an experience without adequate support or resources to process it.” This concept is getting close to my understanding of what cause a serious Mental Health issue for me. In my case, my serious issue occurs in adulthood which allowed me to evaluate what was happening more than my childhood experiences. I was dealing with a situation that was both dangerous and increasing in severity and for which I didn’t have a solution or information needed to understand what was happening or process it. Therefore, the experience ended with myself carrying an extreme amount of emotion that couldn’t be released. Over time that emotion ate away at me physically as well as emotionally, and impacted thought, memory, etc. The solution to this is difficult. I had to come to understand human behavior that I previously didn’t then work through all the emotion. It took many years. But I feel that if psychiatry understood circumstances that create mental health issues and their impact, that Mental Health services could be supportive and understanding instead of seeing those struggling as the problem. It’s very hard to recover when there isn’t understanding and you’re seen as the problem. Plus psychiatry isn’t helping people understand human behavior that is confusing. So psychiatry doesn’t give people information to process experiences.

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  8. As a victim of severe narcissistic abuse. A lot of victims of domestic abuse are wrangled into therapy. Many of people calling crisis hotlines are victims of abuse. I don’t want to talk to a therapist. I want to talk to an attorney. I can deal with my abuse and PTS when I get a divorce. I can relax when I have financial stability. I can stop being riddled with anxiety if the justice system doesn’t tell me I’m mentally unstable and throw my abuser in jail. I want people to stop blaming me for the abuse. It is more traumatic not getting the practical help. I can honestly say, from my situation, get me social help and legal help before I can start healing.

    The only reason I was stuck in that marriage was because I had a “chemical imbalance”. I needed to see a psychiatrist for the rest of my life. I have to take medication for the rest of my life. I must be on disability on forget a career so that I can have financial independence. I was obviously getting worse.

    I lost all credibility. I had to have medical insurance to pay for the doctors and the drugs. I can’t work because I’m mentally I’ll. Nobody knew the constant PolyPharm was what making me worse.

    Having a sociological model would be a better way to help people’s mental health. The US already speaks openly about how our society is causing mental health problems while still handing out prescriptions.

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  10. “It is no measure of health to be well adjusted to a profoundly sick society.”
    -J. Krishnamurti

    How much study does it take to arrive at the common sense conclusion that abuse and trauma f*ck people up? Perhaps as long as it takes to repress and replace people’s natural desire to learn with knowledge commodified, monopolized, and administered by ruling institutions, which legitimate systemic abuse and trauma of society by leaving the framing of ‘our’ problems – and solutions – in the hands of professional authorities tasked with managing and maintaining the system.

    Accordingly, access to resources to ameliorate one’s suffering and struggle is limited to expertise presiding over specialized discourses and disciplines required for navigating Kafkaesque bureaucracies, basic epistemology which enforces upon compliant populations the necessity of rank and hierarchy, and ‘the way things are’. What remains unthinkable and thus out of reach is any radical change going to the roots of this system.

    Professional classes are trained to remain within the grand framework of class-based systems of power over masses of people, which by design produce destruction of human lives like genocidal impoverishment of the many for the few, class war far greater than any conventional theater of war in which organized crime against humanity inevitably results in violent reactions to the system’s abuse and trauma. Those reformists who work to change this system from within, often only to end up having the system work within and change them, are permitted to get by as loyal critics, short of total revolt that leaves one a renegade, reprobate…whatever it takes to decertify if not crucify rebels and revolutionaries.

    The same bought and paid for ‘science’ (of social engineering) that prevails in mental ‘health’ and such pharmafia control as the biomedical model oversees the endless ‘humanitarian’ practices of global institutions like the WHO, whose ranks routinely cry crocodile tears over the plights and plagues of the masses on behalf of benevolent billionaires and corporate state fascists who fund them, and who hardly are challenged by psychosocial paradigms simply enlarging the philanthrocapitalist stakeholder schemes to manage and maintain the system, always with a human face for PR purposes, even as they roll out a more robotic society administered by AI algogarchy amounting to a boot stamping on a human face, forever (Orwell).

    With the current industrial revolution or Great Reset ruling powers have planned and are implementing (as noted by JP Hobach in comments here), ruling institutions in the habit of creating cures worse than whatever disease they’re going to war on next are in fact now poised to altogether extinguish anything arguably human with automated resources replacing obsolete labor power to live off. The parasites and predators who exploit us are currently arranging our disposal as useless eaters through programmatic eugenics under cover of public health, like planetary ‘vaccination’ that is genetically engineering human lab rats as experimental colonies for depopulation and biodigital convergence with a techno-totalitarian system and prison planet.

    Of course, to those who benefit from and otherwise believe humanity’s great benefactors feel people’s pain as they govern the proles from on high, all this must sound mad. But common sense, if it has been regained by critical awareness waking up from slumber to all the gaslighting from those in the know, knows better, simply by reason of compassionate understanding for the perpetually poor and oppressed, that we live in lies wrapped in mystification inside an empire of deceit, and that what we call human society is the source of the anti-human insanity that would make us all mad.

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