# Why is there mental illness? *Different lens, different perspectives* Reference [[20220107 My current understanding of treatment rationale and theories]] [[What's our conceptual framework]] ## What are the assumptions, theories, beliefs, and discourses about mental illness? **Lecture note: working with clients with mental health issues** evernote:///view/463671/s5/b4721a14-cd5d-4e3d-abfb-e398c4f7af1b/0a8fa695-fb09-4a11-adf6-d655c722af9a https://www.evernote.com/shard/s5/nl/463671/b4721a14-cd5d-4e3d-abfb-e398c4f7af1b?title=Lecture%20note:%20working%20with%20clients%20with%20mental%20health%20issues (GDIP counselling notes on working with people with mental health issues) ### Medical Model - The medical model/approach emphasizes on the biological/ genetic factors - But not to adopt a reductionist view which reduces the problem to a gene? chemical? - Treatment plan is a symptom is through medication means - **Refer to "Guide to Psychiatry. Singapore Perspective 16th Revision by Prof Chee Kuan Tsee"** - The categorical approach and the dimensional approach are two different approaches to psychiatric nosology. The main differences between these two approaches are as follows: ^e93b50 **Categorical Approach:** - The categorical approach considers illness as being either present or absent, and similarity with the prototypical description of a disorder is taken as a marker[1]. - It involves classifying mental health disorders into distinct categories based on their symptoms and signs[1][4]. - The categorical approach assumes that mental health disorders are discrete entities that can be reliably diagnosed and treated[1][4]. - This approach is useful in clinical practice for making diagnoses and guiding treatment decisions[4]. - The categorical approach is based on the assumption that mental health disorders are distinct entities with clear boundaries[3]. **Dimensional Approach:** - The dimensional approach regards that symptoms of a disorder exist on a continuum from normal to severely ill[2][3]. - It involves assessing the severity of symptoms and signs of mental health disorders on a continuous scale[2][3]. - The dimensional approach assumes that mental health disorders are not discrete entities but rather exist on a continuum[2][3]. - This approach is useful in capturing the heterogeneity of mental health disorders and can provide a more nuanced understanding of the severity of symptoms[2][3]. - The dimensional approach is based on the assumption that mental health disorders are not distinct entities but rather exist on a continuum[3]. **Hybrid Approach:** - The hybrid approach combines both categorical and dimensional approaches to psychiatric nosology[1][3]. - It involves assessing the severity of symptoms and signs of mental health disorders on a continuous scale while also classifying them into distinct categories[1][3]. - The hybrid approach aims to capture the heterogeneity of mental health disorders while also providing a clear diagnostic framework for clinical practice[1][3]. In summary, the categorical approach and the dimensional approach are two different approaches to psychiatric nosology. The categorical approach involves classifying mental health disorders into distinct categories based on their symptoms and signs, while the dimensional approach involves assessing the severity of symptoms and signs of mental health disorders on a continuous scale. The hybrid approach combines both approaches to capture the heterogeneity of mental health disorders while also providing a clear diagnostic framework for clinical practice. Citations: [1] https://pubmed.ncbi.nlm.nih.gov/25316945/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4181189/ [3] https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00101/full [4] https://sites.bu.edu/tabrown/files/2014/08/Brown-Barlow-2005.pdf [5] https://onlinelibrary.wiley.com/doi/pdf/10.1176/appi.prcp.20190053 [6] https://www.annualreviews.org/doi/full/10.1146/annurev-clinpsy-032816-045020 ### Psychological [[Chapter 5 Psychological Approaches to Mental Illness - Christopher Peterson]] Alternative Views ### Social / Systematic - Mental Health issues as happening between people, not in a person. - A result of the broader social context, rather than pathological - ==Interactional Approach: [[Systemic Thinking]] [[020.200 Systemic Perspective MOC]] [[Context is everything]] [[Relational Dynamics]] [[Function of illness]]== - Mutually influencing, interactive parts of the system - Whole greater than the sum of the parts - Reciprocity - the governing principle of relationships - Intervention - Focuses on relational and interactional patterns that reinforce the "problem." - Bateson's Double Bind - Bowen's Triangles - Diathesis-stress model - Emotional system - Expressed Emotions (Communication Theorists) ### Stress-Vulnerability Model The stress-vulnerability model ([Liberman et al., 1986](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357360/#R17); [Zubin & Spring, 1977](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357360/#R38))  posits that the course and outcomes of schizophrenia are determined by the interplay of biological vulnerabilities (e.g., predisposition for the illness), stress, and coping. To improve illness outcomes,  illness-management strategies for schizophrenia based on this model aim to interrupt the cyclical relationship between stress (e.g., fatigue,  interpersonal conflict, poor medication adherence) and vulnerability that often lead to symptomatic relapse and illness exacerbation ([Mueser et al., 2006](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4357360/#R24)). #stress_vulnerability_model Related to **Oxidative Stress and Inflammation in First-Episode Psychosis**.pdf https://www.evernote.com/shard/s5/nl/463671/5b7690b0-280d-491a-bab3-80f63fec2f6c?title=Oxidative%20Stress%20and%20Inflammation%20in%20First-Episode%20Psychosis.pdf ## Themes of Mental Illness ^0064cb - Stigma - Grief and Loss - Loss of Control - Loss of preferred identities and hopes - Resilience and Coping - Guilt/Blame - Shame - Failure - Powerlessness/helplessness - Burden - Social Isolation