You remember earlier that I said social workers use a biopsychosocial perspective
when thinking about mental health and mental illness.
This is a way to link up how what's happening in a social environment is
connected to what's happening psychologically and what's happening
biologically, I guess based on an assumption that mental illness is somehow
biological. We've already had a few things mentioned
that allude to these connections. For example, the work on positive mental
health shows that some think that they did to effect people's mental health
change that their hormones and their neurotransmitters performed.
So, there's obviously a link there between the psychology and the biology.
Our discussion of social determinants of mental health in the context of
indigenous people in Canada pointed out quite specifically how social policies
and institutional practices, which were all in the social environment, turned
into social and biological consequences over several generations.
So there, we see the connection between the social, the psychologial, and again
the biological as manifested in mental, mental illness in substance use and other
similar problems. I assigned a paper on neuroplasticity and
mental illness because this adds another piece to the puzzle.
It's one of those pieces that I think is coming into place to help us understand
how what's happening with us biologically can have an influence on how we are
functioning mentally. So, we now understand ourselves to have
brains that are capable of change. I've called it the dynamic animal brain
here because we want to bear in mind that we are talking about research that is
largely done on animals, so it is suggestive of human processes but not
definitive. So, according to this research, the
experiences we have and the environments we're in, change the way that our brain
functions, both positively and negatively.
We believe that cells and pathways are created and destroyed as a result of
things that happen to us. So, some of the things that promote
growth are things like environmental enrichment, which I think is a nod to the
social determinants of health. Things like exercise and learning, and I
see that they also seem to think that ECT and anti-depressants promote this.
I know that when I first started practicing in psychiatry, we knew that
ECT worked for many people but we didn't completely understand why.
It's amazing to me to think that within this relatively short period, we're
beginning to actually get research that can tell us why it's supposed to work and
why it does work for some people. On the other side, we know that negative
experiences like mental illness, physical illness, trauma and brain injuries can
undermine the brain, and this leads to pathways in the brain shutting down and
cells dying. So, we understand our mental health is
being affected by the impact of these environmental conditions and personal
experiences have on our brain pathways and our brain cells.
When it comes specifically to mental illness, this research suggests that it
is an interaction between our genetics and our environment that creates the
possibility of mental illness. Basically, genetics and the social
environment affects the way our brain is structured and the way it works.
So now, we look to Neuroplasticity as possibly explaining why when people are
experiencing mental illness, they can experience improvements if they have
treatments that affect the brain, like electroconvulsive therapy, or deep
brain stimulation. Or have experiences that affect the body,
like exercise. Of course, this is all pretty new and
maybe a bit speculative at this point. But I, I would guess that they're
probably also going to be similarly able, at some point, to demonstrate that things
like psychotherapy, spirituality, group involvement.
Other things that we know have an affect on mental health, also have an impact on
how the brain is functioning. So, while you could think of this as
being a line of research that is pulling us deeper into positions of biological
determinism, when it comes to understanding mental health, I think
there's actually huge potential for verifying the relevance and importance of
a biopsychosocial perspective. An additional thought.
This neuroplasticity stuff can seem pretty dismay if you consider that some
people spend their early years or even much of their lives in environments that
this research suggests compromises their brain function.
Experiences of long term deprivation, violence, fear, etc.
These were all things that this work might suggest actually lead to negative
changes in the brain. But, this research is more optimistic
than that. It also suggests that if people have
those kind of experiences, and if, and if it has those kind of effects on the
brain, the neuroplasticity means that it they can be restored.
Positive changes in the environment, positive experience in room, its, pos,
sorry, positive experiences in relationships are all things that can
allow people to heal from those past negative experiences.
I often tell my students in social work that that's what we're trying to do as
part of our work. We are hoping to reverse or remove the
effects of negative experiences that have compromised our clients and make it
harder for them to reach their full potential.
In the context of mental health, I would say that this points to opportunities for
people to experience healing and to have experiences that promote mental health
that will protect them from the effects of negative experiences that they had in
the past, or might have in the future. So, what do this, what does this look
like? Your genetics are a potential that affects how your brain is structured and
functioning, and potentially your mental health outcomes.
This line of work suggests that the psychological and social environment
makes a difference in that potential, a difference that can be negative or
positive. And all kinds of things in a
psychological and social environment have a role to play in shaping that potential.
The biopsychosocial perspective makes intuitive sense to a lot of people.
And there's definitely a growing body of research that is working all the way from
studying brain cells to studying policy outcomes.
And this substantiating these links between mental health, and biological,
psychological and social experiences. This is actually a perspective that's
been around for a very long time. Something that you wouldn't necessarily
guess when looking at our history of mental health care treatment.
Despite the energy that has consistently been put into demonstrating that
psychiatry is scientific and biological, there's a long tradition of also seeing
it as connected, seeing it as connected to psychologial and social issues.
And this has been manifested in many things over the years,
including the use of moral therapy, psycho therapy, the critiques of the
anti-psychiatry movement, the movement towards community based mental health
care, and the recovery movement. When Adolf Meyer, who is, who is credited
with pioneering this perspective said many years ago is still true.
You can not understand a person's experience with mental illness without
getting to know that person fully, which includes their psychological and social
world. I do want to mention that the
biopsychosocial perspective while intuitively appealing, has not always
been welcomed in psychiatry. In this paper that I'll list in your
resource section, David Pilgrim suggests that there has actually been quite a bit
of resistance to integrating the biopsychosocial perspective because it's
seen as a threat or a distraction from a true biomedical approach to mental health
and illness. He suggests that there are four reasons
why the biopsychosocial perspective has been able to persist over the years.
First, he suggests that the biopsychosocial model was needed at the
turn of the century to help provide an explanation for the high levels of shell
shock that were seen among soldiers returning from the first World War.
You will remember that there was a bit of resurgence of interest in mental health
care in the early 20th century, and one of the problems it was supposed to
address was returning soldiers. There was resistance to suggesting that
these soldiers, who we had understood to be the finest young men that England,
Canada and other countries had to offer, were suffering from mental disorders
because they were of the type of inferior stock that the mental hygiene movement
was designed to remove. So, the biopsychosocial perspective
became a way of explaining how these otherwise healthy men could succomb to
mental illness. The psychological and social parts of
that equation became the place to locate an explanation about the traumas of war
and its effect on the brain. Another thing that Pilgrim suggests helps
the biopsychosocial perspective was the anti-psychiatry movement.
The anti-psychiatry movement forced the psychiatrists to consider explanations
beyond the biological For mental illness. You may remember that some of its
champions, like Franco Basaglia in Italy, made very direct connections between
social environment and mental illness. Advocating for psychological and social
treatments rather than biological treatments.
So, the biopsychosocial perspective was a way of letting some of that perspective
in. Perhaps, because of a genuine openness to
the idea, perhaps just to stop the fighting, who knows? Either way, it
helped the perspective gain some Ground. Another suggestion from Pilgrim is that
the biopsychosocial perspective is one way that so many different professions
ahve been able to work together in mental helath.
You may have noted that I earlier said that the biopsychosocial perspective is
something that has been mostly championed by psychologists, social workers and
sociolgists. These are, of course, non-medical
professions and disciplines. Pilgrim suggests the biopsychosocial
perspective provides a way for them to work together with some agreement as to
the distinct areas in which they intervene and how they cal all work
together cooperatively to the benefit of their clients.
Finally, and a little more positively, Pilgrim also suggested that
biopsychosocial perspective has gained ground because of the advocacy of service
users as an overall desire to be more humanistic in our approaches to dealing
with mental health and illness. This takes us right back to what Adolf
Meyer said over 100 years ago. People need and want to be understood in
their context. So, putting all of this together, we can
start to think about how a biopsychosocial perspective attempts to
answer the question that has been threaded throughout this lecture.
Why are some people able to keep mentally healthy? And why is it so much harder for
others? In terms of things that promote mental health, we can see that there are
biological things like good health and nutrition that can contribute.
Psycho, psychologically, resiliance, positive coping, self esteem and a sense
of meaning. These are all things that are suggested
in the literature on wellness and well being and positive psychology as things
that will promote mental health. Here, I've included the family
environment as a factor in the biopsychosocial perspective,
one that often can bridge between the psychological and the social in some
ways. Things that, things like feeling
supported by a family, feeling close to them, feeling positively attached to them
are understood to promote mental health as well,
and this is something that we will Particularly think about when we're
working with children. Socially, being in good social networks,
having a valued social roles, stability and security are all things that promote
mental health. And environmentally, being in safe
circumstances, having access to leisure, pleasure, nature and access to help, to
help when you need it, are all things that promote mental health.
It's not that you need to have all of these things all of the time.
But you can see how having them in place increases the chances that someone is
able to maintain a state of good mental health.
On the other side, there are things that undermine mental health in the same
areas. I have genetic predisposition here.
Because we know that there seems to be some type of genetic underpinning to many
mental illnesses. Other issues like illness, injury,
material deprivation are all things that have an effect on the body, and in turn
can have an effect on mental health. Psychologically, experiences like trauma,
high stress and not having the opportunity to develop healthy ways of
coping, perhaps even developing unhealthy and damaging ways of coping with stress,
these are all things that can undermine mental health.
In the familial area, disruption and violence are examples of things that can
undermine mental health, and this was something I mentioned when we were
looking at social determinants in the context of indigenous communities.
This type of disruption is often associated with the kind of social issues
you see next to it. Dislocation of communities, isolation,
violence and oppression. These are all things that we discussed as
part of the social determinants of health, and we know that they have a
negative effect. Finally the environmental piece that is
also mentioned in social detminants, we know that being in unsafe physical
environments has a negative impact. I've added the examples of war and
disaster here because they're, these are environmental influences that we have
seen several times in recent history have a significant effect in terms of
destabilizing people and undermining their mental health.
Just like with the other things that promote mental health, promote mental
health, you don't need to have all of these things in place to experience
mental illness. But you can see how they present the
potential for the type of difficulties that can undermine mental health.
Hopefully, you can also see that it's possible to have biological,
psychological, familial, social and environmental factors that help to
balance each other off so that if someone is having difficulty in one area might be
able to sustain them. Or if they have, they might be able to sustain them or
recover from them if they have health promoting factors in other areas.
It's always very important to be mindful that people have strengths and resources
that they bring even to the most difficult and potentially undermining
circumstances. So, that's a picture of the biopsy,
psychosocial perspective of mental health.
What will we, what we're going to do next is similar to what we did with social
determinants. Let's see if we can use this model to try
to understand how someone can be mentally health, or mentally ill,
or even both at the same time.
