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.
