Mental health refers to our cognitive, and/or emotional well being and is all about how we think, feel and behave. Approximately 1 in 4 people in the UK have a mental health problem at some point in their life. Mental health can affect daily life, relationships and can even affect physical health. For an individual to enjoy life, it is desirable to attain a balance between life activities and efforts to achieve psychological resilience (Nordqvist, C). This essay will explore the various approaches used to understand mental health and illness, referencing well known studies.
A historical overview of health will be discussed along with biological views, the labelling theory and anti-psychiatry views. Hippocrates (c. 460-377BC) made such an impression on medical history that his name is still very much associated with medicine today. All newly qualified doctors are required to take what is called the ‘Hippocratic Oath’ which is named after him. Hippocrates was the first person to say that people become ill because of scientific reasons and was therefore seen as the father of medicine (Trueman, C).
Moving on a few hundred years, Galen (c. 130-200AD), doctor to the gladiators viewed mental illness as something that could be fixed with diet, exercise and natural remedies. This period saw mental illness in terms of a medical model (Armstrong, S). During medieval times when the church was very powerful, disease was seen as the work of the devil. Anyone seen to be deviating from the norms of society were tortured, hanged and burned at the stake.
This is demonstrated by The Salem Witch Trials of 1692 – at a time when a small pox epidemic and threats from warring tribes created a fertile ground for fear and suspicion, 150 men and women from surrounding towns were put into prisons, their names were ‘cried out’ by tormented young girls as a cause of their pain. This resulted in 19 of the 150 innocent men and women being hanged for witchcraft before the court was disbanded (salemwitchmuseum. com). The 18th century saw the growth of medicine. Mental institutions were introduced for people behaving in an odd manner, people were locked up to keep them safe and away from society.
Mental illness was recognised as a result of sickness (Armstrong, S). The industrial Revolution in the 19th century saw a rise in technological advancements, people were now able to travel easily to and from cities, at this time prostitution was very common which saw a rise in cases of syphilis – a sexually transmitted disease that can ultimately cause brain defects. It was during this period that a definite link between mental illness and biology was discovered, the medical model was now dominant.
The biological approach to mental illness is the dominant approach in the western world where mental illness is seen as a real illness that can be treated by medical professionals. In accordance with the medical model, it is said that there are two main causes for mental illness. The first being a disturbing experience, which would require a psychoanalytical approach to treatment such as Cognitive Behavioural Therapy which can help change how you think and behave. This type of treatment has been shown to be effective with illnesses such as post-traumatic stress disorder (ptsd.va. gov).
The second cause is of a biological origin such as a chemical/hormonal imbalance in the brain which would be treated with medicine such as anti-depressants. For example, research shows biological explanations for eating disorders such as anorexia. These are the result of inherited behaviour traits, neurochemical abnormalities in the brain, structural damage to the brain or because of infection. Kaye (1999) found that 10% of eating disorder patients have a relative who is also an eating disorder patient demonstrating that eating disorders tend to run in families.
According to the genetic study on anorexia rates by Holland et al (1984), 55% of monozygotic twins developed anorexia compared to 7% of dizygotic twins suggesting genetic contribution, although it is recognised that this was from a very small sample. Serotonin is a neurotransmitter which plays a part in the regulation of learning, mood and sleep (Nordqvist, C). Flava et al (1989) found links between anorexia and changes in the levels of serotonin, illustrating a biological link.
By prescribing anti-depressants to people with anorexia, the effects of serotonin were reduced (psychology4a.com) however, it is unknown whether anorexia patients have a predisposition for low serotonin levels or if the low levels were due to dietary habits associated with anorexia making it very difficult to tell cause from effect.
The labelling theory emerged in the 1960’s as a challenge to the dominance of the medical model. Mental illness is viewed as a social construct as opposed to an illness which resulted in concerns over the power of medical professionals labelling those with less power in a negative way. The labelling theory is based on the idea that behaviours are deviant only when society labels them as deviant.
As a society we have to question whether we are too quick to pathologise certain behaviours and label people with a mental illness. Individuals are given different labels for varying behaviour traits, such as depression, ADHD and bipolar disorder. Once a person has been labelled as mentally ill they may come to be seen in these terms only, all of their behaviour will be interpreted as symptoms confirming their label and they may also use this label as an excuse to become more deviant.
Goffman (1963) argues that medical professionals engage in ‘spurious interaction’ with those labelled as mentally ill meaning that the professionals are only hearing what the mentally ill person is saying and not what the sane person is saying (Armstrong, S). Anti-psychiatry views are divided between those theorists that believe that mental illness does not exist such as Szasz and Rosenhan and those that believe mental illness is a reaction to an unbearable stress in life such as Laing.
Thomas Szasz (1920-2012) saw mental illness as a myth believing that mental disorders such as ADHD did not exist and that children were being misdiagnosed and over-medicalised for something that was merely bad behaviour, completely normal in children. Rosenhan (1973) conducted a study where he arranged for a number of perfectly sane people to falsify some symptoms of insanity in order to be admitted into a psychiatric hospital. Once in the hospital they resumed normal behaviour however each one was discharged with a psychiatric diagnosis.
From this experiment on being sane in insane places, Rosenhan concluded that professionals were unable to distinguish the sane from the insane and that the patients had been given a label that would stick with them forever. Laing (1927-1989) stressed that individuals can often find themselves in situations where it would become impossible to behave within the conforms of society, which led to immense pressure and distress, this in turn was seen as madness (Armstrong, S).
Anti-psychiatry theorists argue that the medical view is wrong and dangerous because vulnerable people are being labelled with an illness, being forced to take medication and in some cases deprived of their freedom in order to keep them away from society. To conclude, there are two main approaches to mental health, the biological approach and the anti-psychiatry approach, both approaches have advantageous and disadvantageous views. Advantages of the medical approach are that help and support is plentiful, as are clinically trialled medicines.
Disadvantages would be that people are sometimes misdiagnosed and over-medicated. Advantages of the anti-psychiatry approach would be that everybody would be given a fair judgement and not just labelled with an illness and that behaviour and social factors would be considered when proposing treatments. A disadvantage would be the belief that mental illness does not exist. A good approach would be to find a middle ground, society could slow down the process of handing out labels and be more thorough in investigating the many possible causes for the behaviours that are described as not normal in today’s society.