Our Approach to Mental Health Isn’t Working

Our Approach to Mental Health Isn’t Working

Eleanor Longden was a university student when she first started hearing voices. After she was given a diagnosis of schizophrenia, a doctor told her she’d be better off with cancer instead, because it was easier to cure. 

Longden’s experience of being “diagnosed, drugged, and discarded” by the health care system is not unusual. But her subsequent recovery—she is now a research psychologist completing her PhD and an international speaker on mental health—isn’t unusual, either. She still hears voices, but she doesn’t need medication to handle them. 

Longden’s story challenges mainstream perceptions—that schizophrenia is a debilitating illness—and it underscores why we need to rethink the biomedical approach to mental health.

What is the biomedical approach? Put simply, it’s the tendency to see mental health problems as biological diseases of the brain: inevitable, incurable, and genetically determined. But the evidence for this model, which has come to dominate both medical practice and public opinion, is shaky at best. 

For example, while genes may play a role in influencing vulnerability to trauma, there is much stronger evidence that experiences and environment have a significant impact on mental health. Children who experience poverty, abuse, and discrimination are much more likely to develop mental health problems later in life. According to clinical psychologist Richard Bentell, “the evidence of a link between childhood misfortune and future psychiatric disorder is about as strong statistically as the link between smoking and lung cancer.” 

The biomedical approach can also lead us to pathologize normal human responses to suffering. It’s not surprising that people who go through divorce or unemployment may experience depression and anxiety, but needing support and services isn’t the same thing as having a disease.

Because the biomedical model tends to isolate mental health from the broader social context, it emphasizes treatment rather than prevention, and the treatment models it promotes tend to rely heavily on drugs. While psychiatric medications work for some people, they certainly don’t work for everyone, and their side effects can be debilitating. A pill won’t erase the effects of being homeless or bullied in school.

Moreover, there’s evidence that the perception of mental health problems as a disease might actually increase its social stigma—which causes further harm to people who need support and community to recover. And recovery is possible; people can and do get better. They can go on to live full and rich lives, supported by family and friends, and succeed in education and work. But recovery is harder if the only treatment available to them is pharmaceutical, and fails to address the root causes of their distress and provide the resources they need to heal.

We need a better way of thinking about mental health. We need to develop health systems that integrate mental and physical health care, especially at the primary care level. Mental and physical well-being are inextricably linked—physical illness and pain can cause depression and anxiety, and conversely can mask underlying medical conditions, especially when doctors interpret these experiences solely through the lens of a psychiatric diagnosis. 

Any treatment has to start with a focus on the whole person. We need appropriate community-based care and holistic solutions that take social, economic, and cultural factors into account. We also need to broaden our understanding of recovery to mean a person’s ability to live a good life on their own terms, rather than defining it as the absence of certain symptoms.

Finally, we have to start treating mental health as a social justice and human rights issue. That’s why Mental Health Europe advocates for a psychosocial model that acknowledges the profound impact of lived experience and social environment in shaping mental health. We know that poverty, racism, and violence put people at higher risk of developing mental health problems—so that means we need population-level interventions which can focus on fighting the root causes of this public health crisis.

Our current systems for mental health care are failing at both treatment and prevention—and the biomedical model is one of the chief reasons. Future research may provide more insight into the complex relationship between genes, the brain, and mental health. But no discovery will prevent people from experiencing painful things, or erase their need for support. 

By focusing on disease, the biomedical model leaves little space for the voices of people with lived experience of mental health problems—who are the real agents of recovery, because they’re the best experts on their own lives.

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4 Comments

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a fantastic thoughtful article with the courage to break away from the thoughtless re-iteration of mental illness as a 'disease'. Sometimes it is, but so very often it is the sequelae of childhood trauma and that is something that happened to us not something that is wrong with us.

I couldn't agree more however, as well mental and physical approach, a spiritual element needs to explored. I'

Open Societies approach to “mental health” is not far enough removed from mainstream biological medical model to be able to call itself an alternative.

The fatal flaw in this thinking is that poverty and other "experiences" lead to "mental health" problems.

It is far more accurate to say that accumulated experiences of trauma are worsened by poverty (lack of access to vital nutrients, poor housing conditions in poor neighborhoods and working conditions that lead to toxic exposure, overwork, underpay, and other hardships that take a toll on the human body leading to real biological disease (medical mimics such as thyroid disorder, brain injury and countless other disease (poor hygiene, bad teeth, lack of sleep, extended stress, use of drugs, dangerous or unhealthy lifestyle.)

The above are NOT “mental illness's” but are used as pseudo-evidence of a “mental health” condition. The failure of this approach continues to be the medicalization of social problems, conveniently positioned as impending “mental health” problems. Bunk.

The insidious creep the this fraudulent medical model, benevolently mascaraing about as "mental health" help, is the problem. This approach, like the rest of them takes advantage of all situations and uses them as “evidence” of “mental illness” in order to force stream (by default-, owing to lack of appropriate services) everyone into the system where they are treated like cattle, labeled, drugged and possibly much worse, for profit without consideration for the lack of science, facts and positive outcomes from being in contact with the system.

One is guilty by virtue of birth, by the mere act of being alive, of being vulnerable to adverse life experiences that corrupt ones “mental health” into a disease. Where does it end?

Had bad experiences? Think long and hard before you answer, because what you are really vulnerable of here, is being accused, tried and convicted of the crime of "mentally illness" by association of having “mentally ill” alcoholic parents, by genetics, or epi-genetics, or whatever meme works to push you into the “mental health” system.

This myth is dangerous "any trouble in your life" Yes- BOOM – this IS your "mental health" problems, that were lying in wait to become the “disease” in living, in later life”.

So although this approach has the good sense to criticize the dangers of the medical model, it falls prey to and supports the medical model throughout and most specifically with the statement:
"Mental and physical well-being are inextricably linked—physical illness and pain can cause depression and anxiety, and conversely can mask underlying medical conditions, especially when doctors interpret these experiences solely through the lens of a psychiatric diagnosis. "

Wrong. The problem is that the medical model invented "mental health" as a separate and unique health for the head/mind/brain that is NOT remotely accurate. The is only one health, human health. There is no separation so no link can be claimed. Claiming one affects the other, IS saying that the medical model is accurate, while pointing out that it is problematic. It's a confusing contradiction and a totally twisted misunderstanding that mistakenly solidifies the problem while claiming to try to mitigate the damages of the same. Its just as wrong headed and dangerous as the medical model it claims to be an improvement upon. It isn't.

This approach also claims to support "prevention", and yet any "prevention of mental health" by designs will include the invasive judgment of and into people's private lives, their individual thoughts, feelings and believes and as such, had nothing to do with supporting their rights, and everything to do with judging and labeling them. Although it may come under a different disguise, it will be some other toxic version of "mental health first aid"; and state-trained watch-dogs groomed to peer over our shoulders looking for signs to point their finger at and cry out "poor mental health" alerting the mind police to arrest the accused for per-disposition to psychosis or over-texting, or excessive fidgeting (AKA - ADHD).

This is not remotely a "rights" based model as it claims to be. It is just another slightly twisted version of a bigger brothers every impending reach into our minds so it can continue to attempt to control what happens to us in our lives on this planet. This approach, claims to be different and more humane (like all of them) but anyone who chooses to continue to use the fraudulent medical model concept of “mental health” is the same old thing hoping no one will notice and call them on it.

© JMG 10/11/17 MH, AB, CA

I have been in the mental health scene in USA for years
and between stigma fromworkers and family and lack of
useful treatment, I feel totally cheated !!

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