Mental Health in the Consumer Society Looking beyond the Biological Dogma

As Mental Health Disorders are on the verge of becoming one of the leading factors of disability in the world, a new perspective of mental health disorders is necessary. In fact, mental health disorders are largely analyzed within the biomedical model, leaving out those social and power structures in which a disease might be embedded. In fact, due to a focus on growth, individualism and materialistic values, societies have grown ever more fragmented in the age of capitalism as is visible within diminishing relationships. Therefore, this thesis proposes an analysis of the structural forces behind mental health disorders that can be linked to a social logic of consumption

The Beliefs of Non-Psychiatric Doctors about the Causes, Treatments and Prognosis of Schizophrenia

Objectives To examine the causal beliefs about schizophrenia of non‐psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors’ views about treatments and prognosis. Design and methods Three hundred and five non‐psychiatric doctors working in outpatient community centres completed the ‘Opinions on mental disorders Questionnaire’ after reading a clinical description of people with schizophrenia. Results The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy‐five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty‐two per cent of respondents thought it ‘completely true’ that drugs are useful in schizophrenia, and 33.9% thought it ‘completely true’ that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia. Conclusions These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed

Mental health clinicians’ beliefs about the causes of psychosis: Differences between professions and relationship to treatment preferences

The ontology of mental health problems is an area of long standing debate. This has been fuelled by strong claims of a genetic basis to mental health problems, particularly in relation to the more serious difficulties such as schizophrenia and psychosis (John, Thirunavukkarasu, Halahalli, Purushottam, & Jain, 2015). The result of this biological framework has influenced practice at a service-level, with medication the primary treatment offered to this client group. Although neurobiological and genomic research has substantially progressed over the past decade, findings have also provided strong evidence for the role of environmental factors. Deprivation, trauma, social isolation, urbanicity and adverse childhood experiences have all been associated with the onset of psychosis (Cohen, 1993; Read, Van Os, Morrison, & Ross, 2005; Van Os, 2004). Given the evidence-base, psychosis is now considered by many experts in the field to be the result of a complex interaction of biological and environmental factors, for which the relevance of these differs for each individual. As a result, an integrative approach to treating psychosis is now endorsed by some clinical guidelines, with a recommendation that everyone be given a comprehensive, multidisciplinary assessment and be offered both antipsychotic medication and psychosocial interventions (NICE, 2014)

Lived experiences matter: The role of mental health professionals’ psychological crises and vulnerability in shaping their health beliefs and concepts

BackgroundMental health professionals are often affected by mental health problems and disorders. Yet, the effects of these lived experiences on their causal beliefs and health concepts have not been investigated. The current study investigates how professionals’ lived depressive experiences and their perceived vulnerability to mental illness affect their causal beliefs about mental disorders, their general concept of mental health and their specific concepts of depression and burnout.MethodsAn online survey was conducted with 218 mental health professionals from 18 psychiatric clinic departments in the German federal states of Berlin and Brandenburg, investigating their experiences with depression, self-assessed vulnerability, their causal beliefs of mental illness, their general health concept and specific illness concepts of depression and burnout. A path model was calculated to examine the relationships between these variables. Participants with and without lived experience of depression were grouped.ResultsLived experience of depression was indicated by 126 participants. For participants with no experience of depression, perceived vulnerability negatively predicted beliefs in biological causation, which positively predicted higher differentiation between depression and burnout. For participants with previous depression experiences, perceived vulnerability positively predicted beliefs in psychological and social causation. Continuum belief was predicted only in this group by the three variables of causal beliefs. Psychological and social causation was positively associated, while biological causes were negatively associated with continuum beliefs.ConclusionMental health professionals are not external to the clinical situation. Their lived experiences do matter, shaping their beliefs and concepts and, thus, possibly also their actions toward patients

Illusion of Understanding in a Misunderstood Field: The Illusion of Explanatory Depth in Mental Disorders

Humans fail to fully understand the world around them and to recognize their limited understanding. The illusion of explanatory depth (IOED) exemplifies these failures: people believe they understand the world more than they actually do and only realize the illusory nature of this belief when they attempt to explain phenomena. An unexplored factor of the IOED is how people may become overconfident by confusing their own understanding with others’ understanding. In three experiments, I compared the IOED in devices, where it is typically examined, with mental health, a domain where society has a more limited understanding. In Experiment 1, I demonstrate that laypeople believe society understands mental health less than devices and that people demonstrate a smaller IOED in mental health than in devices. Experiment 2 shows that explanation is necessary for the illusion to be revealed in mental health. Finally, Experiment 3 suggests that explicitly describing others’ understanding as limited eliminates the illusion. Implications for meta-cognition and for mental health are discussed

Causal explanations of mental illness and perceived credibility of psychological therapy

Aim Biological explanations of mental health difficulties have remained dominant in recent decades, particularly in the case of psychosis. Research has shown that these explanations can lead to reduced empathy and a bias towards offering pharmacological rather than psychological intervention. This study aimed to explore whether this bias can be reduced by presenting evidence that CBT for psychosis (CBTp) also brings about neurobiological changes (i.e. neuroplasticity). This was examined both in samples from the general population (Study 1) and mental health clinicians (Study 2). Method An experimental design was employed in which participants read a vignette of a person with psychosis. Participants were asked to report which treatment they would recommend (i.e. medication versus psychological therapy) and how effective they perceived each to be. These ratings were elicited before and after reading information about the effects of CBTp: either control information about its clinical effectiveness or evidence of CBTp-led neuroplasticity. Results In Study 1, the predominantly biological description of psychosis elicited lower therapy effectiveness and higher medication effectiveness ratings compared to the predominantly psychosocial description, replicating previous work. Therapy effectiveness ratings were higher and medication effectiveness ratings were lower after either type of CBTp effectiveness evidence was presented. In Study 2, evidence of CBTp-led neuroplasticity had a greater impact than the control information on treatment recommendation ratings amongst psychologists, but not psychiatrists. Conclusions We replicate a previous finding that when biological factors are emphasised in patient information, it biases people to choose medication rather than psychological therapy as a treatment option. When the general population are presented with any type of evidence that CBTp is an effective treatment, they are likely to rate psychological therapy as a more effective treatment method. The impact amongst clinicians is more varied, depending on their training background

Effects of the diagnostic label “schizophrenia”, actively used or passively accepted, on general practitioners’ views of this disorder.

Background. General Practitioners (GPs) play a key-role in the care of somatic and psychiatric problems in People With Schizophrenia (PWS). It is probable that, like other health professionals, GPs are not all free of prejudices towards PWS. In clinical practice, GPs sometimes interact with clients diagnosed with schizophrenia by specialists, passively accepting this diagnosis. Other times, GPs interact with clients having symptoms of schizophrenia but who have not been diagnosed. In this case, GPs are expected to actively make a diagnosis. Giving the key-role of GPs in the process of care, it is worthwhile examining whether passive acceptance and active usage of the diagnosis schizophrenia have differential effects on GPs’ attitudes toward people with this disorder. Aims. To investigate GPs’ views of schizophrenia and whether they were influenced by a “schizophrenia” label, passively accepted or actively used. Methods. Four-hundred and thirty randomly selected GPs were invited to complete a questionnaire about their views of schizophrenia, either after reading a description of this disorder and making a diagnosis, or without being provided with a description but passively accepting the label “schizophrenia” given in the questionnaire. Results. The GPs who passively accepted the label schizophrenia (N=195) and those who actively identified schizophrenia from the description (N=127) had similar views. Compared to the GPs who did not identify schizophrenia in the description (N=65), those who used the diagnosis, actively or passively: more frequently reported heredity and less frequently psychosocial factors as causes of the disorder; were more sceptical about recovery; were more convinced of the need for long-term pharmacotherapies, believed more strongly that PWS should be discriminated against when in medical hospital; and perceived PWS as more dangerous and as kept at greater social distance. Conclusions. The diagnosis “schizophrenia”, however used, is associated with pessimistic views. Stigma education should be provided to GPs

Modifying Essentialist Beliefs Toward Mental Illness: An Alternative Focus for Anti-Stigma Interventions

A Thesis Presented to the Faculty of the College of Science and Technology Morehead State University in Partial Fulfillment of the Requirements for the Degree Master of Science by Fredrick T. Chin on July 8, 2014

How do people with brain injury understand the interaction between mind, brain, self and injury?

This thesis explores the conceptual models adults with acquired brain injury (ABI) use to understand changes following injury, particularly those reflecting the relationships between mind, brain and self. Part one is a conceptual introduction on how philosophical perspectives impact clinical models and clinicians’ understandings in this area. Research into the self was also outlined indicating how adults with ABI understand changes. Biopsychosocial models were presented to demonstrate holistic understandings before an argument for the inclusion of service user accounts in our understandings. This paper concludes that there is a dearth of research exploring the conceptualisations adults with ABI use to understand changes, particularly regarding relationships between mind, brain and self. Part two is a qualitative empirical paper exploring the conceptual models adults with ABI use to understand changes following injury. This was conducted jointly with Alice Chesterfield, although we have separate thesis with separate populations. Semi-structured interviews were conducted with 15 participants with ABI. Grounded theory guided the analysis. Results indicated that participants generally centred their brain injury, within a more holistic understanding, to understand changes. Changes in the self and the mind were indicated following brain injury and were generally attributed to ABI. Furthermore, these understandings were sometimes incomplete or indescribable. The clinical implications are outlined regarding how we should speak with adults with ABI about changes. Part three is a reflective paper which critically appraises the process of conducting the research with regards to my assumptions, considerations of conducting research with adults with ABI and outsider research

Is the mainstream construction of mood disorders resistant to systemic thinking?

IntroductionIn this study we explore how the diagnostic category of mood disorders is constructed in two handbooks of Psychopathology as an example of the mainstream construction of psychopathology. Despite the increasing criticism and lack of evidence, the debunked chemical imbalance theory of the etiology of depression still dominates the professional and pop/folk understanding and interventions.MethodsWe analysed the breadth of the inference field and the type of etiopathogenetic contents of the explanations of mood disorders using the “1to3” Coding System.ResultsOur findings show that the dominant explanations draw almost exclusively onto monadic explanations, followed by limited dyadic ones. Intrapersonal etiopathogenetic contents prevailed, and biomedical explanations were dominant in both textbooks.DiscussionWe critically discuss the underpinnings of these results and address the clinical implications of these biased representations, as well as potential alternative approaches to psychopathology