Individual Development and Change

Critical Perspectives

Thinking About Theory

‘Ín the case of mental disorder, theoretical disputes have led to varying and conflicting explanations. Moreover, these different understandings have led to different practices and treatments. If the cause of madness is said to be the possession of the individual by evil spirits, the appropriate response is exorcism. When the explanation of mental disturbance lies with chemical imbalances in the brain, treatment by drugs is recommended. If mental confusion is generated in the disturbed communication pattern of family life, family therapy is offered. What is to be done depends on what it is you think is going on.’

• David Howe (1999)

Implications

• There is conflict or disagreement between different models / explanations.

• Thus a person with mental health difficulties could receive a variety of different explanations / diagnosis depending on who he or she sees and furthermore these different explanations will clash leaving the service user or patient very confused.

Practice Implications

Different explanations and differential service user experience leads to a lack of quality assurance and standardisation

Implications For Service Users

• Different explanations or models lead to different practice models and modes of intervention

• For the service user or lay person this is very confusing. It means we could have a room of people with the diagnosis of depression who have all had different experiences of treatment with different outcomes.

Key Questions For Critical Thinking

In the conflict and disagreement between explanations and models the question must be asked of:

Who decides which is the best explanation and why.

KEY MODELS

• Bio - Medical• Behavioural• Cognitive• Psychodynamic / psychoanalytic• Humanistic• Service User – Recovery model• Psycho-Social• Located in terms of: Societal

Inter-personalIndividual

The Power of Models

‘What does it mean for a word not only to name, but also in some sense to perform and, in particular, to perform what it names’

Judith Butler (1997) Burning Acts, Injurious Speech. Found in Salih Sara Ed (2004) The Judith Butler Reader

Why Have a Model / Thoery?

‘The Choice for the practitioner is not whether to have a theory but what theoretical assumptions to hold. All persons acquire assumptions or views on the basis of which they construe and interpret events and behaviour, including their own. These assumptions frequently are not explicit but more what has been called implicit theories of personality’. Thus the appeal for practitioners to be atheoretical amounts simply to an argument that theory ought to be implicit and hidden, not explicit….particular assumptions about human behaviour can be expected to influence professional actions and therefore, have important consequences for clients.’

(Briar and Millar 1971 pp. 53-54)

Questioning the individualisation of social problems

‘Psychology’s deflections of social problems into individual maladjustments, together with an abuse of power by professionals, led me ..to practice a psychology that would not blame victims, that would not be divorced from social issues, and listen to people’s concerns, in all their complexities. I have been searching for theories and practices that show the intricate connections between psychology, power, oppression and domination.’

Isaac Prilleltensky, (2002) ‘Doing Psychology Critically’ ISBN 0-333-92284-0

Social Construction of Madness• In the serene world of mental illness, modern man no longer

communicates with the madman: on one hand, the man of reason delegates the physician to madness, thereby authorising a relation only through the abstract universality of disease; on the other, the man of madness communicates with society only by the intermediary of an equally abstract reason which is order, physical and moral constraint, the anonymous pressure of the group, the requirements of conformity. As for a common language, there is no such thing; or rather, there is no such thing any longer; the constitution of madness as a mental illness, at the end of the eighteenth century, affords the evidence of a broken dialogue, posits the separation as already effected, and thrusts into oblivion all those stammered, imperfect words without fixed syntax in which the exchange between madness and reason was made. The language of psychiatry, which is a monologue of reason about madness, has been established only on the basis of such a silence.

• (Foucault, 1965; x-xi)

Social Construction of Madness

‘In his usual rather dense style, Foucault encapsulates many of the paradoxes at the root of the study of mental health and illness, and sets the stage for many of the themes which will be of significance. The centrality of the medical model of insanity is asserted, imposing a scientific order onto the profoundly un-ordered world of the mad. While madness is displayed in the form of a disease, sanity is a constraint, both physical and moral into which the insane person is confined through pressure of the group, the sane. All this is a construction of the reasoned, and reflects the world of the reasoned; to the insane person, it is an alien landscape.’(Mental Health law 2nd Edition Peter Bartlett and Ralph Sandland 2003)

Bio-Medical / Disease Model

• regards mental malfunction as a consequence of physical and chemical changes primarily in the brain but sometimes in other parts of the body.

Example

• Depression is caused by a chemical imbalance in the brain and will be treated accordingly

Behavioural ModelThe terms classical and operant conditioning are two key concepts within this model.

• Classical conditioning is associated with the work of Pavlov, whereby biological responses are regulated and respond to external stimuli creating a conditioned reflex.

• Operant conditioning is associated with the work of Burrhus Skinner whereby a link exists between positively affirming behaviour that reinforces a particular stimulus. Operant behaviour differs from classical conditioning in that behaviour determines conditioning, not the stimulus.

Humanistic Model

• Highlights not just the importance of external factors but the individual’s subjective experience of those external factors.

• Maslows's hierarchy of needs proposes that individual’s thoughts and the mind is influenced by the extent to which physiological and intellectual needs are being met

Humanistic Model

• Highlights not just the importance of external factors but the individual’s subjective experience of those external factors.

• Maslows's hierarchy of needs proposes that individual’s thoughts and the mind is influenced by the extent to which physiological and intellectual needs are being met

Cognitive Model

This model proposes that it is the dysfunctional thinking of the patient in response to a variety of stimuli that creates mental disorder that would not otherwise be present.

Psychoanalytic Model

• Concept of mental apparatus –

Id, Ego, Super – Ego

• Concept of the unconscious

• Concept of defence mechanisms

• Concept of internal conflict

Psycho-Social / Social Model

• Relationship between social conditions and mental health

• The social construction of Mental Health

• Concept of Internalisation

Social Model‘The problems of madness and misery, then, lie not inevitably in any inherent impairment of perception, emotion or conduct of identified patients. Instead they are located in the contexts they inhabit, particularly in intolerant norms and the fetish for rationality. Once this epistemological tack is taken then warranted paternalism to those with psychological affliction melts away’(Pilgrim D, & Rogers A, (2008) in ‘Critical Issues in Mental Health’. ISBN- 978-0-230-00905-9)

The Social Model‘for nearly every kind of mental illness, disease or disability, and especially those which afflict large numbers of people, poorer people are afflicted more than richer people, more often, more seriously and for longer’

(Roger Gomm 1996 in ‘Mental Health and Inequality’ )

Orientation

Conflict / Radical Change

Subjective…………………...….Objective

Regulation / Order