The alternative view can be summarized as the belief that people break down for reasons in their lives and relationships—loss, trauma, abuse, poverty, discrimination, domestic violence and so on. These experiences are bound to be reflected in the brain and body in some way, but the evidence suggests that even the most extreme forms of mental distress can be understood in the context of life circumstances and the sense that people have made of them; in other words, by asking not ‘What is wrong with you?’ but ‘What has happened to you?’
Frances, while agreeing with Johnstone that the biomedical model is incomplete and has been oversold–to the detriment of patients–, is concerned that Johnstone’s articulation of an alternative view represents a “psychosocial reductionism” that may prove to be just as incomplete and harmful as the biomedical reductionism it seeks to replace. Frances makes the case for a more balanced approach:
The integrated bio/psycho/social model has a long tradition and remains the best guide to clinical practice. It has always been threatened by reductionisms that would privilege one component over the others–but this interacting tripod of bio/psycho/social approaches is unstable and incomplete without the firm support of all three of its legs. In my view, it is equally mistaken to call for a premature ‘paradigm shift’ tilting toward biology (as was suggested by DSM and NIMH) or a ‘paradigm shift’ tilting toward the psychosocial (as was suggested by the DCP [and Johnstone]). An integrated bio/psycho/social model is essential to understanding each patient and also to unite the mental health professions.
Interesting stuff. I’m just glad to see that this debate is getting some long overdue attention, and I’m hopeful that thoughtful individuals like Johnstone and Frances can make a real difference in pushing the debate (and the field of mental health) forward.
For more see: Does It Make Sense To Scrap Psychiatric Diagnosis?
Hurray, at long last, a psychologist (Dr. Lucy Johnstone is, I think?) who is talking sense: ‘people break down for reasons in their lives and relationships—loss, trauma, abuse, poverty, discrimination, domestic violence and so on.’
I have been very low, stressed, anxious and on occasion suicidal and I know why this is but doctors, counsellors, psychotherapists and a psychiatric nurse (PN) all thought they knew better than me and refused to listen to me, hear me and desperately searched for other reasons (long in my past which had caused me no bother) to blame. Why did they do this? Is it their personalities, training issues and/or what info they were passed about me (without knowing or being asked let alone saying OK to). The PN and GP tried to push me onto SSRIs, wouldn’t address the causes (why so down and crying so often) I was explaining to them and chose to dump me.
The NHS counsellors used tests on me which didn’t have the right questions in and even when they (actually computer said) I was very depressed and anxious they (and the NHS) dumped me. 2 counsellors interrogated me and knew things they would have been unable to know unless info about me (not the truth) had been passed to them by those who abused me.
There are no questions in the silly (dangerous) tests (anxiety, depression, PTSD) asking about sudden disability, neglect of duty to give remedial healthcare after injury, refusal to give info, repeated letters and ‘explanations’ in person which gave various versions of what happened – none of which were the full truth and on many occasions contained gross untruths. I was repeatedly betrayed by those who had injured me = iatrogenic injury in an NHS hospital.
No questions about being a mum (my my important role and joy), none about losing your job (because too ill/injured to work), zilch about trying to form-fill for social security benefits (when brain, eyes, body injured, memory/cognition damaged) and having GP’s sick note (big hole: didn’t put my physical injuries only PTSD = affected social security DWP doctor’s questions/answers). These tests don’t ask about poverty, trying to exist on money you can’t pay the bills/live on; nothing about mounting debts and that stress. And nope, not one question about relationship breakdown (partner, family, close friends), very odd.
And then, to top it all, to be forced to sell my home and lose possessions then 8 moves (mega physical, emotional and financial costs) and live in places impossible for me, no security, silly rules (so different from owner-occupier), no choices – nope, no questions about any of that in the tests nHS use to ‘diagnose’ depression, anxiety and so on.
How can this be? A series of ‘mistakes’? Is it purely coincidence that the main (and widely known/very obvious) reasons people suffer distress and mental breakdown were omitted? Please can somebody explain?
I am desperate for help with how I’m feeling: I’ve been pleading for help for years and everyone ignores me. I feel totally betrayed and let down and need help fast. All I’m offered is more drugs but I’m already taking enough and they don’t change anything. I’m so stressed, my sleep is terrible, my memory and sight worse and I’ve recently fallen again and am in severe pain most of the time. Why is nobody hearing me or helping me? There’s nowhere else to turn. I’m scared what will happen to me.
Ms. Hughes,
I’m sorry to hear of your struggles and the suffering that you have endured. I am not at all familiar with how psychiatric services are delivered in the U.K., as I’ve never been there, but it sounds like your experience has been terrible. I feel that there is little I can offer, from this side of the pond, except my warmest wishes and the hope that you find the assistance you are seeking.