So now, we're going to talk about the kind of treatments that are available in

mental healthcare and for mental illness. And as we've done with everything else,

we're going to think about how the social context affects what treatments are

available in the given context. We start with a definition of treatment.

Just like the definition of diagnosis, it puts us firmly in the arena of medicine

and medication. In mental health however, there are a

range of treatments that are biological, psychological, and even social as you

would expect based on the biopsychosocial perspective of mental health.

We often make distinctions between medical or biological treatments and

psychosocial interventions, but sometimes treatment is referring to what is done in

all three areas. We have touched on this in a few ways

through the course, that there's been this pattern of oscillation between

medical and psychological, or psychosocial emphasis in mental health,

and this has been reflected in the treatment options available to people who

are diagnosed with mental illnesses. In the early 20th century, there really

wasn't much available way of treatment for mental illness.

But there was a belief that mental illness had biological origins and

therefore required biological treatments. At the time, the kind of things that were

available were cold baths and exercise. But eugenics was also considered an

important intervention at the time because madness was thought to be

something in the genes. So, the Mental Hygiene Movement was

literally about cleaning up the gene pool so society would deal with madness less.

Of course, eugenics eventually fell out of favor when it was associated with

nefarious practices like mass murder and forced sterilization.

After the first World War, psychological treatments came into favor.

As we've already discussed, this was partly encouraged by the need to find a

way to deal with returning soldiers who were suffering from shell shock.

Suggesting that they were mentally ill because they were of inferior genetic

stock, which was the accepted explanation up to that point, was considered

treasonous. So, psychological explanations for

illness and psychological treatments became acceptable.

And as this was a time when awareness of psychotherapeutic interventions were

growing, these were leading methods of intervention.

Things shifted in the 1920s and 30s to favoring biological models again.

If you remember the 1924 exhibit by the Canadian National Committee For Mental

Hygiene, the descriptions of insanity and feeble mindedness were grounds in

biological reasoning and biological treatments we proposed as part of new

more scientific era of psychiatry. This was when some damaging and dangerous

treatments were developed and used. Things like insulin coma, which involved

inducing seizures, and then a coma to calm the mind.

Lobotomies, which were surgeries on the brain believed to calm people.

And early versions of ECT, that used high levels of electrical current to induce

seizures that could result in broken bones.

After World War II, these treatments were declined in favor of the new medications.

Then called major tranquilizers, these medications are often credited with

facilitating the institutionalization, although you hopefully remember that the

story is more complex that that. Of importance to our chronology of the

oscillation treatment preferences in mental health, the introduction of the

major tranquilizers in the medications that would soon follow, ushered in what

now seems to be a very long and extreme shift towards biodeterminism and the

established doctrine that mental illnesses are biological disorders that

are to be treated using biological methods.

After the 1960s, which included the antipsychiatry movement, of course, the

popularization of psychotherapy and the emergence of a biopsychosocial

perspective on mental health started the beginning of an integration of all three

type of interventions into mental healthcare.

However, because mental health is located in the health care system, medical

authority is established and was maintained by the dominance of biological

or biomedical treatments. Some would suggest that this was

important for maintaining the status of psychiatry as a medical specialty on par

with other medical specialties. The psychiatrist prescribe medication

just like everyone else. Another consideration is that a

pharmaceutical industry has been able to use their tremendous power and influence

to support the dominance of pharmacological treatments for mental

illnesses. Biomedical treatment is precede as

preferable to other treatments for many reasons which include, biomedical

treatments are less costly to the state than investing in the human resources

required for psychosocial treatments or investing in the social resources

required to deal with social ills. And the biomedical treatments can be

administered involuntarily and without consent so they are useful for the

control of disruptive behavior and unwilling patients.

Here are, here is a list of some of the biological or pharmacological treatment

options that are most widely available. The minor tranquilizers refers usually to

medication that treat anxiety. Antipsychotic medications are used to

treat psychosis and then what are used to be called major tranquilizers.

And anti-depressants are usually for treating depression.

Mood stabilizers treat mood disorders like bipolar disorder, bipolar disorder.

Some of you may be in places where they refer to that illness as manic

depression. Electroconvulsive therapy is still used

in the treatment of mental illness but in much safer forms and without the side

effects that were seen in its earlier versions.

This is not an exhaustive list, of course.

And some would include treatments like exercise and biofeedback as biological

interventions, although they are not pharmacological, of

course. When we talk about the pharmacological

interventions, there are concerns that have been raised about them.

People can become psychologically or physically dependent on medications.

Many medications have side effects or if we're more precise about it, they have

effects that are undesired in addition to the effects that are desired.

And this can make taking those medications very uncomfortable and some

would suggest more uncomfortable than dealing symptons of an illness,

a mental illness. Another concern is that people can become

ill or relapse even if they are taking medications.

So, they are not the guarantee of good health that is sometimes suggested.

And finally, there are people who have suffered significant damage or injury

from biological treatments. You may remember, in the first sector,

that Caroline Quock referred to being in a coma because of problems with

medications she received during a hospitalization.

In the consumer movement many people complained about permanent damage they

had suffered. Permanent movement disorders and tremors

from pharmacological treatments, permanent memory loss from

electroconvulsive therapies. So, many people are quite resistant to

biological treatment for mental disorders and believe that these treatments are at

least unhelpful and potentially quite harmful.

At the same time, many people are tremendously helped by

psychopharmaceuticals. You may remember Dr Ellen Sachs talking

about how she believes medication saved her life and has been a large part of why

she has been able to live such a full life instead of succumbing to some of the

very negative consequences that can befall many people.

In the area of psychological treatment options, there are so many

psychotherapies available, it would impossible to create any kind of

representative list of them. Psychotherapies can be something that is

used for individuals, groups or families, and they are used across all kinds of

mental disorders. I'm sure many of you will know that it is

also used to support people who don't necessarily meet criteria for any kind of

mental disorder. There are many people who think that all

mental disorders should be treated with psychological therapies because they

perceive them as universally helpful and more appropriate for dealing the

emotional mental problems. However, it is not true that there are no

potential harms associated with psychotherapies.

In the hand of untrained, unethical or incompetent therapists, psychotherapy can

be quite dangerous. Psychotherapy can definitely cause harm

to vulnerable people. If you look at the history of mental

health, there is a story to be told about how psychotherapeutic interventions have

been dangerous. For example, therapies have been used to

control and contain people whose are socially disruptive in the same way that

biological therapies have been used. There's potential for dependence on

psychotherapy as well. Psychotherapy and psychotherapist can be

seen as an industry that wants to maintain its privilege and clientele just

like the pharmaceutical industry. Just as with biological treatments,

people can become ill or relapse into illness even if they are receiving

psychotherapy and have already alluded to the potential for damage and injury.

But just as with the biological therapies, there are many people who get

tremendous help from psychotherapy. We currently have a lot of

psychotherapies available that have been demonstrated to be just as effective as

biological treatments or able to make biological treatments work even better.

Finally, there are also social treatments available.

I've included family and group interventions in the social treatment

section because these are therapies that are designed to alter the social

environment for people and that can be a very important intervention from a

biopsycho perspective. Case management is a type of social

therapy. Case management, the term case management

is a rather unfortunate one and that, it has a way of turning an individual who

has a personhood into a case, but the interventions that it refers to are

designed to support an individual integration, intergration into the social

fabric of the community. So, case managers support the social

aspects of maintaining mental health, things like having good social support,

living in safe, stable housing, having meaningful and purposeful activities,

etc. Case managers are also involved in the

kinds of things, you see, I have listed under community interventions, because

they work to facilitate a person being in the type of social environment that will

help them maintain optimum mental health. Therapeutic environments are not seen as

much as now as they once were but you may recall that some of the leaders in the

anti psychiatry movement established therapeutic environments.

Places in which people diagnosed with mental illness could feel accepted and

fulfilled. This is also the intent of many of the

social clubs and club houses that are sometimes available for people diagnosed

with mental illnesses. I have the spiritual interventions here

because spirituality is something we are understanding more and more as being

relevant to recovery for mental illness and maintaining mental health.

I list it as a social intervention because it often involves feeling

connected to other people who share the same spiritual outlook.

It's also interesting that recently I was listening to a BBC interview with

somebody who had actually investigated the mental health benefits of organized

religion versus spirituality. And the finding was that people who

engaged in organized religion were less likely to become mentally ill than people

who, who identified themselves as being spiritual.

So, there's something I think about the social aspect of that that's important.

And finally, the community interventions that I've already mentioned would ideally

represent a community committing to creating social environments that promote

mental health. That's something we'll talk more about in

our final lecture. Of course, there are some shortcomings to

social treatments as well but they are different than the ones we've seen with

the biological and psychological treatment options.

Social treatments and investment in creating health-promoting environments is

very costly. And these are costs that the public, up

this point, has not really been willing to pay.

Also the effects of social interventions are difficult to measure or capture.

And in an era where everyone wants to know what is the evidence behind

practices, social interventions are at significant disadvantage.

3.4a The social context of treatment options

The Social Context of Mental Health and Illness

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