Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
3.4a The social context of treatment options
Loading...
来自 University of Toronto 的课程
The Social Context of Mental Health and Illness
92 个评分
从本节课中
The social context of diagnosis and treatment of mental illnesses
与讲师见面
Charmaine WilliamsAssociate Professor
Faculty of Social Work
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.
