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Mental health: United we stand, divided we fall

Developing better approaches to treating and preventing mental illness is one of the greatest challenges we face. But by sharing ideas and working together we can make progress, says Professor Sir Michael Owen, Director of the MRC Centre for Neuropsychiatric Genetics and Genomics at Cardiff University.

Prof Mike Owen

Prof Mike Owen

 

Mental health is never far from the headlines these days, and this is as it should be. One in four of us will suffer from some form of mental ill health in any given year. Mental illness affects people across the lifespan from children to the elderly, and the burden imposed on individuals and society is immense.

It is widely acknowledged that we need more investment in care provision, and research into the causes and prevention of mental ill health and into the development of new treatment approaches.

We need new thinking about care and treatment, causes and prevention. We also need to hear from a wide constituency, including those with direct or indirect personal experience of mental illness (virtually all of us), healthcare professionals and academics.

I am an academic psychiatrist and have spent my professional life caring for patients with severe mental illnesses such as schizophrenia and bipolar disorder, and researching the causes of psychiatric disorders and dementia. Also, like most of you, I have encountered mental illness and dementia in my personal life.

Many of you will know that mental illness can be a controversial area. Stories in the media often give the impression that there are widely held fundamental disagreements about whether mental illnesses are disorders of the brain or mind, caused by nature or nurture, and whether they should be treated by drugs or psychological approaches. These polarisations may make good copy but I sincerely hope that we can move away from them.

First, they are profoundly misleading. They assume, implausibly, that mind and brain are separate independent entities rather than different aspects of the same thing. They also fly in the face of a large body of evidence indicating the importance of genes and altered brain states in contributing to disorders of mental health, and equally compelling lines of evidence that psychological and social adversity impact on mental health.

There is also strong evidence that drugs, psychological therapies and social interventions can be effective and often work better in combination than when given separately. Most mental health workers, researchers, and those with personal experience of mental illness recognise that mental health disorders reflect a complex interplay of social, psychological and biological factors, and that the relative balance of these varies from person to person.

Providing treatment consists of working out for each individual the optimal combination of social care, psychological therapy and drugs as well as management of any concurrent physical illness, and is delivered by a multidisciplinary team of nurses, psychologists, social workers, occupational therapists and doctors (both psychiatrists and GPs).

The second reason I hope we can move away from these polarisations is that not only do they misrepresent the evidence and the views of the majority, but they also misleadingly suggest that there is widespread disagreement among mental health workers about how mental illness should be treated and researched.

Surely, if we wish to bring much-needed resources and innovation into mental health, we need to present a coherent and unified case for greater investment and a positive image of the many exciting possibilities for progress whether in genomics, neuroscience, social sciences, psychological treatments, early intervention, public health measures and so on.

While understanding mental illness and developing better approaches to treatment and prevention represents one of the greatest challenges we face, there are grounds for optimism. Many voices are calling for change; the need to integrate social, psychological and biological approaches to both treatment and research is widely acknowledged; and new research approaches are making this increasingly possible. What we need to do now is share ideas and work together to make this happen.

Mike Owen

Mike speaks in his own capacity and his views do not necessarily reflect those of the MRC.

This article has been re-purposed from an article published originally on Cardiff University’s blog.

24 Comments Post a comment
    • For clarity, I’ve copied the post from my website

      I have mentioned Mike Owen in a previous post. In a recent blog, he argues for less polarisation in the debate about the nature of mental illness. I couldn’t agree more.

      However, Mike does need to represent his opponents correctly if there is going to be a rapprochement. He says, “They assume, implausibly, that mind and brain are separate entities rather than different aspects of the same thing”. This isn’t true. The argument being made is not Cartesian. As Steven Rose says, “That brains enable minds is uncontroversial. That they ‘are’ the mind is a reductionism too far” (see Lancet article).

      Similarly, Mike also says “They also fly in the face of a large body of evidence indicating the importance of genes and altered brain states in contributing to disorders of mental health”. Again, not true. The critiques are evidenced-based. Genes, of course, set the boundaries of the possible but environments define the actual. More caution is needed in interpreting so-called altered brain states.

      It is important that Mike understands what people are saying who are critical of his view. As Steven Rose says, people like Mike should not “dismiss without a backward glance not only millennia of philosophical debate but also a huge current literature on mind/brain relationships”. There is a “conceptual innocence” about his position, although he is, of course, trying to dismiss any criticism. Despite what he may think, modern psychiatry has not solved the mind-brain problem.

      March 17, 2017
      • ibaker #

        Dear Duncan, Thanks for your comments; I agree with you. I read Steven Rose’s excellent book “The Conscious Brain” as a student and am aware of the dangers of arguing for causation across levels of the hierarchy of organisation (forgive me if I have the terminology wrong but it was 40 years ago!). Like you I am materialist but not reductionist. You say I don’t represent my opponents correctly, but you misunderstand the purpose of my piece. It was not to argue that psychiatric disorders can only be understood in biological or genetic terms. Rather I was suggesting that both types of extreme view, biological or psychosocial, are incorrect. Moreover setting the issue up as a dichotomy between the two views, as some do (see other comments on my blog), contributes to the lack of investment in mental health services and research.
        All the best, Mike Owen

        March 20, 2017
        • I agree there should be “critical friendship”, as Nikolas Rose (Steven’s brother) calls it, between critical and mainstream psychiatry.

          March 21, 2017
  1. Professor Richard Bentall #

    It’s impossible to disagree with Professor Owen’s general position that, when attempting to understand and treat mental illness, the often made distinction between biological and social/psychological approaches is a false dichotomy. However, an implication of rejecting this dichotomy is that biological and psychological approaches should be equally valued, and that attempts to integrate the two should be pursued using methods that enable the relationship between biological and psychological variables to be studied. Far from supporting this kind of research, the MRC has acted to prevent it. In fact, only about 3.7% of the MRC budget is spent on mental health (which is the cause of about 20% of the illness burden in the UK), and studies that have included psychological and social variables have been given a very low priority.

    It is not hard to understand why this has happened. The MRC’s decision-making body for mental health, the Neurosciences and Mental Health Board, is dominated by neuroscientists, and has very few members who are mental health clinicians or researchers with expertise in psychosocial approaches. This means that, when a decision is made to fund a project, and Board members with conflicts of interest leave the room, there is very often no one who is not a neuroscientist left. Neuroscientists make the decisions so, overwhelmingly, neuroscientific research gets funded and psychosocial research does not. The conseequence is that funded studies are often those least likely to have a direct benefit for patients or society.

    The British Psychological Society has long been campaigning for the Board to have a wider membership, with greater representation from psychology, but these entreaties have been strongly resisted by MRC staff. Hence, it is the MRC that has been promoting the false dichotomy between biological and psychosocial approaches and mental health research in the UK will be poorer until the Council takes a more inclusive view.

    March 13, 2017
    • ibaker #

      Dear Richard, Thank you for your interest in my blog post. I am glad we are in agreement that the false dichotomy between biological and psychological/social approaches is unhelpful scientifically and also serves to perpetuate the lack of funding for research in mental health relative to its burden. You direct criticism at the MRC for giving low priority to studies that have included psychological and social variables but I have not been involved in funding decisions at the MRC for many years and am unable to give an informed view of your criticisms. I will leave this to the MRC to respond. I will say that I absolutely see the need for research into psychological and social, as well as biological factors as I tried to make clear in my piece. In fact there are many ways that the different areas can inform each other, as I’m sure you are aware.
      All the best, Mike Owen

      March 17, 2017
    • ibaker #

      Dear Richard, Thank you for your response. We welcome the opportunity for discussion on this important topic.
      MRC boards are the custodians of major sectors of biomedical research, and are made up of experts whose role is to provide high-level guidance on funding decisions and offer strategic advice to the MRC. The Neurosciences and Mental Health Board has a broad scientific remit and portfolio that includes mental health and addictions, neurodegeneration, neurobiology and development, neurophysiology, cognitive and behavioural neuroscience including psychology, and underpinning support such as neuroimaging and brain-banking. In 2015/16, the MRC spent £25.2 million on mental health research.
      Expert peer review is a cornerstone of the MRC’s work. Every research proposal submitted to us is scrutinised by independent scientific experts who consider the importance, scientific potential, methodology, ethical issues, and the potential for impact of the research. You can see an animation of the MRC peer review process here: https://www.mrc.ac.uk/funding/peer-review/peer-review-at-the-mrc. We hope this information helps address some of your concerns.
      All the best, Dr Kathryn Adcock, Head of Neurosciences and Mental Health, MRC

      March 17, 2017
  2. As the editor of the British Psychological Society’s recent consensus report on psychosis (www.understandingpsychosis.net) I agree with Professor Owen that of course our biology cannot be divorced from our psychology, nor from the effects of our material and social environment. However I disagree with him on two issues in particular.

    Firstly, mental health *is* a contested area and I think it is important to be honest about that, not only in research but in clinical practice where too often service users are offered one view as if it were proven and universal. The recommendation in our report was simple – and on the ground perhaps only an extension of what Professor Owen was suggesting – but a radical departure from most current practice:

    ‘Mental health is a contested area. The experiences that are sometimes called mental illness, schizophrenia or psychosis are very real. They can cause extreme distress and offering help and support is a vital public service. We know something about the kinds of things that can contribute to these experiences or cause them to be distressing. However, the causes of a particular individual’s difficulties are always complex. Our knowledge of what might have contributed, and what might help, is always tentative. Professionals need to respect and work with people’s own ideas about what has contributed to their problems. Some people find it helpful to think of their problems as an illness but others do not. Professionals should not promote any one view, or suggest that any one form of help such as medication or psychological therapy is useful for everyone. Instead we need to support people in whatever way they personally find most helpful, and to acknowledge that some people will receive support partly or wholly from outside the mental health system.’ (www.understandingpsychosis.net, page 103).

    Secondly, given the current overwhelming and increasing dominance of a biological approach, both in services and with respect to research funding, a better starting point for this much-needed conversation might be an acknowledgement that in many cases – in the words of former President of the American Psychiatric Association Steven Sharfstein – ‘we have allowed the biopsychosocial model to become the bio-bio-bio model’.

    Anne Cooke
    Canterbury Christ Church University

    References

    Cooke, A. (2014). Understanding Psychosis and Schizophrenia: Why some people hear voices, believe things other people don’t, or appear out of touch with reality, and what can help. A report by the British Psychological Society Division of Clinical Psychology. Leicester: British Psychological Society. Available from http://www.understandingpsychosis.net

    Sharfstein, S. (2005). Big pharma and American psychiatry: the good, the bad, and the ugly. Psychiatric News 40 (16): 3–4. http://psychnews.psychiatryonline.org/doi/10.1176/pn.40.16.00400003

    March 14, 2017
    • ibaker #

      Dear Anne, Thank you for your interest in my blog post. There is much implicit and explicit agreement in your comment with my piece. Where we disagree is whether we should present ourselves to the outside as a profession in conflict. My point was that in fact many of us agree that the relative emphasis that should be given to biomedical, psychological or social approaches differs from case to case (your quote from the BPS report appears to be in agreement with this). The problem is that services are often inadequate and we struggle to recruit the brightest and best in to the mental health professions. We also need better treatments and this requires more research. The main argument of my piece was that by presenting ourselves as divided we perpetuate these things.
      All the best, Mike Owen

      March 17, 2017
  3. cobweb #

    Mike, as he was referred to, was included in a piece about mental health on R Wales. Wales has been notorious for it’s use of ECT -government, it was given 10 times to a lady who suffered from post partum psychosis – she thought it had helped. What would have helped more was if there had been a mother and baby unit – there is not one in the whole of Wales. It would have helped if the psychiatric hospital she was referred to had not been one of the most horrific experiences of her and her partner’s life. Mike Owen did mention this but spoke in weasel terms so as not t o offend the Welsh So he came over as a nice enough man but it was shame the producers did not find one woman to speak on behalf of women – all the researchers were men. Why?

    March 14, 2017
    • ibaker #

      Dear Cobweb, Thank you for your interest in my blog post. I’m sorry but I can’t comment as it wasn’t me you heard on BBC Radio Wales. I think you might be referring to this documentary on Postpartum Psychosis (http://www.bbc.co.uk/programmes/b08j2bqz) which featured Professor Ian Jones and Dr Mike Jackson.
      All the best, Mike Owen

      March 17, 2017
  4. I’m not really sure what this article is all about. The author seems highly defensive and has devoted most of his column to defending his profession and it’s ideologies, only to then tell us that the vast majority of people are on his side anyway! That gives me the impression that he is less certain than he suggests…

    Working together is another strange request. Working together with who? The dissatisfied patients, the dissenting professionals or his fellow psychiatrists…or are some of them in opposition to psychiatry’s principles now too?

    As for the numbers of people with mental ill health that he cites…let’s face it, one look at the categories and tick boxes of the DSM and he’s spot on! It covers every aspect of the human condition these days so yes, we probably all do know someone with a “mental illness”. It’s not normal to be normal anymore and psychiatry have seen to that!

    March 14, 2017
    • ibaker #

      Dear Pauline, Thank you for your interest in my blog post. The article was aimed at a wide readership. It was trying to make the point that often mental illness is presented in the press as an area where there are fundamental disagreements as to what care should be delivered and into what areas research should be conducted. In my view the people who lose out as a result of this are those with mental ill health who want, and need, appropriate care but who can’t get it because services are under-resourced and because we have inadequate treatments. Some of the main areas of disagreement are between psychiatrists and psychologists, and between people with mental health problems who feel that they have been poorly treated by the system. While I am all in favour of people expressing their views, mental health is effectively in competition with other areas such as dementia, cancer, cardiovascular disease for resources to fund treatment, care and research. I believe if we make a coherent and unified case we might stand a better chance of receiving more support.
      All the best, Mike Owen

      March 17, 2017
  5. Bob #

    Agreed!

    March 14, 2017
  6. Kirsty Lilley #

    I’m left wondering how many people with lived experience have an opportunity to take part in discussions about what research the funding is directed towards? Is this perhaps another example of individuals who live with the effects of distress and trauma being ‘done too’, ‘decided for’ and part of a system in which the power is unequally distributed.

    March 14, 2017
    • ibaker #

      Dear Kirsty, Thank you for your interest in my blog post. As noted in my response to Richard, I am not involved in deciding what research gets funded. What I can say is that through Cardiff’s National Centre for Mental Health (http://www.ncmh.info) people with lived experience have opportunities to advise us about our research and to participate, as well as to help us in our mission to challenge stigma. Please check the website for more on this.
      All the best, Mike Owen

      March 17, 2017
  7. Nicky Haywad #

    While there is much that I could say about this article, I am going to concentrate on the audacious cynicism of the pitch for yet more funding and support being mounted here by a man whose team at Cardiff University has just been granted the sum of £2,407,100 of taxpayers’ money by the Medical Research Council: to carry out ‘molecular genetic studies of schizophrenia’. This is on top of a previous £4,000,000 awarded to the same team. It has to be recognised as a considerable haul at a point in the history of psychiatry at which global pharma giants AstraZeneca and GSK have closed down their neuroscience laboratories worldwide in the last decade: https://www.theguardian.com/society/2016/jan/27/prozac-next-psychiatric-wonder-drug-research-medicine-mental-illness.

    I am writing in my capacity as a lifelong stakeholder of the mental health industry. Three of my four original family members were diagnosed with ‘brain disorders’ – namely ‘schizophrenia’ and ‘bipolar’ – which (it is widely acknowledged in medical, clinical and academic circles nowadays) in fact do not exist as discrete categories of any validity (the lists of criteria which determine what qualifies a person to attract such labels are “not based on research in the way the body works. In the end it comes down to the vote by a committee”: ‘A Straight talking introduction to psychiatric diagnosis’. Dr Lucy Johnstone ). We suffered the consequences – my brother killed himself at age 19, having been written off for life by the ‘mental health services’; my mother has spent the last half century on a cocktail of mind-altering pharmaceuticals and had her brains fried with electric shock ‘therapy’, the cumulative effect of which has condemned her to a mere existence here on this earth and I, myself, spent the last 20 years on ‘medication’ since I was intercepted by the medical ‘system’ when traumatized by my daughter’s near death during childbirth. Since learning of the ‘alternative truth’ foundation that mental health diagnoses and ‘treatment’ are built on, I am the only one of the three who was able to discontinue the drugs exposing the whole charade (with its claims of inherited tendencies) for what it is: an unscrupulous marketing campaign, effectively involving kicking the most vulnerable in society when they’re down while laughing all the way to the bank.

    Owen is not alone in utilizing popular ‘mental health’ myths to further his own professional interests. The vast majority of professionals involved in the industry do the same. I sometimes work at a local university and am appalled to observe that – although no one takes any issue with the fact that the validity of the concepts ‘abnormal-‘ and ‘normal psychology’ are finally being openly disputed (https://he.palgrave.com/page/detail/Psychology-Mental-Health-and-Distress/?K=9780230549555) – teaching there is still predicated on standard, traditional diagnostic categories.

    The following passage from the article clearly illustrates the nature of the calculated and sophisticated confidence trick being played on an unsuspecting public (what is deliberately not said here is as significant as what has been written):

    “Many of you will know that mental illness can be a controversial area. Stories in the media often give the impression that there are widely held fundamental disagreements about whether mental illnesses are disorders of the brain or mind, caused by nature or nurture, and whether they should be treated by drugs or psychological approaches.”

    … and the rest, surely?! If you listen to professionals debate such issues, you can very often detect a clear jostling between biologically-focussed and psychological disciplines – which goes nowhere – while the rest of us continue to have our brains zapped, and/or pickled in chemical solutions, meantime. Professor Sir Michael Owen knows he is bandying around archaic and debunked concepts here, and sidelining the real issues openly being debated in the public domain, and yet he evidently feels no qualms about doing so.

    “Providing treatment”, he claims, “consists of working out for each individual the optimal combination of social care, psychological therapy and drugs as well as management of any concurrent physical illness, and is delivered by a multidisciplinary team of nurses, psychologists, social workers, occupational therapists and doctors (both psychiatrists and GPs)”. This sounds seamlessly professional – impressive, worthy and convincing, doesn’t it? However, if you went out and asked a cross-section of the people who have fallen into the hands of what I call the ‘non-system’ – and their families – whether this is how they’d describe the kind of service they received, I can guarantee you’d hear a very different story about what actually, more often than not, occurs ‘on the ground’. This disparity equals the difference between rhetoric and reality.

    The psychiatrist gets to the point in the article’s penultimate paragraph:

    “Surely, if we wish to bring much-needed resources and innovation into mental health, we need to present a coherent and unified case for greater investment and a positive image of the many exciting possibilities for progress whether in genomics, neuroscience, social sciences, psychological treatments, early intervention, public health measures and so on”,

    and in his final statement:

    “Many voices are calling for change; the need to integrate social, psychological and biological approaches to both treatment and research is widely acknowledged; and new research approaches are making this increasingly possible. What we need to do now is share ideas and work together to make this happen”,

    it seems to me as though he must be feeling the pressure … appealing even to traditional adversaries and critics to all band together, to present a united facade, and apparently even offering them a potential share of the dwindling millions that are currently still available!

    The National Survivor User Network (NSUN) paints a very different picture of the issues that individuals themselves who are beset by emotional distress/the experience of altered states are facing, should your paper’s readers care to educate themselves a bit more comprehensively. This piece I myself wrote just over a year ago – together with brain injuries specialist psychologist Stephen Weatherhead – for example, brings a number of different considerations not touched upon in the Owen article into sharp relief: http://www.nsun.org.uk/news/blogs/its-not-all-about-the-money/

    March 14, 2017
    • ibaker #

      Dear Nicky, Thank you for your interest in my blog post. The purpose of my piece was not to try and raise more funds for my own research; there are other ways of doing this. I agree that the mental health services in the UK are greatly under-resourced and often fail to give people what they want and need. What I was saying is that we need to bring in new ideas and more resources in order to develop and deliver better approaches to care and treatment. There are many exciting possibilities right across the biological, psychological and social landscape. But society needs to invest more in tacking these issues and in attracting smart people to try and solve what are extremely complex problems. You say, “If you listen to professionals debate such issues, you can very often detect a clear jostling between biologically-focused and psychological disciplines – which goes nowhere –“. Exactly. My contention is that there is a place for biological, psychological and social approaches if applied appropriately. Current medical and psychological treatments are certainly inadequate and societal and economic factors clearly contribute to much mental ill health and distress. But I also believe (and there is plenty of evidence to support this) that some forms of mental illness are better conceived of disorders of brain function and for these we need more research and better treatments as well as better care.
      All the best, Mike Owen

      March 17, 2017
  8. Richard Hassall #

    Pauline Dove comments that it isn’t clear what Professor Owen’s article is all about, and I had a similar feeling reading it. I also had the feeling that I’ve heard all this before. Whilst he made welcome comments about recognising psychological factors in mental “illness”, he basically seemed to be going round the same circuit that many have covered previously.

    In particular, he frequently talks about “mental illness” as though this term is uncontentious. I dislike it because of the implications it carries. What is “mental illness” an illness of? The mind? He acknowledges that mind and brain are not separate entities, but if this is so, what can be meant by “mental illness”? The mind is not some kind of mysterious and distinct substance somehow inhabiting the body. Nor is it an organ of the body like the heart or liver, both of which can be the site of diseases. There are also genuine diseases of the brain, such as Alzheimers. So what kind of diseases are “mental illnesses”, or is it better to stop thinking of them as diseases at all? It won’t do to reply that an illness is not the same thing as a disease, because there is a huge amount of overlap in how we use these two terms, and any proposed distinction between “illness” and “disease” would be arbitrary. (Some people have tried to argue that a coherent distinction can be made here.) Owen might reply that HE doesn’t think of mental “illness” as a disease of any kind, but it doesn’t follow that other people will interpret these terms in the same way as him. Moreover, the continued use of the term “mental illness” invites the assumption that there are distinct entities corresponding to different “illnesses” which can be discriminated and categorised in diagnostic manuals in much the same way as we do with diseases generally.

    The continued use of “mental illness” language therefore reinforces the view of human mental distress as an illness or disease of some kind, with the obvious location being in the brain. But in most cases, evidence for this is lacking. So I suggest that continuing adherence to the language of “mental illness” is likely to impede our understanding of the psychological processes leading to severe mental distress and breakdown, as it continues to focus attention on ideas about putative disease entities. This is not to deny that biological processes may well influence how mental distress can build up and be experienced in any individual. But episodes of psychological distress are not the kind of things that can be broken down into distinct illnesses in any way comparable with disease entities.

    March 16, 2017
    • ibaker #

      Dear Richard, Thank you for your interest in my blog post. Language is a tricky business and, as you say, all terms carry connotations. To my mind cases of “mental distress” occupy a spectrum that goes from those who clearly have an “illness” with biological underpinning (for example most cases of schizophrenia and bipolar disorder) right across to those whose symptoms are more appropriately understood in psychological or social terms (for example someone in an abusive relationship). The challenge for mental health professionals is to identify in each case where the particular emphasis lies and in providing the best treatment and support for that individual. The diagnostic categories we use are far from perfect and I think psychiatry will increasingly need to develop dimensional approaches (see http://dx.doi.org/10.1016/j.neuron.2014.10.028).
      All the best, Mike Owen

      March 17, 2017
  9. s #

    I’m writing as a service user. In my experience, it’s hard to get access to psychological services unless you can afford to pay for them privately and/or have private health insurance.

    Mental health care is classist. There’s this idea that the poor are somehow less deserving of help..that they’re lacking in willpower..that it’s all their own fault anyway. I don’t think that attitude is helpful.

    There are socially deprived communities with intergenerational social issues like drug addiction, poor parenting. They are more likely to go to their GP more often and have more health issues than someone from an affluent background.

    I think the biomedical model has allowed successive governments to underfund mental health care-to say that mental illness is just a chemical imbalance & not due to any social circumstances like austerity, poverty, zero hour working hours, housing shortages, abuse etc.

    I have felt fobbed off when prescribed an anti-depressant because I think “how long will I have to take this for?”

    I know a woman who’s on anti-depressants for 10 years. That strikes me as excessive-that yes, the anti-depressant would initially restore her social functioning but over time, her mental wellbeing just became stagnant..that her symptoms were just being treated or stabilised as opposed to also offering psychosocial services like a choice of evidence-based therapies.

    I also wonder whether mood stabilisers and anti-psychotic medications are overprescribed to patients deemed “difficult” and/or “angry”. I think it’s important for mental health professionals to listen to patients in emotional distress-to try to understand their inner world and not just focus on symptoms.

    I personally found it hard to even identify myself as depressed because I don’t think of myself as merely a constellation of symptoms. I see myself as an individual..that I’m unique and that my depression is going to be different in some way to another patient’s so I think having more emphasis on patient-centred care is a good idea.

    I understand your concerns-that you feel that in fighting isn’t going to help patients with mental health difficulties. I can sympathise with that argument however my counter-argument is that mental health services are so weighted in favour of biomedical model that it’s not really balanced. Pharmaceutical companies have such influence so I think it’s time for other voices to be heard.

    March 18, 2017
  10. Dr Sue Holttum, Canterbury Christ Church University #

    Dear Professor Owen, I think you have just confirmed with your last posting that – rather different from your claim of taking an integrated bio-psycho-social view – you divide mental distress into two different kinds – one that is essentially biological and one that is not. There is now a great deal of research showing how childhood abuse and adversity affects our biology, causing the sort of experiences that get labelled as ‘schizophrenia’. An abusive relationship will also affect someone’s biology, in terms of stress responses, for which there is also a great deal of evidence. I suggest that whether or not we should talk about people in either of these situations as having ‘symptoms’, or whether a pill is the answer, is a different question. My own view is that this is not a particularly helpful approach for either. Recognition of what has happened to the person may be helpful as a starting point, but great sensitivity is usually required, and time, and kindness – perhaps all rather old-fashioned concepts these days.

    March 19, 2017
    • ibaker #

      Dear Sue, Thanks for your interest in my blog post. I’m sorry if that was your impression but I’m not dividing mental illness into two different kinds. Instead I’m saying you can conceive of a spectrum going from one (largely biological) extreme to the other (largely psychosocial). Of course biological, psychological and social processes are impacted in all but the emphasis may differ, as might the suitability of applying a “medical model”. All the best, Mike Owen

      March 22, 2017

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