Bio-psycho-social models

So Pat Bracken and his colleagues set out a very different vision for the future of psychiatry than Nick Craddock. Again, for Pat and his colleagues, their emphasis is on how social factors and the differences between people in terms of the experiences that they’ve had in life, or the circumstances in which they live, drive mental health issues. For Pat Bracken and his colleagues, what matters most are the social-environmental factors. The nurture part of the equation.

The reason that people end up in really bad shape is obviously complex, obviously different for each individual. What we do know after the last 20, 30 years of research is that there is no specific genetic predisposition to any of the mental health disorders. And we know that the best predictors by far of all of them, whether it’s depression, suicidality, psychosis, are all life events. The strongest predictor all by itself is poverty. Not because poverty by itself causes depression, but because it is a predictor of all the other things that are causal. So poverty has been described as the cause of the causes.

And those other causes are a whole raft of things– childhood neglect, childhood abuse, loneliness, all sorts of difficulties growing up, from problematic parenting, which I have to say is usually inter-generational. It’s not about bad parents, it’s about parents who themselves haven’t perhaps had the sort of childhood that predisposed them to good enough parenting. And on and on– war, combat, rape, all the things interestingly that when you ask the public what causes mental health problems, the public say poverty, child abuse, child neglect, unemployment, stress at work, stress at home. And then maybe way down the bottom of the list they might say perhaps some of it’s a bit biological as well.

But the public are well tuned in to what actually causes mental health problems. It’s only one part of one profession that seems to get it wrong, that seems to still be left 30 or 40 years behind of its very simplistic idea that something wrong with your brain causes you to have mental health problems. It’s this old-style, American-style medical model that still seems to dominate in some quarters. But the public and most mental health professionals understand that bad things happen to you and they drive you crazy. Of course, John Read and Pat Bracken and colleagues wouldn’t deny that the brain is the organ with which we think. And they wouldn’t deny that biological factors are important.

They certainly wouldn’t deny that we use our brain to do our thinking. But the difference between a fundamentally biological account and a fundamentally social account is really where differences are explained. So for John Read and colleagues, for Pat Bracken and colleagues, differences between people in terms of their experiences of major mental health problems can better be explained in terms of differences between people in terms of their experience than differences in brain functioning. John Read in particular has suggested that it’s this shift in focus that particularly affects our understanding of mental health issues.

And he’s referred to the way that the bio-psycho-social model, incorporating biological, psychological, and social factors, often gets turned into what he’s termed the bio-bio-bio model of mental health. You can read more papers by John Read where he sets out, first of all, how social factors and importantly the impact of childhood sex abuse can impact on our mental health. And also his frustration at what he terms the bio-bio-bio model of mental health on links on the course website.