Get the Message Right: A Psychosocial Model of Mental Health and Well-being

Abstract

Psychiatry is a specialty within medicine, and medical thinking shapes many people’s understanding of the nature and causes of psychological distress, and of what constitutes appropriate care. We talk of being ‘ill’, of taking ‘sick leave’ from work, of retiring ‘on ill-health grounds’, of ‘diagnosis’ and of ‘treatment’. Diagnostic manuals are based on the assumption that distress can be diagnosed like any other, physical, illness. Researchers study the ‘aetiology’, or causation, of problems that are assumed to be illnesses ‘like any other’. We have become so used to thinking of psychological distress as a branch of medicine that we are in danger of no longer really challenging this assumption. But we need to start thinking differently. Real positive progress may only be possible when we realise that we are discussing a psychological and social phenomenon, not a medical one.

The first step towards a humane, scientific, approach to care is to ensure that we get the message right — we need to change the framework of understanding from a ‘disease model’ to a ‘psychosocial model’. That means recognising that our mental health and well-being depends on the things happen to us, how we make sense of those events and how we respond to them. Differences between people are largely the result of social and psychological influences, rather than reflecting individual pathologies, medical or biological factors. Adopting this approach would be entirely compatible with the best traditions of psychiatry, and may even be the profession’s last chance to secure its future.