I ask this question not because I believe necessarily that there is a need to reconceptualize mental health, but because in a conversation with colleagues over a social prescription project we're setting up as an intervention model, it was suggested that individuals in the health and medical fields were discussing such a reconceptualization (in the main because current services in the UK are failing). We wouldn't want to develop something that years down the line would be defunct.
Since I am not quite sure about the question, not sure if my response will be applicable.
It is not at the policy level that mental health (or diagnoses /mental illness) is conceptualized, but rather it is done by the health and medical fields based on science. Given the history on this along with ongoing research, there are always some changes that will happen, but at a grand scale that would be a reconceptualization of mental health? not likely
Thank you Mary-Helen, in all honesty this is new to me too, and I deliberated over how best to sum up the discussions we had. I think that my mention of policy as you're right isn't correct I have edited the blurb to try and reflect this - according to your helpful comment. Thanks again
Hi, Simon,
Tom Insel, former Director for the U.S. National Institute on Mental Health, has a few videos on YouTube about the reconceptualization of mental health under his leadership at NIMH. In essence, he proposed that conceiving of mental health as a behavioral disorder precludes early diagnosis and treatment which is essential to develop effective interventions. He proposes understanding mental health as a brain disorder and conducting research with domain criteria ranging from the level of genes to connectomes to the social environment. I believe he has a perspective that is worth investigating.
The brain disorder conceptualiation was around years before Insel. I worked in the field of psychiatry and mental illness for many years (direct service, research and policy) and it was at its start in the early 90s. It was debated then and it still is so. A quick lit review will show there are arguments on both sides, but for the most part,," mental illnees as brain disease," has not been wholly accepted. From a practioner pov, the biology concept led to prescribing a pill for every disorder in DSM and the notion that therapy, psychotherapy was practically useless.
Here's a very good artcle on this with a link for a syllabus on the issues provided by the author. It includes this quote from Insel
“I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.”
It seems like even the most arduous proponents of naive reductionism can have a change of heart. Insel, for instance, concluded in a 2017 interview in WIRED: “I spent 13 years at NIMH really pushing on the neuroscience and genetics of mental disorders, and when I look back on that I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs—I think $20 billion—I don’t think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness. I hold myself accountable for that.”
http://eiko-fried.com/all-mental-disorders-are-brain-disorders-not/
Thank you so much Mary-Helen, this is incredibly helpful indeed. And to you too Peter!
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