Mental health practice models
Just as definitions of mental health and mental illness are influenced by Western society throughout Asia, Africa and Latin America, so too is the scientific knowledge, whether theory or empirical research, upon which most of the world’s mental health policies are based. Transferability of models of intervention to what are usually totally different social and cultural systems has been uncritically assumed.
Over most of the past six decades, Freudian psychoanalytic theory, initially developed in the Viennese society of the Victorian era, held sway in psychiatric circles around the globe. While the early work of Sigmund Freud has been and continues to be in dynamic evolution, much of the world uses dated texts which have been rejected by many in the West today. Psychoanalytic treatment is based upon the principle of psychic determinism.
Each psychic event is thought to be determined by proceeding events. The theory of the unconscious which stipulates that unconscious mental processes cause confused and non-objective reactions to life is also a fundamental principle. Critics of psychoanalytic theorists fault them for concentrating on intrapsychic conflicts when often the environment is more likely to be the cause of the problem. Freudians maintain, in defense of their paradigm, that their focus is psychological because desires and prohibitions are internalized in maturity. They argue that regardless of their external origin, they become part of one’s psychic structure. While the reasoning holds merit, the problems perpetuated by ignoring social causality may offset the rationale.
Object Relations Theory: one of the more recent psychoanalytic models, holds that development is a continuous process that persists despite early affronts to the psyche. It is concerned with separation (from the mother) and individuation, a development phase parallel with separation that represents the process of forming and specialising the individual personality. While a more hopeful theory than its predecessor, it has been criticized by cross-culture advocates for its inattention to the importance of connectedness, a prevalent norm throughout the world. Instead, the concept of autonomy
is the ultimate measure of mental health. Clearly, while the balance may be different from culture to culture, regard must be given to both concepts if people are to develop fully
Contemporary Western models increasingly reflect the avant-garde wing of the psychiatric establishment which espouses biological/genetic determinism in understanding human behaviour. Biochemical theories hold that mental illness is caused by an imbalance of the chemicals in the brain. The person thus is viewed as a ‘faulty machine’, assuming a medical model similar to the diagnosis and treatment of physical disorders. It is unclear whether the chemical imbalance is the result of heredity (gene transmission) or abnormalities in brain chemistry that predispose a person to life stress vulnerability.
The grounds upon which criticism of this model are based, range from the epistemological,
ideological and political, as well as moral and ethical. Two responses have predominated over the years, both of which hold true of physical illness as well. The first stresses the lack of conceptual clarity and implications that may be harmful to the patient, in contrast
to more sociological methods. The second response provides sociological criticism. It is pointed out that diagnosis and treatment are based upon judgments and social demand that may be biased, and which always have political consequences which tend to preserve
the status quo.
Family Treatment Models
Paradigms of family therapy have become commonplace over the past decade. Most models are concerned with the systems concept of reciprocity wherein everyone involved
in a problem plays a part in its continuance by reinforcing the behaviour of the other. The model is being criticized for overlooking power differentials, on the one hand, and perpetuating hierarchical power, on the other (Walters et al., 1988). Nonetheless, the importance of the family environment across culture should not be overlooked. Familial supportiveness has been found to be highly therapeutic, while unsupportive, controlling family environment increases vulnerability to depression (Wetzel, 1984/1991). Other diagnoses, such as schizophrenia and substance abuse, are equally responsive to family treatment. Openness to family counselling, however, differs markedly throughout the world. Those cultures, largely Asian, that regard family matters as sacrosanct, their problems considered private business not to be shared, are not generally amenable to outside intervention unless they become acculturated to different customs.
Educational Programme Models
Educational programming is an alternative to counselling that can be used when working with families and communities. Many people who have difficulty accepting the notion of mental illness can readily accept the concept of education as a respected, stigma-free method of self or community improvement. Psycho-education is a popular model that teaches and includes families as part of the therapeutic milieu. It is often used, for instance, when a family member is schizophrenic.
Other models include non-stigmatising therapeutic Psychosocial Programming which creatively provides culture appropriate activities designed to enhance the development of connectedness, independence, positive action and positive perception. These qualities are catalysts to well-being. Their negative dimensions, however, are not only barriers to mental health, but increase vulnerability to mental illness. Thus, overdependence, alienation, negative actions and perceptions, whether emanating from the sufferer or the environment, are also to be countered through constructive programming