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Exploring Mental Health:
A Working Group

"Models of Mental Health: A Critique and Prospectus"
and
"Culture as Disability"

Participants: Laura Cyckowski (BMC student), Natsu Fukui (BMC student), Paul Grobstein (BMC Biology), Xuan-Shi Lim (BMC student), Amy Malleck (BMC student), Laura Socol (BMC student),


In lieu of significant input from practitioners at this session, an interesting question raised in the forum about the degree to which mental health practice does or does not continue to be dominated by the "medical model" and the role of insurance arrangements in that dynamic (see Sheikh and Fogel) was raised but not fully discussed. It did, however, lead on to some useful further discussion of what constitutes the "medical model" and what changes in it might be desired.

Underlying the "medical model" is a presumption that one can in fact distinguish with some "objectivity" health from illness (see A Critical Analysis of the Scientific Model of Health). It was pointed out that this presumption persists even if one extends the "medical model" to include some psychological as well as cultural factors. A "biopsychosocial" model may still retain the perhaps problematic notions of "health" as a desired norm and "illnesses" as deviations from that norm, even as it acknowledges the possibility that "illness" may have cultural causes and require therapeutic measures at either individual ("biological" and "psychological") or socio-cultural levels (or both).

There followed extended discussion of the pros and cons of an understanding of mental health based on a presumption of norms and well-defined ("objective") deviations from norms ("disabilities"). On the positive side, well-defined norms and disabilities are convenient for insurance purposes, may facilitate research, and are opted for at times by "patient groups" themselves seeking the benefits of community and enhanced agency/power. On the other hand, labels frequently lead to stigmatization and tend to promote a decreased sense of agency in many individuals (contra the earlier suggestion that mental health should promote "enhancement of the ability of individuals to shape their own futures, to be causal and creative agents in their own lives." The "objective" approach also tends to diminish attention to the "subjective", to distinctive "inner experiences" that may be as meaningful as external measures of well-being. Finally, it retains the idea that discomfort and pain should be "fixed".

In this context, it was noted that many human variations characterized as "disabilities" have not been so characterized in the past (or in other cultures), frequently have advantageous as well as problematic features (see, for example, Grandin and Jamison, and come in various shades of grey in different people at different times. The suggestion was offered that perhaps people should be thought of as "evolving" in consequence of various states they pass through rather than as "well" at some times and "ill" at others. From this perspective, the task of mental health care is not to "fix" problems but rather to facilitate continuing evolution of individuals along their own distinctive trajectories.

The "evolution" notion of mental health is consistent with the "enhancement of the ability of individuals to shape their own futures" but raises new problems of its own, such as how to deal with people who hurt themselves (act to expand their sense of alternative behaviors?) or may be hurtful to others (pedophiles?). The question was also raised, as in the last session as to whether such a definition of mental health is too culture-specific, applicable only in cultures that value individual achievement and not in those that place greater stress on group identity.

The group agreed that, in light of this last point, it would be worthwhile to spend some time on cross cultural perspectives on mental health. A set of appropriate readings for the next meeting, to be held on Sunday, December 3, will be announced on the working group web site in the near future.


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Last Modified: Tuesday, 31-Oct-2006 15:13:01 EST