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Models Of A Phenomenon
Editor's Note: In this article Martin discusses often controversial perspectives from which different philosophies see mental illness. This discussion goes beyond academic theorizing when Martin makes an essential point which sums up the existential dillemma for those of us who live with the psychiatric condition. I want to describe for you some distinctive models of a phenomenon referenced as ‘mental illness’. Each model seeks to explain, not only the phenomenon, but also the method by which to treat it. Each model seeks to be complete in itself, so correspondence among the models are hard to draw. Historically, the models have different origins and different adherents. A model often used by self-helpers and others is the political model. Many self-help groups have mobilized around issues of rights violations, housing, poverty, discrimination, and stigma. Others offer emotional support, problem-solving, improved self-confidence, practical assistance, and help in staying out of the hospital. For instance, M-POWER is a self-help group dedicated to system change within Massachusetts. In the political model people are held to be dysfunctional because they are poor, oppressed, exploited, underserved, and ignored by mainstream society. The self-help answer: people should be given access to resources like education, housing, and jobs, to rebalance the political imbalance in society, which prevents them from living optimally. As Howie the Harp wrote in Reaching Across II:, “We found that we could help ourselves and each other more effectively than the system {could}, and without its oppressiveness, and that we could do it on our own.” Farris and Kurtz, in Social Work With Groups, Vol. 10 (3), point out the altruistic factor in self-help. “Altruistic behavior fosters a concept of the self as one who is afflicted and as one who is able to help others....Cognitive processes shape the individuals perceptions of reality—the sense of self, the world, and the self-in-the-world {In self-help groups,} mystery is dispelled by straightforward explanation: faulty inference and overgeneralization are challenged....The goal is to accept the self-as-is: Self perceptions cease to be formed against an illusory standard of perfection.” Another model of the phenomenon combines learnings from physical rehabilitation and from psychotherapy, namely the psychiatric rehabilitation model. Here, people are seen as disabled if they lack skills or supports necessary to function in the living, learning, or working environment of their choice. Psych. Rehab. focuses on diagnosing and building client skills. Research shows that client skills, not symptoms, relate most strongly to rehabilitation outcome. It is crucial that the client accept the diagnosis as valid, because he or she will be expected to take action based on an understanding of his or her present functioning. Psychiatric rehabilitation often involves directly teaching clients those specific skills they need to function successfully in their own particular environments. In addition to skill development, resource development forms part of Psych. Rehab. The resource development might be directed toward creating new environments, such as a new apartment, an evening class, or a volunteer job—or towards developing old resources: returning to stamp collecting after twenty years, borrowing a video from the library, or obtaining a special needs pass for the buses and subways. {Guidance taken from Anthony, Cohen and Cohen: Philosophy, Treatment Process, and principles of the Psychiatric Rehabilitation Approach} For historical reasons, medical people and the medical model have come to dominate the care and treatment of ‘mental illness’. In this day and age, the medical model is usually formulated thus: “You have a chemical imbalance in your brain”. You must submit to a doctor’s treatment, which usually entails taking medications, possibly for the rest of your life. Good luck! In the face of this hard- nosed approach, what’s a poor patient to do? Well, his most potent weapon is informed consent. Informed consent is a law that requires a doctor to give you complete information about a proposed treatment. He or she must then wait to obtain your consent before proceeding. The medical model inevitably is expensive to apply, and in some cases is risky or unpleasant. Yet, when you have been identified as a patient, it is very difficult to escape the ministrations of the medical model.
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