 ‘The medical model doesn’t perfectly fit mental health – and it confuses a lot of people.’ (Emma McAdam) Is mental health all in the mind? I don’t think so, but I do believe we’re sometimes getting a bit lost in how we think about and approach it. Take Sam. He’s 27, talented and full of potential. Yet Sam often finds himself these days feeling jittery and irritable and struggling to concentrate. His partner finds his mood swings and erratic behaviour increasingly difficult to cope with. Feeling concerned, she took him recently to see his GP who referred him for a mental health assessment. The assessor asked Sam briefly over the phone to describe his symptoms, diagnosed his state as ADHD and recommended prescription medication to resolve it. Now step back with me for a moment. Consider human factors that lead to a sense of mental, emotional and physical well-being, and which can influence a corresponding felt-experience of unwellness if persistently absent in our lives. Things such as: safety and security; sense of purpose; engaging in positive and meaningful human relationships; ability and opportunity to exercise free choices; feeling of making a valued contribution in the world, especially for the benefit of others; achieving something worthwhile; fresh air; change of scenery; prayer, intimacy; sex; physical exercise; personal hygiene; laughter; diet; sleep; rest. Sam stays mostly indoors; sleeps until mid-afternoon; rarely washes; spends all night, every night, playing intense computer games; eats junk food; lives on high-caffeine energy drinks. He did have a job for 2 weeks at a call centre but resigned because he felt unhappy dealing with customer complaints. He has now been unemployed for some time and lives on state benefits. From a psychological and relational perspective, we could view ‘feeling jittery and irritable and struggling to concentrate’ as natural outcomes of Sam’s lifestyle choices, not as a pathological dysfunction requiring medication. Social prescribing could be a healthier response.
26 Comments
Funmi Johnson
19/6/2024 10:52:38 pm
We’ve got to start looking at the impact of a person’s whole life/environment before we start pathologising them.
Nick Wright
20/6/2024 12:03:03 pm
Hi Funmi. Yes, it seems to be an unintended personal and social consequence of applying the medical model, often uncritically, to mental health and wellbeing phenomena.
Winifred Ereyi
20/6/2024 03:14:42 pm
Spot on, Funmi. Becoming well involves more than taking powerful psychiatric medications which have lots of negative side effects.
Funmi Johnson
20/6/2024 03:15:37 pm
Winifred: the truth is that it’s easier and possibly more lucrative to medicalise people’s mental health challenges. The other alternative will involve a cold hard look at the structures and systems that perpetuate inequality and oppression.
Kathrin Hoffmann
20/6/2024 10:18:11 am
Hi Nick! If it really is a mental problem that means no work is possible, then I wish this person all the help that is good for them and that they have the strength to carry on.
Nick Wright
20/6/2024 12:18:49 pm
Hi Kathrin and thank you for such a challenging response!
Kathrin Hoffmann
20/6/2024 12:47:35 pm
Thanks for your answer. I think that there are many people in Germany who do not go to the doctor for mental health issues and therefore cannot work. I think they go to the job center because they don't WANT to have a job and they get enough money there for them. They don't have a suitable school qualification or find many reasons why a job offered doesn't suit them. This is a big discussion here because many people say that if they don't want to work but could, then they should get less money from the job center.
Nick Wright
20/6/2024 03:09:46 pm
Hi Kathrin. Yes, I know people personally in the UK who aren't interested to work because they receive sufficient money on benefits and find that easier than having to do a job to earn money. Some people I know also genuinely believe they can't work because they have accepted a label applied to them by doctors and mental health professionals (e.g. Anxiety or Depression) which, they believe, prevents them from being able to work. Again - a complex social-economic-political debate with huge implications for individuals and society as a whole.
Jan Rutter
20/6/2024 11:59:02 am
Thought provoking blog as always Nick. Everyone in the younger generation seems to have a "condition" these days. Autism, ADHD, anxiety or whatever. Why do doctors keep drugging them up on meds rather than helping them get their lives together and so do something constructive instead?
Nick Wright
20/6/2024 12:09:56 pm
Thanks, Jan. It's a complex question. My sense is that the current trend towards medication is driven by a number of intersecting factors, for example: the increasingly prevalent medical model that views discomfort or distress as an outcome of some defect or disease within the individual; an absence of critical thinking, leading to a belief that we are 'discovering' more and more conditions rather than 'creating' them; pressure on doctors and mental health professionals to prescribe medication because that's what people have come to believe they need; lobbying and marketing from the pharmaceutical industry to convince medical professionals to use their products.
Jan Rutter
20/6/2024 12:20:59 pm
That's interesting. I hadn't thought about background role that pharma plays in the equation.
Nick Wright
20/6/2024 12:27:09 pm
Hi Jan. Yes, I read recently that "the ‘mental disorder’ drugs market is estimated at $36.77 billion in 2020 and projected to reach at a market value of $58.91 billion by 2031." This raises a fundamental conflict of interest in the mental health well-being arena and associated research, development, provision and marketing in and by the pharmaceutical industry.
Alice West
20/6/2024 03:17:19 pm
We drug people to stop them feeling.
Nick Wright
20/6/2024 03:20:01 pm
Hi Alice. Stark - and profound. A few of days ago, I spent some hours comparing notes with an insightful and experienced Polish child psychologist who works with young people and families. We noticed a significant number of common themes in our work, particularly vis a vis the application of a medical model to individuals experiencing discomfort or distress. Medication is often prescribed as a solution, as if treating some kind of pathology within the individual or, at least, providing a coping mechanism. On that theme, you may find this short related piece interesting? https://www.nick-wright.com/turning-point.html
Hailey Thomas
20/6/2024 06:03:12 pm
Of course, it shouldn't be the first and only way to prescribe medication. But sometimes it has to be done in order to improve the situation for myself and those around me.
Nick Wright
20/6/2024 06:08:16 pm
Hi Hailey. Yes indeed. There are situations in which medication may be the best or only option, or could be offered alongside other forms of support to be most effective for that person and others affected.
Robert Edmond
20/6/2024 06:18:11 pm
Hello Nick. So are you saying ADHD isn’t causing Sam’s symptoms but his lifestyle is?
Nick Wright
20/6/2024 06:27:35 pm
Hi Robert. That’s a good and important question and the answer is quite complicated. Firstly, ADHD isn’t a ‘cause’ of Sam’s symptoms per se but, rather, a label for that cluster or pattern of symptoms. Secondly, the pattern itself is socially constructed within the medical/mental health community, rather than something that is per se. Thirdly, there appears to be a correlation between Sam’s lifestyle choices and how he is feeling and behaving…but we can’t be sure which is causing which…or whether something else could be causing both. In case of further interest: https://www.nick-wright.com/turning-point.html
Nick Wright
28/6/2024 11:45:00 am
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