A study of psychiatrists' concepts of mental illness

Abstract

BackgroundThere are multiple models of mental illness that inform professional and lay understanding. Few studies have formally investigated psychiatrists' attitudes. We aimed to measure how a group of trainee psychiatrists understand familiar mental illnesses in terms of propositions drawn from different models.MethodWe used a questionnaire study of a sample of trainees from South London and Maudsley National Health Service (NHS) Foundation Trust designed to assess attitudes across eight models of mental illness (e.g. biological, psychodynamic) and four psychiatric disorders. Methods for analysing repeated measures and a principal components analysis (PCA) were used.ResultsNo one model was endorsed by all respondents. Model endorsement varied with disorder. Attitudes to schizophrenia were expressed with the greatest conviction across models. Overall, the ‘biological’ model was the most strongly endorsed. The first three components of the PCA (interpreted as dimensions around which psychiatrists, as a group, understand mental illness) accounted for 56% of the variance. Each main component was classified in terms of its distinctive combination of statements from different models: PC1 33% biological versus non-biological; PC2 12% ‘eclectic’ (combining biological, behavioural, cognitive and spiritual models); and PC3 10% psychodynamic versus sociological.ConclusionsTrainee psychiatrists are most committed to the biological model for schizophrenia, but in general are not exclusively committed to any one model. As a group, they organize their attitudes towards mental illness in terms of a biological/non-biological contrast, an ‘eclectic’ view and a psychodynamic/sociological contrast. Better understanding of how professional group membership influences attitudes may facilitate better multidisciplinary working.

Doing Fence Sitting

“…As outlined in the literature review, clinicians' views and assumptions about mental health have been found to guide and inform their approaches to assessment, formulation, and intervention (Harland et al, 2009) and to shape service users' views about their conditions (Ahn et al, 2009). This implies that there is a need for clinicians to be honest about the contingent and situated nature of their knowledge and language, to make their assumptions about mental health explicit, and to be mindful of the effects of their use of language on different stakeholders in talking about mental health.…”

An Exploratory Study of American Muslim Conceptions of Mental Illness

“…For example, the lay population may interpret a DSM-defined mental disorder as God's will (Link et al, 1999;Wesselmann & Graziano, 2010), a sign of weakness Schnittker, Freese & Powell, 2000), or a result of upbringing (Kuppin & Carpiano, 2006). Many lay definitions tend to be broader, and exclude many symptoms used in the diagnostic manual (Granello & Granello, 2000;Harland et al, 2009;Pescosolido et al, 2000;Link, Phelan, Beshnahan, Stueve, & Pescosolido, 1999;Kuppin & Carpiano;. Given a lack of agreement among mental health professionals and between professionals and lay people regarding what is and what causes mental illness, there continues to be a discrepancy in understanding what constitutes a mental illness in American society.…”

A frame of mind from psychiatry

“…Today a strongly endorsed approach in psychiatry is the socalled medical or disease model of mental disorder (Harland et al 2008). The medical model is a view of mental disorder according to which a mental disorder is a medical disease (Murphy 2006;Andreasen 1984Andreasen , 2001Kandel 1998).…”

“…For example, a genetic predisposition for depression may express itself only if triggered by a major stressful life event (Kendler et al 2003). If we take the case of schizophrenia, the disorder for which the medical model is most strongly endorsed (Harland et al 2008), there is no evidence for one common underlying biological correlate of psychosis, either genetic or neurophysiological (Kidd 1997;Flashman and Green 2004). Rather, psychosocial/ environmental factors like living in an urban area, living with families with high expressed emotion, drug use during adolescence or belonging to a minority group are contributing causes of a large number of schizophrenia onset incidents and their post-onset course (Kavanagh 1992;Sundquist et al 2004;Broome et al 2005;Van Os et al 2008;van Os et al 2010;Pharoah et al 2010).…”

“…Yet, though lip service is paid to the attempt to bring together the different levels, such integration is to a large extent currently missing from the actual practice of psychiatry where the predominant tendency is to have different explanatory models for different disorders (Harland et al 2008)-something that may in part be due to the practical training of psychiatrists. So what is needed is to try and incorporate pluralism more in medical practice.…”