Different Conceptions of Mental Illness: Consequences for the Association with Patients†

Abstract

Whenever partial knowledge is considered absolute and turned into ideological and dogmatic conceptions, the risk increases that the conditions for the people involved might become dangerous. This will be illustrated by casuistic examples of consequences of one-sided psychiatric conceptions such as social, biological, and psychological ideas about the treatment and care of the mentally ill. Present perspectives of an integrative model, i.e., an advanced bio-psycho-social conception about evidence-based characteristics on the social, psychological, and molecular-genetic level, require that all of these dimensions should be considered in order to personalize and thereby improve the care and treatment of the mentally ill.

Toward psychiatry as a ‘human’ science of mind. The case of depressive disorders in DSM-5

“…On one side, it is considered as an important antidote to the reductionist biological psychiatry in as much as it reaffirms the importance of the psychological and social factors in understanding and treating mental disorders. Not by chance, BPS arose as an answer to the increase in the use of psychopharmacology linked to DSM-III ( Ghaemi, 2009 ); so its caveats are still very relevant today ( Adler, 2009 , Helmchen, 2013 ).…”

“…Such a combination, according to the critics, does not prove to be fully consistent and robust. Stier (2014) , in his commentary on Helmchen’s (2013) defense of BPS as an advanced, integrative, evidence-based conception of mental illness, argues that “the biopsychosocial model of mental illness is valuable as a reminder that there is more to mental illness than brain functions. Seen as theory, it will either be based on biology and meet similar trouble as the so called biologism in psychiatry, or else it will indeed be vague and border on anarchy” (p. 2).…”

The biopsychosocial model between biologism and arbitrariness. A Commentary to H. Helmchen

“…Instead, he favors the biopsychosocial model as a remedy for “the narrowing of conceptions that depict only partial aspects of mental illness” (Helmchen, 2013, p. 3). The main criticism of this model is traditionally that it “borders on anarchy” because one can emphasize the “bio” if one wishes, or the “psycho” […], or the “social.” There is “no rationale why one heads in one direction or the other” (Ghaemi, 2009, p. 3).…”

Mental disorders are somatic disorders, a comment on M. Stier and T. Schramme

“…Secondly, the inability to spell correctly due to dyslexia is judged differently to poor spelling that is attributable to a lack of care or effort (and dyslexia has for the majority of the past 2000 years of our history almost totally escaped diagnosis). Thus, a concept which is not supported by knowledge of the etiological underpinnings can only be partial and, as Hanfried Helmchen points out, potentially dangerous for patients (Helmchen, 2013 ).…”