Individual Development and

Change
Critical Perspectives
 Thinking About Theory
‘Ín the case of mental disorder, theoretical disputes have
led to varying and conflicting explanations. Moreover,
these different understandings have led to different
practices and treatments. If the cause of madness is
said to be the possession of the individual by evil spirits,
the appropriate response is exorcism. When the
explanation of mental disturbance lies with chemical
imbalances in the brain, treatment by drugs is
recommended. If mental confusion is generated in the
disturbed communication pattern of family life, family
therapy is offered. What is to be done depends on what
it is you think is going on.’
• David Howe (1999)
 Implications
• There is conflict or disagreement between
different models / explanations.
• Thus a person with mental health
difficulties could receive a variety of
different explanations / diagnosis
depending on who he or she sees and
furthermore these different explanations
will clash leaving the service user or
patient very confused.
 Practice Implications
 Different explanations and
differential service user
experience leads to a lack of
quality assurance and
standardisation
 Implications For Service Users
• Different explanations or models lead to
different practice models and modes of
intervention
• For the service user or lay person this is
very confusing. It means we could have a
room of people with the diagnosis of
depression who have all had different
experiences of treatment with different
outcomes.
Key Questions For Critical Thinking
In the conflict and disagreement between
explanations and models the question
must be asked of:

Who decides which is the best explanation

and why.
 KEY MODELS
• Bio - Medical
• Behavioural
• Cognitive
• Psychodynamic / psychoanalytic
• Humanistic
• Service User – Recovery model
• Psycho-Social
• Located in terms of: Societal
Inter-personal
Individual
 The Power of Models
‘What does it mean for a word not
only to name, but also in some sense
to perform and, in particular, to
perform what it names’

Judith Butler (1997) Burning Acts, Injurious Speech. Found in Salih

Sara Ed (2004) The Judith Butler Reader
 Why Have a Model / Thoery?
‘The Choice for the practitioner is not whether to have a
theory but what theoretical assumptions to hold. All
persons acquire assumptions or views on the basis of
which they construe and interpret events and behaviour,
including their own. These assumptions frequently are
not explicit but more what has been called implicit
theories of personality’. Thus the appeal for practitioners
to be atheoretical amounts simply to an argument that
theory ought to be implicit and hidden, not
explicit….particular assumptions about human behaviour
can be expected to influence professional actions and
therefore, have important consequences for clients.’
(Briar and Millar 1971 pp. 53-54)
Questioning the individualisation
of social problems
‘Psychology’s deflections of social problems into
individual maladjustments, together with an
abuse of power by professionals, led me ..to
practice a psychology that would not blame
victims, that would not be divorced from social
issues, and listen to people’s concerns, in all
their complexities. I have been searching for
theories and practices that show the intricate
connections between psychology, power,
oppression and domination.’

Isaac Prilleltensky, (2002) ‘Doing Psychology Critically’ ISBN 0-333-

92284-0
Social Construction of Madness
• In the serene world of mental illness, modern man no longer
communicates with the madman: on one hand, the man of reason
delegates the physician to madness, thereby authorising a relation
only through the abstract universality of disease; on the other, the
man of madness communicates with society only by the
intermediary of an equally abstract reason which is order, physical
and moral constraint, the anonymous pressure of the group, the
requirements of conformity. As for a common language, there is no
such thing; or rather, there is no such thing any longer; the
constitution of madness as a mental illness, at the end of the
eighteenth century, affords the evidence of a broken dialogue,
posits the separation as already effected, and thrusts into oblivion
all those stammered, imperfect words without fixed syntax in which
the exchange between madness and reason was made. The
language of psychiatry, which is a monologue of reason about
madness, has been established only on the basis of such a silence.
• (Foucault, 1965; x-xi)
Social Construction of Madness
‘In his usual rather dense style, Foucault encapsulates
many of the paradoxes at the root of the study of mental
health and illness, and sets the stage for many of the
themes which will be of significance. The centrality of
the medical model of insanity is asserted, imposing a
scientific order onto the profoundly un-ordered world of
the mad. While madness is displayed in the form of a
disease, sanity is a constraint, both physical and moral
into which the insane person is confined through
pressure of the group, the sane. All this is a construction
of the reasoned, and reflects the world of the reasoned;
to the insane person, it is an alien landscape.’
(Mental Health law 2nd Edition Peter Bartlett and Ralph
Sandland 2003)
 Bio-Medical / Disease Model
• regards mental malfunction as a
consequence of physical and chemical
changes primarily in the brain but
sometimes in other parts of the body.
Example
• Depression is caused by a chemical
imbalance in the brain and will be treated
accordingly
 Behavioural Model
The terms classical and operant conditioning are
two key concepts within this model.

• Classical conditioning is associated with the work of

Pavlov, whereby biological responses are regulated and
respond to external stimuli creating a conditioned reflex.

• Operant conditioning is associated with the work of

Burrhus Skinner whereby a link exists between positively
affirming behaviour that reinforces a particular stimulus.
Operant behaviour differs from classical conditioning in
that behaviour determines conditioning, not the stimulus.
 Humanistic Model

• Highlights not just the importance of external

factors but the individual’s subjective
experience of those external factors.

• Maslows's hierarchy of needs proposes that

individual’s thoughts and the mind is influenced
by the extent to which physiological and
intellectual needs are being met
 Humanistic Model

• Highlights not just the importance of external

factors but the individual’s subjective
experience of those external factors.

• Maslows's hierarchy of needs proposes that

individual’s thoughts and the mind is influenced
by the extent to which physiological and
intellectual needs are being met
 Cognitive Model

This model proposes that it is the

dysfunctional thinking of the
patient in response to a variety of
stimuli that creates mental
disorder that would not otherwise
be present.
 Psychoanalytic Model
• Concept of mental apparatus –
Id, Ego, Super – Ego
• Concept of the unconscious
• Concept of defence mechanisms
• Concept of internal conflict
Psycho-Social / Social Model
• Relationship between social
conditions and mental health

• The social construction of Mental

Health

• Concept of Internalisation
 Social Model
‘The problems of madness and misery, then, lie
not inevitably in any inherent impairment of
perception, emotion or conduct of identified
patients. Instead they are located in the
contexts they inhabit, particularly in intolerant
norms and the fetish for rationality. Once this
epistemological tack is taken then warranted
paternalism to those with psychological affliction
melts away’
(Pilgrim D, & Rogers A, (2008) in ‘Critical Issues
in Mental Health’. ISBN- 978-0-230-00905-9)
 The Social Model
‘for nearly every kind of mental illness,
disease or disability, and especially those
which afflict large numbers of people,
poorer people are afflicted more than
richer people, more often, more
seriously and for longer’
(Roger Gomm 1996 in ‘Mental Health and
Inequality’ )
 Orientation
Conflict / Radical Change

Subjective…………………...….Objective

Regulation / Order