The title of the long-running Ou/BBC Radio 4 programme ‘All in the Mind’ suggests something that most people involved with it probably don’t actually believe: that mental health problems are ‘all in the mind’. The natural follow-on to believing this is that if only we could think differently there would be no reason to be disturbed or distressed. Of course, popular approaches such as Cognitive Behavioural Therapy and Mindfulness meditation do seek to change how we think and feel about our situation, but this does not mean that we can ignore the circumstances under which mental health problems develop in the first place.
I can remember from my student days a popular Tee-shirt slogan, attributed to Kurt Cobain and still available, which went ‘Just because you are paranoid it doesn’t mean that they are not out to get you’. Although that might seem in rather poor taste, it does alert us to the danger of not taking each person’s situation seriously.
The early pioneers of psychotherapy, such as Sigmund Freud (1856-1939) and Carl Jung (1875-1961), were very interested in the workings of the mind and how early childhood experiences had an impact on later life. The first psychiatrists, such as Emile Kraeplin (1856-1926), came to see certain mental health problems as having their origins in the physical pathology of the brain (Burns, 2006). One early indication that mental health problems could have a social origin arose from the work of the 19th Century sociologist Emile Durkheim (1971). He found that the risk of suicide was much greater in certain types of society than others, and that events such as economic crises would lead to an increase in the suicide rate. Similarly, recent studies e.g. (McManus et al., 2009) have shown that the rate of psychotic disorders can be as much as four times greater in the poorer households compared to those that are better off, whilst rates of anxiety and depression can be twice as great in the lower income households.
There is still much debate about the contribution of biological, psychological and social factors to mental health and distress. The biopsychosocial model developed by George Engel in the 1970’s attempts to bring all these factors together and this approach can be seen in action in our multi-disciplinary mental health teams. However, there is often a feeling that the social aspects of mental health don’t get the attention they deserve (Leach, 2015). Although knowledge of the mind (and body) is very important in understanding mental health issues, so too is knowledge of the societies and communities in which we live.
Burns, T. (2006) Psychiatry: A Very Short Introduction. Oxford: Oxford University Press.
Durkheim, E. (1971) ‘Anomic Suicide.’ In K. Thompson and J. Tunstall (eds) Sociological Perspectives. Harmondsworth: Penguin.
Engel, G. L. (1977) ‘The need for a new medical model: a challenge for biomedicine.’ Science, 196 pages 129-136.
Leach, J. (2015) Improving Mental Health through Social Support: Building Positive and Empowering Relationships. London: Jessica Kingsley.
McManus, S., Meltzer, H., Brugha, T., Bebbington, P. and Jenkins, R. (2009) Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. London: NHS Information Centre for Health and Social Care.