40-2 How do the medical model and the biopsychosocial approach influence our understanding of psychological disorders?

The way we view a problem influences how we try to solve it. In earlier times, people often thought that strange behaviors were evidence that strange forces—the movements of the stars, godlike powers, or evil spirits—were at work. Had you lived during the Middle Ages, you might have said “The devil made him do it.” To drive out demons, people considered “mad” were sometimes caged or given “therapies” such as genital mutilation, beatings, removal of teeth or lengths of intestines, or transfusions of animal blood (Farina, 1982).

Reformers, such as Philippe Pinel (1745–1826) in France, opposed such brutal treatments. Madness is not demon possession, he insisted, but a sickness of the mind caused by severe stress and inhumane conditions. Curing the sickness, he said, requires “moral treatment,” including boosting patients’ morale by unchaining them and talking with them. He and others worked to replace brutality with gentleness, isolation with activity, and filth with clean air and sunshine.

Barbaric treatments for mental illness linger even today. In some places, people are chained to a bed, confined to their rooms, or even locked in a space with wild hyenas, in the belief that the animals will see and attack evil spirits (Hooper, 2013). Noting the physical and emotional damage of such restraint, the World Health Organization launched a “chain-free initiative” that aims to reform hospitals “into patient-friendly and humane places with minimum restraints” (WHO, 2014).

By the 1800s, a medical breakthrough prompted further reform. Researchers discovered that syphilis, a sexually transmitted infection, invades the brain and distorts the mind. This discovery triggered an excited search for physical causes of mental disorders and for treatments that would cure them. Hospitals replaced asylums, and the medical model of mental disorders was born. This model is reflected in words we still use today. We speak of the mental health movement. A mental illness (also called a psychopathology) needs to be diagnosed on the basis of its symptoms. It needs to be treated through therapy, which may include treatment in a psychiatric hospital. Recent discoveries that genetically influenced abnormalities in brain structure and biochemistry contribute to many disorders have energized the medical perspective.

To call psychological disorders “sicknesses” tilts research heavily toward the influence of biology and away from the influence of our personal histories and social and cultural surroundings. But as we have seen throughout this text, biological, psychological, and social-cultural influences together weave the fabric of our thoughts, feelings, and behaviors (FIGURE 40.1). As individuals, we differ in the amount of stress we experience and in the ways we cope with stressors. Cultures also differ in the sources of stress they produce and in the traditional ways of coping they provide. We are physically embodied and socially embedded.

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The environment’s influence on disorders can be seen in culture-related symptoms (Beardsley, 1994; Castillo, 1997). Anxiety, for example, may be manifested in different ways in different cultures. In Latin American cultures, people may display symptoms of susto, a condition marked by severe anxiety, restlessness, and a fear of black magic. In Japanese culture, people may experience taijin-kyofusho—social anxiety about their appearance, combined with a readiness to blush and a fear of eye contact. The eating disorders anorexia nervosa and bulimia nervosa occur mostly in food-abundant North American and other Western cultures. Increasingly, however, such North American disorders have, along with McDonald’s and MTV, spread across the globe (Watters, 2010). Even disordered aggression may be explained differently in other cultures. In Malaysia, a sudden outburst of violent behavior, called amok (as in the English phrase “run amok”), was traditionally attributed to an evil spirit.

Two other disorders—depression and schizophrenia—occur worldwide. From Asia to Africa and across the Americas, people with schizophrenia often act irrationally and speak in disorganized ways; people with depression experience long-term hopelessness and lethargy, have trouble concentrating, and lose interest in activities that once brought them pleasure.

Disorders reflect genetic predispositions and physiological states, psychological dynamics, and social and cultural circumstances. The biopsychosocial approach emphasizes that mind and body are inseparable (see FIGURE 40.1). Negative emotions contribute to physical illness, and physical abnormalities contribute to negative emotions. As research on epigenetics shows, our environment can also affect whether a gene is expressed, thus affecting the development of psychological disorders.