Behavioural Perspectives of Mental Wellbeing

Introduction to The Biomedical Model of Mental Disorder

This assessment is about behavioural prospective of mental wellbeing. In this, various controversies surrounding the psychiatric diagnostic classification systems and the medicalisation of behaviour has been discussed. The purpose of psychiatric labels and diagnosis is to reflect the complexities of an individual’s mind and recognizing that it can never be fully described in a single label. Medicalisation is the process by which health conditions and behaviours are considered as medical issues and prioritizing the treatment to these issues (Kaczmarek, 2018, pp. 119-128). Psychiatric diagnostic classification system such as DSM-5 and ICD-10/11 as well as medicalisation can be problematic. The focus of this assessment is to determine the controversial issues regarding the statement “Psychiatric diagnostic classification is not fit for the purposes”. This paper has stated clear evidence-based arguments in favour of this statement as well as active counter arguments against this statement to consider both sides of the debate regarding these issues.

Controversies Surrounding Psychiatric Diagnostic Classification Systems

Psychiatry is focused medical speciality which defines the mental status of a person. The purpose of psychiatric labels is to address the ways by which the person dealing with any kind of psychiatric disorder can adapt themselves to deal with the loss (Falissard et al., 2017, pp. 1151–1154). Psychiatric diagnosis is necessary to identify the mental disorder, disease or illness in an individual, and provide an explanation about aetiology of a disease and its reason. Although, DMS-5 & ICD-10/11 does not contain any treatment guidelines, it is just a list of diagnosis criteria of different categories of illness. But it is important to demonstrate the treatment process followed by the diagnosis, which is also been in controversial issue (American Psychiatric Association, 2020, para. 9).

Currently, the diagnosis, treatment and prevention of psychiatry are in debate. These controversies are getting more focused by the launch of DSM-5. This is the 5th edition of Diagnostic and statistical manual of mental disorders released by American Psychiatric Association, which basically categorizes the diagnostic labels by observing the behavioural traits of an individual. Another guideline, named as ICD-11 (International Classification of Diseases-11), which is the revised version of ICD-10, published by World Health Organization (WHO). It is a global system of categorization for physical as well as mental illness. DSM-5 and ICD-10/11 both are authoritative guidebooks for medical professionals that they use for the diagnosis and treatment of various diseases. DSM-5 focus on the mental disorders and ICD 10/11 covers all parts of mind and body. Currently ICD-10 is active, because ICD-11 will come into effect by 1 January 2022. This critical review is to discuss about the current controversies in psychiatric diagnosis or challenges in mental health of an individual. Many psychiatrists debate that DSM-5 or ICD-10/11 should not be presaged as ultimate guide in diagnosis of psychiatric disorders, which shows that these guidelines are not fit for the purpose to treat mental disorder (Timimi, 2014). However, some authors did active counterargument and defence to support the guides DSM-5 & ICD-10/11.

The biggest controversy with DMS-5 was the removal of “bereavement exclusion criteria”, which means depression can be detected immediately following a death on the grounds that these symptoms has been taken as normal part of bereavement process. DMS-4 has considered the symptoms of major depressive disorder (MDD), which has been excluded in DMS-5. There has been the highest controversy for debate surrounding the new definition of grief. Authors argued that "bereavement does not 'immunize' the patient against a major depressive episode, and is in fact a common precipitant of clinical depression" (Pies, 2014, p. 19). Some authors said that it was a major mistake to take something previously thought of as a normal reaction to grief and change it into something abnormal, arguing that there was "little empirical justification for the changes" (Thieleman & Cacciatore, 2013, p. 3). Some have said that "there is no conclusive scientific evidence to show what a normal length of bereavement is". Overall, critics have fear that depression may now become over diagnosed due to current system of DSM-5, and this shows the problematic nature of DSM-5 (Kleinman, 2012, p. 608). However, some research counterargument and justify the fact that termination of bereavement is meaningful. Those patients who have at least 5 major depressive episode symptoms (MDE) for 2 weeks, a diagnosis of MDD should be made, regardless of any originating cause. Although some researchers suggest extending the minimum period of MDE symptoms does not address the central concerns about eliminating the bereavement raised here (Lamb et al., 2010, pp. 19-25).

New diagnoses coming into the DSM-5 were eating disorder, disruptive mood dysregulation disorder, pre-menstrual dysphoric disorder etc. The other major controversial new disorder in the DSM-5 was disruptive mood dysregulation disorder. It was particularly controversial because it was added to the DSM-5 without published validity studies having been conducted first i.e. there was a lack of empirical evidence before the DSM-5 decided this was a disorder (Baweja et al., 2016). However, the opposed argue that psychiatric functioning is only one measure of long-term functioning of disruptive mood dysregulation disorder (Copeland et al., 2014, pp. 668-674).

Broad categories describing the psychiatric disorders are involved in DSM-5, which is not important. The focus should be on to develop the new approaches that identify the pathways of the disease. The questionable use of antipsychotics or antidepressants is only one of the latest controversies in psychiatry. The use of antidepressants, their length and antipsychotic treatment in schizophrenia remain a matter of discussion (Correll et al., 2015, pp. 119–136). According to a research, the benefits of psychiatric drugs have been exaggerated and the harms underplayed due to poor trial designs. While some authors counteract in same research that the evidence supports the use of these drugs and they are needed for benefits of people (Gotzsche et al., 2015). Moreover, psychiatrist debate that these guidelines do not tell about the conceptual level of mental illness, which means what exactly mental illness is or how can we control this? How much science is available to support the people from mental illness? All these raised questions indicate that the unfit values of psychiatric diagnostic system (Thibaut, 2018, pp. 151-152).

Controversies Regarding the Medicalisation of Behaviour

The process by which non-medical problems are treated as medical problems is called as medicalisation or pathologisation. Medicalisation can occur when we choose to look at things through a biomedical lens and when we see differences of behaviour/experiences as medical diseases with biological roots. During medicalisation, some people experience hallucinations of hearing voices as an evidence of psychiatric disorders and want to treat this. However, some people critics this finding and try not to remove these voices and take it as normal part of their life. Person-centred care approach is useful here to deal with this critical situation (Heriot-Maitland et al., 2019).

The DSM-5(andICDs) have been created using the biomedical model, where people's behaviour may be viewed as being indicative of a mental illness, if it meets certain criteria that a committee decides represent categories of illness (Deacon, 2013, pp. 846-861). However, psychotropic medications are heavily marketed as effective treatments in the absence of this robust evidence. It doesn't mean to throw out the biomedical model completely either. It just means that as evidence-based practitioners, these guidelines must be evaluated. This suggest that biomedical interventions such as medication should be first line interventions for mental distress and psychiatric symptomatology and that diagnosis and intervention is the only method of exploring these issues. There are various controversial ethical and behavioural issues raised by the medicalisation, which shows that medicalisation can be problematic and does not fit for the purpose to provide healthcare services.

Patient safety and medicalisation is one of the biggest controversies in medicalisation. It is not safe to use drugs or medications which are really not needed. But many pharmaceutical and biotechnology companies sell these medications to as many customers as possible to make their profit. As these companies have invested their money and time in these medications, so they want heavy marketing of them, in spite of thinking about the side effects of these medications (Al-Worafi, 2020, pp. 21-28). Moreover, medication errors like extra dose, wrong time, medicine omitted, wrong patient, wrong drug etc., leads to harm the patient. This has been a controversial issue for medicalisation. However, another research indicates 4 major recommendations to overcome these issues in medicalisation such as, written communication, working environment, medication procedures, education and training (Donaldson et al., 2017, pp. 1680-1681). Moreover, gender discrimination, recreational drug use & racism are also being in controversial issues for medicalisation. There has been another controversy of discrimination with women. As in older times, pregnancy and birth of child can be carried out inside homes by the midwives or any older women. But now situation has changed due to medicalisation. Now childbirth happens in a clean operating room in hospital with medications and electronic monitoring systems. Due to this body process and functions of women are more visible to the society, which is criticized as unfair trend for the women. Other research counter this point of controversy saying that hospitalization is effective for delivery of pregnant women (Gramlich, 2020). Moreover, by medicalisation, race is also affected, as by providing medical care genome secrets are uncovered. It has been a controversy for discriminating based on racial profile. These points suggest the unfit values of medicalisation system.

Conclusion on The Biomedical Model of Mental Disorder

This assessment cites various controversies surrounding the psychiatric diagnostic classification systems and the medicalisation of behaviour in favour of the statement, “Psychiatric diagnostic classification is not fit for the purposes”. After critically evaluating these controversies it has been seen that many psychiatrists debate that DSM-5 or ICD-10/11 and medicalisation should not be presaged as ultimate guide in diagnosis, which shows that these guidelines are not fit for the purpose to treat mental disorder. However, some authors did active counterargument and defence to support the guides. Applying these results of critical evaluation, it has been concluded that these guides may be imperfect to apply and are not fit for the purpose of psychiatric diagnosis and medicalisation. However, by addressing the issues of researchers and doing modifications, these can be implemented well to treat mental illness by providing good quality care to people. 

Video Analysis

Millions of Australians experience mental illness or psychiatric disorders in their life. This study is on ten Australians from rich backgrounds of Australia and diagnosed with varied mental illness across their life. They all participated in this show in hope of breaking down this stigma and live in a rural retreat of Mornington Peninsula in Victoria for a week. Three most well-known experts from Australia. They struggle throughout the program to diagnose the kind of mental illness among the 10 Australians (Hickey, 2018a). In order to diagnose the mental illness, series of specially designed test were carried out, such as gambling test, body image test, building rafts test, cognitive test, and complex figure drawing test etc. Based on these test, group behaviour and clinical observations of the selected Australians, the experts decide the mental illness of all individuals. One of the applicants in the program, Mitch, had past history of anorexia. During his interview, he said that the most important part to treat mental illness is to recognize the condition, rather than denying from the illness they are facing. He has gone through all the activities and personal interviews throughout the program, and he seems to have no remarkable symptoms of mental illness now. Mitch said that his recovery from anorexia is due to the treatment he has followed, that is counselling by a private psychiatrist, cognitive behaviour therapy, yoga etc. He said yoga is the best way to connect mind and body which would eventually treat the mental health (Hickey, 2018b).

References for The Biomedical Model of Mental Disorder

Al-Worafi, Y. M. (2020). Medications registration and marketing: Safety-related issues. Drug Safety in Developing Countries, 21-28. doi:10.1016/b978-0-12-819837-7.00003-0

American Psychiatric Association. (2020). DSM–5: Frequently Asked Questions. https://www.psychiatry.org/psychiatrists/practice/dsm/feedback-and-questions/frequently-asked-questions.

Baweja, R., Mayes, S. D., Hameed, U., & Waxmonsky, J. G. (2016). Disruptive mood dysregulation disorder: current insights: NDT. doi: 10.2147/NDT.S100312.

Copeland, W. E., Shanahan, L., Egger, H., Angold, A., & Costello, E. J. (2014). Adult diagnostic and functional outcomes of DSM-5 disruptive mood dysregulation disorder. American Journal of Psychiatry, 171(6), 668-674. doi: 10.1176/appi.ajp.2014.13091213

Correll, C. U., Detraux, J., Lepeleire, J., & Hert, M. (2015). Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World psychiatry: official journal of the World Psychiatric Association (WPA), 14(2), 119–136. doi: 10.1002/wps.20204

Deacon, B. (2013). The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846-861. doi: 10.1016/j.cpr.2012.09.007

Donaldson, L. J., Kelley, E. T., Dhingra-Kumar, N., Kieny, M., & Sheikh, A. (2017). Medication without harm: WHO's third global patient safety challenge. The Lancet, 389(10080), 1680-1681. doi:10.1016/s0140-6736(17)31047-4

Falissard, B., Monégat, M. & Harper, G. (2017). Psychiatry, mental health, mental disability: time for some necessary clarifications. European Child and Adolescent Psychiatry, 26, 1151–1154. doi: 10.1007/s00787-017-1037-4

Gotzsche, P. C., Young, A. H., & Crace. J. (2015). Does long term use of psychiatric drugs cause more harm than good? BMJ, 350. doi: 10.1136/bmj.h2435

Gramlich, J. (2020). Key findings on gender equality and discrimination in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2017/12/28/10-things-we-learned-about-gender-issues-in-the-u-s-in-2017/

Heriot-Maitland, C., McCarthy-Jones, S., Longden, E., & Gilbert, P. (2019). Compassion focused approaches to working with distressing voices. Frontiers in Psychology. doi: 10.3389/fpsyg.2019.00152

Hickey, J., (Series Producer and Writer), Grusovin, D., & Elkin-Jones, N. (Directors). (2018a). Episode 1. [TV series episode]. In D. Dale (Producer), How 'mad' are you? Blackfella Films Pty Ltd. https://edutv-informit-com-au.dbgw.lis.curtin.edu.au/watch-screen.php?videoID=2676395

Hickey, J., (Series Producer and Writer), Grusovin, D., & Elkin-Jones, N. (Directors). (2018b). Episode 2. [TV series episode]. In D. Dale (Producer), How 'mad' are you? Blackfella Films Pty Ltd. https://edutv-informit-com-au.dbgw.lis.curtin.edu.au/watch-screen.php?videoID=2673948

Kaczmarek, E. (2018). How to distinguish medicalization from over-medicalization? Medicine, Health Care and Philosophy, 22(1), 119-128. doi:10.1007/s11019-018-9850-1

Kleinman, A. (2012, February 18). Culture, bereavement, and psychiatry. Redirecting. doi: 10.1016/S0140-6736(12)60258-X.

Lamb, K., Pies, R., & Zisook, S. (2010). The bereavement exclusion for the diagnosis of major depression: to be or not to be. Psychiatry, 7, 19-25.

Pies R. W. (2014, July). The Bereavement Exclusion and DSM-5: An Update and Commentary. Innovations in clinical neuroscience, 11(7-8), 19–22.

Thibaut, F. (2018). Controversies in psychiatry. Controversies in Psychiatry Dialogues in Clinical Neuroscience, 20(3), 151-152. doi:10.31887/dcns.2018.20.3/fthibaut

Thieleman, K., & Cacciatore, J. (2013, June 10). DSM-5 and the Bereavement Exclusion: A Call for Critical Evaluation. OUP Academic. doi: 10.1093/sw/swt021.

Timimi, S. (2014). No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished. International Journal of Clinical and Health Psychology, 14(3), 208-215. doi: 10.1016/j.ijchp.2014.03.004

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