Medical vs social model of mental health

[Awakeupnorth]

Aagh, CPN is strongly encouraging me to take medication for very low mood and anxiety, and I have long held (20/30/40 years) views about social determinants/models of health versus biological/medical models in terms of health generally.

Does anyone have any similar experiences, or ideas about what might be useful (it's recognised that a lot of major stressors that I'm under are out of my contro).

I have no problem holding both these views - mind, body and the environment interact, and physiologies differ between people.

The anti-depressants I took in my 20 just numbed me, but at the end of the 90s SSRIs came in. Floroxetine was the first medication to have a real effect.

What I do take issue with is the labelling of clusters of symptoms as a sort of disease. I have a diagnosis of bipolar disorder, but this is merely a label attached to behaviours, symptoms and mental states. I am currently well, but am wondering how I would be without the 3 meds I am on, though not planning on stopping taking them (though I hope to get them reviewed). I am not happy being a longitudinal drug trial.

So my advice is to try the meds and see if there's an improvement. This means sticking with them for at least 6 weeks, though as I say, the effect for me was almost immediate.

Tricky. I have been highly resistant to taking them too but have taken them at points of complete necessity. I know my anxiety is rooted in my childhood so I struggle to reconcile how a drug can help me when I can now see what happened to me. That also goes against the medical model. I have had a lot of therapy though so am leaning into that rather than terribly brief doctors appointments where I am told what to do. It is a grey area though and I believe we should all have choices.

I really admire your viewpoint and have a very mixed relationship with meds myself. I think they can be helpful whilst addressing the underlying causes. If you're keen to take an alternative approach there is nutritional psychiatry or functional medicine?

Mental health seems to be going towards the biopsychosocial model where it's not social versus biological, but that it's biological, psychological and social all mixed together.

That's interesting @slashlover

I think integrative has to be the way to go. I've been seeing a functional medicine doctor and was convinced enough to start training in it myself. A functional approach puts diet and supplementation first and then sees what you are left with if that makes sense. Silly to get a diagnosis if the underlying cause is a hormonal imbalance, food intolerance or nutritional deficiency.

@rainbowninja

That's interesting *@slashlover*

I think integrative has to be the way to go. I've been seeing a functional medicine doctor and was convinced enough to start training in it myself. A functional approach puts diet and supplementation first and then sees what you are left with if that makes sense. Silly to get a diagnosis if the underlying cause is a hormonal imbalance, food intolerance or nutritional deficiency.

I'm currently studying Psychology and Counselling so it's obviously theoretical and the 'perfect' diagnosis/treatment plan but there's no point medicating someone if any underlying issues aren't fixed so it's integrating

Biological - antidepressants/antipsychotic drugs but also if there could be a biological cause. Some illnesses cause low mood, hormone issues could be if someone has given birth recently.

Psychological - Does someone have treatment strategies - CBT, exposure therapy, talking therapy etc.

Social - Does someone have a support system, are they working, do they have financial issues, are they in a relationship, what is their living situation? Has there been any big changes - bereavement, relationship breakdown etc.

Unfortunately, as the NHS is so stretched, the easiest thing is to prescribe drugs and hope they work.

Interesting. I have physical issues that triggered depression generally well controlled with AD. I wouldn’t function without them, but social factors can make it worse. (I’m in MH and starting a thread because I can foresee that coming now and seeking strategies).

I’m a GP and have bipolar 1 disorder think they both have a role, I actually agree with you that for many people the issues are more social but then I also think we live in an incredibly sick and messed up society and it takes more than one person wanting to change it for real change to occur with society… I also think there are a subset of people like shelf with a strong biological predisposition to mental health issues, we are probably the canaries in the coal mine when it comes to unhealthy social changes but also respond well to medication even if we wouldn’t have got sick in the first place without the social stressors on us. I think it’s a little unfair what a PP said that in the NHS we just throw drugs at the problem, that’s not true. However if someone is about to be evicted from their housing and can’t earn enough to make ends meet despite killing themselves working 2 minimum wage jobs with unsympathetic employers for example, I really don’t know what the NHS is supposed to do about that!! We can’t win as we’d be criticised for not at least discussing a potential role for medication to someone in that situation who was coming to us for help with depression. Of course the better thing would be for me to give her decent housing, a sympathetic landlord and find her decent employment paying well with an understanding employer but that’s really not within my role! And may sadly not exist in the modern UK. You said yourself OP that you have a few major and I changeable stressors so in view of that I think it’s not unreasonable to give medication a go to see if it helps you live with the stressors that cannot be changed while working on ones that can be.