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Six short posts about mental health 1: Biopsychosocial perspectives

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Edited by Meg-John Barker, Saturday, 29 Oct 2011, 16:54

A short while ago I was asked to take part in an Open University day about mental health for tutors. It was a good chance to give a workshop about self care and why that might be useful for both students and staff. But I was also given a lecture slot in the day. I decided to share some of my thoughts on mental health more broadly. I was nervous because this was the first time I had spoken on this topic specifically and I know that my ideas on it can be challenging to hear. However, the talk seemed to go well and led to some great discussions, so I've decided to share it here too.

The talk preceding mine set the scene very well as Saroj Datta gave us an update on the latest evidence regarding the interactions between genes and the environment in relation to mental health. Saroj was involved in the OU science course on mental health which takes a 'biopsychosocial' approach to the issue, and her talk demonstrated just how impossible it is to tease apart those elements: bio, psycho, and social (which is why they are combined into one word).

I already knew about 'neuroplasticity': the fact that the way our brains connect up changes over the course of our lives depending on the experiences we have (this is the way that we learn, of course, but we often forget this and regard brains as static and unchanging). Saroj presented evidence that there is also flexibility on a genetic level. Whilst the set of genes in every cell in our body remains fixed, whether they are 'switched on' or 'express themselves' is not. Animal studies have shown, for example, that a glucocorticoid receptor gene tends to remain switched off, leading the animal to be fearful and anxious, unless the mother displays nurturing behaviours (due to not being anxious herself) in which case it is switched on, leading to pups who are calmer and less stressed. This research is in its early stages, and needs to be treated with caution when applied to humans of course.

Human research supports the genetic-envionmental interaction, finding that, for example, rates of depression are high when a particular allele of a gene is present and someone has experienced three or more stressful life events, but lower if just that allele, or just the life events, are present. It is the interaction between genes and environment that is vital. There have been similar findings in relation to childhood maltreatment. However, it is important to remember that some people were still depressed without those particular elements in the place (either that gene allele, those life events, or the two together): so this is not the whole picture. Also there is unlikely to be any one single gene involved in any element of human behaviour, but rather many.

Saroj suggested that such 'epigenetic' changes are potentially reversible and it has been suggested that this, and neuroplasticity, may explain why there are multiple different routes to repair and recovery.

My own interest has been mainly about the social end of the biopsychosocial composite, but it is vital to remember that this is as impossible to tease apart from the rest of it as the bio end is. The ways in which the society in which we live understands, and treats, people, is vital to the way in which we understand and treat ourselves. And one of the main things our society currently does is to split apart the biopsychosocial in a deeply problematic way when understanding issues of distress or 'mental health'. This is something I will explore, in detail, in the next post.

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The next post in the sequence is here.

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The 'social' aspect has a far larger impact than many people realise. Sadly it could as easily be described as the 'anti- social' aspect, as the need to 'exclude' and 'outcast', the 'you're not one of us' types of behaviouir is unfortunately common, and often results in those with so-called 'problems' turning away from people as a whole.

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In the BioPsychoSocial model of which you speak, does the Social include as part of its whole, the Economic? I know that the Economic aspect affects the Social, but also it affects the Bio and Psych areas. And it has a huge impact (beyond both its obvious, and iti assumed forms) upon the way some with certain types of mental illness cope and interact with the world. In particular I am thinking of those who are forced into certain situations, and to be with certain people, which, if they had independent means, they would never choose. Another ugly issue is that of Economic impact upon privacy and respect.

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You're spot on about economic Wren. This is indeed included within 'social', but I think some people read 'social' as just about interpersonal relationships or the smaller groups people are in, whilst others read it as encompassing 'society' (as I do) which leads us to think about the involvement of economic factors, institutional discrimination and prejudice, cultural messages, social injustice and the like.

I think your point about how the economic restricts people (including the people we are able to surround ourselves with) is excellent.

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Thank you for posting Meg, and I agree that it's pointless trying to separate the bio, psycho or social influences and effects. I like Wrens thinking too and we often comment on each others posts. So, I agree with you agreeing with Wren about personal economic resources effecting privacy and respect availability. I totally get that. I just want to add a subtlety...sometimes when someone attains a level of economic independence that enables them to have 'privacy', an unforeseen downside can occur. They can become out of daily and obvious reach from family or friends and if they are inclined to deal with problems alone without actively seeking help then other people don't even notice and so can't help. Of course this is fine if their problem is within their means to deal with, but if it isn't... Also, whilst much social regulation can be harmful, not all is. If family friends or neighbours can see what's going on in peoples lives and they know them and care they can help. But perhaps more useful is the 'knowing' that people can see you and how that helps motivate someone to do the daily stuff that they might otherwise feel like not doing (if they are feeling down). So, I reckon privacy is definitely desirable, (I personally need it), but unfortunately it can sometimes allow people to struggle without anyone noticing, and can remove a social motivator too. But, very much pleased to have read these posts. Thank you. And thanks Wren too.

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Mm thanks so much for that Emily. I think you are quite right about privacy - and it fits into what I say in post 5 about self-monitoring culture. We are so encouraged to present a positive 'mask' to everyone else that this often pushes our suffering into the private sphere (either only we ourselves, or our nearest and dearest, know about it). And right that does come with the economic capacity to be private - and is perhaps a major downside of it. As well as trying to enable those who can't afford it to have privacy, it would be useful to consider the downsides of withdrawal into privacy for those who can afford it.

I think that openness about all our suffering is a potential way through the privacy problem, but needing to find ways to do that which don't reinforce the ill/well dichotomy - like Wren suggests perhaps, not claiming an 'illness' but identifying that we struggle (oppressed rather than depressed).

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This wikipedia entry gives a lot more information about how the regulation of gene expression works.

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You're both helping me see this particular point (social inclusion/ exclusion) from another angle/direction clown I will enjoy chewing on this and post it later, thanks both of you.