Psychological and Social Aspects in Mental Illnesses

-

 

Bio-psycho-social model

Most of the psychiatric illnesses have a bio-psycho-social model of origin, meaning they have a biological component which could be some genetic vulnerability, autoimmune mechanisms, neurodevelopmental defects (during the brain’s development) and so on.


They also have psychological component which include their thought patterns, emotional aspects, behavioural reactions to stress and other life events, coping skills, temperament and personality traits.


The third aspect is social which includes family dynamics, interpersonal relationships, social structure and the patient's relationship to various social elements. Most of our mental health issues develop due to interaction between these three aspects of the individual.


In our medical profession, we tend to pay more attention to the biological aspects, often ignoring the other two domains. However as I learnt and studied psychiatry, I realised the importance of Psychosocial aspects. There many robust studies which demonstrated the impact of these factors on mental health and illnesses.

Social Factors
For example, there is higher chances of mental illnesses in urban areas compared to rural areas, especially in socioeconomic marginalized population living in cities, often called the 'urban poor'. These are more pronounced in areas of rapid urbanization such as cities in developing countries due to several interlinked social, economic, psychological factors.

Psychological Factors: Expressed Emotions
Another robust relationship is between the hostility and critical comments of family members (called Expressed Emotions) towards patients of schizophrenia and their relapse rate. Needless to say, it is very evident that patients exposed to high levels of expressed emotions in their families had multiple relapses and frequent readmissions, despite good compliance with medications.

These are two very common examples. There are multiple theories and many more literature available which suggest the strong relationship between psychological, social factors and mental illnesses.


Psychosocial assessment and treatment

Psychological assessment can identify unresolved conflicts, interpersonal issues, personality patterns and even latent psychosis. Family assessment helps in understanding family dynamics, the power struggles within the family structure, or other socially confounding factors.  

Any form of psychotherapy, individual therapy, supportive therapy, counseling, family therapy, interpersonal therapy or even psychoeducation, which means educating the patients and family members about the illness, medications, how to identify relapse signs can go a long way in improving treatment adherence and long term outcome.

They are effective for depression and anxiety disorders, especially in mild to moderate cases. In my experience, many individuals, especially urban youths and adults are more receptive towards therapy and other psychosocial approaches when it comes to taking care of their mental health.

Most patients benefit with a combination of medications and psychosocial measures. While medications help with relieving acute symptoms, the other measures help in identifying faulty patterns which lead to relapses. 

For example, in cases of substance use disorders like alcohol, detoxification with medications reduces the withdrawal symptoms and craving, while psychotherapy like Motivation Enhancement Therapy (in short, MET) helps to motivate the individual to maintain long-term abstinence.

They also build a good doctor-patient rapport which again improves long-term outlook in chronic psychiatric illnesses. In addition, they help in reducing the stigma and negative connotation that many have regarding mental illnesses and individuals suffering from them.

In fact, many patients are very apprehensive regarding psychiatric medications. Taking a few minutes out to explain them why medications are necessary helps allaying their fears to certain extent.

Conclusion

Since psychosocial factors play a significant role in development of mental health issues, the inclusion of Psychosocial approaches in the treatment of patients provides a complete and holistic care.
One or the other form Psychosocial treatment must be included in the treatment module so that we can improve overall patient outcome.

-Dr. Suhasini Das, MD, FIPS

Comments

Post a Comment

Popular posts from this blog

May I have your ATTENTION, please?

-
Image
A Piece of our Attention In today’s world, we are constantly bombarded with information throughout our waking hours, by our television sets, computers or the ubiquitous mobile phone. The internet made information transmission easy, rapid and with the ability to penetrate the remotest corner of the world. I am sure many of you will agree with me that although we have to navigate sheer volume of data every day, only a handful of them are actually essential, most are unnecessary and some are purely fraudulent. However whatever may be their purpose, one thing is common - they are all craving for our attention . In our personal lives, we have our families, children, parents, friends, work, health, community, environment and many different domains and each seeks a share of our attention. If we focus just on a particular area for long and neglect others, the consequences are inevitable. Our health may suffer, our relationships may lack warmth and affection, we may become distant and discon...
Read more

Every Life Matters: Changing the Narrative on Suicide

-
Image
Introduction Every year more than 7,00,000 individuals commit suicide, that translates to 1 person dying every 40 seconds.   To create awareness around this serious issue, World Suicide Prevention Day is observed on 10 September across the globe. Every suicide impacts not just a single person but the whole family and community at large. It raises a lot of questions, many remain unanswered. The family members often find themselves at loss, sometimes blaming themselves, but mostly clueless about where they missed the red flags. Suicide is not an isolated incident but a culmination of multiple factors - emotional, psychological, personal, social, and economical- which eventually leads an individual choose death over life. For every suicidal death, there are many who will attempt, putting a large number of people at risk. What does Statistics say? As per the National Crime Records Bureau, 1,64,033 suicides were reported in 2021 , which is an increase of 7.2% as compared to 2020. T...
Read more

The Eyes see what the Mind knows: Cognitive Distortions

-
Image
Introduction The eyes see only what the mind knows and more often than not, we may become victims of our own minds, our own perceptions because of several reasons like our limited knowledge, distressing experiences and memories, need to feel safe and in control or simply a refusal to accept the reality as it is. Hence we develop some mental mechanisms to deal with our reality. One such mechanism is called cognitive distortion , a term used by mental health professionals for a set of automatic thoughts that pop up between the external events and one’s reaction to them; a core process in a multitude of psychological disorders.   Imagine a situation where we see our friends conversing with each other but cannot hear what they are talking about (so we have limited information). The logical and rational response in such a situation will be to ask them what they were talking about. However, on the backdrop of any anxiety disorder, let’s say social anxiety, the automatic thought that m...
Read more