Okay. So, it's all fine and good to talk about mental health as being separate from mental illness. But we all know that in everyday life, we're more likely to think of healthiness and illness as being on some type of continuum. When we're feeling good, we think of ourselves as healthy and when we're not feeling well, we're more likely to consider the possibility of illness. So, let's take a moment to think about when we start to consider that someone is experiencing problems with mental health or in other words, what is mental illness? From a lay perspective, basically the perspetive a hypothetical average person walking down the street. It's possible to identify mental illness in ourselves or others. Although we all have experience of things like sadness, confusion, agression, disorginization, etc., there is some kind of a sense that there are experiences of this stuff fall outside what we would call normal or healthy. That sense, or consensus is usually based on whether people are able to continue performing whatever social role they have. And this, of course, opens up a lot of questions about who gets to determine, what are appropriate social roles, and who gets to determine whether they're being performed appropriately. It's one of the reasons we have to think so carefully about issues that are coming up in the next few lectures. Like how we diagnose mental illness and how we take into account things like cultural differences when we're doing it. For now, I'm just going to leave it at recognizing that even without any kind of professional involvement, there is some kind of social idea about mental health that takes into account the possibility that people can be functioning well and therefore able to function appropriately. But this can shift so that we might identify ourselves or someone else as no longer functioning well and experiencing some kind of disorder or what we might even call madness. From a medical perspective, there's a distinction that's made between mental health and illness, and it has to be made in order to determine when someone should receive a diagnosis and how they should be helped or treated. And then also, what kind of expectations we might have for their future outcomes. Medical definitions of mental illness are largely based on an assumption that there is a correspondence between problems in thinking, emotions, and behavior, and then some kind of underlying problem with biological functioning, usually in the brain. The medical profession certainly works with an understanding, I think, that there is a continuum of illness and health, but there is a need to make some kind of decision about someone meets the threshold for diagnosis and treatment. Our legal systems gives them the power to take all kinds of actions once a determine is made, sorry, once the determination is made that someone has met that threshold. Some people like to point out that the medical perspective is weakened by the fact that we haven't actually been able to find biological correlates or foundations for supplement disorders. And that is true. But it is important to weigh this against the knowledge that our current technology is actually making it more possible all the time to make links between mental illnesses and what's happening biologically with people. And although we tend to pick on psychiatry and mental health for not being able to make those links, the truth is much of medicine has the same problem. So, although we can't always make the, we, we can't always point to the specific cell or connection or gene sequence that is, is associated with what we're calling a mental illness I think we have to recognize that it doesn't necessarily mean that it doesn't exist, it just may mean that we don't know how to find it. And and what we don't know is whether we will eventually find it or, or whether we won't. So, I've thrown in a slide here on the psychoanalytic perspective on, on what constitutes mental illness, because psychoanalysis and psychodynamic perspectives have such a pervasive influence all through mental health so it's worth checking in with them. in the psychoanalytic framework, there's definitely a continuum of mental health and illness. Some would say that there's actually an assumption that we're all ill or disordered to some extent, and it's really just a question of how ill or disordered we are. Now, there are many different streams of psychoanalysis and I couldn't hope to represent them adequately on one slide, but I think the sort of general idea that we can get across here is that in psycho analysis there's a premise that early relationships and previous relationships can leave behind a residue that creates unconcious processes that influence the way we think and behave in the present. So, if you're a person who is really dominated by those unconscious processes, you're acting, thinking and feeling in ways that really aren't under your control fully, you're being sort of ruled by these, these, these residue, then then that constitutes disorder. And really, what somebody is trying to do when they're in some kind of psychodynamic or psychoanalytic treatment is to shift the balance so that more of what they're thinking, feeling, and doing is part of concious processes rather than unconscious processes. So, that's how mental illness or disorder is thought of in the psychoanalytic perspective. Moving on, Psychology is also a discipline with many different perspectives and theories, so I can really only give examples of the kind of things that Psychology would suggest identifies a person as experiencing mental disorder. Psychologists tend to focus on things that are measurable. So, things like behaviors or cognitions which are ways of thinking they are identified as maladaptive. and when I say maladaptive, what I'm talking about is these are ways of thinking and behaving and feeling, I suppose, that get in the way of people being able to be successful and effective in life. These things become the markers of disorder and the targets of intervention. There's also a very interesting stream of Psychology, at least it's interesting to me, that focuses on personality dimensions. For example, there's a model called the five-factor model of personality that suggests that basic personality is constituted of the specific dimensions that you see here. Conscientiousness, agreeableness, neuroticism, openness to experience, and extroversion. If you're extreme on one or more of these dimensions, then you could be seen as somebody who has personality psychopathology. In other words, you have some kind of mental disorder. Psychology also has made some contributions that are not just focused on illness, they're also focused on wellness. So, Humanistic Psychology, which really I think, to my knowledge, is where we first started hearing about things like people's feelings of well-being and things like self-actualization. And again, you know, I'm using these terms recognizing that they're very North American. But these kinds of concepts came out of Humanistic Psychology and they're really, I would say, being reflected quite strongly in the current emphasis on wellness. It uses a lot of the same language. Another thing is that there's a lot of work that's being done in an area called positive psychology that's really about the the study of happiness. What makes people happy? What keeps them happy? How do we make more people happy? So Psychology isn't just focused on illness, but they do have these very clear ways of thinking about what constitutes mental disorder. We've already had a bit of exposure to sociological perspectives on what constitutes mental illness. although I'm referencing Goffman's work here and you'll remember that that's been associated with anti-psychiatry thinking, I want to assure you that sociological perspectives do not all question the existance of mental illness and there's a huge literature of socilogical work on metal health. That starts from a position of recognizing that there is something called mental illness that has an effect on the way people function and can contribute to experiences of suffering. Because of sociology's emphasis on the social context, it is also concerned with how mental illness is defined in the context of regulating and controlling deviance. This is line with Goffman's work on the topic. Along with this, there is interesting habit to finding of mental illness search and develop an industry around it that creates experts and expertise and how that industry may serve those interests at least as much as it serves the interests of people who are diagnosed with mental illness. Illness. A lot of the work around stigma as well has been done by sociologists. And again, we look to Goffmann as someone who spearheaded a lot of that work. So, the defintion of mental illness is also examined in the context of how it reflects social negotiations. About what is acceptable and unacceptable ways of thinking, feeling, and behaving. I'm a social worker so I'm going to weigh in on behalf of social work. Social work is a profession and discipline that has always had an integrative approach. We draw on a lot of different perspectives we've already reviewed. So, it would be fair to say that we probably agree with much of what has already been said. Social workers use what is called a biopsychosocial perspective on health. And we'll be talking about that more as we move through the lecture. So, within that perspective, we are concerned with the biological, psychological, and social foundations in mental health and mental illness. This is also keeping, this is also in keeping with what social workers use which is called a person-in-environment perspective. And that looks at all issues for the ones of how it is effected by the fit between people and their environments, the environments in which they're living. In addition, because social workers are a profession that is quite involved with community based mental healthcare, at least in North America. And also because of our concern with issues of social justice, our focus on the environment takes us to raising questions about stigma against mental illness. we're also interested in things like the resources that are committed to promoting mental health and treating mental illness. So, a social work perspective on mental illness takes all of these things into account. Another thing that social workers take into account, is how the ways that we deal with mental health and illness can reflect overarching balances of power and privilege in our society. With that in mind, we're mindful of the potential for the labeling of mental illness to be potentially implicated in the misuse of power. And there are always vigilant for opportunities to resist those processes. We also see part of our work as seeking out opportunities for the empowerment for people who are diagnosed with mental illness. I would also say that we want to look at how you could also empower mental health professionals and communities to promote the right to environments and institutions that promote mental health. Finally, I want to close by returning to the recovery perspective. From a recovery perspective, what is mental illness? I think the recovery perspective takes us full circle by returning to the ideas that are being put forward as part of an emerging agenda around mental health. From a recovery perspective, mental illness is a real thing. Something we don't completely understand, but something that undoubtedly contributes to difficulty and suffering for many people. The recovery perspective says that mental health can be promoted in the context of those experiences of mental illness and it also suggests that people who are experiencing mental illness can look forward to also experiencing mental health. Okay. So, that's seven perspectives on what is mental illness. So, what is mental illness? I guess it's a pretty complex question to answer and maybe that's all you can learn from that because I tell you, 7 is what I presented here, but there's probably a lot more. So, we'll return to that question because, of course, that is deeply implicated in issues of diagnosis and treatments. And and it'll be interesting to see how this connects to that when we get to that lecture. But for now, what we're going to do is move more directly into the social context. So, our next discussion is going to be about the social determinations of mental health. And this again, is going to be part of us trying to answer, why is it that some people are able to stay mentally healthy and why is it that some people get mentally ill?
