Mental illness, models

Eccleston D (1973). Adenosine 3 5 -cyclic monophosphate and affective disorders Animal models. In LL Iversen and SPR Rose (eds), Biochemistry and Mental Illness (pp. 121-126). Biochemical Society, London. 

In a related vein, researchers have argued that theory based taxonomies are needed for research to progress. Theory is obviously useful in making the taxonomy testable. Explicit theory based models of mental illnesses can be compared with one another to allow us to determine which model is more consistent with available data. Failure to specify a theory may limit the pace of scientific progress. 

Despite these limitations, there are several models of what goes wrong in the brain when mental illness strikes. It is helpful to review these ideas. 

The French physician, Jacques Joseph Moreau, remains the most-cited connection between cannabis and the art community. Moreau first used hashish while traveling through the Middle East in the 1830s. He assumed that cannabis-induced sensations might model the hallucinations and delusions common in psychotic individuals. He had hoped that this research might help the treatment of the mentally ill. The outspoken hedonist and popular novelist, Theophile Gautier assisted Moreau in this research. He not only participated himself, but he also recruited other members of Frances artistic community. This group of hedonists and experimenters met monthly in an old mansion in Paris which was known at the time as the Club Des Hachichins (Hashish Club). For historical reviews on cannabis, see Abel and Mechoulam. ... 

Once people have made the fundamental decision to continue on medications, the question becomes how best to live with their new partner how to reach accommodations that will make the relationship healthy and satisfying. The shift in emphasis from whether to how best to maintain a medication relationship solidifies their investment in the biomedical model of mental illness and its claim to appropriate treatments. While many may still dream about a future free of pills, by this point they have likely made a lifelong commitment to drug therapy. The decisive moment comes with the realization that I ve accepted now that this is the way I am. This [using medications] is what I ll need to do for the rest of my life. ... 

Yet to stop at that model, to say that mental illness is nothing but disease, is like saying that an opeta is nothing but musical notes. It impovetishes us. It impoverishes out sense of human possibility. ... 

Psychiatric treatment of new illnesses has accelerated since the 1980s. Whereas psychiatry traditionally had been dominated by a psychodynamic perspective on illness, the field has turned its back on that tradition in favor of predominantly biological definitions of mental illness. Critics of this shift focus their attention on the social factors that have led psychiatrists to the prescription pad. One can only express wonderment at the discovery of so many new brain diseases since 1980. The bible of psychiatric diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, or DSM, has now been revised three times since 1953, most recently in 1994. The first two editions classified illnesses in accordance with the psychodynamic model prevalent at the time. Conditions warranting psychiatric treatment were understood as disorders of the mind. Then, in the 1980s, the language of psychotherapeutic disorder abruptly disappeared and was replaced by... 

As the last two comments suggest, getting well is hard work. The notion that emotionally ill people need to explore multiple avenues leading to wellness is a welcome antidote to a passive patient model. By making people responsible for actively managing their own illnesses, this idea simultaneously restores their personal autonomy and diminishes the power of mental illness. There is wisdom in the following observation ... 

The gradual rediscovery of the medical model of mental illnesses, associated with research into pathological anatomical causes. 

It is clear that these trends are contradictory to some extent. A spatially segregated patient cannot lead a normal life in society. The medical model of mental illnesses, with its objective of detecting and, where applicable, correcting anatomical or functional disorders in the patient s body, contradicts a socially orientated concept of the illness underpinning treatment by educational methods. Modem psychiatry has grown up with these contradictions and still lives with them today (Rosen, 1969). 

In the earliest research with DET and the related dialkyltryptamines, the chemistry of metabolism was studied for any clues that could explain the activity of these materials. It must be remembered that this was in the heyday of the concept of psychotomimesis, the search for drugs that would imitate the psychotic state. What an appealing concept, that there might be a drug that could produce the syndrome of mental illness and thus be an accepted model for designing some treatment for it. There was a delicious search made at that time (the 1950 s) for names that could be given to these remarkable substances that would obscure any spiritual or positive aspects, so that one could present one s findings into the orthodox medical literature. 

Back to the metabolism discussion. And to the search for the actual drug, the magic bullet, that actually precipitated a model schizophrenic state. If one were to find it, one could look skillfully for the counterpart in the human animal, the one that simply appeared on the scene from some mismanaged metabolic process, and thus could be blamed for mental illness. It had been observed that the longer the chains on the N,N-disubstituted tryptamine, the less the potency. And the longer the chains, the less of the drug was excreted as the 6-hydroxyl metabolite. This focused attention on the hydroxy metabolites of the two simplest and most potent of the dialkyltryptamines, DMT and DET. 

LSD-25 to the behavioral and psychic actions of this drug. In other instances, we are still far from establishing such functional relations. It is hoped that renewed efforts with new and better techniques will enable us in the not-too-distant future to explain the whole "experience" produced by these substances, the whole "model psychosis," in terms of neural events. Should this be the case, one also would be a giant step closer to establishing a functional pathogenesis of endogenous mental disease i.e., one would be able to explain some or all the behavioral symptoms of the mentally ill in terms of abnormal neuronal function. It seems that with such a prospect in mind one could not think of a nobler task for a substance like LSD-25. 

The first phase, typically identified in the literature by the use of the adjective "psychotomimetic," was characterized by dominance of a priori, structured models. Seriously underestimating the effects that such preconceptions might have on the content and aftereffects of the subjective experience, researchers variously reported that psychedelics mimicked mental illness (when given in a setting that provoked it), illuminated Freudian theory (when administered by a com-... 

Many research questions remain about the role that factors such as family, role models, existing health problems (such as mental illness, HIV/AIDS, or alcohol abuse), and peer influences play in a young person s decision to start, continue, increase, or stop abusing inhalants. 

Although Rolland s (1994) model is focused on chronic, physical illness, the spirit of his model fits in understanding how families cope with mental illness as well. For example, the demands associated with caring for a family member with a chronic depression are very different from those facing the family of a person who suffers from an acute panic attack, and these are different from the demands created by ADHD. 

---