Models for Mental Disorder E-Book

Peter Tyrer

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 375

Veröffentlichungsjahr: 2013

Beschreibung

Models for Mental Disorder, first published in 1987, anticipated the
move towards integration of psychiatric services into multidisciplinary teams
(doctor, psychologist, nurse, social worker, etc) and the need to bring together
the different philosophies of mental illness. Peter Tyrer has identified four
different models of mental disorder that are relevant to clinical practice:
the disease, psychodynamic, cognitive-behavioural and social models.
Each model is described and reviewed, with reference to case studies and
illustrations, to show how it relates to mental health disorders and can be
used to interpret and manage these disorders.

The book has been widely read and is often used for training purposes so that
each professional can understand and appreciate that differences in viewpoint
are often a consequence of one or more models being used in a different way
rather than a fundamental schism in approach.

Since the fourth edition was published in 2005, the disciplines of mental health
have moved even closer together with the growth of assertive outreach and
more integrated community teams. This, combined with the greater awareness
of mental health among users of services, which leads to more penetrating and
informed questions at interviews with professionals, has emphasized the need
for a wider understanding of these models.

• The only book to describe the models framing mental health diagnosis
and management
• A great review for those wanting a better grasp of psychiatric disorders
and for integration of concepts for treatment planning
• New information on formal classifi cations of mental disorder
• New information on mindfulness and mentalization regarding
the dynamic model
• Clearly written in a style which includes some humour and a
conversational presentation – a joy to read for the beginner and more
experienced practitioner alike
• Features a teaching exercise for use when training students in the
various models

Leseprobe

CONTENTS

PREFACE

ACKNOWLEDGEMENTS

1 INTRODUCTION

REFERENCES

2 THE DISEASE MODEL

WHAT IS DISEASE?

STAGES OF IDENTIFICATION OF DISEASE

STAGE 1 – IDENTIFICATION OF THE CLINICAL SYNDROME

STAGE 2 – IDENTIFICATION OF PATHOLOGY

STAGE 3 – THE NATURAL HISTORY (COURSE) OF THE SYNDROME

STAGE 4 – DETERMINING THE CAUSE AND SELECTING RATIONAL TREATMENTS

DEFENCE OF THE DISEASE MODEL

REFERENCES

3 THE PSYCHODYNAMIC MODEL

IS IT TRUE? DOES IT WORK?

BASICS

VARIATIONS ON THE THEME

ATTACHMENT THEORY

THE EVOLUTIONARY MODEL

PRACTICAL APPLICATIONS

CONCLUSION

REFERENCES

4 THE COGNITIVE-BEHAVIOURAL MODEL

DIFFERENCES FROM OTHER MODELS

HOW THE COGNITIVE-BEHAVIOURAL MODEL DEVELOPED

MOVING BEHAVIOURISM FROM THE LABORATORY TO THE CLINIC

INTRODUCTION OF THE COGNITIVE COMPONENT

TESTING THE MODEL

MINDFULNESS CBT

FURTHER EXAMPLES OF THE COGNITIVE BEHAVIOURAL MODEL IN PRACTICE

THE CASE OF THE ANXIOUS HOUSEWIFE

THE CASE OF THE HYPOCHONDRIACAL DEPRESSIVE

FUNDAMENTAL DIFFERENCES BETWEEN THE COGNITIVE-BEHAVIOURAL MODEL AND OTHER MODELS

OTHER APPLICATIONS OF THE COGNITIVE-BEHAVIOURAL MODEL

CRITICISMS OF THE COGNITIVE-BEHAVIOURAL MODEL AND THEIR REBUTTAL

PUTTING THE PATIENT IN CONTROL

REFERENCES

FURTHER READING

5 THE SOCIAL MODEL

LIFE EVENTS, SOCIAL FORCES AND ENDOGENOUS ILLNESSES

IDENTIFICATION OF SOCIAL CAUSES OF MENTAL ILLNESS

SOCIAL MODEL IN PRACTICE

CAUSES AND SYMPTOMS OF MENTAL ILLNESS WITH THE SOCIAL MODEL

ALLOWING ADJUSTMENT TO TAKE PLACE IN ADVERSITY

DEALING WITH DEVIANCE IN SOCIETY

USING THE SOCIAL MODEL TO REVERSE DIAGNOSTIC PRACTICE

NIDOTHERAPY

OTHER APPLICATIONS OF THE SOCIAL MODEL

SUMMARY

REFERENCES

FURTHER READING

6 AN INTEGRATED MODEL

DIAGNOSIS AND CLASSIFICATION IN PSYCHIATRY

HOW CAN DIFFERENT MODELS INTERACT?

THE MEDICAL MODEL

MATCHING MODELS TO DISORDER

RESOLVING CONFLICTS IN THE INTEGRATED MODEL

LEVELS OF DISTRESS AND DISORDER

STAGES IN THE DEVELOPMENT OF MENTAL DISORDER

CHILD AND COMMUNITY PSYCHIATRIC PRACTICE AS ONE MODEL FOR TEAMWORK

COMPLEXITY IN MEDICINE AND PSYCHIATRY

CONSULTATIVE APPROACHES TO COMPLEXITY

PATIENTS’ VIEWS AND MODELS

MODELS OF CARE

MODELS OF PROFESSIONAL WORK

CONCLUSION

REFERENCES

APPENDIX: TEACHING EXERCISE

Clinical example

Interpretation – disease model

Interpretation – psychodynamic model

Interpretation – cognitive-behavioural model

Interpretation – social model

GLOSSARY OF TERMS

REFERENCES

INDEX

This edition first published 2013 © 2013 by John Wiley & Sons, LtdPrevious editions © 1987, 1993, 1998, 2005 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Tyrer, Peter J., author. Models for mental disorder : conceptual models in psychiatry / Peter Tyrer. – Fifth edition. p. ; cm. Includes bibliographical references and index.

ISBN 978-1-118-54052-7 (pbk.) I. Title. [DNLM: 1. Mental Disorders. 2. Models, Biological. 3. Models, Psychological. WM 140] RC437.5 616.89–dc23

2013017990

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: © Derek Steinberg

PREFACE

A great deal has happened to mental health in the 26 years since the first ­edition of this book was published. Rather shamefacedly in retrospect, we intended it originally to be a guide for psychiatrists and students in the mental health professions only when we first conceived the book. At that time the people who received mental health care and their relatives had only distant knowledge of how psychiatrists viewed their world. Now everything is ­different and I would like to think this is for the better. Mental health professionals can no longer hide behind jargon, obfuscation, half-truths and their perceived status in their interactions with others. Their activities are now centre stage and open to scrutiny from their other colleagues, regulatory bodies, patient lobby groups of various sorts, professionals from other disciplines, and the general public. ‘What are you doing, what is the reasoning behind it, and what is the likely outcome?’ are the questions everybody is asking. Of course, this is not only true of mental health professionals but indeed of all medical practitioners in this new spirit of openness. The problem mental health professionals have is they are not singing from the same hymn book; the cacophony of sound emanating from their vocal chords is not harmonious or synchronized. The aim of this book is to explain why, but not to criticise unduly, and instead to attempt a synchronization that makes the mental health choir a joy to listen to.

To do this I have brought up to date each of the four major models of mental disorder and added extra interlocking pieces that make the integrated model a more successful one. Because I understand that many who receive ­psychiatric services are naturally keen to know more about the reasoning behind their care, the language has been edited slightly to make it more readable and easily understood. But I apologise if I have failed in my task here. For the past 10 years I have been editor of the British Journal of Psychiatry and have tried to improve the readability of the journal while maintaining high s­cientific standards. The sad fact is that high scientific standards usually go with very turgid reading and I hope that I have been able to overcome this to some extent.

You will note that the pronoun ‘we’ has now become ‘I’ in this fifth edition. I am very sad to report that my fellow author and illustrator, Derek Steinberg, died shortly after the last edition of this book in 2006, but I have retained most of his cartoons as they remain a fitting memory for his talents. Derek was more of an adherent to the psychodynamic model than the others in this book and I do hope in editing this particular chapter I am being fair to his aims and intentions. We had great fun in piecing together the different chapters of this book and throughout this time, despite many arguments, I never once heard Derek raise his voice. This is not easy when negotiating with an irascible academic with strong feelings and in the editing of this fifth edition I have imagined Derek sitting behind me and reminding me that I need to tone down some of my more extreme views. I would like to think that he has succeeded here but that is for the reader to decide.

I should like to thank my editorial colleagues in the Royal College of Psychiatrists, particularly those who had been serving on the Janitor Committee, for helping me to maintain my precarious position on a rickety fence separating the domains of the adherents of each of my four models, when judging papers for publication. They have helped me to agree that all models can win and all can have prizes. I also thank Peter Lee, a model social worker, and my wife, Helen, for helping me to develop the social model much more coherently, and for the development of nidotherapy, which owes a great deal, much more than she may realize, to her. Finally, I must acknowledge the contribution of my twin cats, Running Thunder and Chasing Small, for being secure custodians of my manuscript, and for acting as my flanking cavalry as we move into the jousting arena where the battle of the models will begin.

ACKNOWLEDGEMENTS

This fifth edition has been helped greatly by the discussions I have had with many outside the field of psychiatry. These particularly include my wife, Helen, whose experience in general medicine, general practice and cognitive-behavioural therapy has helped enormously in my understanding of how we are seen by others, and also by colleagues in general medicine where we have recently been involved in many studies in liaison psychiatry. I have also had many stimulating and amusing arguments with Sandra O’Sullivan and Clinical Studies Officers in the North London hub of the Mental Health Research Network that have also altered my views, I hope for the better. When you are involved with trying to persuade patients to take part in research studies in mental health you realize that both they and their carers, including other physicians, have widely disparate views about mental health and the many models that underlie interventions. These have convinced me that models of mental disorder will continue to be constructed, sometimes crazily, often inappropriately, but always with some value, for many years to come, and, despite all their failings, we would be lost without them.

1

INTRODUCTION

Welcome to models for mental disorder. It may seem an odd subject, but it is not peripheral to understanding of mental illness. Many years ago I was responsible for the undergraduate teaching programme in psychiatry at our medical school. One of our students showed great aptitude in the subject and told me that he would like to specialize in psychiatry after he qualified. I gave him every encouragement, not least as this subject tends to be low on medical student career priorities. I did not think much more about it until I saw him shortly after his final examinations, where he achieved distinction in psychiatry, but also in some other subjects too. He was looking a little discomfited when I saw him and I asked him if anything was the matter. He told me he had just come out from a two-hour meeting with the Dean of the medical school. He added at some length exactly what had happened. ‘I have heard a rumour that you want to specialize in psychiatry,’ said the Dean, ‘this can’t be correct, can it?’ The student said it was. ‘What on earth do you think you are doing?’ said the Dean. ‘Psychiatry is not a proper part of medicine. People tend to go into it if they fail at everything else, but you are an outstanding student who ought to be doing something better.’ ‘I’ve considered all the options, sir,’ said the student, ‘but I feel more comfortable with specializing in mental health than any other part of medicine and I feel I can be of more value there.’ ‘But psychiatry is not a scientific subject,’ expostulated the Dean, ‘it has no proper base. Most of the people practising it rely on their experience and opinion only. Do you really want to specialize in a subject where everyone has different views and it is the loudest voice that wins, not science?’