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      Mental Health in Social Context: What Is Normal and Who Defines It?

      Journal of Health and Rehabilitation Sciences
      Alma Mater Europaea - ECM

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          Abstract

          The purpose of the paper is to encourage a critical attitude and shed light on the background and perception (and not the definition) of “normal” through the prism of society, which to a large extent conditions human functioning and well-being. Understanding the variability of normality and mental health as a socially defined and ever-changing concept leads to normalisation and de -stigmatisation of not only mental disorders in the narrower sense, but also of mental distress of modern man, and is a prerequisite for reducing false diagnoses. Human vulnerability and inner struggles, which are the norm, not a peculiar, isolated problem, need to be seen as such while taking into account all the factors, i.e., biological, psychological, and social, affecting the person. A better understanding and use of the biopsychosocial model could help improve healthcare and make this world a little kinder.

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          Most cited references36

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          The need for a new medical model: a challenge for biomedicine

          G. Engel (1977)
          The dominant model of disease today is biomedical, and it leaves no room within tis framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.
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            "A disease like any other"? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence.

            Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice. The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma. In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection. More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.
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              The global burden of multiple chronic conditions: A narrative review

              Globally, approximately one in three of all adults suffer from multiple chronic conditions (MCCs). This review provides a comprehensive overview of the resulting epidemiological, economic and patient burden. There is no agreed taxonomy for MCCs, with several terms used interchangeably and no agreed definition, resulting in up to three-fold variation in prevalence rates: from 16% to 58% in UK studies, 26% in US studies and 9.4% in Urban South Asians. Certain conditions cluster together more frequently than expected, with associations of up to three-fold, e.g. depression associated with stroke and with Alzheimer's disease, and communicable conditions such as TB and HIV/AIDS associated with diabetes and CVD, respectively. Clusters are important as they may be highly amenable to large improvements in health and cost outcomes through relatively simple shifts in healthcare delivery. Healthcare expenditures greatly increase, sometimes exponentially, with each additional chronic condition with greater specialist physician access, emergency department presentations and hospital admissions. The patient burden includes a deterioration of quality of life, out of pocket expenses, medication adherence, inability to work, symptom control and a high toll on carers. This high burden from MCCs is further projected to increase. Recommendations for interventions include reaching consensus on the taxonomy of MCC, greater emphasis on MCCs research, primary prevention to achieve compression of morbidity, a shift of health systems and policies towards a multiple-condition framework, changes in healthcare payment mechanisms to facilitate this change and shifts in health and epidemiological databases to include MCCs.
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                Author and article information

                Contributors
                Journal
                Journal of Health and Rehabilitation Sciences
                J. Heal. Rehab. Sci.
                Alma Mater Europaea - ECM
                2820-5480
                June 12 2023
                August 26 2023
                : 2
                : 2
                : 1-7
                Article
                10.33700/jhrs.2.2.84
                32e8f3f1-65fc-4a86-8c6b-05ff2fd42f14
                © 2023

                https://creativecommons.org/licenses/by/4.0

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