How Do I Wrap My Head around What’s Going on in My Head?—Part One

Hey Guys, 

This is the second part of a talk on the biopsychosocial model, which is a useful framework for understanding mental illness.  If you are just now tuning in, I’d suggest going back to look at the first part of the talk where I discussed biological factors that may be contributing to symptoms of a mental illness. 

Now, just to rehash a bit of the first segment, if you or your loved one are struggling with symptoms of a mental illness, it can be helpful to have a framework to make sense of symptoms.  It can help you figure out what triggered the symptoms in the first place or why the symptoms are still occurring or even getting worse.  And ultimately, this framework can be useful for determining ways to adequately treat, manage, or eliminate the symptoms.   

So, if you’re new to me, I’m Dr. K Martin also known as Dr. K.  I’m both a child and adolescent psychiatrist and general psychiatrist based in the Southeast. My goal with these brief posts is to provide you with quick and easy access to information about mental health.  And hopefully, I will deliver it in a way that you can understand.  Do note, however, this information is not meant to serve as a substitute for your personal mental health care.  Please talk to your provider before implementing any suggestions that I mention in these talks.  Now for today, the framework that we are going to continue talking about is called the biopsychosocial model. 

In the first segment, we talked about the “bio” in biopsychosocial.  And “bio” refers to biological factors that may be contributing to a mental illness.  Now we are going to shift to talking about some of the “psychosocial” issues that may be contributing to symptoms of mental illness. 

So, the “psycho” in biopsychosocial stands for “psychological.”   

Now as I mentioned in the first segment, whenever I am evaluating new patients, I usually start by asking what they are seeking treatment for.  That’s what we in the medical field call the “chief complaint.”  Let’s say a patient comes in with a “chief complaint” of persistently sad mood for the last three months.  I’ll start by asking questions to better determine what factors could be contributing to this sad mood and I’ll start categorizing these factors.  Usually, I start by looking for biological factors that are contributing to the patient’s sad mood—again, I talked about that in the first segment.  Then, after that, I’ll shift gears and start looking for psychological factors that could be contributing to the patient’s sad mood.  Now when I say “psychological,”  I am trying to understand what goes on in the “internal world” of that patient or what’s happening in their headspace.  One of my primary goals is to determine how patients see themselves, how they see others around them, how they see the world, and how they see their futures.  I need to understand how they perceive things.  And not only that, I need to understand what shaped these perspectives.  What experiences—starting in childhood—came to shape the lens through which they see themselves, others, the world around them, and their futures?  I need to know why they believe what they believe and why they think the way they think.  Let me give you an example so that you can better wrap your head around what I’m talking about.  Let’s say a forty-five-year-old woman comes in complaining of persistently sad mood for the last three months.  I’d want to understand if anything is going on in her headspace that’s contributing to the sad mood.  If she’s going around thinking “I’m worthless.  My life sucks.  People can’t be trusted.  The world is a terrible place.  I might as well go ahead and die right now.”  Then, yeah, that’s a recipe for a persistently sad mood.  But I can’t stop there.  I need to dig a little bit deeper to figure out how she got to thinking this way.  It could be that she was raised in a household where her father skipped out early, her mother worked all the time, and she was generally left to fend for herself.  As an adolescent and young adult she could have had multiple abusive partners, had a difficult time holding down a steady job, and generally found little opportunity for achievement or success.  Those negative life experiences could go on to shape negative views of herself, others around her, the world, and her future and these negative perceptions could serve as a huge contributor to the sad mood that she’s experiencing.  Now, as a mental health provider, one of my primary jobs is to help patients unyoke themselves from unhealthy patterns of perceiving and behaving that may have been established in childhood and realize there are other lenses through which they may view the world and other choices for behaving outside of their usual pattern of responding.  For example, I once had a patient who grew up with a father who abused alcohol.  During one session, she talked to me about how her father had recently telephoned her and proceeded to cuss her out and berate her for an extensive period of time over the phone.  I asked her why she didn’t hang up the phone, and it had never crossed her mind as an option.  Together, we figured out that--as a child--she had no choice but to live in the same house and put up with his abusive language.  Her perception that she was trapped and helpless continued into adulthood—despite the fact that she was a grown woman and lived in a different household and now had the power to simply end the conversation and hang up the phone.  It took work with me as her therapist to perceive that she had options that were outside that were previously outside of her awareness.  That’s why it’s so important for us as mental health providers to evaluate for psychological factors that may be contributing to symptoms of mental illness.     

Social contributors to mental illness are the final part of the biopsychosocial model that must be taken into consideration.  Now, “social” refers to what has occurred in patients’ current or past circumstances or environment that could be contributing to symptoms of mental illness.  For example, in the case of the patient reporting persistently sad mood for the last three months, I’ve already learned some about her childhood circumstances that lead to negative patterns of thinking.  Now, I want to know if there is something that happened three months ago that may have triggered the sad mood.  A recent death or some other kind of loss.  Trouble on the job or in school?  Trouble with a significant other?  So, generally during evaluations, I ask patients about school or employment status, the status of significant relationships, financial status, legal status, or if there have been recent changes in their environment or living situation.  I also make efforts to understand the patients’ family life and the culture within which the patient is rooted. Sometimes patients’ deviation from familial or cultural expectations may cause conflict that contributes to problems with their mental health.   I also try to figure out if they have a healthy social support network or if the lack of social support is contributing to their sad mood.  I also want to do a safety assessment.  Do they feel safe in their current living environment?  Are they safe at work or are they being harassed?  Are they safe at school or are they being bullied?   I also ask about traumatic events—current or past—that could be contributing to the symptoms of mental illness.  Is there a history of or ongoing verbal, physical, sexual, or emotional abuse?  Have events occurred during which patients have feared for their lives or the lives of those close to them?          

Finally, when I’m doing this part of the assessment, I also take what I call a spiritual history.  I want to understand the patients’ spiritual beliefs and religious practices if they adhere to any.  This is also a crucial factor to consider, as spiritual beliefs and practices can actually be utilized to facilitate improved mental health.  However, they also may negatively impact mental health, if for instance, patients believe that God is punishing them or that they are receiving retribution for some sin committed by ancestors or that they are under a curse or that they will never be able to fulfill expectations of the religious group to which they adhere.  

Now, I know that this has been an information-dense talk, but I hope that you’ve understood it and been able to appreciate that there are truly innumerable potential contributors to mental illness.  Mental illness is not due to emotional weakness, moral deficiency, flawed character, or just plain old poor parenting.  Mental illness is truly multifactorial in nature, and the biopsychosocial model can serve as a useful tool for helping us to appreciate this. 

Now folks, let’s make it our business to understand mental illness and those who struggle against mental illness.  I’m Dr. K, and this has been Mental Health | Plain Speak.  And remember, “Be kind, for everyone you meet is fighting a hard battle.”