Mental health articles

OF mental health care and mentally ill

What is mental disorder and models of mental disorder

Experiencing ‘mental health’ or having a ‘mental illness’ may appear as two distinct, separate states of being. Such dualistic thought may also appear advantageous. The boundary it represents provides a point of exclusion beyond which we can place our fears of the unknown. ‘Madness’ becomes distinct from ‘sanity’, and for the majority, ‘madness’ is not within ‘us’ but belongs to ‘them’. This seems a comforting position to pursue, but is human experience quite so linear? ‘Mental health’ is in fact inseparable from ‘mental illness’. They do not exist independently of one another, in the same way as night can only be understood in relation to day, black to white, up to down, happy to sad, and of course, back to front. These pairs of opposites each describe the same phenomenon of interest but do so from different perspectives, which is the very antithesis of a boundary that distinguishes two separate entities.

‘Mental health’ and ‘mental illness’ are terms of relation, not of reality, and the reality they describe is human experience. We begin this text with such a cautionary note since the history of mental illness is a history of exclusion, separation, distinction and ‘otherness’ (Tudor 1996). What we present in the following pages are the approaches different schools have taken to explaining the aetiology of mental disorder. We examine also a number of treatment implications for each of the models. However, this should not be viewed as a definitive account of the terrain within which mental health nursing operates. Professional interest should necessarily incorporate mental health or ‘well-being’, and for this reason we recommend this chapter is read in conjunction with Tudor’s chapter on health promotion. So, as we describe different models, or ways of understanding mental disorder, it is important to beware of the artificial boundaries such distinctions draw. To identify professionally with only these shades of the spectrum of human experience is to miss something vital about the human condition. If as nurses we focus only on disorder and illness, what chance is there to promote the mental health of those who endeavour to live a fulfilling life in spite of an illness or disorder?

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