Although the study and practice of mind-body medicine have made great strides over the last few decades, the predominant method for dealing with “mental illness” is still traditional medical care. In other words, the mechanistic model, the basis for most modern medical interventions, has been the primary tool used to assess and treat mental health in clinical practice. To understand this further, it is important to investigate two schools of thought regarding mental illness: the biological and psychological models.
The biological model of mental illness views the mind from the same mechanistic perspective that modern medicine uses to view the physical body; that is, physical and biochemical laws can fully explain all mental processes. According to this line of thinking, mental dysfunction is a consequence of chemical changes in the brain. These changes—due to either an overproduction or underproduction of hormones or neurotransmitters, or perhaps even to a flaw in the metabolic pathways of certain brain chemicals—can cause an afflicted person to behave differently than what society generally considers “normal.” At least this is the historical rationale behind the biological model of mental illness. Proponents believe that the best way to treat these biochemical abnormalities is with drugs, surgeries, or other physical modalities like electroshock therapy.
The psychological model, on the other hand, believes that most mental disorders stem from the mind, that abstract component of human consciousness manifested in our thoughts, perceptions, emotions, will, memories, and imagination. Proponents of this model believe that many mental disorders are due to psychological or social stressors, early life trauma, or learned cognitive patterns, rather than strictly chemical changes. They point out that, as of yet, no modern instrument or technological device has been discovered to effectively measure a simple, causal biochemical imbalance (like a serotonin deficit) for major depressive disorder. Considering these facts, proponents emphasize that no convincing evidence exists that definitive, convincing evidence is still lacking to implicate genetics or simplistic biochemical imbalances as the singular cause of most mental illness.
I should note that there are distinct differences between the practices of psychiatry and psychology, both professionally and philosophically. Psychiatrists are medical doctors; hence, they receive all the training necessary to become medical professionals. Not surprisingly, most psychiatrists have historically subscribed to the mechanistic paradigm that is so predominant in the medical sciences—that is, the human body operates as a complex machine, and the brain, as its most complex organ, is no exception. The brain is comprised of an elaborate network of neurons and glial cells (support cells), and it carries out regular electrical, chemical, and hormonal actions. A psychiatrist, then, can be thought of as a specialist, one who focuses on an intricate neuroelectrobiochemical structure. Due to this historic philosophy, psychiatrists have traditionally believed that mental disorders are brain disorders that can be treated effectively by electrical, chemical, and hormonal means, and their treatment methods generally reflect this point of view. The psychiatric profession is thus one of the strongest and most vocal advocates of the biological model of mental illness.
Psychologists, in contrast, are not medical doctors (MDs), but Doctor of Philosophy (PhDs) or Doctor of Psychology (PsyDs). Their education is not bound by mechanistic ideology, but instead by the study of the mind. This discipline is best known for the work carried out by its forefathers: Sigmund Freud, Carl Jung, and William James. These pioneers focused on mental processes and human behavior, and the profession continues to use these principles as the foundation of its practice today. Most psychologists would not deny the physical and chemical nature of the brain; nevertheless, they believe that psychological conditions should be approached primarily through cognition, behavior, and interpersonal dynamics. And they believe that neurological conditions should be treated neurologically, not biochemically. It is important to note that neurological disorders (like Alzheimer’s disease) do, indeed, exist. However, psychologists do not use the existence of these diseases as a rationale for attaching biochemical explanations to all mental disorders. Instead, they subscribe to the psychological model of mental illness.
Many people are unaware of the distinction between psychiatrists and psychologists. Most people tend to think these two professions are the same, not realizing that when they hire a therapist, they are generally hiring someone from the field of psychology. Psychologists are not qualified to prescribe medications; therefore, psychotropic drugs are administered by psychiatrists or, more commonly, by primary care physicians (PCPs – your general family doctor). On the other hand, psychotherapists practice talk therapy, which, up until very recently, was the primary form of treatment for mental disorders.
But times have drastically changed. Although the prevailing academic framework is the biopsychosocial model—recognizing that biological, psychological, and social/environmental factors all interact—modern healthcare pushes the biological approach. In practice, due to limited time, high cost, and long waiting lists for therapy, medication has become the primary treatment model for most patients with depression and anxiety, even when clinical guidelines recommend psychotherapy as the initial treatment, especially for mild-to-moderate conditions. This tension between holistic theory and mechanistic practice (immediate prescribing) continues to define the landscape of mental health care today.
