AN INTEGRATIVE
APPROACH TO
PSYCHOPATHOLOGY
R ASUMBRADO, RPM, MACP, ICARSS
CASE OF DEPRESSION
Developmental
Factors
Biological
Factors
Psychosocial Factors
UNDERSTANDING PSYCHOPATHOLOGY:
AN INTEGRATIVE APPROACH
• Biological Dimensions (Genetic Predispositions, Brain Plasticity, and Vulnerabilities)
• Psychological Dimensions (Psychodynamic, Behavioral, Cognitive Processes)
• Sociocultural Dimensions (Upbringing, Interpersonal Influences)
• Developmental Dimensions
No influence operates in isolation.
Each dimension—biological or psychological—is strongly influenced by the others and by
development, and they weave together in various complex and intricate ways to create
a psychological disorder.
ONE-DIMENSIONAL MODEL
• To say that psychopathology is caused by a physical abnormality or by
conditioning is to accept a linear or one-dimensional model, which
attempts to trace the origins of behavior to a single cause.
For example, depression is caused by depletion levels of serotonin
MULTIDIMENSIONAL MODEL
• A system, or feedback loop, may have independent inputs at many different points,
but as each input becomes part of the whole, it can no longer be considered
independent.
• This implies that any particular influence contributing to psychopathology cannot be
considered out of context.
Context, in this case, is the biology and behavior of the individual, as well as the
cognitive, emotional, social, and cultural environment, because any one component
of the system inevitably affects the other components, forming a complex network.
INTERACTIONS OF GENE AND THE
ENVIRONMENT
• Eric Kandel speculated that the process of learning affects more than
behavior. The very genetic structure of cells may change as a result of
learning if genes that were inactive or dormant interact with the
environment in such a way that they become active.
Changes in the neuronal level may lead to changes in biochemical
functioning of the brain.
INTERACTIONS OF GENE AND THE
ENVIRONMENT
• We tend to assume function of our internal organs and
most of our physiology are set or, in the case of the
brain, hard-wired.
• Brain is plastic – subject to continual change in
response to the environment.
DIATHESIS-STRESS MODEL
MULTIDIMENSIONAL APPROACHES TO PSYCHOPATHOLOGY
• According diathesis– stress model, individuals inherit tendencies to
express certain traits or behaviors, which may then be activated under
conditions of stress.
• Each inherited tendency is a diathesis - a condition that makes someone
susceptible to developing a disorder. When the right kind of life event,
such as a certain type of stressor, comes along, the disorder develops.
Ever wonder why not all people who drink alcohol have problems with it?
DIATHESIS-STRESS MODEL
THE GENE–ENVIRONMENT
CORRELATION MODEL
MULTIDIMENSIONAL APPROACHES TO PSYCHOPATHOLOGY
• This model suggests that genetic endowment MAY INCREASE THE
PROBABILITY that an individual will experience stressful life events.
Genetic Seeking out
Predisposition difficult Depression
to Depression relationships
• These people, then, might have a genetically determined tendency to
create the very environmental risk factors that trigger a genetic
vulnerability depression.
Genetic
Cheating Cheating
Predisposition Break Depression
Partner Partner
to Depression
• Even on a biological perspective, we have this tendency to ‘attract’
and/or ‘create’ environments that may trigger our vulnerabilities.
So how should we make changes about this?
Would it possible to make changes in the neuronal level?
“GENETIC INFLUENCES ARE OFTEN A LOT
LESS POWERFUL THAN IS COMMONLY
BELIEVED. THE ENVIRONMENT, EVEN
WORKING SUBTLY, CAN STILL MOLD AND
HOLD ITS OWN IN THE BIOLOGICAL
INTERACTIONS THAT SHAPE WHO WE ARE”
(SAPOLSKY, 2000)
ALTHOUGH THE ENVIRONMENT CANNOT CHANGE OUR DNA, IT CAN CHANGE THE GENE EXPRESSION.
• It seems that environmental manipulations, particularly early
in life, may do much to override the genetically influenced
tendency to develop undesirable behavioral and emotional
reactions.
• The strongest evidence exists for the effects of early parenting
influences and other early experiences (Cameron et al., 2005;
Mill, 2011; Ouellet-Morin et al., 2008).
“DIAGNOSIS” IN PSYCHOLOGY (AND
PSYCHIATRY)
• The predominant way of understanding ‘psychopathology’ is heavily based on
a ‘medical model’.
Depression is not a choice. It is a sickness.
Addiction is not a choice. It is a sickness.
We tend to liken the diagnostic labels in psychology to that of medical models.
Why is this? Because once we see these people ‘having’ disorders, then we can
‘treat’ them.
“DIAGNOSIS” IN PSYCHOLOGY (AND
PSYCHIATRY)
• One major assumption that is not talked about in diagnosis is that when we
‘label’ people with ‘clinical depression,’ or ‘social anxiety disorder’, it means
that there is something ‘wrong’ with them.
• Something is going ‘haywire’ – that needs ‘fixing.’
• Repeated beatings as a kid (Parents love their children.) <- Ideology
• Wildly confused about what love is (Love hurts.) <- Ideology
• Finding love in romantic relationships (Ambivalence, commitment issues)
• Profound despair, feelings of emptiness, and alcohol dependence due to failure of meeting
basic needs (i.e., caring attention and love)
• Seeking help (possible diagnosis: clinical depression and alcoholism)
• Personal Narrative: I am sick.
Onus: Person
Self-concept: Victimized
Treatment: Rehabilitation addressing alcoholism
Treatment: Medication for depression (SSRIs)
Treatment: (Reframing Mindset: Your problems in the past made you stronger. *Looking at
things from a different perspective (e.g., abuse as a form of love) <- expert power
> Possible emotions? Shame.
Weak for having depression after continuous treatment.
I DON’T HAVE ‘SPECIAL
NEEDS.’
I JUST HAVE ‘DIFFERENT’
NEEDS.
“THEY JUST WANT ME TO BE LIKE THEM.”
“I AM TIRED OF TRYING TO FIT IN THEIR IDEAS OF WHAT
A NORMAL PERSON SHOULD BE.”
“MY DOCTOR TOLD ME I DON’T HAVE DEPRESSION,
THEN WHY DO I FEEL LIKE THIS?”
‘BORDERLINE PERSONALITY DISORDER’ FOR WOMEN WHO ARE TOO ANGRY;
‘DEPRESSION’ FOR WOMEN WHO ARE EXHAUSTED BY DOMESTIC DEMANDS;
‘ANOREXIA NERVOSA’ AS A REACTION TO THE UNREALISTIC ROLE AND APPEARANCE
STANDARDS FACED BY MODERN WOMEN;
ALCOHOL MISUSE AND SUICIDE FOR MEN WHOSE SOCIALISATION DOES NOT PERMIT THE
EXPRESSION OF DESPAIR IN OTHER WAYS;
‘ADHD’ FOR CHILDREN WHO ARE NOT SUITED TO EDUCATIONAL REGIMENTATION
POWER-
THREAT ALTERNATIVE CRITICAL
PERSPECTIVE TO
UNDERSTANDING
MEANING PSYCHOPATHOLOGY
FRAMEWORK
TRAUMA-INFORMED APPROACH TO
UNDERSTANDING PSYCHOPATHOLOGY
POWER-THREAT MEANING FRAMEWORK
IT IS NOT “WHAT IS WRONG WITH ME?”
IT IS “WHAT HAS HAPPENED TO ME?”
TRAUMA-INFORMED APPROACH TO UNDERSTANDING PSYCHOPATHOLOGY
POWER THREAT MEANING FRAMEWORK
• The Power Threat Meaning Framework is a new perspective on why people
sometimes experience a whole range of forms of distress, confusion, fear, despair,
and troubled or troubling behaviour. It is an alternative to the more traditional
models based on psychiatric diagnosis.
• The Framework summarises and integrates a great deal of evidence about the role
of various kinds of power in people’s lives; the kinds of threat that misuses of power
pose to us; and the ways we have learned as human beings to respond to threat.
In traditional mental health practice, these threat responses are sometimes called
‘symptoms’.
POWER THREAT MEANING FRAMEWORK
• ‘What has happened to you?’ (How is Power operating in your life?)
• ‘How did it affect you?’ (What kind of Threats does this pose?)
• ‘What sense did you make of it?’ (What is the Meaning of these situations and
experiences to you?)
• ‘What did you have to do to survive?’ (What kinds of Threat Response are you
using?)
POWER THREAT MEANING FRAMEWORK
• ‘What are your strengths?’ (What access to Power resources do you have?)
• ‘What is your story?’ (How does all this fit together?)
• ‘Symptoms’ (from the medical perspective) are considered to be ‘Threat
responses’ (trauma-informed perspective) which help us survive.
Example: Self-mutilation, Dissociation, Depression, Substance dependence
• Psychological services can re-traumatize people (labels, stigma)
• Psychiatric labels (diagnoses) tend to strip off the complexity of the person’s
situation.
• We are dealing with people with problems, not patients with illnesses
• Instead of diagnosing people, we need to start listening to their stories.
“You are experiencing a normal reaction to abnormal circumstances.
POWER THREAT MEANING FRAMEWORK
• The Power Threat Meaning Framework can be used as a way of helping
people to create more hopeful narratives or stories about their lives and the
difficulties they may have faced or are still facing, instead of seeing
themselves as blameworthy, weak, deficient or ‘mentally ill’.
• It highlights the links between wider social factors such as poverty,
discrimination and inequality, along with traumas such as abuse and violence,
and the resulting emotional distress or troubled behaviour.
POWER THREAT MEANING FRAMEWORK
• It is important to note that Power Threat Meaning is an over-arching
framework which is not intended to replace all the ways we currently think
about and work with distress. Instead, the aim is to support and strengthen
the many examples of good practice which already exist, while also suggesting
new ways forward.
