John Weaver, Psy.D.
An Overview of Integrated Mental Health – Part 3
This will be a multipart blog, so keep watching for the subsequent updates.
The psychological dimension of human behavior, another element of the biopsychosocial model of behavior, is often overlooked by the medical establishment, which has focused on the biological as the source of understanding human behavior.
There are reasons for this focus. In the (not so recent) past, psychological was equated with psychotherapy and with psychodynamic theories that originated with Sigmund Freud. Long and painstaking psychoanalysis often failed to improve maladaptive behaviors exhibited by individuals seeking help. Psychoanalysis is less likely to be practiced when someone is seeking psychotherapy although aspects of it are still taught in graduate training programs, and it still provides underlying the theoretical basis for some psychotherapeutic interventions.
Other psychotherapeutic systems have also seen their popularity rise and fall in the past 50 years. This should be unsurprising since many medical interventions that have also risen and fallen within that same time period. Theoretical approaches change and develop as we accumulate more scientific knowledge and we adapt to the needs of our changing cultures.
However, psychotherapeutic interventions are an essential dimension of the healing process. And (shades of my previous blog) there are reasons that are grounded in the biological processes in our brains.
First point: when I was studying for my doctorate (decades ago), I was taught that the brain continued to develop until sometime in a person’s mid-20’s. Once it was fully formed – according to the best available scientific knowledge at that time – our task was to prevent the loss of brain tissue as best we could until aging finally resulted in our inevitable decline and death.
Newer research, however, definitively establishes that this is not true. We are adding new brain cells throughout our life, albeit at a slower pace as we age. These new brain cells start out as “stem cells.” Stem cells are undifferentiated at their inception and develop into mature cells by absorbing their “identity” from the cellular environment in which they reside.
This is one of the ways that good psychotherapy contributes to good health. By helping you to develop healthy thought patterns and healthy emotional reactions, these stem cells will mature into healthy neurological cells because they are absorbing the information from their environment.
Implication: We get good at what we practice. And this actually has an effect on the biology of our bodies. We know that exercise and diet changes the shape of our bodies and the ability to move and function. It turns out that the brain in more like a muscle than we once thought. If I spend a lot of time worrying, my brain adapts and the neurology that supports worry becomes stronger and more effective. Being courageous develops the brain structures to support courage. Compassion increases our brain’s capacity to be compassionate. This is why we need to discipline ourselves to attend to the elements of life that are truly aligned with our values.
Second point: humans are very different from other animals in that when we are born, we are quite unable to survive. The brain is only at 25% capacity of what it will eventually develop to be when a human is fully matured. The muscles of a newborn are not even able to hold his/her head up for nearly 6 months, let alone able to perform smooth or coordinated movements. Learning is much more essential for humans than for other animals. Most animals have strong instinctual responses present from birth to guide it in adapting to its environment. These instincts bring much greater capacity to the majority of animals at birth or right after. But those same instincts constrict the ability to adapt to different environments as effectively as human do.
Also, to a much greater degree than other species, humans learn beyond direct experience. We learn from other humans. We learn from the culture in which we are embedded. We learn from knowledge passed down from previous generations.
This learning is so essential to an individual’s ability to survive that it must be included in any attempt to comprehensively understand human behavior.
The dimension of “psychology” in the biopsychosocial model is the element of the theory that accounts for the dynamic nature of human experience. In addition to a brain, through which an individual experiences the world around him/her, there is a process of learning that shapes the function of the brain in dramatic ways. The psychological contribution assists us to develop the skill to be able to effectively utilize the biological “equipment,” on an individual level, to function and adapt to the environment.
Implication: We are always learning. Much of the learning takes place outside of our conscious awareness. For example, many fears are acquired without a rational or reasoned choice. At other times, our learning is quite intentional. For example, reading this blog is an act of intentional learning (even if you learn that you don’t like what I am writing). The learning process is dynamic, even though we have a tendency to think about ourselves as having a fixed identity. It is not a question of “am I learning?” I am always learning, but when I choose to be intentional, I have the ability to shape that learning and move toward the goals I set for myself, and to take actions that align with my deepest values.
Learning is certainly mediated by the neurological system. Even individuals born with malformations of the brain or individuals who have acquired injuries to their nervous system are learning and adapting to the circumstances on the environment. Malformations and injuries will affect the way learning occurs, but we are still always learning.
Assume for a moment that an individual has acquired an injury to the nervous system because of a traumatic loss of loved one, in the context of other losses (a job loss and a financial setback, in this example). The injury to nerve cells makes it difficult for the individual to recover from these losses. Anti-depressant medication is prescribed, and in this example, is successful at restoring normal neurological function. The individual is capable of functioning in normal interactions with his/her environment, but has learned, from the recent series of traumatic events and outside of conscious awareness, to be extremely cautious about opening to new relationships and about applying for challenging but potentially satisfying work.
The outcome for this individual becomes constricted by the anxiety of potential new trauma, so he/she does not return to “normal” life. It may appear that the medication intervention did not work because the person still gets little satisfaction in life due to a change in day-to-day decision making. But an effective psychological intervention, coupled with the biological intervention (anti-depressant medication) could help that individual to accept the traumatic loss but reestablish a life that is satisfying. He/she could consciously learn that relationships and challenges, while potentially painful, are also filled with purpose and joy when carefully selected and cultivate.
In the above example, the biological and psychological interventions are complementary. Neither would be sufficient on its own. The psychological interventions are oriented toward helping the individual to adapt to his/her current environment. There are also social dimensions and spiritual components to this that will be discussed in future blogs in this series.