Title: Medicine, Psychiatry and Process Work: Individual and collective dimensions of working with embodied experiences and mental states
1Medicine, Psychiatry and Process Work Individual
and collective dimensions of working with
embodied experiences and mental states
2Main Points
- Studies over the last 25 years have found
significant relationships between inequality in a
society and various health outcomes. - Processes of social marginalization, rank
relative poverty in populations may be a critical
risk factor for physical and mental health. - Psychology, including the way we process or
internalize cultural dynamics has a big impact on
our health.
3Health is both an individual and a cultural or
group process
- What makes us healthy or sick depends both on
individual and social factors. Research shows
that social conditions the jobs we do, the
money were paid, the schools we attend, the
neighborhoods we live in are as important to
our health as our genes, our behaviors and even
our medical care.
4Medical Models
- Bio-medical model
- Social determinant model
- Bio-psycho-social model
- Balance/Holism model
- Psychodynamic model
- Positive psychology (Seligman), Positive health
model (Antonovsky) - Indigenous model
- Recovery/Self-management model
5Current Roles/Polarities
- Victim Healer/Expert
- Nature Nurture
- Biology/Genes Society
- Body Mind
- Pathology Positive Health
- Disease management Recovery
- Evidence based Care
- Efficiency
-
6Health Disparities
- Available studies show the US to have the most
mental illness, of any country. - Trends show mental distress increasing in the US
over the last decades. - Studies over the last 25 years have found
significant relationships between inequality in a
society and various health outcomes, including
self-assessed health, mortality measures, teenage
birth rates. It also correlates with rates of
violent crime. - Relative poverty in populations may be a critical
risk factor for mental health. - The escalating rates of mental illness observed
may represent an adaptive response to the
increasing hierarchy in the US.
7Health Disparity
- Relative poverty
- Disparity between the rich and the poor High gap
correlates with poor population health. - Social comparison Feelings of humiliation,
resignation and shame affect our stress
physiologies.
8(No Transcript)
9Wilkinson 1992 BMJ
10Somebodies and Nobodies
- Sense of being a nobody in social comparison to
others. - Loss/lack of status/rank because of
marginalizing processes. - Sense of shame and humiliation, loss of respect
and dignity. - Independent of individual psychology.
- Power of internalized social values.
11Competition outcomesthrough dominance /
attraction
Dominance upperness
fight
Lack of control
POWER
HEDONIC
AGONIC
flight
Social Integration approach closeness friendlines
s ingroup orientation (insider) love
attractiveness
Social Isolation withdrawal distance hostility ou
tgroup orientation (outsider) hate
AFFILIATION
co-operation
withdrawal
Control
yielding
Submission lowerness
Stevens 1996
12Social Position/Rank
Occupational status
Income, wealth
Common physical and mental disorders
Education
Biological and psychological factors/powers
13Social Position
Psychosocial Resources -mastery/self-efficacy sel
f-esteem
Health Outcomes - mental - physical
- Stress
- life events
- chronic strains
- daily hassles
- early adversities
- Social Support
- emotional
- instrumental
- social integration
Stress Process Model (Pearlin 1989)
14SES, Social Class, Inequality
- Gender, age, race, SES, sexual orientation,
health are sources of inequality that form
inter-locking webs of disadvantage - power, resources are differentially distributed
within and between these status positions - we do not occupy single status categories
- Double or Triple Jeopardy Hypothesis
15Marginalization
- Overt or covert trends within societies whereby
some qualities/behaviors/traits are given more
centrality and those perceived as deviating from
the group norms tend to be excluded by wider
society. - Marginalized groups racial or ethnic minority
groups, the poor, the elderly, the sick, the
disabled, the obese, homosexuals etc
16Levels of Influence
-
- Dispositional/personal power/rank an
individuals capacity to influence their actions
or those of others - Psychological
- Spiritual or transpersonal
- Social
- Situational/contextual power/rank derives
from ones momentary roles in a given situation
as a teacher, health care provider, parent, bank
teller etc.... - Systemic power/rank the complex of
powerful forces that create situations/envi
ronments -
17Rank
- Rank reflects the underlying power differences of
the many hierarchies we use on a daily basis to
compare ourselves (Fuller, 2003). - Conscious or unconscious, social or personal
ability or power emerging from areas of
socio-cultural influence, personal psychology,
and/or spiritual ties (Mindell, 1995) . -
18Subjective Rank and Health
19Relative Poverty
- "When everyone is poor together, there is no
shame in being poor." (Gilligan) - "A house may be large or small as long as the
surrounding houses are equally small, it
satisfies all social demands for a dwelling. But
if a palace rises beside the little house, the
little house shrinks into a hut" (Karl Marx)
20Process Work Approach
- Individual FIELD Community
Process Consensus Reality Dreaming Essence Physi
cal Symptoms Mental States Dreams Conflicts/Group
Process
21Opportunities for Public Health InterventionsA
Social Determinants Framework
Social Health Determinants
Targeted Protection
Primary Prevention
Secondary Prevention
Tertiary Prevention
Equity and Social Justice
Reduces Vulnerability
Disability and Death
A Safe, Healthy Population
Vulnerable Population
Diagnosed, but with no complications
Clinical complications requiring treatment
Societal Resources
Creates Vulnerability
Adverse Social Conditions
The Physical Environment
Upstream Approaches Social Cohesion, Social
Equity, Social Capital
Downstream Approaches Provision of Clinical
Services
Adapted from Milstein B, Homer J. The dynamics of
upstream and downstream why is it so hard for
the health system to work upstream, and what can
be done about it? CDC Health Systems Workgroup
Atlanta, 2003.