Models of Mental Health Problems: A Quasi-Systematic Review of Theoretical Approaches

Dirk Richter Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Bern, Switzerland

Jeremy Dixon Department of Social and Policy Sciences, University of Bath, Bath, BA2 7AY, United Kingdom.

Address for correspondence: Dirk Richter, PhD Bern University of Applied Sciences Department of Health Professions Murtenstrasse 10 CH-3008 Bern Switzerland E-Mail: [email protected] Phone: +41 31 848 3768

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Abstract

Mental health and mental illness have been contested concepts for decades, with a wide variety of models being proposed. To date, there has been no exhaustive review which provides an overview of existing models. We conducted a quasi-systematic review of theoretical models of mental health problems. We searched academic databases, reference lists and an electronic bookshop for literature that proposed, endorsed, reviewed or critiqued such models. Papers, book chapters and books were included with material by researchers, clinicians, non-medical professions and service users writing between 2000 to June 2020 being considered. A quality appraisal could not be provided due to the theoretical content of publications. The study was registered with the Open Science Framework (No. osf.io/r3tjx). On the basis of 110 publications, we identified 34 different models which were grouped into five broader categories. Many models bridged two or more categories. Biological and psychological approaches had the largest number of models while social, consumer and cultural models were less diversified. In addition to established theories, we found a large number of new theoretical approaches, most stemming from academic fields. Due to the non-empirical nature of the publications, several limitations in terms of search and quality appraisal apply.

Keywords

Mental illness models; Systematic review; Definition of mental illness

Declarations

Funding: None

Conflicts of interest: None

Availability of data and material: All data is included in the Supplementary Material.

Code availability: Not applicable

Authors' contributions: Both authors contributed equally to all parts of the work.

Ethics approval: Not applicable

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Mental health and mental illness have been contested concepts for decades, if not centuries. Scholars from medical and non-medical disciplines such as psychiatry, psychology, biology, neurology, philosophy, sociology and medical history have tried to answer questions about the essence of mental health, the cause of mental health problems and how to classify or operationalize them. In recent decades, a variety of theorists with differing backgrounds and traditions have debated the pros and cons of paradigms, approaches and models.

Whilst the 1940s to 1970s were dominated by social theories and psychoanalysis, this changed during the 1980s and 1990s, with biomedical models becoming central to research and treatment and the 1990s being declared the ‘Decade of the Brain’ by the United States Congress [1, 2].

Although the discipline of psychiatry moved into the medical mainstream in the 2000s, issues around how mental health problems should be understood became more disputed. By the time that the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) was published, many commentators were arguing that basic conceptual issues about the nature of mental illness remained unsolved [3, 4].

Until relatively recently, major criticisms related to the concept of mental illness came from outside of the biomedical community; being levelled by critical psychiatrists and sociologists [5, 6, 7]. Now, disputes have emerged within this community. This was illustrated through the launch of the Research Domain Criteria (RDoC) in 2009, in which the American National Institutes of Mental Health caused controversy through explicitly questioning DSM validity shortly before the DSM-5 was released (for an overview, see: [8]).

The key areas where theoretical and empirical differences have emerged within the mental health literature are: (1) dimensions vs. categories of symptoms, (2) thresholds between health and illness, (3) etiology of mental disorders, and (4) comorbidity of distinct disorders [9]. Furthermore, new debates are emerging about how mental health problems should be classified. New psychopathological research focussing on comorbidity suggests that there are probably one to ten mental disorders rather than several hundred, as outlined in current classification systems [10, 11].

The range of theoretical and historical approaches has been reviewed within several scholarly disciplines [e.g. 12, 13, 14, 15]. Additionally, the topic has been covered within monographs [e.g. 16, 17], anthologies [e.g. 18] and even a large book series (International Perspectives in Philosophy and Psychiatry by Oxford University Press). These reviews have usually focused on specific aspects of concepts of mental health problems, e.g. on historical or taxonomic characteristics.

Whilst previous reviews have been valuable, practical considerations associated with concepts of mental health problems remain. Questions such as, ‘what are mental health problems?’ or ‘what 4 counts as a mental illness?’ are highly practical and are relevant to social institutions both in and outside of mental health care. For example, the variety of illness models has led to tensions between professions within health care systems [19]. Disagreements about the nature of mental health problems may also lead to disputes about how behaviours such as aggression are interpreted by service users and staff [20].

Definitions of mental health problems also have legal and policy implications. For example, a recent research article on definitions of mental disorder in legal contexts came to the conclusion that whilst current illness models “…refer to something ‘not working properly’ in the mind, it is difficult to specify exactly what [this] means.” [21] Definitions of mental health problems also have relevance for policy makers, who need to consider whether mental health problems are increasing and whether money should be spent on preventing them.

Publications on mental health models are rising steeply and new communities and sub-communities debating them are emerging. Consequently, a review of recent approaches giving an overview of what is being proposed and discussed is needed. To the best of our knowledge, there are no exhaustive reviews that cover the entire range of perspectives. This systematic review aims to close this gap through providing a comprehensive overview of models of mental health problems whether they originate from the scientific community or through groups that have traditionally been neglected (e.g. academic publications by service users). We define ‘models’ as approaches that aim to explain and/or describe either mental health problems in general or a particular mental health problem from a certain perspective.

The inclusion of non-scientific publications is an important but neglected issue for two reasons. Firstly, perspectives from non-scientific publications are highly relevant to the topic of mental illness, particularly in the fields of law and politics. For example, the ‘United Nations Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ has recently urged parties to welcome “…a diversity in terminology, which can promote different approaches to mental health that are equally important.” [22, p. 3]

Secondly science-based approaches are frequently challenged by non-academic positions as the service user or even survivor perspectives are often not sufficiently represented in the discourse, an issue that is commonly referred to as ‘epistemic injustice’ [23].

The language used to describe mental health problems varies widely across publications. Whilst concepts of mental illness and mental disorder remain dominant within the literature, many scholars question the concept of mental illness entirely. In order to allow for a broad and pragmatic discussion of the literature we therefore adopt the term ‘mental health problems’ in this article. To 5 aid ease of reading but not at the expense of content, we use this term throughout, although authors may have used other terms within their own writing.

Materials and Methods

Researchers face a number of challenges when conducting a systematic review of theories, models and approaches [24]. Many relevant publications are not indexed in research databases (e.g. book chapters and books), quality and bias assessment are difficult, if not impossible, and search strategies are not straightforward. Another difficulty is the synthesis of sometimes incommensurable approaches. We found only one previous template for searches on theories [25], but this was not suitable for our project.

As the PROSPERO database of systematic reviews does not register non-empirical studies, the current research was registered with the Open Science Framework (registration number: osf.io/r3tjx).

Search strategy and data extraction

A literature search was conducted on Pubmed, Cumulative Index for Nursing and Allied Health Literature (CINAHL) and PsychInfo. Reference lists were also searched. We also conducted a search for books on Amazon.com.

Publications were eligible for inclusion where the main focus was on a theory or model of mental health problems. We included papers, book chapters and books where a theory or model of mental health was either proposed, endorsed, reviewed or critiqued. Our intention was to identify all published theories of mental health problems, including material written by clinicians, consumers or survivors. In addition to peer-reviewed articles in academic journals, we accepted editorials, letters, books, book chapters and on-line material as long as the publications contained sufficiently detailed information about the featured model(s). These formats were accepted because they are places at which theories and methods of mental health are frequently proposed and debated. All papers written in English, German, French or Dutch from 2000 onwards were eligible for inclusion. The search terminated on 30th June 2020.

We excluded empirical papers because they usually do not develop a theoretical approach but rather test it and primarily philosophical publications when we could not identify a link to mental health issues. For example, we rejected philosophical papers focusing on theories of consciousness. We also excluded book reviews and historical articles. In some cases, an author or a group of authors had 6 developed a theoretical model over time. Where this occurred, the most recent iteration of that theory or model was used and earlier versions were excluded.

The initial search process was conducted by [Author 1] and was cross-checked by [Author 2]. The following search terms were used for the Pubmed search: (((taxonom* [TI] OR model* [TI] OR concept* [TI] OR explanat* [TI] OR causal* [TI] OR framework* OR kind* [TI] OR theor* [TI] OR philosoph* [TI] OR approach* [TI] OR structur* [TI]) AND ("mental illness" [TI] OR "mental disorders" [TI] OR psychiatry* [TI] OR psychopathol* [TI] OR madness [TI]) NOT (animal OR mouse OR mice OR rat OR rodent OR structural equation OR latent class OR decision tree OR Bayes* OR Markov OR proof-of OR five-factor OR health belief OR fMRI OR hierarchical OR multilevel OR multivariate OR “theory of mind”))). The search term was adapted to the requirements of the other databases accordingly. References were managed in Endnote.

As papers were theoretical in nature, and as we were more interested into the heterogeneity of models rather than theoretical and scientific rigour, we did not carry out a quality appraisal. A template was designed by the authors to extract data from papers. This recorded the type of output (whether this was an original article, chapter, letter or editorial), the focus of the article (clinical practice, research, theory, consumer issues), the purpose of the article (proposal, endorsement, critique or review) and the model reviewed / key findings. The initial template was piloted and was then revised by the authors.

Reporting of the results

Due to the large amount of information and due to its heterogeneity in terms of background (science, service user activism etc.), we present our results on a graph (see Figure 2) which provides a broad overview of our findings. The labeling of the model and the subsequent grouping of the model into broader categories were conducted by consensus of the authors. We then provide brief details of every model identified (see Table 1). Details of all publications included in the synthesis are given as supplementary data.

Results

Our search identified 3423 publications (research articles, book chapters and books) from databases, from screening of reference lists, hand-searches and through searching Amazon.com (for details see PRISMA flow-chart, Fig. 1). One-hundred-and-ten publications were eventually included into the synthesis. 7

We identified 68 articles, 7 books, 33 book chapters and 2 editorials from scientific journals. Ten publications took a pure research perspective, 21 a sole clinical perspective and 25 an exclusively theoretical stance. As the numbers suggest, the remaining publications had multiple perspectives. Fifty-six publications proposed a model, 44 papers/books endorsed one and 10 took a critical stance about a specific model. However, many publications that proposed or endorsed a model also comprised critical positions against other approaches.

We identified 34 different models of mental health problems (see Figure 2). Details of the identified models are provided in Table 1. For a better understanding, we tried to relate each model to the following broader model categories: Biological, Psychological, Social, Consumer and Cultural. Biological models primarily refer to the neurobiological and genetic determinants of what are conceptualized as mental health problems. Psychological concepts focus on symptoms and associated or causal mechanisms. Social models deal with societal issues and reactions to what is being seen as mental health problems. Consumer models reflect on the experiences of people who have been treated in mental health services. Cultural models, cover specific cultural, traditional or spiritual understandings of what current psychiatry refers to as illness.

Many of the models could be assigned directly to the broader categories. However, several models combined different categories or were judged to include joint models or a mixture of models. To provide a better understanding of the joint models we tried to ‘locate’ them between the larger categories and/or as overarching models. Differences in labelling of joint or mixed models sometimes refer to nuances only (e.g. biopsychology vs. neuropsychology). Biological approaches and psychological approaches (and combinations of them) had the largest number of models. Social, consumer and cultural models were less diversified.

Discussion

To the best of our knowledge, this is the first review focusing on models of mental health problems utilizing systematic review methodology. We have identified accounts from the natural sciences, social sciences, from service users and activists as well as from those advocating a traditional or spiritual / cultural approach. All deliver different perspectives on what counts as a mental health problem. Although we excluded publications prior to 2000, we found a huge variety of models that aimed to describe, understand or analyze mental health problems. We found a mixture of older models developed several decades ago, which continue to be discussed and endorsed (e.g. psychoanalysis, Anti-psychiatry) and newer models (e.g. network approaches, computational 8 neuroscience). Seen from a historical perspective, it is clear that new models have not entirely replaced older models but rather are oftentimes additional to them.

Several limitations should be noted that suggest our findings should be labelled as quasi-systematic only. A number of books and book chapters included were not listed on databases and were identified through a hand search. It is therefore likely that other publications which are not listed on a database or have been indexed by different keywords that we may have missed. Our review only included papers written in English, German, Dutch or French and excluded material written in other languages. The grouping of models (into Biological, Psychological, Social, Consumer and Cultural) relied on the subjective judgement of authors. However, we did experience something similar to a saturation effect in qualitative research, in that no new theories emerged by the time we had categorized half of the papers subject for inclusion.

We note a number of significant findings from our review. There are a range of different goals related to the proposed, endorsed or critiqued models. While models promoting a biological or psychological science approach have scientific and/or clinical aims, psychosocial models, often propose political and/or legal solutions. Notably, there are few approaches which encompass both realms; that is, clinical and social justice concerns. An exception to this is the ‘Power-Threat-Meaning Framework’ developed by the British Psychological Society, which draws on sociological concepts of power and psychological concepts of trauma [26].

While discussions about the most appropriate way to define mental health problems are not new [27], it seems that these understandings have diversified in recent decades. Definitions are becoming increasingly contested too, with many publications arguing for one perspective over another (e.g. psychosocial approaches vs. biomedical models or vice versa). In this regard, we could not identify criteria that could be used to prioritize approaches. As such, our review mirrors previous non- systematic reviews from both psychiatry and other fields (e.g., philosophy). For example, a previous overview of psychiatric approaches aimed at developing a conceptual taxonomy, concluded that researchers should make a choice between approaches, drawing on ‘judgement’ and empirical data [28]. Adopting a broad philosophical perspective, a further review has asked whether science or society will win the “tug of war” as to how mental health problems are defined [29].

We can only speculate on why theories and models of mental health problems are increasing. One reason may be the science-inherent process of specialization, exemplified by the broad spectrum of biomedical approaches in our review. A second reason could be dissatisfaction with conventional clinical taxonomic approaches such as the DSM, which are increasingly being disputed by researchers, clinicians and service users [30]. We also observe that perspectives from non-medical professions, such as nurses, social workers, service users and policy makers, are now receiving more 9 attention, meaning that the domain of mental health problems is no longer viewed as an exclusively psychiatric or psychological field.

We also note that contemporary arguments about the nature of mental illness have tended to focus on the tension between polar positions, i.e. biomedicine or the critical perspectives proposed by the user / survivor / critical psychiatry camps. Whilst the use of the bio-psycho-social model has been used to hold divergent perspectives together, this consensus seems to be fracturing. The reasons for this appear to be two-fold. First, increased confidence in biological approaches by their proponents (possibly focusing on support from policy-makers following ‘the decade of the brain’). Second, dissatisfaction with the model at a theoretical level, on the grounds that it reflects eclecticism; understood as an unprincipled mix of different approaches [e.g., 31]. Third, dissatisfaction from psychosocial representatives who have received support from different policymakers. The latter have observed that the bio-psycho-social approach has masked a ‘bio-bio-bio’ approach to mental health problems within health care’s daily practice [32].

Despite the above disagreements, the range of models outlined in our graph are still best viewed as a continuum. Theories attempting to bridge the divides have diversified and tend to draw together specific elements of models rather than attempting to bridge the whole range, i.e. new bio-psycho or psycho-social models are emerging, rather than new bio-psycho-social ones.

What is notable from our cluster model is the expansion of psychological approaches. Whilst older psychological models, such as psychoanalysis and phenomenology continue to be considered, there is a clear growth in the psychological and bio-psychological categories. In addition, those who use services are becoming more vocal. There is an increase in consumer models which prioritize the perspectives of service users over clinicians thereby widening debates, by allowing for the inclusion of more subjective concepts of wellbeing. Finally, concepts of mental health problems apparently cannot be developed in medical or health care communities exclusively. What counts as a mental health problem is not a question of right or wrong but rather a question of gaining acceptance in communities that are affected by issues and decision based on those concepts.

Conclusion

We conclude that the uncertainties around what constitutes a mental health problem have become more pronounced in recent decades. We were unable to detect any approaches which might act as a basis for consensus within the academic field, amongst clinical professions or between stakeholders. Key areas of contestation are: (1) the characterization of mental health phenomena as a disease (or not), (2) the etiology of such phenomena, (3) the boundary between mental phenomena and mental 10 health problems, (4) whether to take a first, second or third person perspective, (5) the best way to conduct research about the phenomena, and (6) the best way to support people with mental health problems.

From a theoretical perspective, we see two options. The first option is to finally acknowledge that at least some models are incommensurable with others. This is not the first time in the history of psychiatry that the argument regarding the incommensurability of approaches has emerged. Drawing on Kuhn [33], Kendler concluded that the notion of incommensurability between approaches such as psychoanalysis, social psychiatry and biological psychiatry “may be too pessimistic” [34]. However, his conclusion only referred to the perspectives of different researchers. When the additional and more diverse approaches of non-medical professionals and service users are considered, the incommensurability argument becomes stronger and, in our view, must be accepted [35]. In mental health care and psychiatry, we have to acknowledge that mental health problems cannot be explained by one approach only; a position referred to as ‘Epistemic Pluralism’ in the field of philosophy [36].

The second option is to develop a meta-theory. Rather than trying to integrate diverse approaches into a holistic one (such as with the biopsychosocial approach), such a theory should aim to trigger new theoretical and methodological research [37]. This could, for example, result in a future terminology for mental health problems which is more widely accepted than current ones. It may also result in a notion that practically leads to the acceptance of pluralism by all parties.

In clinical terms, this leads us to a service model that is based on endorsing perspective diversity. Following postmodern theories in the 1990s, Bracken and Thomas have called such a concept “Postpsychiatry” [38]. A more recent approach from the sociology of health and illness refers to ‘polycontexturality’ [39] which means that a multitude of contexts and value systems need to be considered simultaneously, particularly in health care settings. Mental health care, according to such a model, should be guided by service user preferences rather than by evidence-based psychiatry [40]. For clinicians, such an approach would require them to develop ‘Conceptual competence’ [41], in which they become aware of fundamentally different assumptions and concepts so that these are not interpreted as illness symptoms or ‘lack of insight’ in users of mental health services

Wider implications of acknowledging polycontexturality in mental health care are related to legal and political issues. As mentioned in our introduction, legal scholars do not always adhere to the medical perspective in legal cases. This is reflected in ongoing debates around the United Nations Convention on the Rights of People with Disabilities (UN-CRPD) when applied to mental health care [see e.g. 42]. The UN-CRPD has strengthened the rights of service users in order to lead a life that is more likely to 11 be in accordance with their preferences rather than with conventional medical views. A diversity approach could serve to alleviate and defuse conflicts based on different perspectives.

Finally, we would like to stress that discussions about models of mental health problems need more input from non-medical professions and service users. Currently, the diversity of perspectives in and around clinical settings is not sufficiently reflected in the literature. This is unfortunate as academic discussion on these issues is growing and is being led by increasingly specialized scientific communities. Therefore, we propose that collaborative initiatives between non-medical stakeholders and academics working on scientific projects should be included within theoretical discussions about mental health problems.

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Figure 1: Flow-Chart according to PRISMA

Records identified through Additional records identified database searching through other sources

(n = 3391) (n = 32) Identification

Records after duplicates removed (n = 2013)

Records excluded

(n = 1773) Records screened (n = 2013)

Screening Full-text articles excluded, with reasons (n = 130)

Full-text articles assessed No Model 76 for eligibility Classification 20 (n = 240) Taxonomy 13

History 6 Eligibility Studies included in Philosophy 4 qualitative synthesis (n = 110) Editorial, letter, short article w/o sufficient information

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Included

Figure 2: Overview of identified models

Biology Psychology Social Models Consumer Models Cultural Models Biology Salutogenesis Recovery Traditional/ Cognitive Psychology Neuroscience/Neurobiology Social Disability Spiritual Mad Studies/ Computational Neuroscience Psychoanalysis Neurodiversity Spiritual Gut microbiota Network – Psychology Critical Realist Systems/Chaos Theory Phenomenology User/Survivor Studies Existentialism

Biopsychology

Network - Biopsychology Radical approach Psychosocial Neuropsychology Anti-Psychiatry Genetics - Evolutionary Evolutionary/Darwinian Neurophenomenology Ethnopsychology

Property Cluster

Power – Threat – Meaning Framework

Biology Culture

Developmental - Biopsychosocial

Biopsychosocial

Theory Development/ Application

Table 1: Brief details of identified models

Model of mental health problem Description

Anti-Psychiatry A critical approach which denies the existence of mental illness Biology A comprehensive but exclusively biological approach for understanding mental health problems Biology - Culture A joint approach focussing on biological and cultural issues related to mental health problems Biopsychology Joint biological and psychological perspectives Biopsychosocial Approaches which stress the interplay between biological, psychological and social factors as a means to understanding mental health problems Cognitive Psychology An approach that stresses the importance of internal mental processes for understanding mental health problems Computational neuroscience An approach that utilizes mathematical models and theories to understand the determinants of mental health problems Critical Realist An approach which proposes the existence of a reality that is ontologically separated from experienced mental health problems Developmental - Biopsychosocial Approaches that stress the interplay of biological, psychological and social factors for understanding developmental mental health problems Ethnopsychology An understanding of mental health problems informed by the culture of particular ethnic communities Evolutionary/Darwinian Approaches which stress the evolutionary origins of mental health problems Existentialism A philosophically based approach that seeks to understand existential issues related to the human condition in order to understand mental health problems Genetics - Evolutionary A joint approach that focusses on the interplay between genetic and evolutionary mechanisms which lead to mental health problems Gut microbiota A biological approach that stresses the importance of gut microbes for developing mental health problems Mad studies / Neurodiversity Approaches which propose normalizing perspectives of mental health issues and which reject illness concepts Network – Psychology An approach which explains mental health problems through mapping the interplay of psychological symptoms Network/Biopsychology A joint network and biopsychological approach Neurophenomenology A joint neurological and phenomenological approach Neuropsychology Joint neurological and psychological approach for understanding mental health problems Neuroscience /Neurobiology A neuroscientific and biological approach for understanding mental health problems 15

Phenomenology An approach that understands mental health problems through analysing structures of consciousness and other mental phenomena Power-Threat-Meaning Framework A model which views mental health problems as an understandable protective response to adverse environments. Property Cluster An approach which proposes that networks of mechanistic clusters cause mental health problems Psychoanalysis A classic Freudian approach Psychosocial Joint psychological and social perspectives on mental health problems Radical approach An approach that asks for a radical liberatory change when dealing with mental health problems Recovery An approach aimed at enabling people with mental health problems to define what recovery means to them so they can live a meaningful life Salutogenesis An approach that endorses health and well-being rather than illness Social disability An approach which stresses the socially induced disabling constraints on people with mental health issues Spiritual Spiritual perspective on mental health problems Systems/Chaos theory Approaches that stress the non-deterministic emergence of mental health problems in biological and psychological realms Theory Development / Application Approaches which propose the need for new models of mental health problems through demonstrating fields of application Traditional / Spiritual Traditional and spiritual perspectives on mental health problems User/Survivor Studies Approaches that stress the centrality of the experiences of people who have been treated in mental health services and are normally critical in nature.

Supplementary Material Type of output Perspective Position of author (s) – proposal, endorsement or critique Model of mental health Article problem

Akaishi (2018) Article Research Proposal - Aims to develop a neuropsychological structured model that can Biopsychology [43] explain overlapping mental conditions and provide a therapeutic response.

Andresen et al Book Clinical / Proposal – A consumer-orientated based model is proposed. Recovery (2011) Theory / [44] Research Avasthi et al Article Clinical Proposal – Proposes that contemporary Indian psychiatry should Traditional / Spiritual (2013) incorporate concepts of mind and mental health from Hinduism, Indian [45] traditions and Indian systems of medicine.

Balbo Ambrosolio Article Theory Proposal – Authors provide a concept of mental illness with regard to inter- Ethnopsychology and Piz-Diez Pretti cultural psychological aspects (2007) [46] Baron-Cohen Editorial Clinical / Endorsement – A neuro-diversity framework is endorsed which accepts that Mad studies / (2017) Research there is no single way for the brain to be normal, adopts non-stigmatising Neurodiversity [47] language, focusses on strengths as well as deficiencies and recognises biological variation as intrinsic to identity. Beauchaine and Article Research Proposal – A model of early-onset externalising behaviour is presented in Biopsychology McNulty (2013) which comorbidities and continuities are viewed as an ontogenic process. [48] Beauchine and Article Research Proposal – Authors propose an integrative motivational model of Biopsychology Zisner (2017) psychopathology which integrates functions performed by bottom-up [49] emotion generation systems with those performed by top-down emotion regulation systems.

Bekhuis et al Article Clinical Proposal - Proposes that a network approach should be used by General Network – Psychology (2019) Practitioners in primary care as a means to understanding psychopathology. 17

[50] Bell (2010) Chapter Clinical Proposal – Author proposes that psychoanalysis should inform psychiatric Psychoanalysis [51] treatment within general psychiatric settings.

Benning (2015) Article Clinical Critique -Author argues that the bio-psycho-social model has failed to Theory Development [52] promote a multi-disciplinary understanding of mental disorder and a new integrative model of psychiatry is required.

Bentall (2006) Article Clinical Proposal – Proposes that diagnostic models should be abandoned and that a Critical Realist [53] new system should focus on patient ‘complaints’ (such as delusions) in order to acknowledge their psychological antecedents.

Benvenuto (2006) Article Theory Critique – Paper focusses on the work of Binswanger and critiques the ‘dead Phenomenology [54] ends’ of the phenomenological approach arguing that phenomenology has not yet presented an up-to-date psychopathological model that is able to compete with current prominent models. Beresford (2005) Article Clinical Proposal – Author argues that a social model of disability should be used Social disability [55] within mental health social work practice.

Bergner (2004) Article Clinical / Proposal – Author proposes a pre-empirical model of psycho-pathology Psychosocial [56] Research which views pathology as behaviour disability, unifies existing theories of pathology to explain personal deficit and integrates existing psychotherapies to reduce this deficit.

Black (2005) Chapter Clinical / Endorsement – Author endorses a medical model of psychiatry that relies Biopsychology [57] Research on empiricism rather than theory, although views psychotherapy as an important explanatory tool.

Bohmer (2016) Article Clinical Proposal – Authors propose an approach to managing narcissism which Spiritual [58] integrates psychoanalysis and spirituality.

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Borsboom et al Article Clinical / Proposal - Authors critique reductionist models and propose that network Network-Psychology (2018) Research models be understood as ‘real patterns’ in which biological and [59] psychological factors are deeply intertwined in feedback loops. Bracken and Chapter Theory Critique – Identifies psychiatry as a ‘modernist’ project which separates User/Survivor studies Thomas (2013) technological from conceptual understandings of mental health, thus [60] privileging the expert doctor and disempowering service-users.

Brendel (2004) Article Clinical / Endorsement – Author highlights the dangers of both reductive and eclectic Biopsychosocial [61] Research models in psychiatry, endorsing the use of clinical pragmatism.

Bringmann and Article Clinical Critique – Authors critique the network approach by arguing that there is no Network-Psychology Eronen (2018) clear boundary between network and latent variable (common cause) [62] approaches. Brune (2002) Article Research / Endorsement – Author endorses the use of evolutionary psychiatry as a Evolutionary/Darwinian [63] Clinical meta-theory that integrates biological and interpersonal aspects of psychopathology. Buckholtz and Article Research / Endorsement – Authors synthesise existing work to argue that genetic and Network-Psychology Meyer-Lindenburg Clinical environmental risk factors impinge upon systems levels circuits for several (2012) core dimensions of cognition, producing trans-diagnostic symptoms and that [64] the risk to these circuits mediates susceptibility to broad domains of psychopathology rather than discrete disorders. Burstow (2014) Chapter Theory Critique – Author argues that psychiatry should be resisted and argues that Anti-Psychiatry [65] an attrition model should be used to unite those from the disability / antipsychiatry / user movement. Butler (2019) Chapter Theory / Endorsement – Provides a defence of the bio-psycho-social model on the Biopsychosocial [66] Clinical grounds that it provides a pluralistic perspective rather than promoting relativism.

Carruthers and Article Research Critique – Author identifies the concept of ‘ipseity disturbances’ which have Phenomenology Musholt (2018) been put forward as generative symptoms of schizophrenia, but argues that [67] different researchers define the concept in different ways.

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Chapman (2019) Chapter Theory / Review – Author sets out the main tenants of the neuro-diversity Mad [68] Clinical perspective which hold that diversity is natural and valuable; rejects the Studies/Neurodiversity view that certain states are ‘right’ and which views social dynamics in neuro- diversity as similar to other forms of diversity.

Cromby (2013) Chapter Theory / Proposal – Author draws on Bleuler’s notion of schizophrenia to argue that Psychosocial [69] Clinical paranoia should not be considered a disease and should be understood as being influenced by the contexts of everyday life and personal biography.

Cromby et al. Article Theory / Proposal – Paper sets out the main assumptions of a social materialist Psychosocial (2012) Clinical psychology and sets out a manifesto for considering distress from a social [70] materialist perspective.

Davidson et al Article Clinical Review - Reviews stages of change model as applied to recovery arguing Recovery (2010) that the current literature focusses on individual motivation but needs to [71] reflect broader issues such as discrimination and supports available. de Gonzalez (2001) Article Theory Endorsement - Aims to provide a psychological well-being model in Salutogenesis [72] distinction to the psychopathological approach.

de Haan (2017) Article Clinical Proposal - Proposes that an enactivist paradigm should be used to Phenomenology [73] incorporate existentialism alongside elements of the bio-psychosocial model. Deegan (2001) Chapter Clinical Endorsement – Uses a first-person account to endorse a recovery model Recovery [74] which is described as a transformative process.

Delille and Kirsch Chapter Theory Review – Paper reviews the status of the scientific metaphors used by Theory Development / (2016) Hacking and discusses the relationship between ‘transitional mental illness’ Application [75] and culture bound syndromes.

Fernandez (2014) Article Clinical / Critique – Author critiques Ratcliffe’s phenomenological model of Phenomenology [76] Research depression and argues that depression should be understood as causing 20

changes to the structure of existence rather than as changes to the mode of existence. Freeman (2003) Article Clinical / Proposal – Author argues that knowledge from brain theory and Neuropsychology [77] Research psychoanalysis needs to be used together in order to provide long-term relief for psychic pain.

Fried and Cramer Article Research / Endorsement – Authors identify challenges to network theory and network Network-Psychology (2017) [78] Clinical methodology and argue resolving these would improve the theory further.

Gardner (2001) Chapter Clinical Review – Author reviews evolutionary psychiatry through setting out its Evolutionary/Darwinian [79] history and identifying why it is neglected by the psychiatric profession and in clinical practice. Ghaemi (2010) Book Clinical / Proposal – Author argues that the bio-psycho-social model is imprecise and Theory development / [80] Research proposes a new model of psychiatric humanism, based on the work of Osler Application and Jaspers. Ghaemi (2003) Book Clinical / Proposal – Author critiques a range of models and proposes a pluralistic Theory Development / [81] Research / model for psychiatry. Application Theory Graby (2015) Chapter Theory Proposal - Author identifies tensions between those adopting a social model User/Survivor Studies [82] of disability and survivors and argues that neurodiversity perspectives might provide a bridge between these camps.

Greenspan (2008) Chapter Research Proposal – Author proposes a Developmental, Individual Difference, Developmental - [83] Relationship-based model (DIR) to address child mental health problems. Biopsychosocial

Huda (2019) Book Clinical / Endorsement – Author identifies and responds to criticisms of psychiatry in Biopsychosocial [84] Research order to endorse the medical model.

Ileva et al (2017) Article Research Endorsement – Authors endorses the use of stem cell research to model Biology [85] autism spectrum disorders.

Jakovljevic (2007) Editorial Clinical Proposal – Authors propose the use of systems thinking and a learning Theory development [86] organisation approach to provide a more integrative model of psychiatry. 21

Johnston and Boyle Article Theory Proposal – Authors argue that mental health problems should be Power-Threat-Meaning (2018) understood as understandable responses to adverse environments with a Framework [26] protective function; best addressed through the Power Threat Meaning Framework.

Kiesler (2000) Book Theory / Endorsement – Author critiques mono-causal explanations of mental health Biopsychosocial [87] Clinical problems and endorses a multi-causal approach.

Kelly and Gamble Article Clinical Endorsement – Authors identify 5 components to recovery and endorse its Recovery (2005) application to mental health nursing practice. [88] Kendler (2008) Article Research / Endorsement – Author endorses a mechanistic model that aims to Biopsychology [89] Clinical understand the mechanisms that derail the key mind/brain functions which are disordered in psychiatric illness.

Kendler (2009) Article Research / Proposal – Author critiques current theories of mental disorder as Property Cluster [90] Clinical / ‘essentialist kinds’, ‘socially constructed kinds’ and ‘practical kinds’ and Theory argues that mental disorders should be understood as Mechanistic Property Clusters.

Kendler and Article Theory Proposal – Authors propose that explanation-aided understandings of Neurophenomenology Campbell (2014) psychotic experiences, drawing on neuro-psychological knowledge should [91] be used to enable a more empathic response to patients.

Kobak and Article Clinical / Proposal – Authors propose a model of attachment and psychopathology Psychoanalysis Bosmans (2019) Research that is premised on an insecure cycle between internal working models and [92] mistuned communication with relationship partners. Leentjens (2004) Article Theory Endorsement - Author endorses a neuropsychiatric approach which takes Neuropsychology [93] into account biological, psychological and social factors, the inter- relationship between them and their relationship with brain processes.

22

Leigh (2010) Book Theory / Proposal – Author proposes a model in which mental disorder is theorised Biopsychosocial [94] Clinical as a product of stressful gene and meme interactions.

Levin (2000) Article Clinical / Endorsement – Paper argues that psychotherapy currently has no over- Systems/Chaos theory [95] Research arching theory of development and that chaos theory provides a useful terminology for charting the change process.

Lewis (2008) Chapter Clinical / Endorsement – Author argues that a narrative / liberationary model of Radical approach [96] Theory psychiatry should be applied through reform of the APA, the creation of a critical psychiatry network and through a shift to a narrative frame within clinical care. Lewis (2014) Chapter Clinical / Reviews – Author reviews key theories in developmental psychopathology. Developmental - [97] Research Biopsychosocial Lydon-Staley & Chapter Research Endorsement - Reviews use and utility of using network neuroscience to Neuroscience Bassett (2018) build biomarkers in psychiatry. /Neurobiology [98] Magnavita (2005) Chapter Clinical / Proposal - Proposes the basic elements of a component systems model of Biopsychosocial [99] Research personality function and a personality guided relational approach. McCauley et al. Article Clinical / Proposal – Proposes a new conceptual definition of mental health recovery Recovery (2015) Research in young adulthood. [100] McGruder (2001) Chapter Clinical Endorsement – Author critiques medical models of mental health from the Recovery [101] perspective of anthropologist / parent and endorses a recovery model as a means to considering biological, social and political aspects of mental health problems.

McLaren (2010) Article Clinical / Proposal - Proposes a model which amalgamates knowledge from Biopsychology [102] Theory osteopathy and psychiatry. Menon (2011) Article Research Proposal - Proposes a neurocognitive network perspective on Network/Biopsychology [103] psychopathology Messas & Gregory Article Research Proposal - Proposes an amalgamation of phenomenology and biological Neurophenomenology (2010) psychiatry 23

[104] Misra & Mohanty Article Clinical / Endorsement – Authors highlight the relevance of the gut microbiota-brain Gut microbiota (2017) Research axis in mental illness [105] Moffitt et al. Article Research Endorsement - Endorses an approach to psychopathology which focusses on Biology (2006) gene-environment interactions. [106] Mullen (2007) Article Theory Proposal - Proposes a renewed phenomenological approach to Phenomenology [107] psychopathology Murphy (2004) Chapter Theory / Endorsement - Reviews and endorses evolutionary theories of Evolutionary/Darwinian [108] Research psychopathology. Murphy (2005) Article Theory Endorsement - Endorses an objectivistic biological Theory development [109] Murphy (2014) Chapter Theory Endorsement – Endorses the ‘natural kind’-approach for psychopathology Theory development [110] Muscelli (2013) Chapter Theory / Endorsement – Endorses the application of phenomenology to current Phenomenology [111] Clinical psychopathological models and phenomenology Nees et al. (2015) Article Research / Endorsement – Endorses the relevance of classic conditioning for Neuropsychology [112] Clinical psychopathology.

NiaNia et al. Article Clinical Endorsement – Endorses the relevance of traditional healing principles for Traditional/Spiritual (2019) understanding the cultural background of Maori psychopathology [113] Nielsen & Ward Article Theory Endorsement - Endorses a view of mental disorder which is based on a view Cognitive Psychology (2019) of the mind as enacted, embodied and embedded (identified as ‘3e [114] cognition’). Northoff (2014) Article Research / Proposal - Proposes a neurophenomenological approach which directly links Neurophenomenology [115] Theory neuronal and phenomenological features. Osborne (2016) Article Clinical Proposal - Proposes that an existential-phenomenological perspective Existentialism [116] should be used to understand and work with delusional beliefs. Penson (2015) Chapter Theory Critique – Chapter aims at criticizing the notion impairment in the social User/Survivor Studies [117] disability model. 24

Pezard & Nandrino Article Theory / Proposal – Article proposes the application of non-linear dynamics (Chaos- Systems/Chaos-Theory (2001) Research Theory) to neuroscience. [118] Pilgrim (2002) Article Clinical Review – Reviews the bio-psycho-social model in American psychiatry. Biopsychosocial [119] Plumb (2005) Chapter Theory / Proposal – Chapter proposes a social/trauma model that maps the Psychosocial [120] Clinical consequences of childhood sexual abuse for mental distress.

Protopescu & Article Research / Proposal - Amalgamation of psychotherapeutic models and neuroscience Neuropsychology Gerber (2013) Clinical proposed [121] Raveesh (2013) Article Theory Proposal - Proposes the application of Indian cultural principles to modern Biology - Culture [122] biological psychiatry related to gender/sex-identity problems Read (2005) Article Clinical Critique – Paper provides a critique of the biopsychosocial and biomedical Biopsychosocial [123] models of psychiatry.

Redish and Gordon Chapter Theory / Endorsement – Authors argue that a computational perspective is Computational (2016) Clinical fundamental to understanding the relationship between mind and brain and neuroscience [124] offers a new perspective for psychiatry.

Richardson (2004) Article Clinical Endorsement – Article endorses the relevance of non-western concepts of Traditional/Spiriual [125] mental illness. Roy (2007) Chapter Theory / Endorsement – Chapter endorses an approach drawing both on radical Radical approach [126] Clinical psychiatry and a social justice approach Russo (2016) Chapter Theory / Endorsement - Argues for the need for survivors to research user User/Survivor Studies [127] Research perspectives of madness and to undertake their own analysis versus biomedical approaches and ‘mad’ identities Sass (2014) Article Theory Endorsement – Article endorses the phenomenological approach as both a Phenomenology [128] means to providing effective descriptions and explanations of psychopathology. Sayed (2002) Article Clinical Proposal - Article Identifies the need for psychologists and psychiatrists to be Traditional/Spiritual [129] aware of Arabic cultural beliefs about mental health. 25

Schlimme (2012) Article Theory / Proposal - Proposes phenomenological description of lived autonomy Phenomenology [130] Clinical describing how this relates to specific psychopathological symptoms of depression. Schmidt (2018) Article Theory / Proposal - Proposes genetic phenomenology to correct shortcomings in Neurophenomenology [131] Research biological reductionism and in Cognitive Theory. Shean (2002) Article Theory Critique – Article critiques reductionist models of mental disorder Biopsychosocial [132] (biomedical). Slade (2010) Article Clinical / Endorsement – Article endorses a well-being approach focussed on Recovery [133] Consumer promoting good mental health which draws on positive-psychology techniques. Slade (2012) Chapter Clinical / Endorsement – Endorses a personal recovery approach based on Recovery [134] Consumer epistemological considerations. Stanghellini & Chapter Theory Endorsement –Endorses a phenomenological psychopathological approach Phenomenology Aragona (2016) to the study of mental health problems. [135] Tew (2015) Chapter Theory Proposal – Chapter proposes that mental distress is a socially situated Social disability [136] response to particular circumstances. Tew (2005) Chapter Theory Endorsement – Chapter endorses the social model of disability. Social disability [137] Thagard (2008) Article Theory Endorsement –Endorses theoretical/computational neuroscience. Computational [138] Neuroscience Thompson (2018) Book Theory / Proposal - Proposes a social model of mental health which acknowledges Psychosocial [139] Clinical meaning, selfhood / identity, roles and responsibilities, spirituality, and draws on individual responses, group responses, community-based and societal responses. Tretter (2004) Article Theory / Endorsement - Endorses a mathematical / computational approach to Computational [140] Research psychopathology informed by systems theory. Neuroscience Troisi & McGuire Article Theory Endorsement - Endorses Darwinian psychiatry. Evolutionary/Darwinian (2002) [141] Troube (2016) Article Theory / Proposal - Proposes phenomenology for a better understanding of Phenomenology [142] Clinical psychosis. 26

Uher (2009) Article Theory / Endorsement - Endorses evolutionary psychiatry based on genetics. Genetics - Evolutionary [143] Research Van der Lee & Article Clinical / Endorsement – Endorses the network approach. Network - Psychology Schellekens (2019) Research [144] Van Wheeghel et Article Clinical / Proposal – Proposes a broad conception of Recovery Recovery al. (2019) Consumer [145] Wakefield (2016) Chapter Theory Proposal - Proposes a ‘harmful dysfunction’ view of disorder to argue that Evolutionary/Darwinian [146] aetiological analysis illuminates the concept of disorder and psychopathology. Wallcraft (2005) Chapter Theory / Proposal – Chapter proposes a Recovery approach based on individual Recovery [147] Clinical service users’ preferences. Wallcraft and Chapter Theory Proposal – Chapter proposes the extension of the social disability model Social Disability Hopper (2015) through use of the Capabilities approach. [148] Williams (2016) Article Theory / Proposal - Proposes a neural circuit dysfunction approach Biology [149] Research Yahata et al. Article Clinical / Endorsement - Endorses the computational neuro-science approach based Computational (2017) Research on machine learning. Neuroscience [150] Yamada & Chapter Research / Endorsement – Endorses a cultural competency approach to Traditional / Spiritual Marsella (2013) clinical psychopathology [151]

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