This paper explores the relationship between the prominent aetiological frameworks for mental illness in Australian psychiatry, and ideas and strategies for preventing mental illness. Data is drawn from the Australian and New Zealand Journal of Psychiatry for the period 1967-2005, and textbooks used to teach the psychiatric component of the medical degree at six Australian universities since 1950. Content analysis of the journal demonstrates that social aetiological models dominated Australian psychiatry until 1985 and the rise of biological models. This represented a shift in the focus of mental health prevention from the social environment to the individual, and the re-location of psychopathology from social relationships to social and biological risk factors. A consequence of this new focus has been the re-targeting of mental health strategies toward individuals and their exposure to social and biological risk factors.
Received 25 January 2008 Accepted 22 February 2008
mental health prevention, risk, psychiatry, mental health policy, neoliberalism, sociology
This paper explores the impact of the ascendency of biological psychiatry upon the construction of mental health prevention strategies in Australia. The central premise is that there has been a fundamental shift in the construction of mental health prevention associated with the mapping of psychopathology on the body rather than the social environment. From 1950 to 1985, mental health prevention strategies targeted the wellbeing of the whole population through a focus on the management of the social environment. After this period, there was a shift toward biological models of aetiology focussing on the individual. These changes in mental health aetiology are related to differing conceptions of the individual. Rose (2003:54) associates earlier, social models of aetiology, with 'psychological individualism', in which the 'source of our individuality and the locus of our discontents ... [is found in] biography and experience'. This view of the individual has been supplanted, for Rose, by a form of individualism in which the locus of individuality and discontent is found in the body and the brain. He calls this 'somatic individualism' (Rose 2003:54). This change provides the impetus for 'improving' mental well-being through acting on the body.
Changes within the dominant aetiological paradigm are traced in this paper through content analysis of relevant articles in the Australia and New Zealand Journal of Psychiatry. The data demonstrates a movement from social models of aetiology for mental illness, towards those that locate the root of psychopathology in biology. The paper then examines the notion of risk in these documents, illustrated through a case-study of changing ideas about the aetiology of schizophrenia. The discussion highlights two aspects of this change: an increasing focus upon biological causes of schizophrenia, and a movement towards a statistical, rather than causal, relationship between social and biological risk factors and schizophrenia. The paper concludes by identifying the manner in which the psychiatric textbooks and the journal depict mental health prevention. This discussion outlines typologies for understanding preventative services, highlighting the recent development of a typology based upon the degree of exposure to risk factors. Central to this discussion is a change from 'psychological' to 'somatic individualism', and a growing interest in identifying and managing those deemed to be 'at risk' (Rose 2003).
Public health and the mental hygiene movement
Armstrong (1983, 1995) describes the form of medicine which emerged at the beginning of the twentieth century as concerned with the hygiene of the population. This hygiene movement protected the political health of the nation by monitoring the personal lives and health maintenance behaviours of citizens and inculcating habits to promote social and physical well-being (Rose 1986, 1996b). …