Biological Psychiatry and Changing Ideas about 'Mental Health Prevention' in Australian Psychiatry: Risk and Individualism
Henderson, Julie, Health Sociology Review
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).
This form of medicine reflected wider concerns with the well-being of the population and is informed by a rationality that enshrines liberal welfare by protecting the population from the excesses of the market through the provision of health and welfare services. For Dean (1999:150), the purposes of government at this time 'were conceived as enframing society within mechanisms of security by which the state would care for the welfare of the population "from the cradle to the grave'". The state intervened in the market and the lives of its citizens, taking direct responsibility for 'social-ising' the individual in the interests of collective security (Rose 1996a:48). Professions, such as social work and psychology, emerged at this time and took a role in ensuring the adoption of the responsibilities of citizenship. Where people fell short of social expectations, the professions taught and enforced appropriate social norms. People were 'governed through society, that is to say, through acting on them in relation to a social norm, and constituting their experiences and evaluations in a social form' (Rose 1993:285; italics in original). …