A Novel Aproach to Medical model and Psychosocial Model Uniting them by Developmental Neuroscience
Moderator: Selin Yurdakul
In this panel first we are going to focus on different modalites of medical and psycosoical models and than we will try to unite them by recent discoveries of neuroscience field. Understanding how psycosocial factors can determine developing brain via epigenetic factors or other developmental milestones will help us better understand the interac- tion between two models.
“Medical Model” refers to any system that medical professionals use in clinical work and research. Unlike the psy- chosocial model, the medical model focuses on the physical body and tries to explain the etiology and pathophysiol- ogy of diseases. Within the framework of the medical model, mental disorders do not have psychological, social and behavioral dimension.
The biopsychosocial model is based on the fact that the brain and peripheral organs are interrelated and sensitive to social changes as well as to physical stimuli. The biopsychosocial model is a patient-centered holistic approach. It is a model that takes into account the integration of biological, psychological and sociological diseases in the evaluation, prevention and treatment of diseases.
In recent years with developing imaging techniques, advances of moleculer biology and genetic analysis we can bet- ter comprehend the working mechanism of the nervous system in a much more detailed way within the framework of neuroscience. In this manner we can understand the importance of early childhood experiences in medical patholo- gies through the effect on the structure of the developing nervous system in early years of life. There is direct impact on mother baby interaction to systems such HPA axis via epigenetic mechanisms. And it is shown my experiments that parasymphatetictonusofvaguscorrelateswithsecureattachmentwithmother.
Uniting The Medical Model And Psycosocial Model By Developmental Neuroscience
Selin Yurdakul / Ph.D Student Psikoterapi Enstitusu, Turkey selintific@hotmail.com
For many years there has been an unbridgeable gap between the medical model and the psychological model.Thanks to the current developments in neuroscience, now we can understand the importance of early childhood experiences in medical pathologies through the effect on the structure of the developing nervous system in early years of life.
One of the most striking examples of this connection may be the relationship between the early mother’s care for the baby and the HPA axis. Studies have shown a decrease in the number of GR receptors as a result of decreased gene expression due to cortisol gene receptor methylation in the children of mothers who did not touch their baby due to postpartum depression. While high cortisol levels are detected in the blood in early childhood due to impaired HPA axis of these babies, low cortisol levels are observed in adulthood due to down regulation. Cortisol is an extremely important hormone in the body’s response to stress. HPA axis disorders have been associated with many chronic diseases such as autoimmune diseases, diabetes,hypertension.
Another reflection of early mother-child attachment is on the vagus. It plays an important role in determining emo- tion regulation capacity. The fact that emotion regulation disorder underlies many psychological pathologies reminds us once again the importance of the vagus. Thanks to advanced imaging and laboratory analyzes in recent years, research under the umbrella of neuroscience shows that the gap between the two modalities comes from a lack of knowledge.
Reference:
- Wong, K. E., Wade, T. J., Moore, J., Marcellus, A., Molnar, D. S., O’Leary, D. D., & MacNeil, A. J. (2022). Examin- ing the relationships between adverse childhood experiences (ACEs), cortisol, and inflammation among young adults. Brain, Behavior, and Immunity – Health, 25. https://doi.org/10.1016/j.bbih.2022.100516
- Murgatroyd, C., Quinn, J. P., Sharp, H. M., Pickles, A., & Hill, J. (2015). Effects of prenatal and postnatal depression, and maternal stroking, at the glucocorticoid receptor gene. Translational Psychiatry, 5. https://doi.org/10.1038/ tp.2014.140
The Medical Model In Mental Health
Hasret Pismisoglu / Medical Doctor Psikoterapi Enstitusu, Turkey hasretpismisoglu@gmail.com
“Medical Model” refers to any system that medical professionals use in clinical work and research. In the treatment of mental disorders, the medical model does not believe that the non-invasive tools of the psychosocial model, such as speaking and being silent, make a difference in the body. Therefore, it uses some invasive methods in the treatment of this disorders.
Unlike the psychosocial model, the medical model focuses on the physical body (we can say “hardware” by analo- gy) and tries to explain the etiology and pathophysiology of diseases. In the biomedical paradigm, the primary aim of research into the nature of mental disorders is to uncover their biological cause(s). Similarly, treatment research seeks to develop somatic therapies that target underlying biological dysfunction (1).This therapies are such as drugs, electroconvulsive therapy and other brain stimulation methods.
The medical model assumes that mental disorders like schizophrenia, major depressive disorder, attention deficit/ hyperactivity disorder (ADHD), and substance use disorders are biologically-based brain diseases. Core tenets of this approach include; (a) mental disorders are caused by biological abnormalities principally located in the brain, (b) there is no meaningful distinction between mental diseases and physical diseases and (c) biological treatment is emphasized (Andreasen, 1985).
Within the framework of the medical model, mental disorders do not have psychological, social and behavioral di- mension. Although it does not need to be evaluated independently of social behavior. It expects self-disorders and interpersonal disorders to be explained on the basis of disordered biochemical and neurobiological processes.
Reference:
1. Deacon BJ, The biomedical model of mental disorder: A critical analysis of its validity, utility and effects on psycho- therapy research. Clinical Psychology Review 33(2013)
Biopsychosocial Model
Gonca Gunakan / Ph.D Student Psikoterapi Enstitusu, Turkey goncagunakan@hotmail.com
Each individual has different genetic structures, learning backgrounds, physical experiences, and this genetic struc- ture, experiences and experiences cause individuals to have different personal and behavioral characteristics. This causes individuals to develop different resistances to certain diseases. However, the social environment in which the individual lives also affects the individual closely. Since each individual does not live in the same social environment, the effect of the social environment on the individual is different, and the individual’s recovery time and resistance to the disease may differ. Based on this understanding, psychiatrist George Engel defined the biopsychosocial model in1977.
The biopsychosocial model is based on the fact that the brain and peripheral organs are interrelated and sensitive to social changes as well as to physical stimuli. According to this model, health and disease; it is shaped by the complex interactions of biological, psychological and social variables and none of them can be categorized by separating from the other. Lab data is a very small part of what patients bring to their doctors. Physicians who only care about their patients’ medical records can get very little information from their patients. In this model, rather than focusing on a single disease cause, that is, taking into account psychological and social factors instead of only dealing with bio- logical factors will provide a holistic understanding of the disease process. In this approach, it is aimed to consider all factors affecting the disease. Thus, the biopsychosocial model extends to hitherto neglected areas of the biomedical framework.
The biopsychosocial model is a patient-centered holistic approach. It is a model that takes into account the integra- tion of biological, psychological and sociological diseases in the evaluation, prevention and treatment of diseases. In this way, it is aimed not to focus on a single aspect, a single organ or a single disease cause, but to recognize all its components. This approach argues that individuals’ biological, psychological and social processes have an impact on their living standards and health, and as opposed to the biomedical model, it evaluates patients’ emotions, physical environment, life, living conditions, and nutrition as a whole.
Resource:
- – Frankel, R., Quill, T., & McDaniel, S. (2004). The Biopsychosocial Approach: Past, Present, Future. The Permanente Journal, 8(3), 75.
- – Havelka, M., Despot Lučanin, J., & Lučanin, D. (2009). Biopsychosocial model–the integrated approach to health and disease. Collegium antropologicum, 33(1), 303-310.
Birth of Intersubjectivity
Inci Cavusoglu / MD Psychotherapy Institute, Istanbul, Turkey drinciklinik@gmail.com
Gulsah Alcan Çapraz / Psychological Counselor Psychotherapy Institute, Istanbul, Turkey gulsahalcann@icloud.com
Modern psychology explains the human mind and psychic structure in the perspective of reason and logic just like other reductionist approaches in natural sciences.
Neurobiological research in the 21st century has shown that the human brain is not a structure that lives and exists on its own as an isolated mind. The myth that human beings have isolated minds that are not affected by each other is a paradigm that has dominated modern psychology for 100 years. This isolated mind paradigm seems to be the most basic hypothesis that intersubjective field theory opposes.
It is known that man cannot maintain his own existence in the absence of the existence of another. While the exis- tence of another is so important for the continuation of life, the quality of this interaction is also a serious determinant for the psychological resilience of the person.
It is claimed in many studies today that the baby’s experiences in the mother’s womb affect today’s intrapsychic structure. And intrauterine life is the first link of the chain that must be considered and reached by going backwards from the story today.
Prenatal attachment is defined to be an emotional bond established between the unborn child and his mother. It is suggested that this attachment during pregnancy is the earliest interaction in between and is a very important determinant in the development of a secure or an insecure bond in the postpartum mother-baby relationship. In our clinical observations, there are also frequent histories that support importance of a secure attachment between mother and baby in the prenatal period .
The prenatal attachment period is arranged in the ecosystem of womb, between the limited mental capacity of the baby and maternal reflective functioning skills. Mother and baby matrix is bidirectional. Current studies have shown that fetus in utero is not as senseless as previously thought. It is also thought that meeting and improving the physical and mental needs of the mother in the prenatal period will improve the woman’s attitude as a mother and will establish a healthy mental bond to the fetus. Then the baby will be born more smoothly and functionally into the world. And his mother’s warm bond and tendency will create a functional basis for future secure attachment of the fetus to his mother and then to the life. Steady and safe basis of future intersubjective field thus depends on the satisfactory fetal-maternal mental dialogue in the prenatal period,
So we will argue in this panel that the birth of the intersubjective field is before the biological birth. Instead, field is detected when the baby is in his mother’s womb as a zygote and even before.Thus we will evaluate the maternal side, the fetal side and the neurobiological clues of prenatal intersubjectivity.
And we will also emphasize that when we to take detailed anamnesis of the clients’ problems in the intersubjective context, we must consider to go back to birth and prenatal period.