Understanding mental health and the causes of psychopathology as specified by the systemic model.
UNDERSTANDING MENTAL HEALTH AND THE CAUSES OF PSYCHOPATHOLOGY AS SPECIFIED BY THE SYSTEMIC MODEL
To understand how the Systemic Model views the causes of psychopathology one first needs to understand the distinctions between a circular and a linear model:
Linearity identifies and implicates a linear cause for abnormal behaviour: X causes Y. Linear causality can be multidimensional, that is to say that more than one cause can be indicated as being responsible for the pathology, however, the relationship between the cause/causes and the abnormal behaviour is not one of reciprocity.
This is not the case with circular causality which emphasises the "...reciprocity, recursion and shared responsibility" Becvar & Becvar (1996, p.10) of interactions. Circularity would identify abnormal behaviour as being embedded within the interaction between A and B which can be said to be both cause and effect.
The Humanistic and Existential Schools, Psychodynamic and Cognitive-Behavioural Schools all identify a cause for abnormal behaviour. They are therefore all categorised as linear models. At face value it might appear that the Ecosystemic School does not implicate a cause for abnormal behaviour and should thus be seen as a circular model. However, the focus of the Ecosystemic School is on the autonomous formation of meaning rather than on interaction, and, as meanings are structurally determined, the Ecosystemic view should be considered asystemic.
The only true circular model is the Systemic Model which analyses human interaction and assigns the presence of abnormal behaviour to the reciprocity of this interaction. The Systems Model positions abnormal behaviour as part of a circular interactional pattern of interconnected behaviour which is seen to maintain and exacerbate the abnormal behaviour. The abnormal behaviour is thus viewed as an integral part (and not a cause) of human interactive behavioural discourse.
The Systemic Model does not seek to find a cause to psychopathology but rather to uncover the interdependent cycle of maladaptive, interrelated behaviour into which psychopathology is interwoven.
The Systemic Model views the causes of abnormal behaviour as circular and seeks to understand mental health by examining the system rather than the isolated elements/people/behaviour that exists within the system. Thus, in viewing causes of psychopathology, understanding mental health and restoring healthy functioning, the system is seen as the primary unit of treatment and focus is on the entire system and not isolated to any specific units within. Thus "...the locus of disorder is seen to reside not within the individual, but within the family system." Sue, Sue & Sue (1997, p.57)
The terms cybernetics and systems theory are often used synonymously. A distinction exists between simple cybernetics or first order cybernetics and the cybernetics of cybernetics or second order cybernetics. In first order cybernetics, the therapist is separate from the system and focuses on observing the dynamics of the interaction of units within the system. The therapist is an observer/describer.
However, "...the mere act of observation distorts and influences outcomes" Ingamells (1993, p.85) and so second order cybernetics includes the therapist as a part of the system, and thus the line which separates the therapist and patient is blurred and the pursuit of objectivity can be seen to be compromised. In seeking to understand mental health and break the cycle within the system that is cultivating psychopathology, the systemic model encourages intersubjectivity because "...it is at the point at which we become restless and uncertain that we may need to seek further rather than seek refuge in 'objectivity'" Ingamells (1993, p.86).
To fully understand mental health and psychopathology, systemic therapists seek to acknowledge and give recognition to the "black and white" of all behaviours. For every behaviour there is a counter and complimentary behaviour which is mutually influential: "Thus a sadist requires a masochist, just as a masochist requires a sadist" Becvar & Becvar (1996, p.65). In conjoining the actions, reactions and behaviour of all elements within a system, the Systemic Model enforces and emphasises shared power and responsibility for psychopathology and optimal mental health amongst all members within the system. Thus, psychopathology is seen as symptomatic of an unhealthy system and inept communication.
To understand mental health, the systemic model suggests the necessity of looking at the "larger enterprise" Ingamells (1993, p.87). The systemic model places pathology within relationships, within the system, and sees the recursive discourse as symbiotic. The therapists role in assisting to regain a healthy functional system is to encourage "...the development of an ecology of ideas that allows the problem to dissolve." Ingamells (1993, p.86).
According to the Systemic Model, a system can re-attain optimal mental health through self-correction in which the mechanism of feedback is employed. Feedback refers to "...any information about the functioning of ...
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To understand mental health, the systemic model suggests the necessity of looking at the "larger enterprise" Ingamells (1993, p.87). The systemic model places pathology within relationships, within the system, and sees the recursive discourse as symbiotic. The therapists role in assisting to regain a healthy functional system is to encourage "...the development of an ecology of ideas that allows the problem to dissolve." Ingamells (1993, p.86).
According to the Systemic Model, a system can re-attain optimal mental health through self-correction in which the mechanism of feedback is employed. Feedback refers to "...any information about the functioning of one or more components of a system that leads to modification of functioning." Reber, & Reber (2001, p.270). As previously discussed, systems theory does not recognise psychopathology as a dysfunction within an individual, but rather as symptomatic of malfunction within the system thus feedback is used to self-correct and "...increase the probability of the survival of the system." Becvar & Becvar (1996. P.68). Feedback can be positive or negative and brings about new behaviour.
To foster a state of optimal mental health, a system must maintain a balance between extreme morphogenesis and morphostasis. This compromise is referred to as dynamic homeostasis. When morphogenesis and morphostasis are excessive, dysfunctionality can be said to occur - probably resulting in abnormal behaviour.
Morphogenesis is a system's potential to change in response to the absorption of environmental information, and Morphostatis is a system's ability to maintain stability. Systems theorists view these as inseparable and essential functions of any healthy system: psychopathology occurs when the balance is disrupted.
If the rules and boundaries of a system are blurred, inconsistent, or oppose each other, psychopathology might occur. An example of this would be when a schizophrenogenic parent places the child in a double bind by constantly giving contradictory verbal and non-verbal messages. Systems theorists would see this as nurturing psychopathology because this maladaptive form of communication does not encourage understanding and adherence to appropriate roles, behavioural expectations, relationships or norms appropriate to that system. If an individual does not possess substantial knowledge of the rules and boundaries of their system, they will find it an inordinate task to function normally within a suprasystem.
The systemic model views psychopathology as occurring when a system becomes stuck, denoting that "...the processes currently in use are no longer effective; and that which is needed is new information and new ways of communication." Becvar & Becvar (1996. P.72). For optimal mental health to occur, patterns of behaviour which are supporting the abnormal behaviour must be identified and replaced with healthier and more appropriate reciprocal interactions.
All systems have a degree of openness and closedness which enables or prohibits the absorption of new information. A healthy system maintains equilibrium. Sometimes it may be necessary for a system to be more open or closed to ensure growth and/or survival. However, if overweightedness in either direction occurs and is not contextually necessary (e.g. a system might be extremely closed as a defence mechanism) a state of entropy will be entered into. A state of entropy indicates that a system faces possible decline, stagnation and disintegration, and is indicative of unhealthy behaviour and psychopathology. The relationship is circularly causal. "By allowing in either too much information or not enough information, the system jeopardises its identity and thus its survival" Becvar & Becvar (1996. p.71). A systemic therapist, in treating this psychopathology, would seek to restore the system to a state of negentropy.
Relationships can be described as the "...sum of communications between individuals at all levels of communication (formal, informal, nonverbal and contextual)" Cottone, R.R. (1989. p.230). In seeking to understand mental health and to bring about stability to a system, the systemic model places great emphasis on communication. Systemic theorists believe that communication is always occurring at some level, and interpretation and reciprocity are inevitable. Communication occurs in three different modes which can be seen as verbal/digital mode, non-verbal mode and context (the blending of non-verbal mode and context is referred to as analog), and on two levels which can be seen as content (i.e. verbal/digital) and the process (i.e. analog). Optimal mental health is seen as occurring when these two levels are co-ordinated and communication is fluid and congruent. However, if these two levels are not matched, the interchange is dysfunctional.
UNDERSTANDING MENTAL HEALTH AND THE CAUSES OF PSYCHOPATHOLOGY AS SPECIFIED BY THE HUMANISTIC-EXISTENTIAL MODELS
Although the Humanistic and Existential Schools are separate and hold somewhat different views on the understanding of mental health, people have come to see them as being linked. In this essay I will discuss the differences and similarities and the impact this has on their perception of psychopathology and mental health.
Evolving in reaction to the determinism of psychoanalysis, humanistic-existentialism views humans as proactive and responsible for their own functioning. We are responsible for creating our own optimal state of mental health.
Both schools believe that a person's reality is in fact a subjective analysis of experiences, perceptions and comprehensions of the world. Therefore, when seeking to appoint underlying causes to abnormal behaviour, it is important to accentuate the person's experience and interpretation of events, rather than the actually occurrences. So, to understand mental health and the reasons for a person's abnormal behaviour, the humanistic-existential therapist must understand that person's subjective universe. In accordance with humanistic principles, "the therapist should have three core qualities: genuineness, unconditional regard, and empathic understanding." Davidson & Neale. (1997. p.506). Without these qualities it is not possible to 'walk' in another persons shoes and this is the only way of understanding how their phenomenological world and assigning causes for their current state of mental health.
Humanistic-existentialistic causes of psychopathology can be seen as an individual's incomplete, inaccurate, unhealthy 'subjective universe' or perception of the world - this phenomenological world has led to a skewed view of reality. Psychopathology can also be attributed to an acute unawareness of one's own behaviour as well as a lack of purpose and goals.
In understanding mental health, both humanism and existentialism see people as responsible for their own decisions, with free will to make choices. Both stress the wholeness of the person, that is to say, they do not reduce people to sets of predetermined and prescribed specifications. Both assign people the ability to self-actualise.
However in understanding these two models' views of mental health, it is vital to recognise important assumptions concerning the human psyche which divide the two schools:
Humanism is more optimistic, focusing on the goodness of human nature and the potential for awareness and development, highlighting limitlessness and oneness. Existentialism is fraught with anxiety and uncertainty and is of the view that to attain optimal mental health and to self-actualise, people need to accept death and non-being as well as apartness and basic aloneness.
"To be truly alive is to confront the anxiety that comes with existential choices." Davidson & Neale (1997. p.510).
So while the focal cause of psychopathology for humanists is a distorted subjective universe or self-reality and a self concept which is incongruent with one's self-actualising potential, existentialists see living in an 'existential vacuum' and the avoidance of the reality of non-being as pivotal in pinpointing the causes for psychopathology. "To avoid choices, to pretend that they do not have to be made, may protect people from anxiety, but it also deprives them of living a life with meaning and is at the core of psychopathology" Davidson & Neale (1997. p.510).
Because humanism has such a positive view of human potential, it focuses not only on treating abnormal states of mental health, but on "improving the mental health if the person who is considered normal" Sue, Sue & Sue (1997, p.46). Humanists view healthy people as being "...aware of their behaviour...(as being) innately good and effective...purposive and goal directed..." Davidson & Neale (1997. p.506).
To attain self-actualisation, and thus, optimal mental health, the humanistic-existential models propound that an individual must "actively strive to attain his or her own goals" and must "rise above circumstances by choosing specific attitudes towards them." Meyer, Moore & Viljoen (1997. pp 359 - 363).
COMPARE AND CONTRAST THE DIFFERENT WAYS MARGARET'S BEHAVIOUR AND SITUATION WOULD BE ASSESSED AND INTERPRETED BY THE SYSTEMIC MODEL AND THE HUMANISTIC-EXISTENTIAL MODEL
Unlike the humanistic-existential model, the systemic model would not focus solely on Margaret, but rather on the whole family and the context in which the behaviour occurs, when assessing and interpreting her behaviour. The systemic model would not view Margaret's behaviour as an isolated phenomenon but rather as indicative of problems within the system (i.e. family), thus the focus for treatment would not be isolated only to Margaret, but on the entire family unit. Everyone in the family is suffering and their behaviour is both reciprocal and reinforcing. Margaret's psychopathology has become part of the family functioning and this cycle needs to be broken if Margaret is to gain and maintain normal mental health.
The humanistic-existential model would examine the early relationships between Margaret and her parents and explore how conditional regard from others caused Margaret to develop an incongruent self image. The systemic psychologist would be less concerned with the etiology of Margaret's disorder, and more concerned with healing the family system and building "complex bonds of relatedness between 'index patient and close others'" Ingamells (1993. P.95).
The systemic psychologist would feel that it is important that the whole family undergo therapy because it is necessary that during and after therapy, the family reinforce and nurture her recovery by forming new relationship patterns with her, and not promoting a reemergence of the old behavioural patterns by expecting and accommodating for her abnormal behaviour, which has become entrenched within the family cycle of functioning.
The humanistic-existential model would see Margaret as responsible for her own behaviour and functioning and for the maintenance of her mental health. Emphasis would not be placed on the role of the family and on family therapy, but rather on person-centred therapy which would be used to explore and expose Margaret's perceptions and subjective understanding of her world. The humanistic-existential model would focus on adjusting the faulty perceptions of Margaret's subjective universe.
In the systemic model, the psychologist would try to exchange the reciprocal, unhealthy relationship between Margaret and Ray for healthier and more appropriate interactions. New information and methods of communication would be encouraged. The psychologist would seek to regain a balance within the family system, and to identify and modify behaviour within the family which is recursive and destructively symbiotic: that is to say that while Margaret is with Ray because he is supportive, stable and understanding of her behaviour, Ray is with Margaret because she is unusual - their interactions and reactions to each other are encouraging maladaptive behaviour.
The systemic model would be concerned with the role that Margaret has come to play within her family. Her husband has come to accept and expect Margaret's idiosyncratic behaviour: "He had grown accustomed to her religious preoccupations, her occasional odd speech and mannerisms, and her habit of locking herself alone in her room..." Margaret's idiosyncratic behaviour and Ray's attempt to tolerate, understand and accommodate it, is a reciprocal and unhealthy relationship which reinforces Margaret's abnormal behaviour. The relationship is circular: Margaret behaves strangely and Ray expects and accepts that Margaret behaves strangely, so Margaret behaves strangely etc. Her psychological disturbances have become part of her persona which operates as a part of the family system.
The humanistic-existential model is a linear model: Margaret's schizophrenia is a result of her inaccurate, incomplete and unhealthy perceptions and lack of purpose and goals. The Humanistic-existential psychologist would recognise Margaret's potential to self-actualise and would work with her to reassess her reality and her attitude towards her circumstances. Margaret has free will to make choices and is responsible for self-actualising and attaining and maintaining optimal mental health and normal behaviour.
The systemic model places responsibility for Margaret's behaviour on the whole family and not just Margaret because their recursive interactions are seen to exacerbate and nurture her actions. Thus, the family, and not Margaret, would be considered to be the primary unit of treatment. Ray and the children's ideas and beliefs about Margaret, as well as their expectations for the future would be closely examined. The systemic psychologist would stress the importance for Ray and the children to get support and encouragement which will enable them to create and maintain a healthy family environment.
Neither the systemic model nor the humanistic-existential model would emphasise the genetic factors associated with Margaret's schizophrenia but would rather "minimise these factors so that the patient's responsibility for himself can be enhanced" Ingamells (1993. p.26). The systemic model would see this as forcing the family system to acknowledge that the abnormal behaviour can be attributed to their behaviour and that they are thus co-responsible for its maintenance or demise. This would discourage Margaret and her family from viewing themselves as victims of the mental illness.
REFERENCES
* Becvar, D.S. & Becvar, R.J. (1996). Family Therapy: A systemic integration (3rd ed). Boston: Allyn & Bacon
* Cottone, R.R. (1989). Defining the psychomedical and systemic paradigms in marital and family therapy. Journal of Marital and Family Therapy, 15, 225 - 235
* Davidson, GC & Neale, J.M. (1997). Abnormal psychology. (7th ed.). New York: Wiley
* Ingamells, D. (1993). Systemic approaches to psychosis part 1 - the systemic context. Australian and New Zealand Journal of family Therapy, 14, 21 - 28.
* Ingamells, D. (1993). Systemic approaches to psychosis part 11 - systemic psychotherapy. Australian and New Zealand Journal of family Therapy, 14, 85 - 96.
* Meyer, W.F., Moore, C. & Viljoen, H.G. (1997). Personology - from individual to ecosystem. (2nd ed.). Johannesburg: Heinemann
* Reber, A.S. & Reber, E. (2001).The penguin dictionary of psychology. (3rd ed.). London: Penguine Books
* Sue, D., Sue, D. & Sue, S. (1997). Understanding abnormal behavior. (5th ed.). Boston: Houghton Mifflin Company
