Cognitive Behavioural Perspectives on Mental Distress – causes or contributory factors

Duration: 10.12 mins

Speakers: 

Interviewer, Tracey Holley 

Professor Max Birchwood, Birmingham and Solihull Mental Health Trust and School of Psychology, the University of Birmingham

Hello, I’m Tracey Holley, I work in higher education with nurses and social workers and I’m a mental health survivor, and I’d like to introduce you to Max Birchwood. 

Hi, Tracey. Nice to be here. 

From your perspective, what do you see is causing or contributing to mental distress? 

Well, mental distress is a big broad spectrum of difficulties that people have, but there have been in the last 10, 15 years, some better understanding of the common social influences on the development of mental distress across the whole spectrum and they’re really rather interesting.   From depression and anxiety problems right through to unusual experiences such as hearing voices and what’s called a psychosis.   One of the most influential pieces of work for me was the wonderful work of Brown and Harris in the 70s, 80s and 90s, and this was an enormously important piece of work looking at the social origins of depression and this was a piece of work initially looking at the risk factors for depression in young women but it has generalisation right across the piece. So what Brown and Harris found was that those individuals who in their very early lives had been exposed to traumas of one sort or another, you kwon, from one level being involved in a car accident or the most severe end of sexual abuse, particularly individuals who’d been subjected to losses of various sorts, particularly where one of the parents had died or the family had split up. And also major social inequalities are very, very important, which we know are very important in health general but particularly important in mental health. So those individuals who have social capital, social assets, a relative level of deprivation relative to others in society, these are the kinds of things that prove to be very important predictors of individuals developing a range of mental disorders, mental distress later on in life.  What’s particularly interesting in the last couple of years and this has been certainly the case in psychoses, is that it’s now understood that social influences at an ecological level, at a kind of wider social level, are very important.  So the individuals who live in fragmented social communities where there’s low, poor relationships, people don’t feel part of a stable social network, and where there’s a lot of social mobility and there’s not many friendships or networks at a community or neighbourhood level, this seems to be very important in predisposing some individuals towards varieties of mental distress.  So from my point of view as someone who practices cognitive behavioural therapy, these sorts of early development experiences are key parts in an individual’s developmental trajectories and have an impact on the way the individual sees him or herself and how the individual views the world, in particular other social relationships. So for example, if someone has had, I don’t know, an abusive history let’s say, this can have two consequences. One, some individuals feel that they deserved that kind of experience and can feel subordinate to others and sometimes even seek out abuse relationships later on in life.   It can also lead individuals to have kind of low self-worth and feel that they’re not worthy of other people’s attention and love and so on. So these sorts of self-evaluations as we call them, can persist and be present in someone right throughout their lives and have a direct influence on how they interact with others and the stress that they have and go through later on in life.  So I suppose that’s the first thing that would be in my mind then, would be these developmental experiences that are a crucial part of an individual’s life trajectory and how that influences the individual’s beliefs and thoughts about themselves and their relationship with other people. But of course, people can also experience important life contexts. Life circumstances change over time, people are not necessarily always a prisoner of their past and life events can crop up as well know at any point in your life. So again, the work of Brown and Harris is always a very powerful influence on my thinking.  We know that if you were assessing a client at this current point in time, as well as wanting to know about this developmental history, I’d be very interested to know in the individual whether there’s a stable context for that person, there’s a stable family or partner and if not, whether that’s a difficulty or a problem for the individual and how that may relate to someone experiencing depression or anxiety and so on.  Employment is a very important factor. We know that people in stable employment and stable relationships, these are very strong protective factors against all sorts of mental distress, but of course in different kinds of work context we all experience stress and difficulties and so again, if assessing a client and talking to a client about their situation now, I’d be very interested in how they would be getting on at work and whether they’ve felt in control of events at work and had a sense of autonomy over their work context. Again, that’s been shown to be very important in developing mental health problems later in life or in maintaining them.  So that would be the kind of context that would be important for me in trying to make sense of someone’s mental distress. What’s interesting is that we talked at the beginning about this continuum of mental distress from depression, anxiety and so on, right through to unusual experiences such as hearing voices. What excites me a great deal in the last few years is that the so-called serious mental health problems, the psychoses and manic depression and so on, when I was trained many years ago I was taught that these sorts of disorders happen, as it were, like spontaneous combustion in different parts of a community or a city, independently of one another. They are not subject to influence in other words by the social context. But what we now know is that there is a very important social context of severe mental health problems, for example people who hear voices, which a lot of my work has  been focused on over the years, we know that people who hear voices are not always distressed by those experiences and individuals can have imaginary friends or experiences when they’re very young at age 10 or 11 and so on. These things can be evenly distributed in the population but for some individuals, those experiences, those kind of childhood experiences, can develop into distress and become in the spectrum of what’s called a psychosis because of the same social influences that are brought to bear on that individual.  So those individuals who’ve experienced childhood traumas, social inequalities and particularly where depression can intervene in adolescence, this can set the scene for a metamorphosis of what was innocuous childhood experiences of voice like things into an experience of auditory hallucinations where the individual is subject criticism and adverse comment and where the voices can be really rather derogatory and unpleasant. And these important social and personal factors can influence the development of distressing experiences such as voices and for therapy, well that’s very, very important. 

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