Iva Paska, PhD

Are we witnessing the emergence of a new paradigm? – Mad in America

JThe prevailing mental health system today still operates, to a large extent, on an old paradigm. This paradigm reduces mental health problems to supposedly dysfunctional characteristics inherent in an organism.

It is, however, a particular way of thinking about things.

In this way of thinking, mental distress is seen as static – a predetermined category fixed in time and space, and usually, a body.

Close-up photo of the Shift button on a computer keyboard, but it's labeled Knowing things does not happen in a vacuum. It is usually embedded in a set of preconceived notions we have about things. There is a construction of knowledge that operates behind our way of thinking about mental health phenomena.

Thomas Kuhn explained in his book The structure of scientific revolutions, how the currently dominant assumptions we have about the world guide thinking within scientific communities. Scientific discoveries operate in what he calls paradigms.

Paradigms are widely accepted patterns within science that provide a framework of fundamental assumptions that guide and shape research and theory, as well as practical scientific discovery. Scientific research takes place within this framework and is interpreted within it. Solutions to common problems can be found within this framework.

It also has an impact on how we see things outside of scientific communities. Namely, the knowledge thus constituted is then transferred into what we regard as “common knowledge” and take for granted in our daily lives.

The same goes for mental health phenomena.

The paradigm that currently prevails in the field of mental health is a biomedical paradigm. It considers mental health problems as categories of dysfunctions, originating from (inherent) characteristics of the organism and which must be treated as such.

“The chemicals in his brain are messed up,” is ubiquitous in public discourse, referring to supposed biological causation in mental health, but sufficient evidence for this has not been found. Gabor Maté, for example, has been speaking out against this idea for years.

The question is also whether this approach has proven to be the most effective in dealing with long-term mental distress.

Unlike the biomedical paradigm, the phenomenological paradigm shows that when we categorize mental distress and use it prescriptively, we risk losing sight of that person’s unique existence. Things that interfere with healing can be lost. Also, the larger meaning of the process can be ignored.

For example, when a person experiences low levels of energy and motivation, loss of interest and pleasure, or fatigue, these are considered symptoms in the category of depression.

In the mainstream biomedical system, these are seen as tied to a person’s biology – fixed and predetermined.

However, when this type of state is explored in the larger context of a person’s life, elements of a subjective sense of loss or a situation felt to be unbearable, deep down, are usually found. Perhaps the person was not able to reverse this situation.

When we look at mental distress from this angle, the loss of motivation and lack of energy can also be a way for the body to escape from a situation that it no longer knows how to manage. The subconscious seeks to protect itself, and if it has exhausted all “rational” options, it may resort to other means.

It is a very different perspective from the position that sees this state as a dysfunction, an inherent characteristic of a frozen organism.

Thomas Kuhn proposed that, within the dominant scientific paradigm, anomalies occur that the dominant paradigm cannot satisfactorily address. New theories are then needed to explain them. This causes a paradigm shift.

That may be what is happening in the mental health field right now.

More and more people find insufficient the perspective that considers mental distress as an isolated and static category, fixed in a biological predisposition or dysfunction. They see it as something that does not satisfactorily explain their experience or solve their problems.

They are looking for alternative solutions and different approaches to mental distress that offer more possibilities.

There are authors, therapists, researchers, who work beyond the current model, many of whom are present on this site. They are scattered all over the world, but I can see the dots connecting, often coming from the most unexpected places and spheres.

I wonder if these phenomena I observe are clues to a new emerging paradigm.

It is difficult to describe this new emerging paradigm under one umbrella, as there are various approaches that could fall under it.

However, some of its “umbrella outlines” can be noticed:

1.) The new paradigm tends to view mental distress as a source of meaning rather than just a deficit or dysfunction. There may be value in the process of mental distress.

As Carl Jung noted, our suffering comes from the unseen, unfelt parts of our psyche. Therefore, it cannot be reduced to a set of static biological determinants or categories. Instead, we should look for the meaning of the symptoms. What are they trying to convey?

2.) Psychological distress is examined in its environmental context.
Intense emotional states are conceptualized as a complex response to environmental trauma rather than inherent dysfunction in the organism. They are divided into smaller parts of reactive physiological-emotional-behavioral responses that could lead to a vicious circle of suffering, resembling a “mass” that is difficult to understand and unravel.

However, instead of seeing it in terms of a static category, new approaches place greater emphasis on understanding how the complex webs of these responses work with context perception to create mental distress. They focus on locating possibilities within this “mass” for a person to experience a new orientation.

3.) Additionally, there is a growing understanding that the larger social context we live in could also be linked to trauma.

We live in societal systems full of structural violence, such as the marginalization of certain social groups due to some of their characteristics. This type of violence, rooted in social structures, is transmitted from generation to generation. Discrimination based on gender, race or other characteristics is often deeply embedded in our daily lives.

We are only beginning to understand how this can affect health. There is, for example, research that shows how racism is associated with poor mental health. The same goes for discrimination against other social groups. Being continually exposed to environments that devalue one’s agency cannot have a positive impact on one’s mental health.

We are beginning to understand this at a societal level. It is becoming increasingly clear that mental distress is linked to its larger social context and to the complex situations that are often linked to these contexts.

4.) There is a growing demand for equality in the new paradigm. This can be seen in the context of the broader trends that have occurred around the world over the past two decades; a move away from hierarchical structures and a demand for more horizontal approaches within various social domains.

For example, we can notice this trend in the field of politics where citizens are increasingly demanding to be included in the decision-making process. A similar movement can be observed in the field of mental health.

These are some of the underlying principles that I believe connect different approaches that have developed over the past two decades and that could be interpreted as possible outlines of the emerging new paradigm.

We must, of course, be aware that paradigms change slowly.

Their “ways” are usually deeply embedded in our everyday knowledge and this is one of the reasons why this change can take some time. This is why public discourse still often operates on the premises of the old paradigm.

The main question today is how we can help the emergence of a new paradigm in practice.

How to raise awareness of new directions and approaches that work on the above principles? How to integrate the outlines mentioned above into concrete mental health support practices?

For example, how can open dialogue practices, as well as practices operating on similar principles, be transferred from the local contexts where they were established to other social contexts?

How to make them accessible to a wider audience?

If we see a new paradigm emerging, and I hope it does, we must ask ourselves today: what can we do to foster its emergence?


Mad in America hosts the blogs of a diverse group of writers. These posts are designed to serve as a public forum for discussion – broadly defined – about psychiatry and its treatments. The opinions expressed are those of the authors.

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