"Reality is not always probable, or likely."

-Jorge Luis Borges-

Theory
Following the example of the evolution of generalist social work, conceptions of mental illness have progressed over the years to encompass micro, mezzo, and macro factors that influence mental well-being. The change was not simply one of perception, but a huge philosophical and paradigm shift. The movement involved the integration of postmodern ideas regarding the nature of consciousness into conversations about mental illness. 

Michel Foucualt
Source: Tresnormale.com

Perhaps the biggest influence on postmodern philosophical ideas regarding mental health was Michel Foucault, who published Madness and Civilization: A History of Insanity in the Age of Reason in 1961. Foucault wrote a history of mental illness and treatment from the Middle Ages up until the 1960s. His work was critical of the mental health profession and subjective views of mental illness. Foucault discussed the social stigmas and cultural assumptions that led to labeling people as mentally ill, and also addressed the oppressive power dynamics that influence how non-conformists become labelled mentally ill.

Foucault shattered the illusion that mental illness was simply a biological disorder. Modern psychologists and social workers now approach mental illness in a more holistic way, and many question the institutional and social structures that impose discriminatory practices on people with mental health issues and dehumanize their patients/clients.

The most essential difference between old views like the dichotomy of conformity versus illness, chronic mental illness versus wellness is the current emphasis on the ecological model. The ecological model emphasizes the importance of adapting an individual to their environment and vice versa. Therefore, modern social workers seek to identify and influence the multiple biopsychosocial, intrapersonal, familial, communal, and political systems that contribute to mental health.

Application

At my internship at Mercy Behavioral Health, we use the Assertive Community Treatment model of care in order to provide community-based services for our consumers. The ACT model was developed in the 1970s in order to address the needs of newly released mental patients during the process of deinstitutionalization. The ACT model emphasizes personalized and comprehensive services and integrates ideas about the many aspects of wellness, including spiritual, emotional, and physical health. The Community Treatment Team I intern for is made up of vocational counselors, substance abuses counselors, therapists, nurses, a peer specialist, and psychiatrists who all work together to provide services for our consumers.

Essential to CTT's functioning is the dual value of human relationships and independence. We teach our consumers self-sufficiency, but also encourage them to socialize and build relationships with others. In addition, our therapeutic aim is to raise our consumer's cognitive awareness of self-defeating behaviors and encourage activities oriented towards recovery.

Interestingly, my placement does not discuss diagnoses very often. Instead, we focus on discussing people's symptoms and level of functioning. Therefore, we focus on the person-in-the-moment, rather than imposing the schema and preconceptions associated with the labels associated with mental health diagnoses.