5E Mental Health? Notes on an emerging style of thought.

Abstract

A new style of thought is emerging in debates around psychiatry and mental health, which I term '5E Mental Health.' This goes beyond the well-known and much-criticized 'biopsychosocial' approach, and entails a fundamental challenge to the deeply socially embedded 'psychiatric complex.' It aims to map the biosocial mechanisms through which 'social determinants' give rise to the ailments that have become the province of clinical psychiatry. Those ailments are: embodied: brought forth not just by the brain but by the whole organism; extended: realized by the organism in interaction with the material and interpersonal environment; emplaced: always shaped in relation to a specific milieu and what it affords or disaffords; experienced: made meaningful by and to the individual (and to others) in language, meaning, memory, salience; and enacted: not just passively received but shaping an active agentive way of being with others, a form of life. These are the tractable pathways through which adverse social experiences give rise to those ailments conventionally diagnosed and treated in individual clinical encounters. It is possible and plausible to enact small-scale local changes in forms of life that can act on these pathways. This requires mental health professionals to work collaboratively with architects, planners, local and national policy makers, and, crucially, those who have experience of mental distress and psychiatric services. It thus requires a paradigm shift in the work of psychiatrists, mental health professionals, and policy makers that is as radical and fundamental as that entailed in the closure of the asylums.