BIOLOGICAL AND PSYCHOLOGICAL APPROACHES IN MENTAL DISORDERS

Human health can be examined under two separate headings: mental health and physical health. Mental health is at least as important as physical health. It affects an individual's functionality and the flow of social life. Mental illnesses, which arise from the deterioration of mental health, can be defined as "the presence of abnormal deviations in patterns of emotions, thoughts, and behaviors." The branch of science that attempts to describe these abnormal deviations, understand human mental processes and behaviors, and explain them using scientific methods is called Psychology. With the emergence of psychology, phenomena and processes present in human life entered the realm of scientific study, leading to the division of psychology into sub-disciplines such as developmental psychology, social psychology, clinical psychology, and industrial and organizational psychology. Among these sub-disciplines, clinical psychology plays an active role in the treatment process of the mental illnesses defined above.

What is Clinical Psychology? Who is a Clinical Psychologist? What Are the Differences Between a Clinical Psychologist and a Psychiatrist?

The field of clinical psychology focuses on emotional, psychological, physiological, social, and behavioral aspects of the human experience. Individuals who have graduated from a four-year psychology program at a university and have completed a master's degree in clinical psychology receive the title of clinical psychologist. Clinical psychologists are specialists who apply psychological tests, conduct observations, and provide psychotherapy in numerous psychological cases, particularly in cases of adjustment disorders.

Psychiatrists, on the other hand, are medical graduates, meaning they are doctors, who obtain the title of psychiatrist after receiving six years of medical education followed by four years of specialized training in psychiatry. Due to their medical training, psychiatrists have the authority to prescribe and recommend medications, whereas clinical psychologists are authorized to conduct psychotherapy.

Since early times, there have been significant developments in the field of mental health. In ancient times, individuals with mental health problems were ostracized and labeled as "witches" or "possessed by demons" and executed, but today, the causes of mental disorders are being investigated, and efforts are made to treat and heal individuals suffering from these disorders. Previously, individuals had to live under inhumane conditions in facilities like the Bedlam mental asylum, but today, interventions are applied in mental health hospitals and clinics where ethical standards and human rights are observed.

Psychological and Biological Interventions in Mental Health Treatment

Psychotherapies: Psychotherapy is the process of establishing a therapeutic alliance between a therapist and a client, with the aim of understanding the client and helping them feel better. The treatment we refer to in psychology is psychotherapy. As a result of the therapeutic alliance established between the client and the therapist during the psychotherapy process, an improvement in the client's mental health occurs. For this process to be considered psychotherapy, it must be conducted by a qualified specialist and grounded in specific theories. In psychotherapy, the client is neither judged nor criticized. This is one of the fundamental aspects that distinguishes psychotherapy from regular friendship support. The expert conducting the psychotherapy selects a therapeutic school based on the theory that they believe will best benefit the client. Each school has its own theoretical foundation and practical methods within that theoretical framework. The psychotherapeutic approaches with proven effectiveness in mental health therapies are as follows:

Cognitive Behavioral Therapy (CBT): This approach posits that a person's emotions, thoughts, and behaviors are interconnected, and that dysfunctional behavior patterns and inappropriate emotions are generally sustained by dysfunctional cognitive thoughts. The primary goal is to replace dysfunctional thoughts with realistic ones. It is believed that this change in thinking will help the individual evaluate reality correctly and as it is, which in turn will help them develop the ability to control their behavior and emotions. Both the client and the therapist play active roles in the session. Techniques such as stimulus control, systematic exposure, social skills training, and coping techniques are used to show the client that they have the maturity and skills to control themselves and solve their own problems. Today, this is the most widely used approach in clinics.

Note: In no psychotherapy method is the client directly guided. The therapy process is like navigating a ship in a stormy sea. The client is the captain of the ship. The therapist accompanies the client in this journey, helping them realize they have the strength to cope with the waves and ensuring the client does not feel alone.

Psychodynamic Therapy: This therapeutic approach is based on Freud's psychoanalytic theory, who is considered the first psychotherapist, and has evolved over time. It argues that the root of mental disorders lies in negative experiences during early childhood. The first six years of life are considered critical, and it is believed that the traumatic experiences during this period will guide us in adulthood. The technique of free association is actively used. Practitioners believe that every thought flowing through the client's mind is important and has a cause. Psychodynamic therapy generally takes longer than CBT, and within this approach, the therapist is less active compared to CBT therapists. This approach has faced criticism due to its emphasis on sexuality and its focus on the first six years of life. Its effectiveness in treating mental disorders is harder to prove and is generally lower. It is the second most commonly used approach in clinics after CBT.

Other Psychotherapeutic Approaches: There are numerous other psychotherapeutic methods such as dialectical therapy, acceptance and commitment therapy, and existential therapy. In this article, focusing on the two most commonly used approaches (CBT and psychodynamic therapy) is more productive for the flow of the text. Other therapeutic approaches also incorporate elements of CBT and psychodynamic therapy but differ from each other in terms of the methods they use. As mentioned in the note above, the goal in each approach is for the client to develop the skills to solve their own problems and to manage the connection between their emotions, thoughts, and behaviors in a healthy way.

Biological Methods

While it is believed that emotions and thoughts are the basis of mental illnesses and problems, another factor contributing to the emergence of these emotions and thoughts is the human body. Hormones, the brain, chromosomal anomalies... Many biological and physiological factors play a role in the emergence and persistence of mental disorders. For instance, research has shown that a deficiency in norepinephrine, a neurotransmitter responsible for communication between neurons in the nervous system, predisposes a person to depression, while an excess predisposes them to bipolar disorder. Therefore, it has been observed that the causes of mental health disorders can also be biological and physiological, based on biological data such as norepinephrine's role in mood regulation, lithium deficiency in individuals with bipolar disorder, and sensitivity to dopamine receptors in individuals with ADHD. It has also been noted that other neurotransmitters, brain regions, and systems influence or may influence mental health. As a result, pharmacotherapy using antidepressant medications like SSRIs and MAOIs, and psychobiological treatment methods like ECT (Electroconvulsive Therapy) and TMS (Transcranial Magnetic Stimulation) are frequently used, especially in treating conditions such as bipolar disorder, schizophrenia, and depression.

Pharmacotherapy: It is known that imbalances in neurotransmitters such as serotonin, norepinephrine, noradrenaline, and dopamine or sensitivity in receptors related to these neurotransmitters contribute to mental disorders such as anxiety disorders, depression, ADHD, and bipolar disorder and exacerbate the severity of symptoms. The combined use of antidepressants and antipsychotics along with psychotherapy can be highly effective in reducing these effects and helping the patient regain functionality.

ECT and TMS: These techniques involve applying electrical currents to specific regions of the brain to stimulate brain cells and increase activity in certain areas. The electric current is applied in a controlled and ethical manner without harming the patient. ECT and TMS are frequently used in treating depression.

In conclusion, psychology and psychiatry, relatively new fields of science, continue to evolve and uncover new information every day. With biological and psychological interventions applied ethically and with respect to individual rights and consent, efforts are made to treat and heal mental disorders.