Psychopathology or the study of mental dysfunctions or disorders is looked at from the points of view of various schools of psychology. Each school has its own understanding of psychological wellness, disease process, treatment, and as well as its own model of psychopathology. Evidence-based studies with regard to the effectiveness of diagnosis and treatment of mental disorders are coming in. At some point in the future, I hope, we will arrive at one effective model of psychopathology that will help accurately diagnose and treat various mental disorders. Currently I am going to describe some of the important models of psychopathology.

Medical Model:

             This model presupposes that there is a chemical cause in the brain for the origin of mental disorders. By blocking or increasing appropriate neurotransmitters by means of drugs chemical balance is restored and the respective mental disorders are brought into remission. The word cure is rarely used in treating mental disorders; the operative word is remission. Persons who arehavingmental disorders often talk about having chemical imbalance – a socially acceptable term – in the brain, and are prescribed psychiatric drugs. Many thousands of mental patients that were kept in huge, secure mental hospitals were released into the community with out-patient clinic services with the advent of powerful psychotropic drugs. Chemical restraints in terms of drugs substituted crude, cruel, and inhuman physical restraints. More humane treatment of mental disorders was instituted. Currently violent, psychotic, and unmanageable patients are sedated. There are tranquilizers that calm and relax patients, and hypnotics that induce sleep. There are problems with medical model as well as medications. Identical twins reared apart may not all develop disorders. There are severe side effects of medications for which further medications will be necessary. Some medications are addictive. Once a patient is on medication, he or she may be on it interminably. Poly-pharmacy (combination of medications to treat a disorder) is not uncommon. The effectiveness of medication in mental disorder is not proven as in physical disease. Psychiatrists can be vulnerable to drug companies that provide very attractive inducements and tempting offers to prescribe their products. It is also important to note that drug companies spend more money on advertisements and commercials than on actual research and development of drugs.

             Psychoanalytic-Psychodynamic Model: The psychoanalytic model had its day; the psycho-sexual stages developed by Sigmund Freud exerted great influence in the field of psychology. The personality is formed at a very early age. The core of personality consists of id (the pleasure-seeking aspect) ego (the reality, executive function), and super-ego (the conscience, the moral-ethical guide). An optimal balance between these three elements constitutes a balanced and healthy personality. Heredity and psychic determinism play an important role. The arrest of development at any particular psycho-sexual stage leads to certain typical mental disorders. Psychoanalysis is the treatment of choice. The ego psychologists extend the psycho-sexual stages into adult life to cover the entire span of one's life. Erik Erickson's eight stages of psychosocial development consisting of Trust versus Mistrust, Autonomy versus Shame, Initiative versus Guilt, Industry versus Inferiority, Identity versus Role Confusion, Intimacy versus Isolation, Generativity versus Stagnation, and Ego Integrity versus Despair are worthy of note. In these stages virtues/challenges such as hope, will, purpose, competence, fidelity, love, care, and wisdom are to be acquired/mastered. Each succeeding stage is built on the preceding stage. And a healthy personality passes through successful completion of all stages to arrive at the goal of wisdom. Challenges not successfully completed lead to problems/disorders in life. Psychodynamic psychotherapy is the treatment of choice.

Cognitive-Behavioral Model:

             This model aims to treat problems concerning emotional, cognitive, and behavioral dysfunctions. It was developed through a merger of behavior therapy with cognitive therapy. Rooted in different theories, combinations of these two treatment approaches find common ground in alleviating symptoms related to dysfunctions such as mood, anxiety, personality, eating, substance abuse, post-traumatic stress disorder, and psychotic disorders. It uses result-driven systematic procedures and brief, direct, and time-limited techniques and applications that can be adapted for individual or group settings. As mental health care is more and more directed by economic considerations as well as effective and evidence-based treatment, cognitive-behavioral model is gaining increasing popularity. This model presupposes that mental dysfunctions or disorders result from faulty learning and erroneous cognitive programming and belief systems. Cognitive behavioral therapies attempt through effective interventions to train clients in correct and healthy thinking and behavior patterns and thus to eliminate inconvenient, painful, destructive, and self-defeating symptoms. Unlike medical model problems are not diseases. Medication is discouraged; when used it is primarily used as chemical restraints for severe symptoms so clients can become amenable for behavioral-cognitive interventions. Elimination of symptoms rather than their cause is focused. The assumption is that once the client achieves the correct cognitive restructuring and relief, elimination of painful and undesirable symptoms, cure or healing takes place. Unlike psychodynamic approach, cognitive-behavioral approach is much less time consuming and lends to quantifiable, evidence-based research.

             Humanistic-Existential Model: This model focuses on the healthy aspects of life; human being essentially has a healthy core; pathological aspects of life are downplayed. Having roots in existentialism and phenomenology, this model advocates a holistic approach to human existence examining one's motivation, search for meaning, value system, freedom to make choices in life, tragic aspects one faces, personal responsibility, human potential, death anxiety, and spirituality. The aim of therapy is to help the client achieve a strong, healthy sense of self culminating in self-actualization. Humanistic-existential model includes several approaches to therapy viewing hierarchy of human needs and motivations, choices and decision-making, tragic aspects of human existence, capacity for self-direction. Eastern philosophy has exerted great influence on humanistic-existential psychology as both are deeply concerned about understanding of human existence and consciousness. Unconditional positive regard and acceptance of others for who they are, genuineness, authenticity, and self-transparence in relationships, and a non-judgmental and non-evaluative attitude are very important in humanistic-existential therapeutic approach. Except in very severe disorders medication is discouraged. Therapist provides a deep empathic understanding of the client, and serves as a mirror in such a way that the client can see his/her own inner self and release blocked potential for growth on account of unique problems in life, and find his/her own direction toward actualization.

Diathesis-Stress Model:

             This model takes into account both genetics and environment, nature and nurture. Diathesis refers to a genetic predisposition toward an abnormal or diseased condition. While genetic factors predispose one for a mental disorder, whether that disorder is going to be expressed in reality would depend on a particular environmental stress as a precipitating factor. So both are necessary for a disorder to take place: hereditary predisposition and environmental stress. This model actually is a catch-all category in that it includes one way or another all other models. It is too general to be of great use. Yet two persons having the same or similar attributes and the environment, one of them manifests a mental disorder, and the other does not. How can we explain this situation except by some kind of predisposition that is not associated with the life stressors? It is also important to note that identical twins reared apart only have a high percent but not 100 percent concordance rate for mental disorders. This strongly suggests some environmental factors or life experiences other than genetic vulnerability at work. Isolating environmental stressors, persons can be protected from them so the hereditary vulnerability may be prevented from being expressed.

             In conclusion, the important models of psychopathology presented above give a handle on the very complicated process of the origin and development of mental disorders. The psychiatrists predominantly follow a bio-chemical model. They study the neuro-chemistry of the brain, the neuro-transmitters, and the cell structure with a view to correcting any chemical imbalance that could result in mental disorders. The chemical imbalance theory certainly diminishes the social stigma attached to mental disorders. It is still a theory that is researched in order to develop the right kind of drugs that can target the problems. While new drugs come into the market, the research is still far away from achieving the right kind of drugs that can treat various diagnoses. The psychological models are also based on theories that have the accuracy only of social sciences. While the cognitive-behavioral model seems to yield empirically better results in that this model is better suited for research. The psychological models comprise various theories and schools of psychologies and psychotherapies. Psychotherapies are methods of learning, re-learning, or unlearning used with emotionally or mentally disordered persons to change their thinking (cognition), feelings (affect), and acts (behavior). Therapist-client relationship or therapeutic alliance is a very important factor in bringing about change in the clients. What works for one client may not work for another. What really works at any given point one may not know for sure. So there is art and science as well as a body of solid psychological knowledge at work. Some important psychotherapies in the western setting include psychoanalysis, psychodynamic psychotherapy, rational-emotive therapy, person-centered therapy, behavior therapy, cognitive therapy, existential psychotherapy, gestalt therapy, and transactional analysis aimed at insight for change. Asian therapeutic methods such as meditation, yoga, Reiki, and Pranic healing are becoming more popular; they aim at awareness and consciousness. Insight and awareness or consciousness convert knowledge into wisdom and eventual change necessary for effective and purposeful coping with stress in life. More systematic work and research need to be done in India in the area of therapeutic modalities. Clinical psychologists in India have not to my knowledge asserted their rightful place in the field of mental health. Many psychiatrists in the USA and India appear to overmedicate their patients. Psychiatrists in India who came into my knowledge appear to be autocrats who do not like to be questioned in connection with legitimate and needed knowledge, and are plenty happy in generously dispensing drugs without even proper diagnosis. While generalization from a few instances is very dangerous, I have no hesitation in saying that at least some psychiatrists in India need to examine their manners in dealing with their patients. They are employees like others who are paid for their services.