How Attribution Theory Helps to Explain Psychiatric Nosology

Abstract

By exposing the assumptions made about dysfunctional behaviors, treatment options can be better understood. Belief in the cause of a disorder determines what is done to alleviate it. By applying attribution theory to psychiatric nosology—categorization of psychiatry dysfunctions—attributional bias of clinicians can be shown. Primarily clinicians are biased to diagnose a patient’s dysfunction as internal, stable and uncontrollable. In reality most dysfunctions are periodic/cyclical and therefore unstable and through behavioral therapy, most are controllable. By changing the attributions, a different meaning of mental illness emerges. Historical evidence illustrates how the attribution of aberrant behaviors has changed which consequently resulted in different theories and treatments. From ‘spirits that invade the body’ of the Middle Ages to the ‘imbalance in the nervous energy’ of the Enlightenment, beliefs dictated how people were treated. From the punitive treatments of the Middle Ages to the ‘Moral Treatment’ of the Enlightenment. With the attribution of biological determinism, a new age of psychopharmacology was ushered in. All these treatment fads rely on different attributions rather than on scientific evidence. With Mad Studies promoting the perspective of the patients who use the mental health care system, the attribution of disease changes again, and a greater emphasis is placed on the external, unstable, and controllable aspects of madness. According to the theory ‘Power Threat Meaning Framework,’ madness is a mental strategy that has become mismatched with its current context. The context determines the expression of dysfunction. Future treatment requires a population-based approach that offers social prescribing, short-term respite programs, and broad community-based cognitive-behavioral therapies. The objective is to focus on alleviating the anxiety and distress experienced by the individual and to aim for personal and functional recovery rather than to aim for a purely clinical recovery.