Chapter 2: Theoretical Perspectives

Raskin explores the major theoretical frameworks used to explain and treat mental distress, highlighting biological, psychological, and sociocultural perspectives. Through case studies of Seth and Lillian, the chapter demonstrates how different approaches interpret the same problems in radically different ways. Biological perspectives emphasize brain chemistry, brain structures, genetics, evolutionary theory, and the immune system, showing how neurotransmitters such as serotonin, dopamine, norepinephrine, GABA, and glutamate influence mood, memory, and behavior, while brain circuits like the HPA axis are linked to stress, depression, and PTSD. Genetic perspectives explain heritability and polygenic influences, while evolutionary views suggest that phobias, depression, and obsessive rituals may once have been adaptive. Immune system perspectives trace mental distress to viral, bacterial, or autoimmune factors, as in the case of general paresis caused by syphilis. Psychological perspectives highlight psychodynamic, behavioral, cognitive, and humanistic approaches. Freud’s psychoanalysis introduces the unconscious, defense mechanisms, and psychosexual stages, later expanded into object relations therapy, time-limited dynamic psychotherapy, and the role of transference and countertransference. Behavioral theories from Pavlov, Watson, and Skinner focus on classical and operant conditioning, while Bandura’s social learning theory emphasizes modeling. Cognitive perspectives, led by Aaron Beck and Albert Ellis, identify dysfunctional thought patterns, schemas, and cognitive distortions, with therapies like CBT and REBT using restructuring and the ABCDE model to challenge irrational beliefs. Humanistic and existential theorists such as Carl Rogers and Abraham Maslow stress self-actualization, free will, and authenticity, with person-centered therapy providing empathy, unconditional positive regard, and genuineness, while constructivist and narrative therapies help clients revise unhelpful personal stories. Sociocultural perspectives widen the lens to culture, oppression, and systemic factors. Multicultural and social justice perspectives argue that many so-called disorders are culturally bound or rooted in inequality, while feminist therapy reframes “the personal as political.” Service user and psychiatric survivor movements critique coercive treatments, and family systems theories by Minuchin and Bowen show how dysfunction emerges from enmeshed boundaries, coalitions, triangulation, and multigenerational transmission. The chapter closes by weighing the strengths and weaknesses of each approach—biological reductionism, psychodynamic determinism, cognitive rationalism, humanistic idealism, and sociocultural politicization—while urging an integrative stance that respects their contradictions. By the end, students see how these diverse perspectives, though in conflict, provide essential tools for understanding and addressing psychopathology and mental distress.