Hodges' model: Is it a virus: or a universal vaccine?

The arrival of 'imposter syndrome' well-over a decade ago(?), from the speaker's podium was an interesting surprise. A case of lived experience, as I'd felt this in trying (and failing) to grapple with the ever-growing, morphing development stack of a software program. Long gone are the days of Sinclair and BBC BASIC. The mountain and learning cliff, was CMS content management system: Drupal. 

What contributed to that feeling back then? Well there was the people I was sat by and sharing time at various European DrupalCons. It was I who was the 'con'. A hobbyist, from pre-PC days. Seeing and hearing what they were creating and the great community. Fascinating also, to see web design fashions come-and-go.

I've written before about Hodges' model being an over-valued idea to me. As a mind-mapping meme it infected me decades ago. Is it a virus? If it is I clearly had no resistance, no immunity. I've always tried to acknowledge, reminded myself that the model is not the be-all-and-end-all.

While the specific mathematical is complex, it is worth trying to grasp some of the intent and meaning (even at the risk of exacerbating imposter reactions). Hestenes provides a paper (and several others):

'ABSTRACT. The discovery of Mathematical Viruses is announced here for the first
time. Such viruses are a serious threat to the general mental health of the mathematical
community. Several viruses inimical to the unity of mathematics are identified, and their
deleterious characteristics are described. A strong dose of geometric algebra and calculus
is the best medicine for both prevention and cure.'

Hestenes, D. (1992). Mathematical Viruses. In: Micali, A., Boudet, R., Helmstetter, J. (eds) Clifford Algebras and their Applications in Mathematical Physics. Fundamental Theories of Physics, vol 47. Springer, Dordrecht. https://doi.org/10.1007/978-94-015-8090-8_1

'The computer virus (CV) owes its name and perhaps its genesis to the biological virus
(BV). Like a BV, a CV cannot function by itself, but when attached to a host it replicates
repeatedly until it impairs the functioning of the host, sometimes to the point of disabling
the host altogether. ...

My purpose here is to call your attention to another kind of virus - one which can
infect the mind - the mind of anyone doing mathematics, from young student to professional
mathematician. As I believe this is the first published paper to explicitly identify
such viruses, I take the liberty of naming and describing them as follows: A mathematical
virus (MV) is a preconception about the structure, function or method of mathematics
which impairs one's ability to do mathematics. Just as a CV is program which impairs the
operating system of a computer, an MV is an idea which impairs the conceptualization of
mathematics in the mind. Indeed, as one definition of "virus," Webster gives "something that
corrupts the mind or soul." Since the identification and classification of MVs has only
just begun, it would be premature to attempt a more precise definition. The better course
is to examine some specific viruses to form a form empirical base for further study.
My first example is an easily recognized MV which is extremely virulent and as common
as the common cold. I call it the coordinate virus, designating it by MV/C to denote genesis
and type, and characterizing it as follows:' pp.1-2. (online copy)

Hestenes' biohistory is an interesting conceptual and interdisciplinary bridge. Another construct to add to our  collection. Is there a virus in the models deployed within medicine and healthcare to date? You know, the bed-round of the medical, biomedical, bio-psycho-social? The round were you don't need to count the number of beds, except in the event of a pandemic. Is the omission of the political, even as the socio-economic reality is now a constant point of reference a symptom of a centuries-long infection? 

For a long time now* the legacies that successive cohorts of students, and newly qualified professionals encounter have stood out. Another question is, just how far back in time do we need to travel to find can the origin of this situation? Was there an initial crisis involving the overt expression of 'power'? Can this be found the as the Hippocratic oath butted up - literally - against triage on the battlefield?

Now: Time won't tell (or will it?). Now that - is some virus.

iii Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

In reading this book and others on W2tQ, I must make the following points:

  * my need to remember the purely USA context (I have never worked there);
  * my healthcare, nursing, informatics experience is NHS-based;
  * this review (and others) is motivated by the project here - Hodges' model;
  * as a result, I will be quoting heavily, there is much to bring to your attention.

As noted in post (i) there is much to whet the appetite, a paradigm shift, 'comprehensive, collaborative, and integrated care' (p.11) certainly have become popular topics in the medical literature. Not only that but 'interpersonal and intersubjective treatment models' too (p.12).

The role of 'Case Managers' is highlighted, plus the Case Management Society of America, which is committed to:

•  Improved Consumer Health Outcomes
•  Professional Diversity, Equity, and Inclusion
•  Cultural Competency and Humility
•  Advocacy for the Health Consumer
•  Integrity and Ethical Principles
•  Promoting Health Equity
•  Educating Case Managers Across the Care Continuum
•  Evidence-based Quality Care
•  Holistic, Compassionate Care
•  Fostering Communication and Collaboration
•  Advancing Research, Innovation, and Use of Technology
•  Fiscal Accountability [ https://cmsa.org/about/ ]

Whether the USA influences global trends in the structure and form of healthcare is another post, but there is a UK Case Management Society too: https://www.cmsuk.org. I can see a fit here [UK] with the development in recent decades on social prescribing. A different role, of course but part of a complex jig-saw.

As expected definitions are provided: 

'Roger Kathol has eloquently defined "health complexity" as "the interference with the achievement of expected or desired health and cost outcomes, due to the interaction of biological, psychological, social and health systems factors when patients are exposed to standard care delivered by their doctors" [1].' p.10. 

Roger G. Kathol, Rachel L. Andrew, Michelle Squire, Peter J. Dehnel (2018) The Integrated Case Management Manual: Value-Based Assistance to Complex Medical and Behavioral Health Patients. 2nd ed. Basel: Springer.

I can see where this definition comes from, but for me, it does not sit right. The problem when there is 'interference' is the assignment of responsibility and consequence that blame can follow. We've seen this, and in mental health too), with the recover model^. Some of the terms here may be completely innocuous politically speaking (which is the author's intent of course), but they can also be 'weighted'. Hence they can become concrete terms of judgement. Think about it: achievement, expected, desired, cost (and) outcomes, standard care, delivered (by doctors)? Or, am I over-thinking again.

In the margin I pencilled/drew:

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Standard -	care
Other -	factors

As ever, the individual patient is our focus. The individual is supported (literally) by the social and political (infra-)structures that act as a scaffold, safety-net for most.

Time flies, I can't believe it was 2007 I posted 

Plush HQ foyer, shame about the mannequins!

I had this notion of life-size cardboard cutouts representing the average people who use a given health service provider (local, or not so local these days?). The data will be there in statistical annual reports. I'd noticed the displays - analogue and digital that greeted visitors at a local NHS Trust HQ. This would be the book's 'routine patients' who receive standard care. 

Chapter 3 introduces 'variables' which again is brief, but imporant as variables recur throughout the book. The 'Clinical Field' is first outlined, as in:

• Sources of clinically relevant factors;
• Dynamic factors;
• and: Variables representing contributions from practitioner(s).

Abstract variables are differentiated from those that are concrete. It's reassuring to read there is no true simplicity within the clinical field, and the author's goal is to 'unpack complexity so it remains as true to life as possible, not just manageable conceptually.' p.18.

Frankel et al. are primed to go beyond this. Maths, as in statistical procedures are one tool. Chapter 4 adds to this with a theoretical model to guide clinical understanding of patients with biopsychosocial complexities, the foundations of our paradigm shift. p.23.

If you have an understanding of Hodges' model you can picture my response to this. But, staying grounded, the whole book and paradigm shift represents a form of scientific "emergence". It is frustrating that literature searches fail to pick out Hodges' model. 

Frustrating too as reading of "awe", also on page 23, I have experienced this many times (over say 1977 - 2019 ...). So, I held on to my dummy (pacifier!?) and read on ...  

Chapter 4 Technical Considerations is one the longest and contributes all of Part III. Here you can read about science, measurement, statistics, empirical, operational definitions, intelligence, reliability. I often see a chapter, book section as a useful primer for students and the same applies here; with inter-judge realiability, validity, control, null hypothesis, statistical methods and much more. Reference to mathematics (axiomatic too) had me hoping for more. I picked out Structural Equation Modelling:

 'We would also like to suggest that following the steps involved in "structural equation modeling" (path analysis) is a good way of conceptualizing and reasoning about complex clinical variables altogether. For example, constructing a clinical model informally (intuitively, loosely from data) and thinking about (diagramming) how the variables involved may moderate and mediate each other can be a useful activity for clarifying the nature and requirements of a complicated clinica1 situation. 
 

 In simplest terms, an independent variable is the causal or influential variable that impacts and effects the dependent variable. A moderating variable is a dichotomy, and refers to two comparison groups (e.g., male/female; passed/fail; religious/nonreligious; tall/short; high versus low socioeconomic status) that display significantly different degrees of magnitude on a correlated relationship. For example, the relationship between a specific treatment for a medical disorder and treatment outcomes may be moderated by socioeconomic differences. The treatment outcome relationship may be stronger and more positive for individuals with elevated socioeconomic standing who therefore have better support systems and access to medical professionals, and fewer economic stressors.' p.36.

I think from this the authors might be sympathetic to giving 'life' to the POLITICAL domain and Hodges' model; after all it lives in people's daily experience - acknowledged or not. The book's structure works thus far: Chapter 5 Nature-Nurture (n.b. no escape!)  and the Epigenome. The structure - flow - works, as at just over four pages, it begs further reading (beyond the listed references). I still have my copy of:

Fritjof Capra and Pier Luigi Luisi (2014) The Systems View of Life - A Unifying Vision. Cambridge: Cambridge University Press.

 

With the epigenome being added to the 'patient complexity equation' in chapter 5, I wondered whether this was predictable, a promise, or a tease?

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

nature?	NATURE?
NURTURE?	nurture?

 

Previously: 'complex' : 'nature' : 'mental health' : 'person(-centred)'

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

Bio-Psycho-Social model: The L-shaped room

Qualification, induction, together with continuing professional development and mandatory training should see all health professionals having due regard for the 'political' in their respective roles. The 'Law and the Nurse' session, used to be, and remains a welcome reminder; also appropriately scary for this time of year. While at work the meaning of 'political' is nuanced with so many aspects and dimensions, e.g.

Public Service

Safety - Statistics - Quality

Zero tolerance - Never events

Leadership

Operating Procedures

Audit - Reports

churn of policy cranked by governments / parliaments

cost - savings - budgets - the plan

pay negotiation - Unions, Professional Organisations

Litigation

Administration Human Resources

Recruitment & Retention 

Disciplinary processes

Planning

Estates - Procurement - Supplies

The organisational tree - communications

structures - providers, commissioners, integrated

News: NHS, private sector, Social Care, Gov. 'Papers'

organisational (footprint) footprint

sustainability, green initiatives

signage - national - local

combined local policy initiatives and national emphasis e.g.

equality, equity, inclusion, 

management of violence abuse in the workplace, bullying, 

managing complaints, confidentiality
changes in reporting incidents, data returns,

information systems, governance and records management)

Is it me, or do the medical model, bio-medical model and the bio-psycho-social model somehow seem lacking?^

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

psycho	bio
social	?

In surgical terms, how is the political domain best realised within a model of health and social care: anastomosis or transplant?

^As seen by a certain lens.

Previously: 'models' : 'bio-psycho-social' : surgery

In 'health' can health itself be treated as aPOLITICAL?

That is, across medicine, nursing, social work, psychology, allied health professionals, public health . . . in theory, practice, management, policy and education ...?

- with all the talk of the biomedical model,

the bio-psycho-social model -

you do do you wonder?

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

INTRA- INTERPERSONAL	SCIENCES
SOCIOLOGY	freedom the science of snowflakes coherence unilateral power POLITICAL

A short & sweet tweet/X for . . .

         ... the challenge of a lifetime ...

    ... for several researchers mathematicians?

Listening to @BBCRadio4's 'The Kitchen Cabinet', reminded of Hodges' model #h2cm as a cabinet, space, place, or repository. A critical cabinet for at least two reasons:
#1. An aide-mémoire
for assessments, plans, interventions (as formulations too), evaluation. #Person 🧵1.

— Peter Jones (@h2cm) March 20, 2025

This thread, also written - copied out beforehand provides the basis for an enlarged post to follow.

Paper: Human social genomics i

Abstract

'The exciting field of human social genomics provides an evolutionarily informed, multilevel framework for understanding how positive and negative social–environmental experiences affect the genome to impact lifelong health, well-being, behavior, and longevity. In this review, we first summarize common patterns of socially influenced changes in the expression of pro-inflammatory and antiviral immune response genes (e.g., the Conserved Transcriptional Response to Adversity), and the multilevel psychological, neural, and cell signaling pathways by which social factors regulate human gene expression. Second, we examine how these effects are moderated by genetic polymorphisms and the specific types of social–environmental experiences that most strongly affect gene expression and health. Third, we identify positive psychosocial experiences and interventions that have been found to impact gene expression. Finally, we discuss promising opportunities for future research on this topic and how health care providers can use this information to improve patient health and well-being.'

Slavich GM, Mengelkoch S, Cole SW. Human social genomics: Concepts, mechanisms, and implications for health. Lifestyle Med. 2023; 4:e75. https://doi.org/10.1002/lim2.75
 

Lifestyle Medicine

For ongoing study of Hodges' model this is an interesting paper, especially in seeking to bridge the humanistic and mechanistic axis, and the social (soft) sciences and (hard) sciences. In trying to view Hodges' model as a mathematical object (categories, objects, relations ..) and extend the bio-psycho-social model (as needed urgently) of medicine (health and social care) the focus of this paper can help us explore the determinants.

It may be possible using Hodges' model, to identity (isolate) some specific ways in which conceptual models are idealised. They can reveal the nature and extent of situations - compositions, formulations and relationships (scope of practice?), but in practice of course we cannot set a situation* in aspic.


This may be important (essential) when we consider the determinants of health globally (across all the domains of Hodges' model).

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

	Genomics
Social Genomics

*Hodges' model is situated.

To revisit ..

Can a whole discipline act as an interface?

Abstract

"In this article, we consider how certain types of contemporary biosocial psychiatric research conceptualise and explicate biology-social relations. We compare the historic biopsychosocial model to recent examples of social defeat research on schizophrenia and cultural neuroscience work on affective disorders. This comparison reveals how the contemporary turn towards the ‘biosocial’ within psychiatric research relies upon ideas of the psychological as an interface. This is problematic because psychological notions of ‘experience’ are used as the central mechanics of biosocial processes, but lack any meaningful engagement with considerable debates within psychology and cognitive science about what the mind, and indeed the psychological, actually is, its relationship to social life, and how we should study it. The psychological interface is therefore vital to these biosocial hypotheses but is remarkably underdeveloped in comparison to its biological and sociological components. We argue that biosocial psychiatric research could gain a great deal from engaging with contemporary theorisations of experience and being more critical of vague appeals to psychological phenomena." p.317. [my emphasis]

Fletcher, J. R., & Birk, R. H. (2022). The conundrum of the psychological interface: On the problems of bridging the biological and the social. History of the Human Sciences, 35(3-4), 317-339. https://doi.org/10.1177/09526951211070503 

Individual
|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

PSYCHOLOGY - as interface? Intrapersonal - Interpersonal Individual psychology	BIOLOGICAL
Group psychology SOCIAL

Does each of the disciplines in Hodges' model act as an interface in certain contexts/situations?

If there is a primary discipline (domain), that determines the context, is this also the interface (interstitial)? Discuss.

If care is integrated, holistic, with parity of esteem demonstrably assured should each discipline have its turn as interface?

My source/prompt:

Preparation for a conference video: 5 ppt slides, Samsung Notes drawing of Hodges' model, 7 slides.

If I can't put this together, it is still worth the effort.

n.b. Bio-Psycho-Social model ... "Outside the Asylum"

In the previous post about Lynne Jones's book 'Outside the Asylum', biopsychosocial model stood out in the index. It is in the text (p.181), but is also apparent from the text I selectively quoted in the blog post.

The argument here on W2tQ, and on twitter @h2cm is that the oft cited 'biopsychosocial model' in the health care literature is insufficient.

This is were I find the SDGs encouraging, despite the typical (and increasingly dangerous) mechanistic slow-turn of COP 'X' outcomes. The SDGs place an emphasis upon the primacy of security.

We need a Bio-Psycho-Socio-POLITICAL model: embedded within the Spiritual.

It is still important to differentiate between use of biopsychosocial in health care and that which Lynne Jones describes and acknowledges. The psycho-social focus, in the importance of self-others, community, being-with, listening, validation, companionship, humanity is clearly explained.

 

If inclusion of the political, (politics, policy, governance, provenance, legitimacy, law ...) proves problematic for people; well that is the point.

 

See also:

Bio-Psycho-Social model ... "Outside the Asylum"

 

Bio-Psycho-Social model ... "Outside the Asylum"

"In Sierra Leone the Krio word for sadness is 'poil-heart'. The literal translation is 'heavy-hearted'. A teenage girl explained it to me.

Outside the Asylum

'Someone who is poil-heart is in a group but she's withdrawn from it, she suffers from something and does not pay attention. If she has a baby she is confused and can neglect the baby. When she or he imagines what happened, she cries all day and cannot sleep or eat. She tries to work but it's no good. When she is at school her concentration is poor.' ...

Families lived in the ruins of their former houses. Life expectancy was less than thirty-five years. Almost every child in the group had lost at least one parent. ...

But none regarded feeling poil-heart, because of those experiences, as an 'illness'. It was a matter for friends or family, whose job it was to 'encourage' you.

The eloquent girl continued her explanation: 'If my friend was poil-heart I would go to her and talk to her to encourage her. If there was a football game I would encourage her to go. If lonely, I would ask her about her problems and exchange ideas. If she told me she could not sleep or was afraid, I would take her to my bed and share it. One would hear the problem, explain it and solve it.'

Nor did they confine themselves to individual solutions. The children were writing a play to educate people about the problems they faced. ... The drama was called All Is Not Lost." p.179-180.

Lynne Jones (2017) Outside the Asylum: A Memoir of War, Disaster and Humanitarian Psychiatry. London: W&N. ISBN 9781474605748. (Book cover image Amazon)

This isn't a review book but was a bargain in Waterstones (£6.99), Gower Street, London. I really wish the rail-strike situation was resolved. Waiting to visit again ... This is a great book too!!

Reference [ii] "Practice in forensic psychiatry: A proposed interdisciplinary model"

Practice in forensic psychiatry:
A proposed interdisciplinary model

Expanding on the post about a further reference for Hodges' model:

Holmes, D. Perron, A. Jacob, J.D. Paradis-Gagné, É. & Gratton, S (2018). Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire. Recherche en soins infirmiers, (Practice in forensic psychiatry: A proposed interdisciplinary model). 134, 33-43. DOI: 10.3917/rsi.134.0033

Here, and on twitter I have sought to stress the limitations of the biopsychosocial model in healthcare, and I value Holmes et al. recognition of Hodges' model as politico-biopsychosocial. 

The authors also identify the structural nature of the model.

 

In comparing 'models of care' there is the question of whether Hodges' model is a model of care. As a generic conceptual framework Hodges' model can of course be used in the health care (as per its original design and creation) but it can be used to compare models of care.

Below, translated by Google are the models used in the paper.

I have altered the listing bringing the Tidal and Recovery model s together. Some I've 'mapped' in pairs, using formatting to indicate the differences.

Tidal Model

"The Tidal Model is a humanistic nursing model of recovery developed by Barker (12) with the premise that the person with mental disorder has strengths, abilities, personal priorities and a future ahead (13). This model of care, popular in forensic psychiatry circles, recognizes certain deficits of the hospitalized patient but it is especially interested in the meaning that the latter attributes to them. The sick person is the expert in his life and is therefore the one who contributes the most to his own recovery. This nursing perspective is therefore centered on the phenomenological experience (lived experience) of the patient and on the role of the staff, which is to allow healing and restore hope (12,14)."  

Recovery Model

"A popular model in mental health care, the recovery model is increasingly gaining ground in psychiatric care settings (28). The postulates of this humanistic model state that anyone, including those suffering from mental disorders, can aspire to a fulfilling future, participate in rewarding and inspiring activities, self-determination and finally, be able to live in an environment free of stigma and discrimination (29). The peculiarity of this model lies in the fact that recovery is part of a process where the person with mental illness can continue to show symptoms while being able to adapt to their condition (often chronic) and pursue their goals. life (30)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

recovery strengths, abilities, personal priorities deficits healing and hope phenomenological - (lived experience) personal responsibility fulfillment - life goals patient as expert personal adaptation living with x,y,z... coping strategies	place as context my future deficits signs - symptoms chronicity Institutional settings clinical - hospital
humanistic - human qualities social expectations social contribution participation - social inclusion free from stigma deficits	Institutional settings politics of recovery free from discrimination forensic deficits

<>

Integrated Practice Model

"This model was developed by Virginia Lynch, a pioneer in forensic psychiatry, and it guides the role of practicing staff in this care setting (15). There are three main theoretical foundations: 1) the fields of expertise involved (nursing, criminal justice and forensic science), 2) the health system (victim and offender, health care and forensic nursing ) and 3) the social impact (social sanction, human behavior, crime and violence) (16). According to this model, patients should be cared for using an interdisciplinary and holistic approach (15)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

nursing forensic psychiatry 2. health system interdisciplinary holistic OFFENDER	nursing theoretical foundations forensic science 1. fields of expertise 2. health system interdisciplinary holistic
VICTIM role of practitioners 2. health system 3. social impact (social sanction, human behavior, crime and violence)	criminal justice 2. health system

<>

Model of Nursing Interaction

"This model of care includes six categories of forensic nursing interaction with the goal of establishing a relationship with the patient: establishing and maintaining a relationship (relationship based on honesty, respect and trust), encouraging and support interactions (help the patient to recognize his qualities and use his resources), the learning of social skills (encourage the patient to do social activities and talk to others), reality orientation (help the patient patient to be aware of his way of being and of acting), reflective interactions (the perception of the patient and his problems) and the learning of practical skills (encouraging the patient to develop good lifestyle habits) ( 17,18)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

patient qualities, resources reflective interaction self-perception of problems reality orientation awareness of way of being and of acting	practical skills develop lifestyle skills
reality orientation learn social skills develop lifestyle skills encourage social activities talk to others	encourage and support interactions reality orientation perception of patient and problems

<>

Healthy Living Program

"This model was developed in response to metabolic syndrome and physical illnesses that may develop in people with severe mental illness (19). It includes programs related to health promotion activities such as weight reduction, smoking cessation, physical exercise, etc. It is a voluntary approach that not only improves physical health, but also independence and recovery. For the program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team."

[ PARITY OF ESTEEM ] 

mental health - metabolic syndrome physical illnesses

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

independence recovery voluntary approach	(physical) health promotion activities such as weight reduction, smoking cessation, physical exercise,
independence recovery	voluntary approach for program to work in the institution and to fit into its organizational culture, the approach must be flexible and systematically maintained by the entire interdisciplinary team

<>

Holistic Model

"This model is used in forensic care in the assessment, health care and psychotherapy of patients with personality disorder (22). Holistic care includes the physical (diet and exercise), cultural, spiritual, and psychosocial needs of the patient. This model is based on problem solving, anger management and decision making. Caring is a central concept in the holistic model and is actualized in an emotional, psychosocial, constant and authentic caring response (23). It is for caregivers to be present for the patient, to respect his situation, to understand his experience and to demonstrate a desire to help."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

holistic care personality disorder [mental] health care psychotherapy assessment emotion problem solving, anger management decision making actualized psycho-	holistic care 'caring' assessment diet, exercise health care 'being present'
-social culture holistic care 'being present' constant and authentic caring understand person's experience respect person's situation desire to help	forensic care holistic care desire to help (also exemplified in the organisation?)

<>

Good Lives Model

"This model focuses on the offense committed by the mentally disordered offender, his recovery, the promotion of personal goals, the reduction of the risk of reoffending, and the treatment of mental illness (24,25, 26). The model favors an approach based on the strengths of the patient. In addition, mechanisms of change are present, that is to say that behaviors judged to be poorly adapted are replaced by adapted behaviors when the patient is equipped with the skills, resources and support provided by the nursing staff. This model contextualizes the offense, focuses on the symptoms of mental illness while conceptualizing both as inappropriate behaviors.This model helps to better understand the relationship between mental illness and crime in order to create an individualized plan of care."

Risk-Need-Responsivity Model

"This model (27) imported from the correctional environment was adapted to the psycho-legal context by the addition of the “mental illness” dimension. It was developed primarily to reduce the risk of recurrence. Care interventions are geared towards the identification and treatment of criminogenic factors. This model is based on three major principles: the risk principle (granting the highest level of resources to the group most at risk of crime), the needs principle (identifying dynamic criminogenic risk factors and targeting them in treatment) and the principle of receptivity (adjusting programs according to the characteristics of the person: learning style, motivation, strengths, etc.) (24,25)."

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

mentally disordered (diagnosis) recovery characteristics of the person learning style (evidence?) motivation, strengths 3. principle of receptivity treatment: skills, resilience personal goals “mental illness” <-> crime recurrence individualized plan of care	1. risk principle -> resource allocation recurrence treatment 2. dynamic criminogenic risk factors  support of nursing staff
treatment [social determinants?] mechanisms of change adapted behaviours inappropriate behaviours recurrence	offense reoffending correctional environment contextualise the offence treatment principles [policy] recurrence

<>

Hodges' Health Career Model

"This model has a politico-biopsychosocial structure which is consistent with contemporary interdisciplinary practice (20); that is, it relies on a multidimensional critical approach, incorporating writings in sociology and politics, in order to understand the person in context. It is based on four objectives: measuring learning, providing holistic care, supporting reflective practice and closing the gap between theory and practice (21). This model is applicable in various clinical situations in a psycho-legal context. When this model is used as a frame of reference, it emphasizes the role of caregivers who must meet the patient's needs and focus on their problems. It also serves as a guide to assess and provide assistance to the patient vis-à-vis their physical, psychological and social needs as well as with the justice system in order to promote their recovery. The theoretical foundations call on four sources of knowledge: interpersonal, scientific, sociological and political (21)."

The PERSON in Context 

(situated)

Individual
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------------ mechanistic

SOCIOLOGY : POLITICAL

|

Group

INTRAPERSONAL INTERPERSONAL reflective practice conceptual structure psychological needs measure of learning psycho-	SCIENTIFIC physical needs theory-practice gap
SOCIOLOGICAL reflective practice (develop self-awareness) social needs practice-theory gap	POLITICAL justice system (needs) -legal

[ all embedded within the SPIRITUAL ]

Not just 'problems' Hodges' model can incorporate any desired stance, perspective or philosophical approach - strengths, disease, skills, weaknesses or deficits, psychosocial for example.

I am not sure about explicitly 'measuring learning, but the model can be used by learners and teaching staff / mentors to demonstrate their understanding and justify their output - formulation.

There is an instrumental potential in Hodges' model as a whole. Hodges' model can illustrate the degree of holistic intent - whether this is realised could also be indicated using the model.

Once again I am grateful to the authors for their inclusion of Hodges' model. The reference is listed in the blog's bibliography (please see the sidebar for others) which includes:

Doyle, M., Jones, P. (2013). Hodges’ Health Career Model and its role and potential application in forensic mental health nursing. Journal of Psychiatric and Mental Health Nursing. 20, 7, 631-640.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2012.01961.x/abstract

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

See also on W2tQ (with overlap):

https://hodges-model.blogspot.com/search?q=forensic

https://hodges-model.blogspot.com/search?q=justice

https://hodges-model.blogspot.com/search?q=interdisciplinary

'New' citation: "Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire."

Practice in forensic psychiatry:
A proposed interdisciplinary model

Checking through emails I missed a notification from ResearchGate about an additional citation for Hodges' model:

Holmes, D. Perron, A. Jacob, J.D. Paradis-Gagné, É. & Gratton, S (2018). Pratique en milieu de psychiatrie légale: proposition d’un modèle interdisciplinaire. Recherche en soins infirmiers, (Practice in forensic psychiatry: A proposed interdisciplinary model). 134, 33-43. DOI: 10.3917/rsi.134.0033

This is very welcome, even though in December 2021, I am 'late to the party'. This it seems is how news of potential additions to the bibliography are bound to arrive, which is a bit frustrating. It would be marvellous to learn of a project much earlier - while the work is 'live'. Not to jump on-board as a co-author necessarily, but to share the dynamism of work-in-process.

I continue to take encouragement from the fact that researchers appear able to find, understand and apply Hodges' model in their respective theoretical, practical and work context.

This is rewarding in itself so many thanks to the authors.

If I can access the English copy I will post again with any observations and comments that arise.

Translated by Google:

"Hodges' Health Career Model

This model has a politico-biopsychosocial structure which is consistent with contemporary interdisciplinary practice (20); that is, it relies on a multidimensional critical approach, incorporating writings in sociology and politics, in order to understand the person in context. It is based on four objectives: measuring learning, providing holistic care, supporting reflective practice and closing the gap between theory and practice (21). This model is applicable in various clinical situations in a psycho-legal context. When this model is used as a frame of reference, it emphasizes the role of caregivers who must meet the patient's needs and focus on their problems.It also serves as a guide to assess and provide assistance to the patient vis-à-vis their physical, psychological and social needs as well as with the justice system in order to promote their recovery. The theoretical foundations call on four sources of knowledge: interpersonal, scientific, sociological and political (21)."

In comparing several models of care please note how the authors here recognise how Hodges' model is not just bio-psycho-social; yes - it is politico-biopsychosocial.

See also on W2tQ (with overlap):

https://hodges-model.blogspot.com/search?q=forensic

https://hodges-model.blogspot.com/search?q=justice

https://hodges-model.blogspot.com/search?q=interdisciplinary

Special issue - International Review of Psychiatry "Conceptual Psychiatry"

   patient / client  PERSON student / practitioner
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------- mechanistic  

SOCIOLOGY : POLITICAL

|

society - group - profession

psycho philosophy, ethics..	bio Einstein's physics, chemistry too!
social	political

 

The bio-psycho-social model is insufficient 

- in care, to care, for care -

in the 21st century.

Hodges' model is a series of conceptual spaces(?). 

In healthcare contexts for all students, what threshold concepts may pertain? ...

'Concepts' here in W2tQ.

International Review of Psychiatry, Volume 33, Issue 5 (2021)

Conceptual Psychiatry; Guest Editor: Awais Aftab

Includes:

Sanneke de Haan (2021) Bio-psycho-social interaction: an enactive perspective, International Review of Psychiatry, 33:5, 471-477, DOI: 10.1080/09540261.2020.1830753

 

My source:

I'm pleased to share the special issue of @IntRevPsych on the theme of "Conceptual Psychiatry." My editorial 👇 provides an overview of the articles in the collection along with some general reflections on current trends & the importance of philosophy /1 https://t.co/GCRSn9jyDb

— Awais Aftab (@awaisaftab) August 11, 2021

There is a marked difference of course in the purpose of this special issue, examining conceptual issues in psychiatry and Hodges' model as a generic conceptual framework for reflection, integrated and person-centred care and critical thinking. I still find the diametrical relationship between the individual and their 'mind' and the political domain with the structures that are invariably found there. The law, mental health legislation, consent, mental capacity, institutions (and in psychiatry the old (asylums) and the new (and how have they changed?) the professions, policy, standards and governance. Then the relationships (social) that define expectations, healthcare and outcomes and how practitioners are socialised and how power is negotiated, expressed and shared (to whatever extent?). 

 

The Pain of Parity of Esteem

"Chronic pain is defined as pain that lasts more than 12 weeks or persists beyond the usual healing time (Treed et al., 2015)."

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

"Functional magnetic resonance imaging studies of the brain have shown that emotional pain stimulates the somatic pain system, and the somatic pain system activates the nuclear accumbens and ventral tegmental areas, which are the seats of emotion and reward pathways (O'Connor et al., 2008). This biological evidence underscores the complex and bidirectional association between physical and emotional pain." (p.14).

12 weeks "the mesocortico-limbic dopaminergic pathway and endogenous opioid system"

 

Majeed MH, Naveed S. Chronic Pain in Youth: Can Mental Health Services Provide Relief?. J Psychosoc Nurs Ment Health Serv. 2018;56(11):13-16. doi:10.3928/02793695-20181012-03

See also:

Morton, J., & O’Reilly, M. (2019). Mental health, big data and research ethics: Parity of esteem in mental health research from a UK perspective. Clinical Ethics, 14(4), 165–172.

https://doi.org/10.1177/1477750919876243
 

RCN: Parity of Esteem – Delivering Physical Health Equality for those with Serious Mental Health Needs

https://www.rcn.org.uk/professional-development/publications/pub-007618

Book: "Rethinking Causality, Complexity and Evidence for the Unique Patient"

Rethinking Causality, Complexity and Evidence for the Unique Patient

Questions arising:

Where would you place whole person care in the model below?

Similarly, what about evidence, complexity,

person-centred care, the unique patient?

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

mind (soul - personhood) subjective (inc. PAIN) quality subject Psychotherapy & others psycho- philosophy Diagnosis: classification DSM.. dispositions, cognition, bias, beliefs mental health PURPOSE(S) 2. -PSYCHO- Intrapersonal Interpersonal (skills) Reflection - Reflexive (individual) psychology

(em-)body (machine) objective (inc. PAIN) quantity object Physiotherapy & others -somatic scientific method Bayesian formula, analgesia biomedical model, treatment Diagnosis: classification ICD SNOMED.. 1. Yes. The BIO- Thresholds, intensity, prediction cause, causality, explanation, reductionism dispositional causality, relation - flow PROCESS(ES) TIME events, clinical 'content', [Sciences(Physics,Chemistry,Biology..)]

(group) psychology relationships, support 3. SOCIAL model sociology (of PAIN, disease) Medical Sociology phenomenological - lived experience PRACTICE CLINICAL ENCOUNTER

political - power - autonomy Where is the individual | within the collective? 4. ... is incomplete (p.83) POLICY CLINICAL ENCOUNTER

See also:

https://hodges-model.blogspot.com/2009/08/combining-h2cm-informing-science-and.html

https://hodges-model.blogspot.com/search/label/4-fold%20care