Medical Model

10 Key excerpts on "Medical Model"

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  eBook - ePub

  Sociology of Mental Disorder

  • William C. Cockerham(Author)
  • 2016(Publication Date)
  • Routledge

    (Publisher)

  The purely medical approach to mental disorders has unquestionably resulted in positive gains for many patients, especially those on drug therapy, who are now able to lead relatively normal lives outside a mental hospital. Moreover, research in the areas of brain chemistry and behavioral genetics has produced significant findings enhancing our understanding of the causes and treatment of mental disorders. As previously noted, the Medical Model is the dominant approach to treatment. It operates to return abnormal behavior—primarily through drugs—to as normal a state as possible and stabilize the behavior at that point. It does not usually eliminate the cause; it attempts to relieve the symptoms so people can better cope with their life situations. What matters most is altering the brain chemistry of the individual.

  Despite the efficacy of many psychotropic drugs, the Medical Model has several shortcomings. First, the model approaches mental disorders as if they were illnesses, even though most psychiatric conditions cannot be shown to result from a disease. Thus the defining condition is whether the disorder can be treated medically, not whether it has a medical cause. The result, states Allan Horwitz (2002a: 3–4), is that this view locates “the pathological qualities of psychological conditions in the physical properties of brains, not in the symbolic systems of minds.” Yet it is through the distortion of these mental symbolic systems that insanity is expressed. Consequently, treating the symptoms may not necessarily help us to understand the cause—especially if the brain’s biochemical changes are a physiological response to an external cause, not a cause in itself. As the French physician René DuBois (1959) noted many years ago, “While drenching fire with water may help in putting out a blaze, few are the cases in which fire has its origin in a lack of water.”

  Second, the Medical Model focuses almost exclusively on controlling symptoms rather than on cures. Unfortunately, the emphasis on control may retard the emphasis on cure, since the model’s major approach is to use drugs as quick remedies for interpersonal problems. This approach also neglects the social situations that may promote the onset and course of the disorder in the first place.

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  The Heroic Client

  A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy

  • Barry L. Duncan, Scott D. Miller, Jacqueline A. Sparks(Authors)
  • 2011(Publication Date)
  • Jossey-Bass

    (Publisher)

  CHAPTER TWO

  The Myth of the Medical Model

  Dethroning Diagnosis and Best Practice

      The great tragedy of science—the slaying of a beautiful hypothesis by an ugly fact.

    —Thomas Henry Huxley, Presidential Address to the British Association for the Advancement of Science

   

  The Medical Model, emphasizing diagnostic classification and evidence-based practice, has been transplanted wholesale into the field of human problems. Psychotherapy is almost exclusively described, researched, taught, practiced, and regulated in terms of the Medical Model’s assumptions and practices. But how did we get here?

  Psychologist George Albee (2000) suggests that psychology made a Faustian deal with the Medical Model over fifty years ago when it uncritically accepted the call to provide psychiatric services to returning veterans of World War II. The Medical Model was perhaps permanently stamped, however, at the famed Boulder conference in 1949, where psychology’s bible of training was developed, under protest by many, with an acceptance of medical language and the concept of “mental disease.”

  Later, with the passing of freedom of choice legislation guaranteeing parity with psychiatrists, psychologists learned to treat clients in private offices and collect from third-party payers requiring only a psychiatric diagnosis for reimbursement. The other mental health professions soon followed suit—all vying to get a slice of the pie, not thinking about the long-term consequences of a high-fat, highcarbohydrate diet. Soon thereafter, in the mid-1980s, the rising tide of the Medical Model reached dangerous levels of influence. Drowning any possibilities for other ways of understanding human challenges, the National Institute of Mental Health (NIMH), the leading source of research funding for psychotherapy, decided to apply the same methodology used in drug research to evaluate psychotherapy—the randomized clinical trial (RCT).

  Adopting the RCT for evaluating psychotherapy had profound ramifications. It meant that a study must include manualized therapies (to approximate drug protocols) and DSM

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  Beyond the Disease Model of Mental Disorders

  • Donald Kiesler(Author)
  • 1999(Publication Date)
  • Praeger

    (Publisher)

  The bioMedical Model places an exclusive priority on distal biological causes of mental disorder. It is this biological distal-cause bias that so vividly separates the bioMedical Model from other perspectives on psychopathology. The implication seems to be that only organic, biological distal causes can be responsible for an organic immediate cause (e.g., the final com- mon pathway). This notion, however, is contradicted by a recent large scale task force that reviewed the available evidence regarding psycho- logical stressors and mental disorders (American Psychological Society, 1996). The task force concluded that extensive research on both animals and humans has demonstrated that repeated exposure to stressful psy- chological experiences can result in persisting changes in brain struc- ture and biochemistry. Psychological, environmental, and sociocultural factors thus can directly produce abnormal brain biology. THE BIOMedical Model: CRITIQUE TWO Another logical inadequacy of the bioMedical Model has been docu- mented. Essentially the counterargument is that mental disorders do not satisfy the conditions necessary for defining a biological disorder. Heinrichs examined in detail the three central conditions of the bio- Medical Model that need to be satisfied before one can identify a men- tal disorder as a biologically based brain disease. (1) A particular mental disorder must have a set of symptoms that cohere as a clinical entity, an entity that is distinct from other disorders. (2) A disorder must be linked, through empirical research, with nervous system dysfunction— it must have evidence of a clearly discovered biological abnormality.

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  Understanding Abnormal Behavior

  • David Sue, Derald Wing Sue, Stanley Sue, Diane Sue, David Sue, Derald Wing Sue, Diane Sue, Stanley Sue(Authors)
  • 2020(Publication Date)
  • Cengage Learning EMEA

    (Publisher)

  Although biological models have traditionally focused only on biological explanations, this has changed in recent years. For example, most researchers now reject the simple linear explanation of genetic determinism; they no longer claim that mental disorders result primarily from “bad genes” or that there is “one gene for one disease” (Rucker & McGuffin, 2010). The majority of biological research comes from physicians and researchers whose worldview strongly supports the Medical Model and the use of medication to treat mental disorders. This is a particular concern given the rapid growth in the sale and marketing of psychotropic medications and the frequent use of these medications without first conducting a careful mental health evaluation (Smith, 2012). There is also little discussion of where psychotherapy fits into treatment planning and when to consider medication in the course of comprehensive treatment. Prescribing multiple medications has also become common, increasing the importance of watching for side effects and possible drug-drug interactions . Another concern is the limited focus on ethnic or gender group differences in physiological response to medication. There is clearly a need for more discussion about how mental health professionals, health care providers, and clients can effectively collaborate in monitoring the effectiveness of medications and other biological interventions; however, it is equally important that all involved consider psychological factors that may be influencing symptoms and treatment outcome. Dimension Two: Psychological Factors A number of psychological factors contribute to the etiology of mental disorders. The psychological dimension focuses on emotions, conflicts in the mind, learned behavior, and cognitions. Interestingly, psychological explanations of abnormal behavior vary considerably depending on the underlying theory.

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  A Prescription for Psychiatry

  Why We Need a Whole New Approach to Mental Health and Wellbeing

  • P. Kinderman(Author)
  • 2014(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  I strongly orientate to the third model in practice, but have a lot of sympathy with Bracken’s approach in terms of ethos and framework of understanding. Rather unexpectedly, I also think that Craddock’s approach has merit. In my clinical experience, I have frequently been disappointed at the medical care offered to clients. I am unconvinced that clients are offered the physical healthcare that they need and which is particularly important for people who are both often poor and taking powerful medication. In particular, I think it would be ideal if all clients were able to consult with an expert psychiatrist who was able to understand and explain the mode of action of the medication and its potential risks. I do not always find this expertise in practice. I agree with Nick Craddock that expert medical input should be part of every mental health team. What I do not agree with is that this expertise renders a medical colleague the natural leader of a clinical team, or that a medical perspective is a natural guiding ethos for the service. I therefore conclude that none of these models fully addresses the depth of psychiatry’s malaise, and none has a fully-developed solution.

  A psychological ethos and model

  We need to develop and implement a new approach to understanding mental health problems. As I outlined in ‘New Laws of Psychology’,37 a psychological approach offers a coherent alternative. Our social circumstances, and our biology, influence our emotions, thoughts and behaviours – our mental health – through their effects on psychological processes. This psychological model of mental health and well-being proposes that our biology and our life circumstances both exert their influence through their effect on psychological processes. Of course, all mental health problems involve the brain, for the simple reason that all thoughts we ever have involve the neurological functioning of the brain. But that’s not an explanation, merely a more detailed description (it’s like explaining warfare in terms of muscular contractions in the fingers on the triggers). In statistical terms, variance in neurological processes seems to account for very little in terms of mental health – or indeed human behaviour in general. Most of the variability in people’s problems appears to be explicable in terms of their experience rather than genetic or neurological malfunctions. Neurotransmitters such as serotonin and dopamine are associated with a variety of emotional problems. That’s hugely unsurprising; reward mechanisms involve serotonin and dopamine ...  but that’s true for everyone.

  Since the 1950s psychologists (and psychiatrists who understand cognitive psychology) have developed sophisticated and practically useful models of how people understand the world. In straightforward terms, people are born as natural learning engines, with highly complex but very receptive brains, ready to understand and then engage with the world. As a consequence of the events we experience in life, we develop mental models of the world, including the social world. We then use these mental models to guide our thoughts, emotions and behaviours.

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  Personality Theories

  Critical Perspectives

  • Albert Ellis, Mike Abrams, Lidia Abrams(Authors)
  • 2008(Publication Date)
  • SAGE Publications, Inc

    (Publisher)

  In addition to the subjectivity involved in his measurements, Sheldon failed to use basic caution in using correlative data. That is, the correlation of two factors does not by itself demonstrate a cause-and-effect relationship. In the case of body type and personality, social factors may be more powerful forces in shaping personality than linked genes. For example, a person with a large symmetrical muscular body may be treated with greater deference, receive more attention from parents and teachers, and be held to higher expectations. Similarly, an undernourished person reared in a socially deprived setting will tend to be both slender and introverted. Thus, social and environmental factors may contribute as much as genetic factors to systematic differences between body type and character. Although body type may appear on superficial examination to be directly linked to personality or character, in actuality, other unmeasured variables are usually in play.

  CHALLENGES TO THE Medical Model

  Thomas Szasz (1920–), a Hungarian-born psychiatrist, has become psychiatry’s best-known and most enduring adversary. Few would argue that the abandonment of demonology has been beneficial to those with mental disorders, but there are some who argue against the medicalization of mental disorders. Szasz has been the most prolific writer and polemicist of this school.

  Image 7.5 Thomas Szasz (1920– )

  SOURCE: Schaler.

  The Medical Model of illness in general maintains that there are identifiable diseases and disorders, all of which have causes, courses, and outcomes. These diseases are presumed to be caused by some organic pathology such as an infection, a traumatic injury, a biochemical imbalance, or a genetic mutation. As applied to psychiatry, the Medical Model holds that most or all mental illnesses are diseases and should be treated accordingly. In part, the Medical Model is the legacy of people like Pinel and Griesinger, who endeavored to make the practice of psychiatry more scientific.

  In Szasz’s (1960) book, The Myth of Mental Illness, he charges that this effort far exceeds any legitimate foundation in science. He points out that virtually none of the common psychiatric diagnoses can be directly linked to lesions or pathology of the nervous system. He likens the collective use of the term mental illness

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  Psychotherapy

  Theory, Practice, Modern and Postmodern Influences

  • Laurence Simon(Author)
  • 1994(Publication Date)
  • Praeger

    (Publisher)

  The Medical Model, rooted in the emerging scientific methods and increasingly successful in diagnosing and treating problems in human anatomy and physiology, was now employed to explain and control deviant individual paradigms. The religious rituals and torture employed by the church to save souls were replaced by the "talking cure" of psychoanalysis and with the chemical and physical therapies of a new field of medicine. THE MYTH OF MENTAL ILLNESS The creation and revolution of a new paradigm were thus accomplished. The new paradigm, however, was built upon a myth. Mental illness and psychotherapy were the words to describe and replace sin and exorcism (Szasz 1974). However, these new words are as flawed and unscientific as those they replaced. Although the new methods were quite different from the old, they were as often as cruel and invasive. The use of psychosurgery and insulin-induced seizures represents a moral low point in dealing with human beings who have problems in living. A flawed paradigm based on the supernatural was replaced by another flawed paradigm in which moral values were confused with scientific, nonevaluative description and in which psychologically meaningful behavior was confused with the neurological and biochemical factors from which behavior is organized. Let me briefly describe why mental illness must be a myth and why searching for it is likened by Sarbin and Mancuso to the search for the unicorn. As stated Psycho "therapy" and the Medical Model 15 earlier, behavior can be either described or judged. Deviancy can be defined statistically or be evaluated in such a way as to define it as good or bad, acceptable or unacceptable. How people are supposed to live, suggest Perry London (1986) and Laurence Kohlberg (1984), can only be demanded and expressed by the use of the word should. Unacceptable thoughts and behavior are those that should not be. Judgments specifically concerning human behavior are moral in nature.

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  A Handbook for the Study of Mental Health

  Social Contexts, Theories, and Systems

  • Teresa L. Scheid, Eric R. Wright(Authors)
  • 2017(Publication Date)
  • Cambridge University Press

    (Publisher)

  On a political level, medicalization can distract from the social origins of stress, and by extension, warp potential policy solutions by redefining these problems as individual in nature. This might lead to missed opportunities for social reform. For example, if ADHD was defined, not as a genetic or neurological problem, but as a reaction to the inadequacy of the organization of classrooms, policy makers might put energy and resources into ensuring a better educational environment for students to learn in. This is not to suggest that the biomedical understanding of ADHD is necessarily wrong, but rather to point out that definitions matter, as they constrain and shape proposed solutions and interventions that follow. The bioMedical Model encourages intervention at the level of the individual, when social and economic policies may better address the root of distress. By systematically ignoring and eliding social factors, the bioMedical Model of mental distress runs the risk of misallocating resources, mislabeling normal reactions as pathological, and distracting policy discussions from targeting the social causes of such distress. Diagnostic Practices Whereas medicalization research focuses on how diagnostic categories are con-structed and the politics involved therein, increasingly sociological research is turn-ing its attention to how the DSM is actually used in practice. Statistical analyses of mental health practice reveal significant changes in psychiatric practice over the past two decades. Psychotherapy has declined precipitously, as psychiatrists focus on more lucrative medication management. The percentage of visits to psychiatrists involving psychotherapy declined from 44.4 percent in 1996–1997 to 28.9 percent in 2005–2006 and only 11 percent of psychiatrists provide psychotherapy to every patient (Mojtabai & Olfson, 2008 ). From these data one can infer that psychiatry has embraced the bioMedical Model promoted by the DSM.

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  The Sedated Society

  The Causes and Harms of our Psychiatric Drug Epidemic

  • James Davies(Author)
  • 2017(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  Sadly, many psychologists themselves use diagnostic labels and do not ques- tion the ‘disease model’ or the widespread use of psychiatric medication. Equally, many psychiatrists reject these views. Historically, psychiatrists including R.D. Laing, Jacques Lacan and the celebrity anti-psychiatrist Thomas Szasz all rejected the biomedical, diagnose–treat, model of psy- chiatry. More recently, as mentioned above, 29 eminent psychiatrists recently co-authored a paper entitled ‘Psychiatry beyond the current par- adigm’ (Bracken et al., 2012) arguing that ‘…psychiatry needs to move beyond the dominance of the current, technological, paradigm…’. Over the past few years, we have seen three very different visions for the future of psychiatry—from within the profession. Professor Nick Craddock, in an editorial in the British Journal of Psychiatry, argued that psychiatry needs to re-establish itself as a branch of medicine, re-establish mental ill-health as a medical concept, re-establish the biological and neurological basis of ‘real’ mental illness and re-establish the authority and status of the psychiatric, medical consultant (Craddock et al., 2008). Professor Craddock and colleagues suggested that much of the day-to-day business of psychiatry is normal human emotional response to difficult social circumstances. I would agree. But this group further suggested that this social distress should be separated from ‘genuine’ mental illnesses— leaving the profession of psychiatry to have appropriate authority over a mental healthcare service predicated on the disease model. In contrast, Professor Pat Bracken, another psychiatrist, and a large number of col- leagues, again writing in an editorial in the British Journal of Psychiatry, argued almost exactly the opposite.

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  Critical Psychiatry

  The Limits of Madness

  • D. Double(Author)
  • 2006(Publication Date)
  • Palgrave Macmillan

    (Publisher)

  Variations on this are known as the 'vulnerability-stress' or the 'stress-diathesis' or the 'biopsychosocial' model (Zubin & Spring, 1977) and are subscribed to by most researchers and clinicians today. These will be discussed below. It is important to be clear what might be implied by these terms. In one sense, such hybrid models are obviously true, hence their plausibility. Genes, like neurotransmitters, are involved in some way and at some level in everything we think, feel or do; we could not think without having inherited a brain to think with, nor could we act without having inherited bodies to carry out our actions. Similarly, it is only commonsense to agree that almost every condition that humans can experience is an end result of biological, psychological and social factors. You could equally well argue The Limits of BioMedical Models of Distress 95 that such a model 'explains' why someone enjoys music, rides a bicycle, and drinks tea. However, as with the equivalent biochemical theories, this actually tells us nothing at all. What needs to be established by supporters of this watered-down version of the bioMedical Model is that genes or biology make a significant primary causal contribution, such that it makes sense to describe mental distress as an 'illness'. As we have seen, evidence for the 'vulnerability' or the 'bio' bit of the model, that is, the bit that involves the identification of a biological malfunction or associated genes, is entirely lacking. As far as we know, the models are only true in the very weak sense outlined above, but to assert this is, in scientific terms, virtually meaningless. Meaningless; but not purposeless -under the guise of open-mindedness and commonsense, psychiatrists have been able to perpetuate the assumption that biological processes are the most important explanatory factors, in the face of increasing evidence for environmental ones.

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