Medical model
Encyclopedia
Medical model is the term cited by psychiatrist
Ronald D. Laing
in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment. Sociologist Erving Goffman
, in his Asylums
, favorably compared the medical model, which was a post-Industrial Revolution
occurrence, with the conduct in the tinkering trades (watch, radio, TV repair). The medical model is an approach to pathology
that aims to find medical treatments for diagnosed symptom
s and syndrome
s and treats the human body as a very complex mechanism (hence, Goffman's tinkering trade analogy).
Among critics of medical psychiatry
, Laing observed that because the diagnosis of a mental illness was based on conduct or patient behavior and not on physical pathology
, such a "diagnosis" essentially contravened standard medical procedure and hence the medical model: physical examination and ancillary tests were conducted, if at all, only after the diagnosis was made. Whereas heart diseases, cancers, and broken bones were diagnosed by evident physical pathology discovered during examination and ancillary tests, a mental illness was diagnosed by examining the patient's behavior (paranoid delusions, catatonia, hypermania, etc.) instead of the patient's body tissues
(e.g. dermatitis
).
The medical model drives research and theorizing about physical or psychological difficulties on a basis of causation and remediation.
It can be contrasted with the holistic model
of the alternative health
movement and the social model
of the disability rights movement
, as well as to biopsychosocial and recovery model
s of mental disorders.
There is no one agreed-upon definition of the medical model (MM). Nevertheless, a basic general definition of the MM in psychiatry might go like this: “The MM is psychiatry views mental illness as a disease or disease-like condition that can and should be treated through somatic (physical) means, by medical personnel, primarily physicians (that is, psychiatrists)”.
The MM attributes mental illness behavior to physiological, biochemical, and/or genetic causes and attempts to treat it primarily through physically based (somatic) procedures particularly drugs. The mentally ill person within the MM is regarded in the same manner as anyone with a physical illness. Psychiatric conditions, such as schizophrenia and the affective (mood) disorders, are viewed as similar to physical diseases such as diabetes, epilepsy, and high blood pressure. The primary treatment providers for individuals suffering from mental illness, according to the MM, should be physicians (primarily psychiatrists), although other treatment personnel (such as nurses, psychologists, and social workers) may also be involved in treating the mentally ill person, although in a lesser position of importance. According to the MM, the psychiatrist should be the primary decision maker, the overall coordinator of care, and is the one who should take primary responsibility for treatment of “the patient”.
The rise of modern scientific medicine during the 19th century has a great impact on the development of the medical model (MM). Especially important here was the development of the “germ theory” of disease by European medical researchers such as Louis Pasteur and Robert Koch. During the late 19th and early 20th centuries, the physical causes of a variety of diseases were uncovered, which in turn, led to the development of effective forms of treatment. While much of these medical successes were in the area of physical illness, advances also occurred in the area of “mental” illness as well. For example, in the late 19th century, approximately 20% of all persons hospitalized in mental institutions were actually suffering from a physical disease -- “general paresis” (advanced syphilis of the brain) – caused by microorganisms called “spirochetes”. As more effective treatments for general paresis began to be developed as a result of this discovery, the rates of mental hospitalization due to the disease greatly decreased. If bacteria caused syphilitic mental illness, many researchers of the time reasoned, maybe a “germ” also was responsible for other forms of mental illness, such as schizophrenia (which was termed “dementia praecox” at the time). Interest in the MM decreased in psychiatry, however, during the 1st half of the 20th century due to a lack of medical advances in treating mental illness. During this time, medical approaches to mental illness were abandoned and psychoanalysis became a major influence in psychiatry in the U.S. Beginning in the 1950s and 60s, however, the development of effective medications in the treatment of some mental illnesses (such as schizophrenia and depression) sparked renewed interest in the MM. Today the MM is the predominant way of thinking about mental illness among psychiatrists as well as many other mental health professionals.
The Concept of “Disease” in the Medical Model
The concept of “disease” is central to the MM, both in psychiatry and in physical medicine. In general, “disease” refers to some deviation from normal body functioning that has undesirable consequences for the affected individual. An important aspect of the MM is that it regards disease signs (objective indicators such as an elevated temperature) and symptoms (subjective feelings of distress expressed by the patient) as indicative of an underlying physical abnormality (pathology) within the individual. According the MM, medical treatment, wherever possible, should be directed at the underlying pathology in an attempt to correct the abnormality and cure the disease. In regard to many mental illnesses, for example, the view is that the cause of the disorder lies in abnormalities within the affected individual’s brain (specially their brain neurochemistry). According to the MM, treatment (such as drugs), to be effective, should be directed as closely as possible at correcting this presumed chemical imbalance in the mentally ill person’s brain. Psychotherapy, according to advocates of the MM, cannot be truly effective because the “real” cause of the mentally ill individual’s problems is physiological, not psychological.
The Importance of Diagnosis
Proper diagnosis (that is, the categorization of illness signs and symptoms into meaning disease groupings) is essential to the MM. Ideally, according to the MM, by placing the patient’s signs and symptoms into the correct diagnostic category the physician’s ability to successfully help the patient is greatly increased. This is because, according to MM proponents, accurate diagnosis can:
1. provide the physician with clinically useful information about the course of the illness over time (it’s prognosis);
2. point to (or at least suggest) a specific underlying cause or causes for the disorder; and
3. direct the physician to specific treatment or treatments for the condition.
Consider the illness, strep throat, as an example. You begin to experience a number of unpleasant physical symptoms -- tiredness, throat pain, muscle aches, etc. You decide to go to your doctor – she talks with you, gets a medical history, and does a physical exam. She notes that your throat is red, your lymph nodes are swollen, and that you have an elevated temperature. Based on her clinical experience with cases like yours (and because of the clinical work and research of other physicians and medical researchers), she has the ability to hypothesize that all of your physical problems and complaints are due to one underlying cause, a disease – a strep infection. To confirm her hypothesis, she tests for the presence of strep bacteria through the use of a “throat culture”. If the test is positive, she can confidently make the diagnosis of strep throat. This diagnosis allows her to predict prognosis, it indicates the cause of the condition (strep bacteria), and it suggests a specific treatment (antibiotics). If her diagnosis of strep throat is correct, the treatment instituted should cure you of the strep infection, the disease responsible for all your various illness signs and symptoms.
This is an ideal example of the use of diagnosis in medicine that many areas of physical medicine (and nearly all areas of psychiatry) fail to meet. However, diagnosis in psychiatry can be useful – at least in some instances. Suppose you are experiencing a number of symptoms that have caused you to see a psychiatrist – you are “hearing voices” that aren’t there, you believe that you are being controlled by alien forces, you are having a hard time relating to others, and are withdrawing from the outside world. Your psychiatrist would (hopefully) take a history, do a physical exam, test your memory and mental processes, and perhaps perform other tests and procedures. From his previous clinical experience (and due to his knowledge of the research of others), he is able to group these various symptoms and signs into a particular diagnostic category termed “schizophrenia”. This diagnosis of “schizophrenia” allows the psychiatrist to treat you in way that he would be unable to do if he simply dealt individually with each of your symptoms (rather than as a group of related problems). Use of the diagnosis of schizophrenia allows the psychiatrist to have some idea of what will happen to you over time (prognosis); it also gives him some ideas regarding the possible causes of your difficulties and how best to treat you. For schizophrenia, for example, certain types of medication (such as Thorazine, Abilify, or Risperidal) are known to be effective in treating schizophrenia, while other medications (Ativan or Prozac, for example) are not.
Exactly how useful is diagnosis in psychiatry? As the readings in this course make clear, there is a great deal of disagreement about this. Some (particularly medically-oriented psychiatrists) would argue that in many cases diagnosis in psychiatry is very useful and that clinicians can objectively and accurately categorize mentally ill patients into the correct diagnostic category. Others (particularly sociologists) however, argue that diagnosis in psychiatry is often not based on objective facts, but rather on the subjective judgement of the psychiatrist and cultural/social biases about what is or is not
“normal”. These two differing points of view constitute one of the main dividing lines between supporters of the MM and supporters of the labeling or social constructionist approaches to mental illness.
Other Important Aspects of the Medical Model
Finally, adherence to the MM has a number of other consequences for the patient and society as a whole, both positive and negative. For example:
1. In the MM, the physician assumes an authoritarian position in relation to the patient. Because of the specific expertise of the physician, according to the MM, this is necessary and to be expected. The patient, on the other hand, is generally seen as passive and dependent on the physician for advice and guidance. In psychiatry, the MM generally supports the use of involuntary treatment when necessary.
2. In the MM, the physician is viewed as the dominant health care professional. The physician’s expertise in matters of disease, diagnosis, and treatment demand that he or she be viewed as the chief decision-maker in medical matters (rather than nurses, psychologists, social workers, or others).
3. At least ideally, according to the MM, an ill patient should not be held responsible for his/her condition. The patient should not be blamed or stigmatized for his/her illness, whether it be cancer, high blood pressure, the flu, AIDS, depression, or schizophrenia.
4. Under the MM, it is the disease condition of the patient that is of major importance. Social, psychological, and other “external” factors, which may influence patient behavior, may be ignored or de-emphasized. From a MM point of view, the problem of mental illness (be it schizophrenia, depression, ADHD, or substance abuse) is an individual problem be treated individually, not a social problem from a social point of view (it should be noted that Bruce et al. in their article, “Mental illness as psychiatric disorder,” disagree with this view (see page 27 of reader).
Psychiatrist
A psychiatrist is a physician who specializes in the diagnosis and treatment of mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
Ronald D. Laing
Ronald David Laing
Ronald David Laing was a Scottish psychiatrist who wrote extensively on mental illnessin particular, the experience of psychosis...
in his The Politics of the Family and Other Essays (1971), for the "set of procedures in which all doctors are trained." This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment. Sociologist Erving Goffman
Erving Goffman
Erving Goffman was a Canadian-born sociologist and writer.The 73rd president of American Sociological Association, Goffman's greatest contribution to social theory is his study of symbolic interaction in the form of dramaturgical perspective that began with his 1959 book The Presentation of Self...
, in his Asylums
Asylums (book)
Asylums: Essays on the Social Situation of Mental Patients and Other Inmates is a book written by sociologist Erving Goffman in 1961. Asylums was a key text in the development of deinstitutionalisation. The book is one of the first sociological examinations of the social situation of mental...
, favorably compared the medical model, which was a post-Industrial Revolution
Industrial Revolution
The Industrial Revolution was a period from the 18th to the 19th century where major changes in agriculture, manufacturing, mining, transportation, and technology had a profound effect on the social, economic and cultural conditions of the times...
occurrence, with the conduct in the tinkering trades (watch, radio, TV repair). The medical model is an approach to pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
that aims to find medical treatments for diagnosed symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s and syndrome
Syndrome
In medicine and psychology, a syndrome is the association of several clinically recognizable features, signs , symptoms , phenomena or characteristics that often occur together, so that the presence of one or more features alerts the physician to the possible presence of the others...
s and treats the human body as a very complex mechanism (hence, Goffman's tinkering trade analogy).
Among critics of medical psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...
, Laing observed that because the diagnosis of a mental illness was based on conduct or patient behavior and not on physical pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
, such a "diagnosis" essentially contravened standard medical procedure and hence the medical model: physical examination and ancillary tests were conducted, if at all, only after the diagnosis was made. Whereas heart diseases, cancers, and broken bones were diagnosed by evident physical pathology discovered during examination and ancillary tests, a mental illness was diagnosed by examining the patient's behavior (paranoid delusions, catatonia, hypermania, etc.) instead of the patient's body tissues
Tissue (biology)
Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
(e.g. dermatitis
Dermatitis
-Etymology:Dermatitis derives from Greek derma "skin" + -itis "inflammation" and genetic disorder.-Terminology:There are several different types of dermatitis. The different kinds usually have in common an allergic reaction to specific allergens. The term may describe eczema, which is also called...
).
The medical model drives research and theorizing about physical or psychological difficulties on a basis of causation and remediation.
It can be contrasted with the holistic model
Holistic health
Holistic health is a concept in medical practice upholding that all aspects of people's needs, psychological, physical and social should be taken into account and seen as a whole. As defined above, the holistic view on treatment is widely accepted in medicine...
of the alternative health
Alternative medicine
Alternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
movement and the social model
Social model of disability
The social model of disability is a reaction to the dominant medical model of disability which in itself is a Cartesian functional analysis of the body as machine to be fixed in order to conform with normative values...
of the disability rights movement
Disability rights movement
The disability rights movement is the movement to secure equal opportunities and equal rights for people with disabilities. The specific goals and demands of the movement are: accessibility and safety in transportation, architecture, and the physical environment, equal opportunities in independent...
, as well as to biopsychosocial and recovery model
Recovery model
The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...
s of mental disorders.
Other uses
Medical Model is a term in psychology which is the view that abnormal behavior is the result of physical problems and should be treated medically.There is no one agreed-upon definition of the medical model (MM). Nevertheless, a basic general definition of the MM in psychiatry might go like this: “The MM is psychiatry views mental illness as a disease or disease-like condition that can and should be treated through somatic (physical) means, by medical personnel, primarily physicians (that is, psychiatrists)”.
The MM attributes mental illness behavior to physiological, biochemical, and/or genetic causes and attempts to treat it primarily through physically based (somatic) procedures particularly drugs. The mentally ill person within the MM is regarded in the same manner as anyone with a physical illness. Psychiatric conditions, such as schizophrenia and the affective (mood) disorders, are viewed as similar to physical diseases such as diabetes, epilepsy, and high blood pressure. The primary treatment providers for individuals suffering from mental illness, according to the MM, should be physicians (primarily psychiatrists), although other treatment personnel (such as nurses, psychologists, and social workers) may also be involved in treating the mentally ill person, although in a lesser position of importance. According to the MM, the psychiatrist should be the primary decision maker, the overall coordinator of care, and is the one who should take primary responsibility for treatment of “the patient”.
The rise of modern scientific medicine during the 19th century has a great impact on the development of the medical model (MM). Especially important here was the development of the “germ theory” of disease by European medical researchers such as Louis Pasteur and Robert Koch. During the late 19th and early 20th centuries, the physical causes of a variety of diseases were uncovered, which in turn, led to the development of effective forms of treatment. While much of these medical successes were in the area of physical illness, advances also occurred in the area of “mental” illness as well. For example, in the late 19th century, approximately 20% of all persons hospitalized in mental institutions were actually suffering from a physical disease -- “general paresis” (advanced syphilis of the brain) – caused by microorganisms called “spirochetes”. As more effective treatments for general paresis began to be developed as a result of this discovery, the rates of mental hospitalization due to the disease greatly decreased. If bacteria caused syphilitic mental illness, many researchers of the time reasoned, maybe a “germ” also was responsible for other forms of mental illness, such as schizophrenia (which was termed “dementia praecox” at the time). Interest in the MM decreased in psychiatry, however, during the 1st half of the 20th century due to a lack of medical advances in treating mental illness. During this time, medical approaches to mental illness were abandoned and psychoanalysis became a major influence in psychiatry in the U.S. Beginning in the 1950s and 60s, however, the development of effective medications in the treatment of some mental illnesses (such as schizophrenia and depression) sparked renewed interest in the MM. Today the MM is the predominant way of thinking about mental illness among psychiatrists as well as many other mental health professionals.
The Concept of “Disease” in the Medical Model
The concept of “disease” is central to the MM, both in psychiatry and in physical medicine. In general, “disease” refers to some deviation from normal body functioning that has undesirable consequences for the affected individual. An important aspect of the MM is that it regards disease signs (objective indicators such as an elevated temperature) and symptoms (subjective feelings of distress expressed by the patient) as indicative of an underlying physical abnormality (pathology) within the individual. According the MM, medical treatment, wherever possible, should be directed at the underlying pathology in an attempt to correct the abnormality and cure the disease. In regard to many mental illnesses, for example, the view is that the cause of the disorder lies in abnormalities within the affected individual’s brain (specially their brain neurochemistry). According to the MM, treatment (such as drugs), to be effective, should be directed as closely as possible at correcting this presumed chemical imbalance in the mentally ill person’s brain. Psychotherapy, according to advocates of the MM, cannot be truly effective because the “real” cause of the mentally ill individual’s problems is physiological, not psychological.
The Importance of Diagnosis
Proper diagnosis (that is, the categorization of illness signs and symptoms into meaning disease groupings) is essential to the MM. Ideally, according to the MM, by placing the patient’s signs and symptoms into the correct diagnostic category the physician’s ability to successfully help the patient is greatly increased. This is because, according to MM proponents, accurate diagnosis can:
1. provide the physician with clinically useful information about the course of the illness over time (it’s prognosis);
2. point to (or at least suggest) a specific underlying cause or causes for the disorder; and
3. direct the physician to specific treatment or treatments for the condition.
Consider the illness, strep throat, as an example. You begin to experience a number of unpleasant physical symptoms -- tiredness, throat pain, muscle aches, etc. You decide to go to your doctor – she talks with you, gets a medical history, and does a physical exam. She notes that your throat is red, your lymph nodes are swollen, and that you have an elevated temperature. Based on her clinical experience with cases like yours (and because of the clinical work and research of other physicians and medical researchers), she has the ability to hypothesize that all of your physical problems and complaints are due to one underlying cause, a disease – a strep infection. To confirm her hypothesis, she tests for the presence of strep bacteria through the use of a “throat culture”. If the test is positive, she can confidently make the diagnosis of strep throat. This diagnosis allows her to predict prognosis, it indicates the cause of the condition (strep bacteria), and it suggests a specific treatment (antibiotics). If her diagnosis of strep throat is correct, the treatment instituted should cure you of the strep infection, the disease responsible for all your various illness signs and symptoms.
This is an ideal example of the use of diagnosis in medicine that many areas of physical medicine (and nearly all areas of psychiatry) fail to meet. However, diagnosis in psychiatry can be useful – at least in some instances. Suppose you are experiencing a number of symptoms that have caused you to see a psychiatrist – you are “hearing voices” that aren’t there, you believe that you are being controlled by alien forces, you are having a hard time relating to others, and are withdrawing from the outside world. Your psychiatrist would (hopefully) take a history, do a physical exam, test your memory and mental processes, and perhaps perform other tests and procedures. From his previous clinical experience (and due to his knowledge of the research of others), he is able to group these various symptoms and signs into a particular diagnostic category termed “schizophrenia”. This diagnosis of “schizophrenia” allows the psychiatrist to treat you in way that he would be unable to do if he simply dealt individually with each of your symptoms (rather than as a group of related problems). Use of the diagnosis of schizophrenia allows the psychiatrist to have some idea of what will happen to you over time (prognosis); it also gives him some ideas regarding the possible causes of your difficulties and how best to treat you. For schizophrenia, for example, certain types of medication (such as Thorazine, Abilify, or Risperidal) are known to be effective in treating schizophrenia, while other medications (Ativan or Prozac, for example) are not.
Exactly how useful is diagnosis in psychiatry? As the readings in this course make clear, there is a great deal of disagreement about this. Some (particularly medically-oriented psychiatrists) would argue that in many cases diagnosis in psychiatry is very useful and that clinicians can objectively and accurately categorize mentally ill patients into the correct diagnostic category. Others (particularly sociologists) however, argue that diagnosis in psychiatry is often not based on objective facts, but rather on the subjective judgement of the psychiatrist and cultural/social biases about what is or is not
“normal”. These two differing points of view constitute one of the main dividing lines between supporters of the MM and supporters of the labeling or social constructionist approaches to mental illness.
Other Important Aspects of the Medical Model
Finally, adherence to the MM has a number of other consequences for the patient and society as a whole, both positive and negative. For example:
1. In the MM, the physician assumes an authoritarian position in relation to the patient. Because of the specific expertise of the physician, according to the MM, this is necessary and to be expected. The patient, on the other hand, is generally seen as passive and dependent on the physician for advice and guidance. In psychiatry, the MM generally supports the use of involuntary treatment when necessary.
2. In the MM, the physician is viewed as the dominant health care professional. The physician’s expertise in matters of disease, diagnosis, and treatment demand that he or she be viewed as the chief decision-maker in medical matters (rather than nurses, psychologists, social workers, or others).
3. At least ideally, according to the MM, an ill patient should not be held responsible for his/her condition. The patient should not be blamed or stigmatized for his/her illness, whether it be cancer, high blood pressure, the flu, AIDS, depression, or schizophrenia.
4. Under the MM, it is the disease condition of the patient that is of major importance. Social, psychological, and other “external” factors, which may influence patient behavior, may be ignored or de-emphasized. From a MM point of view, the problem of mental illness (be it schizophrenia, depression, ADHD, or substance abuse) is an individual problem be treated individually, not a social problem from a social point of view (it should be noted that Bruce et al. in their article, “Mental illness as psychiatric disorder,” disagree with this view (see page 27 of reader).