The Morbid Process—One Process (Psychic and Somatic)

Abstract

The medical model has recently been the target of criticism from a number of directions, and especially its unsuitability as a basis for the understanding of disorders in psychiatry. Careful appraisal of the critical work shows the charges unwarranted and based on a number of factors: 1. The inability to see the fallacy in the assumption of the critics; medicine is defined by them as representing somatic pathology alone. Szasz (1974), a leading critic, states ‘illness means there is something wrong with the body of the person said to be ill’ (author’s italics). Based on this wrong definition it is then confidently stated that medicine cannot include psychic or psycho, pathology. But medicine has always been concerned with both psychic and somatic pathology, the two interact, the two are indivisible. Such is the understanding and practice of medicine over centuries. 2. Psychopathology has not been as well defined and researched as somatic pathology. There are many viewpoints, some illogical, extreme and not based on careful observation of the data. But understanding improves as data flows into psychopathology from clinical work, developmental and experimental psychology, sociology, and anthropology. The pattern now emerging is more factual and not only does psychic morbid phenomena fit the medical model, but the latter is essential in the understanding of it as we shall see below. 3. There has been confusion over what can be termed a ‘social’ or ‘psychic’, entity. Psychic phenomena is misunderstood, termed social and then assumed to be matters to be dealt with by other than the medical profession, i.e. social professions. But ‘anguish’ for instance is not an ethical or social entity but emotional—it belongs to a personal psyche, is very much an aspect of psychopathology and has to be dealt with as pathology by the medical profession. Thus habits and beliefs are confused with emotional symptoms. The term ‘psycho-social’ adds to confusion as invariably when it is employed it is used to cover psychic phenomena; it is a term best abandoned. 4. Inadequate attempts are made to separate pathology from social practice. But it has to be accepted that sociology is a much newer field of study than medicine and the same precision cannot as yet be expected. Pathology can affect individuals, e.g. personal psychopathology can cause a parent to emotionally or physically batter a child with consequent illness in child in addition to parent. Pathology can also affect a whole society, social pathology, affecting society as a large group, e.g. Turnbull (1973) reports how a whole tribe were unrelentingly stressful to children. Social practice can lead to anomalous child care, e.g. Mead (1962) reports how a village can bring up children instead of parents but, though unusual, this practice need not be stressful. Naturally sometimes there are areas when social practice leads to pathological stress, e.g. religious views may dictate a particular diet which can lead to poor nutrition and thus make the individual susceptible to illness. Again, the life style of a business man may be such that the emotional stress consequent on it may lead to anxiety, heavy smoking, and subsequent lung cancer. Personal and social pathology is a matter for the practitioner in pathology, the physician, and social practices a matter for sociologists and social anthropologists. Social and personal pathology arouse interest in the possibility of their prevention; it is natural that those practitioners with an expertise in pathology would understand the nature and practice of its prevention. 5. Psychiatry has itself at times neglected psychopathology. Neuropsychiatrists, especially in Europe, have concentrated on mental hospital practice and psychosis, an organic state. Their disinterest in dynamic psychiatry, based on psychopathology, has led to its neglect and abandonment, and the assumption that it need not be included in their medical practice—which leads to the same conclusion being drawn by others. 6. Medicine, especially in its psychic component is fascinating. Other disciplines have for the best motives, and sometimes less admirable motives, been drawn to help. It furthers their aspirations to attempt to demonstrate that this area is outside medical practice.