Dominant Medical Model Research Articles

Nurse-led family-based approach in primary health care for patients with type 2 diabetes mellitus: a qualitative study

ABSTRACT Purpose The prevalence of Type 2 diabetes is rapidly increasing, with 537 million people estimated to have diabetes in 2021. The literature suggests that nurses can deliver effective person-centred diabetes care and that families can be essential in supporting patients. Thus, a Nurse-led Family-based (NLFB) approach may be particularly effective. This study aims to explore the perceptions of nurses, adults with type 2 diabetes, and family members regarding the NLFB intervention. Methods Guided by the UK Medical Research Council Framework, this seminal study adopted a qualitative, descriptive approach with content analysis. Data were obtained through 16 semi-structured, in-depth interviews. Themes emerged based on an inductive process using constant comparison (Graneheim and Lundman 2004). The COREQ checklist was used in ensuring rigour. Results Three main themes emerged includes: (1) nurses’ experiences with current diabetes care practices, (2) stakeholders’ views on the development of a NLFB approach, and (3) merging the nurse-led family aspects into the diabetes care. The key challenges are the dominant medical model, lack of specialist nurses, and time. The key facilitators are knowledge and social support. Conclusion The study recommends stakeholders embrace nursing empowerment strategies and involve families to enhance the nurses’ advanced roles and family inclusion in healthcare.

'Patient' or 'professional'? Negotiating accommodations and identity in fieldwork education.

Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada-wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice. Thirty-five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first-person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations. Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures. The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient-professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care.

Does Trauma Have a Race?

Abstract The task of theorizing and “curing” psychological trauma posed an unprecedented challenge to Western medicine during World War I. In this article, I analyze linguistic and thematic patterns across influential French medical journal publications (1914–1919) to elucidate the dominant medical model of psychological trauma in white men. My approach highlights the centrality of la volonté (“willpower”), historically a critical aspect of Western masculinity, to experts’ conceptualization of trauma itself. I expand this analysis to consider key differences between the model of trauma in white men and the so-called “facsimiles of pathology” in North African soldiers. This comparative analysis illuminates a larger cultural schema of the healthy (white, masculine) self as discrete, sovereign, impermeable, and “justified” in its occupation of colonial spaces.

Remarks on the medical and social models of research in deafness and language development

Research on deaf children’s language development has a long and complex history. Work is motivated by seemingly incompatible models of what deafness means. On the one hand, the dominant medical model documents hearing loss and spoken language deficits. Research contributes to continuing improvements in spoken language outcomes following neo-natal screening and early cochlear implants. On the other hand, the smaller number of researchers looking at deafness and language development in the social model have championed the diversity of deaf children, their rights to learn signed languages and be educated in bilingual schools. This paper covers a selection of research studies on deafness and language development coming from both the medical and social models.The main objective of the paper is to offer some remarks concerning a set of standpoints taken by researchers which require more careful discussion in order to further thefield. It concludes with a suggestion for how the two diverging models could convergemore. The proposal is to focus attention on the factors which lead to high quality earlycommunicative interactions rather than access to words or signs.

'The day you start lifting is the day you become forever small': Bodybuilders explain muscle dysmorphia.

Muscle dysmorphia (MD) is a pathological preoccupation with muscularity characterised by negative body image, compulsive behaviours, and obsessive thoughts. Since its first identification academics have suggested that it is caused by sociocultural factors. Despite this there has been very little research exploring the role of sociocultural factors in the development and maintenance of MD, and no research that examines MD from within its cultural context. Instead the medical model of MD has dominated understanding. This model presents professionals as the experts on this disorder, and sufferers as pathological individuals in need of expert treatment. This renders cultural context largely irrelevant to understandings of MD. In this paper we present a different kind of expertise with regards MD. We describe the expertise of those most likely to suffer from MD, and upon whom medical descriptions of MD are based: bodybuilders. Specifically, we describe how bodybuilders explain MD (their definition, theory of aetiology and experience of MD, as well as their suggested management strategies), and compare these explanations to the dominant medical model. Through a consideration of the expertise of bodybuilders we break the tunnel vision of medicine, and suggest ways we can move beyond our current under-developed understanding of MD. This paper examines MD from within its cultural context, and in so doing it lays the foundation for a sociocultural explanatory model of MD. If we are to significantly reduce the harms of this disorder we cannot rely solely on treating the few individuals who present to clinicians. Rather we must develop ways to help sufferers to manage their disorder, and to prevent the development of this disorder among those at risk in the first place. To do this we must understand the sociocultural dimensions of MD, and collaborate with bodybuilding communities.

When trauma comes to school: Toward a socially just trauma-informed praxis

Given the prevalence and devastating consequences of childhood trauma, there has been a surge in initiatives to help schools become trauma-informed. However, despite the growing adoption of such initiatives, a number of concerns have been expressed. These include the lack of attention paid to issues of power and inequality including poverty, racism, and community violence as well as the power of adults to neglect, mistreat or abuse children. Contemporary approaches can also serve to inscribe deficit-based perceptions of children, reinforcing negative stereotypes and stigmas; and they tend to overlook the possibility that schools themselves can contribute to students’ distress, especially in the context of accountability and target-driven agendas. This paper examines current terminology in relation to adversity, trauma, and trauma-informed practice. It shows how current approaches are entangled with a dominant medical model, which views emotional distress as symptoms of mental disorder, rather than as reasonable and intelligible strategies to ensure survival. An alternative approach, co-authored by psychologists and service users/survivors and published by the British Psychological Society, known as the Power Threat Meaning Framework (PTMF) is then discussed. The PTMF is an approach for understanding emotional and psychological distress and troubled or troubling behavior, based primarily on issues of power and inequality. It was chosen in order to forefront social justice concerns, whilst remaining attentive to state-of-the-art and evidence-based understandings of psychological trauma and trauma-informed care. Furthermore, by drawing on the anti-oppression educational theory of Paulo Freire, it is argued a trauma-informed praxis guided and informed by the PTMF, can help redress many of the criticisms of existing approaches in schools.

On the Margins: the Challenges of Identifying Domestic Violence in Mental Health Services. Findings of a Qualitative Irish Study

Although the relationship between mental ill health and the experience of domestic violence (DV) is well established, service users frequently report an absence of appropriate professional responses to disclosures. This study explored how professionals in an Irish mental health (MH) setting understand, identify and respond to DV in a multidisciplinary practice context. An exploratory qualitative approach using semi structured focus group interviews was employed. The data consisted of six focus group interviews with occupational therapists, nurses, consultant psychiatrists, junior doctors, social workers and psychologists working in acute MH care (n-27) in Ireland in 2018. Data was analyzed using Braun and Clarke’s Qualitative research in psychology, 3(2), 77-101, Braun and Clarke (2006) six stages of thematic analysis. Study findings suggest that a prevailing medical model along with an exclusive focus on physical forms of violence shaped the [in]visibility of the DV in this practice setting. DV issues were marginalized from MH care due to its construction as a social problem, with resultant patient needs related to DV not considered within the remit of MH services. This disconnected construction was influenced by several factors including training and education, fear, professional roles and team working in a dominant medical model. This study supports the need for conceptual frameworks that do not marginalize issues of DV in the discourse of MH care delivery but provide a foundation for service user centered collaboration across professional disciplines. The potential benefits of trauma informed care models in increasing recognition and response to DV in MH services are indicated by the present study.

Addictive Appetites: Autophagy, Capitalism, and Mental Health

Abstract This article examines how images of self-cannibalism, or autophagy, configure a subjectivity that emphasizes the internalization of precarious existential conditions resulting from contemporary neoliberal principles. With a focus on mental health, I argue that the combination of self-cannibalism and individual responsibility inculcates an individual rather than collective response to mental health pathologies. I demonstrate how the dominant medical model of treatment paradoxically minimizes and internalizes the social and economic factors that contribute to identity formation, and I suggest that the conventional self-other antagonism of cannibalism transforms into a new self-self antagonism. By internalizing principles of competition and self-reliance in neoliberal capitalism, the contemporary subject subscribes to the very conditions that undermine the healthy social and interactive features that define a stable community life. Autophagy shifts away from the negative associations of cannibalism and toward the positive yet paradoxical associations of autophagy as a model of self-sustainability.

From Patients to Populations: Rhetorical Considerations for a Post-Compliance Medicine

Scholars have criticized the rhetoric of compliance for decades. For example, they have offered a more nuanced account of why patients are “noncompliant,” recasting noncompliance itself as rational behavior. While these insights made important strides toward the larger goal of disrupting power dynamics within medical encounters, and while they yielded new rhetorical inventions such as adherence and concordance, these new terms retained many of compliance’s problematic features. Building on the work of rhetoricians of health and medicine and other scholars, we cast compliance’s persistence as a symptom of shortcomings in the dominant medical model and its tendency to discipline individual patients instead of work with communities to facilitate health. We argue that this model is being challenged in especially dramatic ways with the increased focus on populations and communities. Drawing on the work of Michel Foucault to understand how to navigate problems associated with the disciplinary approach, the authors argue not just for a better understanding of the causes of noncompliance, but for a post-compliance conception of medicine. Among other things, such a view of medicine will require new rhetorical structures that can better support the aims of population health and community-based medicine.

Bonner, A.Social Determinants of Health: An Interdisciplinary Approach to Social Inequality and Wellbeing. Bristol: Policy Press. 2018. xxii + 351 pp £80.00 (hbk) £28.99 (pbk) ISBN 978‐1447336853

Bonner, A.Social Determinants of Health: An Interdisciplinary Approach to Social Inequality and Wellbeing. Bristol: Policy Press. 2018. xxii + 351 pp £80.00 (hbk) £28.99 (pbk) ISBN 978‐1447336853

Drama therapy to empower patients with schizophrenia: Is justice possible?

This article develops an empowerment model for treating individuals with schizophrenia, exploring developmental transformations drama therapy techniques. The author contrasts the dominant medical model of schizophrenia treatment, which primarily seeks symptom control, with the emerging recovery model of schizophrenia treatment, which is focused on empowering patients. The author then builds a theoretical framework for an empowering drama therapy, rooted in Winnicott’s notion of transitional space and Johnson’s developmental transformations. These clinical precepts are synthesized with the social justice theories of Rawls and Flax, Boal’s political theatre, and the absurdist “Before the Law” parable of Kafka. Two case examples of an empowering developmental transformations drama therapy are presented, exploring clinical sessions with schizophrenic patients in two different cultures. Emphasis is placed on key techniques: “pre-empting”; “transformation to the here and now”; and “therapist as subject.” The article concludes by suggesting types of research that can test the potential of an empowering drama therapy to fit within the medical model.

Can maternity care move beyond risk? Implications for midwifery as a profession

Maternal and infant mortality rates are reassuringly low in developed countries. Despite this, birth is increasingly seen as risky by women, health professionals and society in general. In wider society, women are subjected to a litany of risks regarding birth, including sensationalising negative incidents by the media. Within maternity care, both structural and operational factors contribute to heightened risk perceptions. Women are processed through a system where risk-management strategies can take precedence over individualised care as health professionals attempt to protect themselves from implication in adverse outcomes and litigation. This results in increasingly interventionist care, depriving women of psychosocial safety in the birth process. Midwifery, as a profession promoting trust in normal birth, is threatened by this dominant medical model of maternity care and interventionist birth practices. Midwives need to act to reclaim their role in promoting normal birth, while balancing considerations of risk with the principle of woman-centred care.

Looking back, looking forward: Recovery journeys in a high secure hospital.

A qualitative study of staff and service users' views of recovery was undertaken in a UK high secure hospital working to implement recovery practices. 30 staff and 25 service users participated in semi-structured interviews or focus groups. Thematic analysis identified four broad accounts of how recovery was made sense of in the high secure environment: the importance of meaningful occupation; valuing relationships; recovery journeys and dialogue with the past; and recovery as personal responsibility. These themes are discussed with an emphasis on service user strategies of cooperation or resistance, respectively advancing or impeding progress through the system. In this context the notion of cooperation is, for many, commensurate with compliance with a dominant medical model. The policy framing of recovery opens up contemplation of treatment alternatives, more participatory approaches to risk management, and emphasise the value of relational skills, but may not elude the overarching bio-psychiatric episteme.

Kultūriškai priešingų praktikos modelių lyginimas ir susiliejimas: struktūrinis ir naratyvu grįstas socialinis darbas

The structural and narrative models of social work practice are summarized and compared relative to the social worker’s role, the conceptualization of the problem, and the intervention techniques utilized. The two approaches are found to differ signifcantly in all areas and most specifcally in problem conceptualization. This difference is indicative of Kuhn’s (1962) observation that different conceptual paradigms are both structured and limited by their theoretical framework. Though both models vary by conceptualization and application, both are determined to be signifcantly different from the dominant medical model paradigm of “helping” and thus considered countercultural. Finally, it is pointed out that the challenge to the dominant paradigm by these two models allows them to be blended together in social work practice.

C.05.01 Long-term treatment goals in schizophrenia

This article develops an empowerment model for treating individuals with schizophrenia, exploring developmental transformations drama therapy techniques. The author contrasts the dominant medical model of schizophrenia treatment, which primarily seeks symptom control, with the emerging recovery model of schizophrenia treatment, which is focused on empowering patients. The author then builds a theoretical framework for an empowering drama therapy, rooted in Winnicott’s notion of transitional space and Johnson’s developmental transformations. These clinical precepts are synthesized with the social justice theories of Rawls and Flax, Boal’s political theatre, and the absurdist “Before the Law” parable of Kafka. Two case examples of an empowering developmental transformations drama therapy are presented, exploring clinical sessions with schizophrenic patients in two different cultures. Emphasis is placed on key techniques: “pre-empting”; “transformation to the here and now”; and “therapist as subject.” The article concludes by suggesting types of research that can test the potential of an empowering drama therapy to fit within the medical model.

Implementing personalisation in integrated mental health teams in England

This article explores how role boundaries and professional priorities in integrated mental health teams have impacted on the implementation of personalised approaches to social care support. We focus on the use of personal budgets to meet mental health-related social care needs as a key mechanism for personalised care. Drawing on 28 qualitative interviews with mental health practitioners from three local authorities in England undertaken in 2013, we report nurses’, social workers’, and occupational therapists’ attitudes towards, and engagement with, personal budgets. Professional boundaries and competing priorities heavily influenced the extent to which personal budgets were perceived as a legitimate part of their roles. Across different professional groups, a sense emerged that personal budgets should be somebody else’s job. A focus on attention to treatment, stability, and risk management often resulted in low prioritisation of personal budgets and led practitioners to avoid recommending them or to exclude service users from the process as a way to save time. Implications of the dominant medical model and the protection of traditional professional roles for the implementation of new, person-centred models of practice are discussed.

The child is father of the man, and mother of the woman.

* Abbreviation: DOHaD — : Developmental Origins of Health and Disease Well before Wordsworth, it was recognized that early life experiences shaped adult personality and behavior. However, until much more recently, the dominant medical model posited virtually a complete disconnect between childhood and adult health. It was as though emerging from childhood without major disease or disability miraculously reset the “health-o-meter” to 0, only to rebegin registering its scores in midlife. A quarter century ago, David Barker and colleagues showed the biological implausibility of such a simplistic model.1 Since then, accumulating evidence has strengthened the “Barker hypothesis” and now “developmental origins of health and disease,” or DOHaD, is an increasingly accepted concept. Although acknowledgment that childhood, fetal, and even preconceptional events can influence later health is growing, skeptics remain, partly because the link is still largely based on association, not proven mechanisms of causation. Mechanistic research is urgently needed to convince naysayers and, more importantly, to devise treatments and preventions, for the many “adult-onset” conditions that actually are rooted in much earlier exposures and events. An example of such mechanistic research … Address correspondence to Alan E. Guttmacher, MD, 31 Center Dr, Rm 2A03, MSC 2425, Bethesda, MD 20892-2425. E-mail: guttmach{at}mail.nih.gov

Critical Psychiatry, Critical Psychology, and the Behaviorism of B. F. Skinner

Critical psychiatry suggests that the currently dominant medical model in psychiatry overstates internal disturbance and understates environmental stressors as important causal factors in psychological distress. Critical psychology suggests that when individuals experience problems in a culture, psychology emphasizes individual, rather than cultural, change. This article provides a brief overview of critical psychiatry and critical psychology and outlines how both movements share important epistemological similarities with the writings of B. F. Skinner, the founder of radical behaviorism.

Social capital among migrating doctors: the "bridge" over troubled water.

The purpose of this paper is to examine the concept of social capital among International Medical Graduates (IMGs). It will specifically examine bridging social capital and greater intercultural communication which provides IMGs access to the wider community and plays a key role in cross-cultural adaptation and acculturation. A review of the literature. An Australian wide shortage of doctors has led to an increased reliance on the recruitment of IMGs. As IMGs migrate, they may encounter different meanings of illness, models of care and a number of social challenges. Nevertheless, greater cross-cultural adaptation and acculturation occurs through bridging social capital, where intercultural communication, new social networks and identity aids integration. This process produces more opportunities for economic capital growth and upward mobility than bonding social capital. Concerns regarding immigration, appropriate support and on-going examination processes have been expressed by IMGs in a number of studies and policy papers. However, there is very little insight into what contributes cross-cultural adaptation of IMGs. As IMGs migrate to not only a new country, but also a new health system and workplace they arrive with different cultural meanings of illness and models of care. These differences may be in contrast to the dominant western medical model, but often bring positive contributions to patient care in the new environment. In addition, improving bridging social capital provides IMGs access to the wider community and has been demonstrated to play a key role in cross-cultural adaptation and ultimately acculturation.

Damning with faint praise: How homoeopaths talk about conventional medicine with their patients

Homoeopathy is one of the most widely used forms of complementary medicine in the West. However, its methods and philosophical underpinnings are basically polarized in relation to those of conventional medicine. Many homoeopathic patients choose to continue using conventional medicine while they receive homoeopathy, but from a homoeopathic perspective, these treatments are often regarded as undesirable or even damaging. This article will utilize the principles of conversation analysis (CA) to explore points in homoeopathic consultations where practitioners address their patients' use of conventional medications. It will be suggested that approaches which display a degree of incorporation are preferred to those which imply categorical rejection. By not emphasizing the underlying tensions between conventional and homoeopathic paradigms, and displaying an adaptive and inclusive approach, homoeopathy essentially sets itself up as a parallel (i.e. equal) system, rather than one that is purely in opposition to the dominant medical model.