Medical Model Of Psychiatry Research Articles

On the Human in Human Dignity

Only the incurious and philosophically challenged doubt the significance of dignity as a central issue in human interactions. Human dignity is much debated in religion, law, moral philosophy, anthropology, psychiatry, bioethics, sociology, philosophical anthropology, psychology, communication studies, and elsewhere. It is subject to competing discourses of ontology, epistemology, axiology, and logic. It appears in intercultural and international discussions of rights, autonomy, race, ethnicity, economics, war, and peace. It is contrasted with guilt, shame, and humiliation, both ordinary and extreme. However, the dynamic roots of dignity are usually presupposed or ignored in favor of reductionist typologies and antinomies. Returning us to lived experience and with post-humanist animal studies and the medical model of psychiatry as exemplary cases of reductionism, I interpret H. Plessner’s semiotic phenomenology as a communicative philosophy of the humane in dignity.

Reflections on US Psychiatry: How the Baton Was Passed From European Psychiatry and the Contributions of US Psychiatry.

The medical model in psychiatry and descriptive psychopathology were established in Germany by Krapelin's textbook and Jaspers' General Psychopathology. In the United Kingdom, Mayer-Gross' textbook synthesized both books, influencing US psychiatry. US psychiatrists from the World War II generation defeated the US academic psychoanalytic establishment by building three pillars: biological psychiatry (brought by Wortis), the psychopharmacology revolution, and the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III). The psychopharmacology revolution included immigrants (e.g., Gershon), Cole's marketing, and textbooks by Klein and Fink. The "neo-Kraepelinians" introduced the medical model in US psychiatry and defined 15 valid psychiatric disorders. Spitzer supervised DSM-III's development. Its 1980 publication started the world dominance of US psychiatry and the multiplication of diagnoses. Major contributions by US psychiatrists include a) McHugh's update of the Jaspersian approach, b) Fink's inclusion of catatonia as a syndrome in DSM-5 (following Abrams and Taylor's studies), and c) DSM-III's departure from the Jaspersian hierarchy of schizophrenia and affective symptoms.

The medical model and its application in mental health

This article provides a conceptual overview of the medical model and its application to psychiatry, understanding the medical model in psychiatry as a biopsychosocial model. The article discusses basic concepts relevant to the medical model (illness, disease, disorder, condition, etc.), the nature of medical knowledge and diagnostic construct, medical classifications in psychiatry, and the medical model within multidisciplinary practice. Salient criticisms of the medical model are discussed and addressed at relevant points. It is recognized that concepts such as disease and illness lack uncontested definitions and are not free from value judgements even in general medicine. Diagnostic constructs used in psychiatry are often descriptive heterogenous categories which can nonetheless offer clinical utility. The medical model co-exists with non-medical approaches and perspectives, and psychiatrists work in an interdisciplinary context with other models and professionals. Criticism of the medical model in psychiatry often fail to recognize the continuities between psychiatry and the rest of medicine, and the persistence of these controversies may be a result of fundamental disagreement over values.

In Praise of Indignation

As a survivor of interpersonal violence and expert in recovery from relational abuse, I instinctively reacted with indignation when I recognized Trump as an abusive personality. Indignation advocates righteous anger in opposition to immoral, disgusting, or unfair behavior aimed at reducing the dignity of others. Accessing indignation to confront abusers is essential for the health of interpersonal relationships. In the same way, I had a moral obligation to be a truth-teller about Trump in service of the country. Prosocial emotions help manage antisocial behaviors universally judged as nonreciprocal. When Trump’s mental health was first discussed, I predicted it would be frustrating, because the medical model of psychiatry has lost its way in many regards, notably its disavowal of the role of emotions. Evolution designed emotions as essential guides for healthy human relationships. A case formulation model I designed advocates identifying those like Trump as other-blamers—people with low self-worth who manage shame and social downranking by blame-shifting. They are attracted to partners with low self-worth who readily accept blame ( self-blamers). The profession should educate on the power of shame, the widespread harms of narcissistic abuse, and help clients access indignation and assertiveness. Moral elements should be reintegrated into psychology.

Medicalization in psychiatry: the medical model, descriptive diagnosis, and lost knowledge.

Medicalization was the theme of the 29th European Conference on Philosophy of Medicine and Health Care that included a panel session on the DSM and mental health. Philosophical critiques of the medical model in psychiatry suffer from endemic assumptions that fail to acknowledge the real world challenges of psychiatric nosology. The descriptive model of classification of the DSM3-5 serves a valid purpose in the absence of known etiologies for the majority of psychiatric conditions. However, a consequence of the "atheoretical" approach of the DSM is rampant epistemological confusion, a shortcoming that can be ameliorated by importing perspectives from the work of Jaspers and McHugh. Finally,contemporary psychiatry's over-reliance on neuroscience and pharmacotherapy has led to a reductionist agenda that isantagonistic tothe inherentlypluralistic nature of psychiatry. As a result,the field hassuffered a loss of knowledge that may be difficult to recover.

Is psychiatry only neurology? Or only abnormal psychology? Déjà vu after 100 years.

Forgetting history, which frequently repeats itself, is a mistake. In General Psychopathology, Jaspers criticised early 20th century psychiatrists, including those who thought psychiatry was only neurology (Wernicke) or only abnormal psychology (Freud), or who did not see the limitations of the medical model in psychiatry (Kraepelin). Jaspers proposed that some psychiatric disorders follow the medical model (Group I), while others are variations of normality (Group III), or comprise schizophrenia and severe mood disorders (Group II). In the early 21st century, the players' names have changed but the game remains the same. The US NIMH is reprising both Wernicke's brain mythology and Kraepelin's marketing promises. The neo-Kraepelinian revolution started at Washington University, became pre-eminent through the DSM-III developed by Spitzer, but reached a dead end with the DSM-5. McHugh, who described four perspectives in psychiatry, is the leading contemporary representative of the Jaspersian diagnostic approach. Other neo-Jaspersians are: Berrios, Wiggins and Schwartz, Ghaemi, Stanghellini, Parnas and Sass. Can psychiatry learn from its mistakes? The current psychiatric language, organised at its three levels, symptoms, syndromes, and disorders, was developed in the 19th century but is obsolete for the 21st century. Scientific advances in Jaspers' Group III disorders require collaborating with researchers in the social and psychological sciences. Jaspers' Group II disorders, redefined by the author as schizophrenia, catatonic syndromes, and severe mood disorders, are the core of psychiatry. Scientific advancement in them is not easy because we are not sure how to delineate between and within them correctly.

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.

Challenging the “Extensive Development Process” of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders

It is evident, over the past 30 years, that there has been widespread promotion of the concept of a biological basis for psychiatric disorders and direct promotion on the belief by medical experts in media, texts, and public meetings. In developed countries, and in particular die United States, this has resulted in epidemic comparable increases in the percentage of the population that are diagnosed as having a psychiatric disorder.The associated increases in drug-based treatments have resulted in financial benefits to pharmaceutical companies and medical experts. This relationship raises questions con- cerning the construction of knowledge, particularly in light of the claims promoting a proven biological/neurological basis for many psychiatric disorders that, at diis point, has not been clearly established in research (Healy, 2012; Whitaker, 2010).The claims made in the biopsychiatric discourse are supported dirough reference to experts' opinions, scientific research studies, and reports in refereed journals. Linked to the research studies and journal articles are medical experts, many in esteemed positions in universities, whose power over the discourse is impenetrable even to practicing physicians, nurses, other health workers, education systems, teachers, parents, and the individuals diagnosed with a mental health disorder.Understanding the context of the hegemonic medical model of psychiatry is critical given the rapid increases in the number of individuals diagnosed with psychiatric disor- ders. What is considered normal in a society varies over time and die definition of devi- ance can and does change in accordance with the values of a society. The increased use of psychiatric diagnoses raises questions concerning the forces in society that have led to die acceptance of, and increasing promotion of drug regimes for an ever-increasing number of psychiatric disorders, evident in each new edition of die American Psychiatric Association's (APA; 2011) Diagnostic and Statistical Manual of Mental Disorders (DSM). With die imminent release of the DSM-5 in 2013, diis issue of the journal has a focus on questioning aspects of the hegemonic psychiatric discourse.Individual and community expectations of psychiatric medical intervention are that treatments will produce positive outcomes and result in improvements in die functioning of individuals diagnosed widi a mental health problem. However, negative consequences from pharmaceutical and biopsychiatric treatments are not new or uncommon phenomena. Iatrogenic outcomes resulting from adverse drug reactions have been well documented in medicine (illustrated by die devastating consequences of dialidomide) and in biopsychiatry (illustrated by the development of tardive dyskinesia in a significant percentage of patients as a result of long-term treatment with neuroleptic drugs; Lader, 1993).This issue of the journal concludes with an In Memoriam to Thomas Szasz. Szasz was one of the first significant critics of biopsychiatry. Szasz's initial text The My[h of Mental Illness, first published in 1961, critiqued the biopsychiatric construct of mental illness and outlined the potentially flawed constructs of biopsychiatry. Szasz's critical commentary was underpinned by libertarian views. He was damning of the role of psychiatry because of its coercive nature, reflected by involuntary treatment programs. Szasz's analysis extended beyond the problems of coercion associated with psychiatric intervention, and condemned the very construct of mental illness and associated treatments (Szasz, 1976).In Pharmacracy, published in 2001, Szasz refined his analysis, defining "pharmacracy" as a totalitarian regime of social control that uses drug therapy as the main regulating mecha- nism (Szasz, 2001). The agents of the regime are the health care professionals, principally psychiatrists, whose certifying role classifies, what Szasz perceived as, socially undesirable, unacceptable, or criminal behavior as diseases and results in die use of psychotropic drugs and other biopsychiatric interventions for treatment and solution. …

Positions in Doctors’ Questions During Psychiatric Interviews

In this article I apply the concept of positioning to the analysis of 15 initial psychiatric interviews. I argue that through their questions the psychiatrists-in-training impose positions requiring the patients to gaze at themselves and their actual problems from particular perspectives. I point to three such positions: (a) the position of the observing assessor, from which it is expected that the patients will make a detached assessment of themselves or their problems, (b) the position of the informing witness, which requires the patients only to verify the information about themselves, and (c) the marginal one, the position of the experiencing narrator, from which talk about experiences and problems is expected. I explore the roots and consequences of the positions, with particular attention toward objectivization of the patients' experiences in the dominant witness and assessor positions. I conclude with a discussion about the medical model in psychiatry.

Hacking’s Reconciliation

In a series of recent works, Ian Hacking has produced a model of social causation in mental illness and begun to sketch in outline how this might be integrated with the medical model of psychiatry. This article elaborates and revises Hacking’s model of social forces, criticizes him for attempting a merely semantic resolution of the tension between the social and the biological, and sketches an alternative approach that builds upon his substantial insights.

George Winokur: a personal memoir

George Winokur, M.D. died of cancer in his home George on affective disorders, Sam on somatization in Iowa City on October 12, 1996 at the age of disorder and Eli on schizophrenia. seventy-one. He was a clinical researcher, beloved I was lucky to become, early on, one of George’s teacher, and a professor emeritus at the University of resident collaborators in the study of mood disorders. Iowa Department of Psychiatry. He had been the Dr. Winokur was always interested in genetics and chairman there until he stepped down in 1990 after spent a summer at Mount Desert Island, Maine, 19 years, to devote himself to full-time research. He learning medical genetics and how to apply the was known around the world because of his research concepts to psychiatric data. I consider him the in the genetics of affective disorder. father of family history studies in psychiatry. He George was born in Baltimore, Maryland. He collected three big systematic data sets of patients received his bachelor’s degree from Johns Hopkins and their families – ‘‘the affective disorders family University and his medical degree three years later study of 750 patients,’’ the ‘‘one grand study’’ and from the University of Maryland. He did a rotating the ‘‘Iowa five hundred.’’ Many of his findings are internship and started his psychiatric residency at the results of these three data sets. He also, after Seton Institute in Baltimore. He decided he was resigning as chairman, worked on analyzing data interested in learning a more scientific approach to from the NIMH collaborative depression study, psychiatry and transferred to Washington University which systematically followed-up 1,000 affectively in St. Louis. His early training was interrupted by ill patients and 3,000 relatives, spouses, and actwo years in the Air Force. When he returned to quaintances. Washington University as an assistant professor in In analyzing data from the St. Louis studies in the psychiatry, two colleagues at the time were Sam mid 1960s, he and I were the first American Guze and Eli Robins. They met regularly to discuss psychiatrists to describe the separation of unipolar the nature of psychiatry. From their deliberations on and bipolar diseases based on family history, age of the medical model of psychiatry, the criteria for onset and course. It was published as ‘‘Family psychiatric diagnosis, the way to validate a psychiatHistory Studies I: Two Types of Affective Disorders ric diagnosis, and the emphasis on family history and Separated According to Genetic and Clinical Facclinical course developed. Despite their long-term tors’’ in Recent Advances in Biological Psychiatry, close association, the three only published one paper Plenum Press, New York, 1967. The reader must together, the famous diagnostic criteria paper on remember that at this time all data were personally which Feighner was first author. In their own resorted by hand with a counter sorter (George loved search each concentrated on different diseases – the counter sorter, which he moved to Iowa with him

Empathy and hierarchy: A response to Sass

The positions Sass offers in his two papers are an invigorating alternative to the psychoanalytic doctrine and medical model of schizophrenia. He offers, first, an argument in favor of the possibility of empathy for the experience of the schizophrenic and, second, a persuasive argument against the psychoanalytic view of psychosis as regressive. Both positions are well developed, offering the particular pleasure of theory well-grounded in data. Both positions have their weaknesses, however, some of which Sass addresses but others he neglects or fails to defend adequately. In the first paper, which focuses on a comparison of the phenomena of the schizophrenic break (for which he borrows de Chirico’s use of Nietzsche’s term Stimmur~g), Sass argues, contra Karl Jaspers, among others, that the schizophrenic experience is available by empathy to a normal person. His evidence for this is the identifiable commonalities between the Stimmung described by schizophrenics and material presented by modernist writers and poets. Despite the convincing quality of the comparison, he neglects an obvious area for disagreement, one that will likely leap to the minds of those persuaded of the correctness of the medical model of psychiatry. The potential objection is that his evidence proves only that the modernists were schizophrenic, or at least schizoid. Sass himself does address this issue briefly in a footnote in the second paper, intended to address the issue of differences between schizophrenia and creativity. Unfortunately, in arguing one case he defeats himself in the other by documenting the frequency of mental illness in the modernists. In other words, although Sass’s argument about the possibility of empathy is predicated on comparing two groups, schizophrenics and modernists, he may, in fact be comparing one group with itself, that is, the single category of schizophrenics and schizoid personalities. A clearer definition of what is meant by “schizophrenic” would assist greatly here, certainly one less simplistic than that which Sass is using, which is essentially a social definition, that is, one who is treated for schizophrenia. All is not lost, however. In his meticulous explication of the Stimmung, Sass has succeeded in displaying his own empathy and evoking in the reader precisely the empathy he is arguing in favor of. Thus, unless the reader and Sass are also mad (not impossible, but perhaps unlikely), empathy for the schizophrenic experience is patent. Reading Sass’s article reminds me of the first time I was with someone who was

Medical expansionism: some implications for psychiatric nursing practice

The paper discusses how health care models in general have been influenced by the authors' concept of ‘medical expansionism’. Emphasis is given to addressing the impact of medical theory and practice on models of psychiatric nursing. The initial section discusses the concepts of medicalisation and medical imperialism, offering general health definititions and examination of mental health problems in more detail. From this analysis a definition is presented of a medical model in psychiatry. The effects of this model of health care on the future development of nursing models in psychiatry is discussed.

Effects of staff changes on psychiatric patients.

The disturbed behavior and dissatisfaction of patients were studied in relation to nurse and junior and senior doctor changes in two different psychiatric wards. One ward represented the medical model of psychiatry and the other a modified form of therapeutic community. The results showed no statistically significant relationship between the weekly level of disturbed behavior and staff changes in either ward. There was a tendency for patients to become more dissatisfied when the nurses left the ward and less dissatisfied with the arrival of senior doctors in the medical model ward only.

Family Therapy in a Biomedical Context

The role of family therapy has to be redefined in the wake of the reemergence of the medical model in psychiatry, which now encompasses biological, psychological, and social parameters. In this biopsychosocial model, the goal of biological therapy is to promote cognitive and affective regulation through the prescribing of neuroleptic and mood‐stabilizing chemicals. The goal of individual psychological therapy is to teach individuals how to achieve intimate relationships and creative work productivity. The goal of social therapy, typified by family therapy, is to promote socialization, involving social belonging and obligation in terms of individual autonomy and freedom. One of the implications of allocating circumscribed objectives to the various therapies is that mental health professionals, even more in the future than in the past, will have to work together as collaborative team members.

The medical model in psychiatry

The medical model in psychiatry has become a much discussed and controversial topic. Articulate proponents of the position that psychiatry should discard the medical model have excited public interest with book titles such as The Myth of Mental Illness 1 and The Death of Psychiatry. 2 The validity of psychiatry's status as a specialty within medicine is being questioned more than ever before in its modern history. In this climate of controversy, it seemed to me that it might be useful to try to answer a few basic questions: What is the medical model? Is it really responsible for psychiatry's errors and failures? How does our science of psychopathology relate to the medical model in psychiatry?

The medical model in psychiatry.

The medical model in psychiatry.

Science, psychiatry and psychotherapy

The paper is a critical deconstruction of the medical model. I examine the medical model in medicine, and how it drives psychiatry and psychotherapy. Using the notion of 'structure determinism' as outlined by Humberto Maturana (Chilean neurobiologist and leading constructivist thinker) I demonstrate the confusion that inevitably arises in daily life when theories about, explanations of, and metaphors for, human behaviour and conduct are confused with psychological processes. I suggest that such theories are about human conduct and therefore are a part of ethics and religion and do not belong to medicine proper. Considering such explanations, theories, and metaphors to belong to medicine, maintains a power of medical expertise to predict and control human conduct. To this extent the medical model in psychiatry and psychotherapy is an issue of power and control and hence belongs to ethics and morality, and not to medicine. I also suggest that human freedom, responsibility, dignity, and integrity may lie in reclaiming such expertise for oneself.