Medical Model Of Mental Illness Research Articles

Resistance to the biomedicalization of mental illness through peer support: The case of peer specialists and mental health

Certified peer specialists (CPS) are mental health professionals who draw their expertise from lived experience with mental illness and mental distress. They tale a nonmedical, nonclinical approach to providing support to community members with mental health difficulties and in doing so, emphasize the role of social environmental factors that contribute to mental distress. Their perspectives are contrary to the biomedical perspective of mainstream psychiatry. While there is a significant body of literature on CPS, there is a dearth of research on how CPS engage in and perceive the broader mental health system. They resist the biomedicalization of mental illness by moving past labels and the language of pathology to facilitate recovery from mental illness and to resist stigma. Drawing from in-depth interviews with peer specialists, participant observation of a peer-run organization, and a survey of peer specialists across the United States, I ask the following research questions: How and why are CPS challenging the medical model of mental illness? How do CPS consider social environmental factors in the etiology of distress and what are the potential implications for resistance to both biomedicalization and stigmatization? My data suggest that CPS, in their critiques of the medical model and the mental health system, are actively resisting the biomedicalization of mental illness and focus on social environmental factors that contribute to experiences of distress. This research has meaningful implications for research on CPS and hope for recovery from mental illness.

Have psychiatrists and general practitioners become traffickers of psychodrug?

Mental health problems are now taken for granted as they involve mental illness. Until some time ago, it was understood that, unlike other physicians, psychiatrists and general practitioners (GPs) were trained to treat biological and psychosocial illnesses, including economic, moral, racial, religious, or political “diseases” (1). But currently, there are no longer differences between medical specialties: every disease must be based on a biological alteration. Thus, most GPs and psychiatrists use the medical model of mental illness and treatment focused on psychoactive drugs. However, not all mental health problems are mental illnesses, nor are these “biological bases” adequate to describe the individual experience of people (2). This approach leads to an overdiagnosis of emotional problems such as mental illnesses, and an overtreatment with psychoactive drugs (3, 4). Thus, currently, the prescription of psychoactive drugs (antidepressants, anxiolytics, hypnotics, and antipsychotics) is considerable and is increasing exponentially; in addition, a large proportion is prescribed by GPs (5); Adolescents are increasingly being prescribed multiple psychotropic medications that are not approved for people under 18 and have not been studied in combination (6). Depression in older adults, which is less frequent than in other age groups, receives a greater number of prescriptions for psychotropic drugs (7). Therefore, psychiatrists and GPs are becoming "traffickers" of psychoactive drugs (8). With this model focused on psychoactive drugs, mental illness is neither understood nor is the patient helped quite the contrary. This implies a deep crisis in which psychiatry and general medicine find themselves, having embraced the pure pharmacological approach in their management of emotional and psychological disorders and having become, due to the weakness of the variables they manage, a scapegoat for the manipulation of scientific evidence by the research sponsored by the pharmaceutical industry (9-11).

Understanding the crisis: Five core issues in contemporary psychoanalysis

The psychoanalytic movement is experiencing a serious crisis: its scientific consensus, social standing, and impact on practice in mental health have all been steadily declining over the last decades. This unfortunate process has been variously explained in terms of prevailing hedonistic social values, the political influence of drug companies, and cuts in health-related expenditures. Following a suggestion by Garza Guerrero, we rather believe that the sources of the contemporary crisis in psychoanalysis are to be searched for within its own development and current social and cultural life. Specifically, we think psychoanalysis has failed to bring the revolutionary contribution of interpersonal and intersubjective paradigms to its fuller consequences. Here, we review five core dimensions in which such failure is particularly apparent: (1) an unwitting reliance on the medical model of mental illness; (2) an ontological, concrete understanding of unconscious processes; (3) a manifest failure to fully appreciate the role of extratransference relationships in the patient’s life; (4) a naive and idealized view of the psychoanalyst’s person and role; and (5) a marginal awareness of the impact of group-level unconscious phenomena on the social life of psychoanalytic institutions.

Adolescent construction of mental illness: implication for engagement and treatment.

Understanding how adolescents perceive mental illness is important for clinicians wishing to improve engagement, and for the development of educational programmes and health-behaviour directed policies. The current research aimed to develop a preliminary model of how adolescents perceive mental illness and construct their understanding of mental health. Forty-six participants aged 11-18 from six schools in Birmingham, UK, took part in one of 12 group interviews. A thematic analysis highlighted a dual perception of mental illness. Adolescents discussed stereotypes and extreme examples of illness, but also displayed an insightful understanding of mental distress which had developed through participants' own experiences. Participants attempted to reconcile and negotiate these conflicting perceptions by creating distinctions between concepts of 'craziness' and 'normality', and reported experiencing negative emotions relating to both perceptions of illness. The findings suggest that once media stereotypes have been acknowledged, adolescents demonstrate a relatively sophisticated understanding of mental illness, although one which differed at times from the diagnostic medical model of mental illness. Focusing on individual symptoms, prevalence rates and prior contact adolescents have had with individuals with mental illnesses provides a framework to discuss mental health and ill-health with adolescents.

Community Psychology, the Church and Theological Perspectives: Introduction to the Special Issue

The indisputable focus in psychology in the past century has been the scientific study of the individual. Individualism in American culture has perforce shaped American psychology in the scope of its scholarly concern, its methodology and therapeutic goals. Alexis deTocqueville (1835/2003) was the first to comment on American individualism with a long train of interpreters there after. Rieff (1966) critiqued psychoanalysis for lacking a commitment to ethical culture that contains the autonomous individual. Bellah (1985) lamented the loss of covenant with increasing individualism in American society. It was Cushman (1995) who detailed psychology's dependence on American individualism. Community psychology emerged as a discipline in response to this social context, particularly the individual medical model of mental illness. The field officially had its beginnings at the 1965 Swampscott conference, where social scientists developed a form of psychology that emphasized prevention, multiple levels of analysis, and change at systemic levels, rather than focusing on individuals as responsible for their condition (Dalton, Elias & Wandersman, 2006; see Todd, 2011, in this issue for a more detailed account of the historical development of community psychology). This form of psychology studies the process through which an individual's context and community shape their development in positive and negative ways at the same time that it examines how individuals shape the systems around them. It should come as no surprise that Christian psychologists whose spiritual formation has been shaped by the church would be interested in community psychology. The church, as a sign of the Reign of God, is key theological fact, a historical presence, and a psychological experience (Green, 2008; Vanier, 1979). Grenz (1994) has made the case that because the Trinity is relational, being made in the image of God means that we more fully manifest this image when we are in community. Hence there are an increasing number of Christian psychologists who are trained in the field of community psychology or who have deep communal and cultural sensibilities that seek to engage in moral, theological and eccle-sial reflection on this field (Canning & Jones, in press; Moore, 1991; Rappaport, 1997, Sarason, 1974; Shwederetal., 1997; Wilson, 1995). In this issue we provide 8 essays that address integrative issues from four perspectives within community psychology: theological reflections, collaborative research, international concerns, and health care and prevention. These articles collectively both summarize and advance theological reflection and application of community psychology methods in faith-based settings, both in the U.S. and internationally. They also point to areas where both integrative reflection and research can be further developed. Theological Reflections on Community Psychology Our special issue begins with two articles that explore theological understandings of community psychology. Canning (2011) enumerates core principles and assumptions of community psychology and examines them through a theological lens. She then provides an example from her community consultation work to illustrate these core assumptions from an integrative perspective, as they are experienced in a community setting. Todd (2011) describes Latin American (e.g., Gutierrez, 1971; Cabestrero & Cardenal, 1981) and North American Black (e.g., Cone, 2003; Williams, 1995) liberation theologies and then generates a dialogue between these liberation theologies and community psychology in order to examine how each field contributes to an understanding of personal and social change through a process of liberation. Collaborative Research and Intervention Methods That Empower Participants Two articles include descriptions of research and intervention methods that empower participants through the process of collaboration and provide case studies where these methods were utilized. …

The influence of corporate and political interests on models of illness in the evolution of the DSM

The diagnostic and statistical manual of mental disorders (DSM) is an evolving document that serves the many mental health care disciplines as the primary reference guide for classifying mental disorders. While the successive framers of the DSM have attempted to base it on scientific evidence, political and economic factors have also shaped the conceptualization of mental illness. These economic and institutional forces have reinforced the DSM's use of a medical model in understanding psychopathology. Though the scientific evidence for a medical model is mixed and evidence for other types of conceptualizations have been given less attention, the medical model provides for reliable diagnoses that allot diverse benefits to treatment providers and researchers, as well as to the pharmaceutical and healthcare industries. This article will outline the development of a medical model of mental illness, highlighting connections between this model and corporate and political interests, and will show how this model relates to the various revisions of, and developments within, the DSM. Such an analysis is especially relevant today as the field looks towards the publication of the newest revision of the DSM and attempts to understand and integrate its proposed changes into current treatment, theory, and research.

Mental Illness Beliefs Inventory: A Preliminary Validation of a Measure of the Level of Belief in the Medical Model of Mental Illness

The Mental Illness Beliefs Inventory (MIBI) measures the extent to which an individual subscribes to the medical model of mental illness. This article reports the results of two preliminary validation studies. The first study establishes the initial psychometric properties for the MIBI, based on a sample of 222 students in the helping professions; the second study tests the model established in the first study with an additional 270 students. The MIBI performs well as a composite instrument measuring belief in the medical model of mental illness. This instrument shows promise for examining the extent to which individual beliefs affect mental health practice.

Reflections on Insight: Dilemmas, Paradoxes, and Puzzles

Reflections on InsightDilemmas, Paradoxes, and Puzzles Marga Reimer (bio) Keywords insight, psychosis, treatment adherence, medical model, autonomy, open placebos, rationality The Practitioner's Dilemma The psychiatrist aware of the potential intractability of what Jennifer Radden calls "insightlessness," faces a dilemma. Should she encourage her patient to embrace a medical model of his "troubles," a model whose adoption is likely to motivate treatment adherence? She might then be trying to do the impossible; she might also alienate her patient in the process. Should she instead encourage her insightless patient to embrace his own non-medical model, according to which treatment adherence makes no medical sense whatsoever? She might then see herself as encouraging a kind of uninformed consent: Her insightless patient might be taking powerful, potentially harmful, medication for reasons (such as sound sleep and "peace of mind") that would never medically justify adherence. In my original paper, I suggested that the way out of this dilemma might be to embrace the latter option, while characterizing the very real (and medically based) benefits of treatment adherence in non-medical terms. I now realize that my proposed resolution reflects an oversimplified understanding of what might be called the "practitioner's dilemma." As Michaela Amering (2010) makes clear, the situation for those with mental illness is improving dramatically. With "recovery orientation" as the "guiding principle of mental health policy," the emphasis is on "health promotion, individual strengths, and resilience." The question becomes: Can the practitioner encourage her insightless patient to partake in this "recovery" movement if she does not simultaneously encourage him to embrace a medicalized understanding of his "troubles"? Not obviously. For although a "recovery" model might eschew notions like illness1 and disease, pathology and dysfunction, and even schizophrenia, it will inevitably involve some medical notions. The patient who partakes in the "recovery movement" described by Amering, would seem to have no choice but to accept a model that is essentially medical. Consider the language used by Amering in characterizing that movement. She talks of mental health problems, therapeutic relations, patient self-determination, diagnosis and, of course, recovery. The concepts underlying such language are intrinsic to the patient-oriented movement Amering describes. The question becomes: How can the insightless patient rationally partake in such a movement without embracing some version of the medical model of mental illness? [End Page 85] This question suggests the importance of promoting some kind of insight, even if not insight "into psychosis." At the close of these comments, I consider briefly what such "revisionary" insight might involve. Paradoxes of Conditional and Relinquished Autonomy Autonomy among patients with psychosis presupposes the sort of clear-headedness that arguably comes only with treatment adherence. This may provide some justification for the "coercive treatments" that Anthony (2006) finds so offensive. For patients with psychosis, genuine autonomy is conditional, requiring some degree of insight: Recognition that their "troubles" are at least amenable to medical treatment. Once the patient recognizes this, he can choose freely to decline such treatment (regardless of whether that choice is ultimately respected). Call this the "paradox of conditional autonomy." The conditional nature of autonomy is a familiar point in philosophical discussions regarding free will. There is no genuine freedom without the sort of knowledge required for informed choices. What distinguishes the patient with psychosis from persons more generally is that his autonomy is further conditioned: The knowledge required for autonomous decision making arguably requires some degree of treatment adherence. However, the mentally ill patient has the right, as do all patients, to relinquish autonomy. He may opt for deference to, and dependency on, the relevant experts: Mental health care professionals (Campbell 1994). We are led once again to paradox. To respect the patient's autonomy, the mental health care professional must respect his right to forego autonomy in favor of deference and dependency. This paradoxical situation, involving a kind of deferred autonomy, is not unique to psychiatry but applies to medicine across the board. Indeed, it applies to the human service industry more generally where, as McGorry (1992) suggests, there is an implicit assumption that the service user is to defer to the expertise of the service provider. This assumption is rightly challenged. Suppose Justin and...

Beyond the counter-narrative

The discourse of the medical model of mental illness tends to dominate people’s conceptions of the origins and treatments of psychopathology. This reductionistic discourse defines people’s experiences of psychological distress and recovery in terms of illnesses, chemical imbalances, and broken brains. However, the master narrative does not represent every individual’s lived experience, and alternative narratives of mental health and recovery exist that challenge our traditional understandings of normality and psychopathology. Guided by the method of interpretive interactionism, we examined how psychiatric survivors position themselves in relation to the medical model’s narrative of recovery. In its inception, the psychiatric survivor movement created a counter-narrative of protest in opposition to the medical model’s description and treatment of psychopathology. Since then, the movement has moved beyond the counter-narrative and has constructed an alternative narrative; one that is not defined in opposition to the master narrative but instead participates in an entirely different discourse.

Meredith F. Small, The Culture of our Discontent : Beyond the Medical Model of Mental Illness

Meredith F. Small, The Culture of our Discontent : Beyond the Medical Model of Mental Illness

The culture of our discontent: beyond the medical model of mental illness

By many estimations, the Western medical model of mental health is dangerously incomplete. If we step outside of the traditional disease model there are many new and different ways to understand, treat, and even accept mental illness. Culture--how we collectively live, interact, and view the world--frames our mental outlook. Arguably, culture even creates it. Western culture, for example, has completely embraced the medical model of mental illness. We quickly turn to physicians if we are unhappy or otherwise mentally discomfited, seeking solutions on a prescription pad. We expect brain chemistry to be at the root of any mental malady, forgetting the deeply entwined relationship between the biology of the brain and the environment in which we think, feel, and react. But every culture has a different view of the world, a lens through which normal or insane are viewed and defined. Anthropologist Meredith Small contends there is much to be learned from stepping away from the traditional Western medical model to explore and embrace alternative perspectives. By examining culture itself, rather than focusing on biology and medicine, we can fully understand the nature of our discontent. Looking at social, evolutionary, cross-cultural, and nutritional influences, Small deconstructs mental illnesses like depression and anxiety conditions that appear in different forms and for different reasons within the culture that defines them. By rethinking assumptions and questioning standard treatment programs, she helps us gradually relax our grip on the medical model to discover a new perspective on mental illness.

The Medical Model of Mental Illness: Ethical and Practical Implications for Diagnosis

The Medical Model of Mental Illness: Ethical and Practical Implications for Diagnosis

Considering alternatives: Student nurses slipping directly from lay beliefs to the medical model of mental illness

When student nurses enter higher education establishments to commence their nurse education it is expected that they would hold lay beliefs of mental health and mental illness. Lay beliefs are generally informed by the medical model of mental health. It is argued that there are many other beliefs and approaches to mental health that student nurses (of all branches) should consider before graduating into the health care world dominated by the medical model of mental health and mental illness. A number of other approaches and theories are summarised and offered as examples to student nurses for their consideration.

Maori experience of community treatment orders in Otago, New Zealand.

To consider the impact of community treatment orders (CommTOs) on Maori patients and their whanau (extended family) and the associated views of mental health professionals. As a distinct aspect of a larger study of CommTOs, eight Maori patients under compulsory community care were interviewed and, where possible, members of their whanau. Associated interviews were held with their psychiatrists, key workers and other carers: 39 interviews in total. Both benefits and drawbacks of CommTOs for Maori were identified by patients and whanau. CommTOs were considered helpful in increasing patient safety and whanau security and in promoting access to services. They were favoured over hospital care, forensic care and homelessness. The drawbacks included the sense of external control imposed on both Maori patients and staff, particularly concerning medication and restrictions on choices. This was a small study of a limited number of Maori patients under CommTOs. Their views may not be fully representative. There was a general consensus among those interviewed that the timely use of CommTOs can enhance the mental wellbeing and social relationships of Maori patients. Continuing efforts are needed by health professionals to communicate effectively with whanau and to understand the conflicts experienced by Maori in reconciling their traditional beliefs with the medical model of mental illness.

Review of Humor: The psychology of living buoyantly.

HERBERT M. LEFCOURT Humor: Psychology of Living Buoyantly New York: Kluwer Academic/Plenum Publishers, 2001, 220 pages (ISBN 0-306-46407-1, us$47.50, Hardcover) Reviewed by JOSEPH F. KESS The joyous heart is a good remedy, but a crushed spirit dries up the bones. Proverbs 17:22, quoted in a chapter outlining the history of early conceptions of humour, may capture the thrust of the book in a way the title does not. discussion does not focus on humour as the panacea for the difficulties that everyday life places in our path, but it does explore its virtues in helping humans cope with stress from both an evolutionary and a synchronic perspective. A dozen chapters deliver a learned inventory of facts and figures about humour from psychology and its interdisciplinary allies, as well as providing a very personal point of view. Lefcourt traces the changing concerns of psychology, and the reason why the psychological study of humour has often been trivialized as an unlikely candidate for research support in the past. author charts his own personal odyssey in the field, one in which he is drawn to the study of human strengths rather than human frailties. How does one come to accept the unacceptable, even control the uncontrollable? Humour seems to offer one avenue by which humans have come to cope, and effectively at that. It may be that Lefcourt is in the vanguard of a movement in which psychology will overcome its past preoccupation with a medical model of mental illness and deficit, and turn its attention to the positive, even optimistic, aspects of the human experience. An early chapter sets us up for the remaining chapters by reminding us how we experience humour in everyday life. Verbatim anecdotes from students in previous seminars offer vignettes which allow the reader to grasp the situation vicariously and to see how and why the humour of the situation could have arisen. It is here that Lefcourt confides that his is a functionalist psychological perspective, and that he views humour as a characteristic that has been useful to our species. If the survival of a species is one of adaptation to circumstance, then humour may have been one of those evolutionary modifications that allowed us to both cope with unbearable circumstances and to draw closer to one another. Perhaps this is why smiles and laughter occur in all human societies, although what elicits them is not universal and much that elicits laughter is not humourous. fact of early onset in the maturational schedule, specific neurophysiological correlates, and reflections in closely related species only reinforces this assumption. absence of verbal play notwithstanding, some higher order primates apparently display a sufficient awareness of self, a theory of other minds, and the cognitive capacity to supply prerequisite underpinnings for humour. For humans, though, Lefcourt makes the crucial distinction between self-directed humour and hostile humour. former is usually self-deprecating, even defensive, and encourages group solidarity; in contrast, hostile humour may cement in-group vs. outgroup identities, but if directed at one's fellows in the in-group, it can be ultimately divisive as others take cover for fear they will be the next target of ridicule. just as with metalinguistic abilities, individual differences characterize children in their appreciation and use of humour. But the suggestion is that individuals with a good sense of humour are more likely to take an active stance toward their own life experiences, taking steps to alter unpleasant mood states instead of enduring them passively. Is it not therefore possible to infer that such individuals are less prone to let the negative effects of stressful life experiences roll right over them, without trying to ameliorate them in some way? Here one comes to the crux of the argument for most readers. Is humour, then, a coping strategy, ultimately devised in our evolutionary ramblings, as a protective cushion against the jagged impact of stressful experiences? …

The Medical Model of Mental Illness: Its Application to the Insanity Defense

The Medical Model of Mental Illness: Its Application to the Insanity Defense

The irrelevance of the medical model of mental illness to law and ethics

The irrelevance of the medical model of mental illness to law and ethics

Poor Job Quality and the Decline of Public Psychiatry

The alarming drop in the number of public-sector psychiatrists in recent years has caused great concern and has prompted efforts to attract young, talented psychiatrists to the public mental health system. To investigate their belief that poor job quality is an important contributor to the decline, the authors asked ten young public psychiatrists to rate their overall level of job satisfaction, to identify what they liked and disliked about their positions, and to speculate about what could be done to attract or retain public psychiatrists. Based on the psychiatrists' responses and a review of the relevant literature, the authors conclude that the public mental health field can better attract psychiatrists by facilitating their autonomy, promoting a medical model of mental illness, integrating public and private psychiatry, and improving benefits and salaries.

Attitudes of Medical Practitioners to Mental Illness

The O.M.I. Scale was used to evaluate the attitudes to mental illness of a sample of 50 Australian medical practitioners. Although the scores of the Australian subjects did not differ from those of previously-tested British medical practitioners, they were significantly different to those obtained in a study of Czechoslovakian practitioners. The Australian, British and Czechoslovakian medical practitioners scored similarly on Mental Hygiene Ideology which reflects a medical model of mental illness. It was suggested that there were several disadvantages in supporting the medical model and that, through undergraduate and continuing education programs, medical practitioners should be exposed to alternative models of mental illness.

Motion Sickness: an Index of Sensory Conflict Relating to Behavior

Diverse measures of behavior are examined in a student and large patient sample for the purpose of supporting the concept that conflict in sensory mechanisms may contribute to diminished or impaired function. Evidence supports the contention that two patterns of orientation may exist at the extremes of motion sickness susceptibility and that individuals showing transitional patterns of organization may be vulnerable to different kinds of central nervous system disorganization. The authors believe that a consideration of sensory function as it relates to patterns of behavior may contribute to an expansion in the medical model of mental illness.