When I began working in the mental health field I began as a caseworker for the county mental health authority. This essentially involved working under psychiatrists as a caseworker. The system being utilized to diagnose and treat mental health "disorders" was, and still is, referred to as "the medical model". What is the "medical model" and why is it important for the general public to understand it?
The medical model is one way of viewing mental health issues. The BFI site has a wonderful article discussing the differences between the medical model and the social model of viewing physical, mental or sensory impairments. They make the following observations:
"A notion of 'normality' was invested with great pseudo-scientific significance. It was based on assessments of impairments from a deficit point of view against normality: what one cannot do, instead of what one can do."
"The 'medical model' sees disabled people as the problem. They need to be adapted to fit into the world as it is."
The Western culture is heavily invested in the medical model of mental health. If we experience psychic discomfort or strong emotions we run to the doctor and ask for a pill. How does this affect the treatment of mental health issues?
1. Emotions are defined as "abnormal" and "treated". Why is this a problem? Because the majority of emotional responses to life events are normal.
A person loses their partner of 20 years, experiences grief, goes to the doctor and gets medication to numb it. The grief is normal. Treating it as abnormal is not. And numbing it is not only inappropriate, but it prevents the person from moving through the grief, developing coping skills for dealing with painful issues, and eventually healing from the grief.
A client is naturally shy. Shyness used to be a natural way of being. Some people are naturally more outgoing. Some people are naturally more shy. Under the medical model, this is diagnosed as Social Anxiety Disorder and medicated.
A client is experiencing stress and tells her doctor she is experiencing "mood swings". She is diagnosed with Bipolar Disorder and placed on heavy duty tranquilizers to "stabilize" her moods. Mood swings are normal for human beings. For more information about this topic see my article, "Mood Swings are Normal".
A child is living in a very chaotic home as his parents go through a very chaotic and messy divorce. He becomes very agitated, anxious and distracted at home and in school. He diagnosed with ADHD and prescribed a stimulant.
2. The doctor "orders" medication. Patients who experience problems with side effects or have complaints that their emotions are being "numbed" are dealt with by changing the medication. Patients who discontinue the edications because they feel they are not helping them or that the side effects are intolerable are labelled "noncompliant".
Example: Please see my article, The Schizophrenic Artist.
3. The patient is not treated as a partner or equal participant in the doctor/patient relationship. The doctor diagnoses the patient and orders treatment. Many times the diagnosis is not even discussed with the patient nor is their input solicited in making the diagnosis.
4. A diagnosis of deviancy from the norm or abnormality is required in order to deal with the mental health issue. This method of dealing with mental health issues is so prevalent in Western culture that many clients believe they must have a diagnosis in order to deal with issues. This is simply not true. The diagnostic system was created by the military for the purpose of research. It was later adopted by the insurance industry as a method of coding "disorders" for their purposes. A diagnosis is not required to treat a mental health issue and many practitioners refuse to make diagnoses at all. Many clinicians believe that diagnosing puts an unnecessary label on the client telling them that they are "abnormal" instead of recognizing that whatever the client is doing is a coping mechanism which they developed to deal with life. They prefer to see clients as survivors who did whatever they had to do to get through life up to this point. They see clients asking for help as people who are now seeking to develop even better ways in which to deal with problems, and this is the choice of a healthy person.
5. "Normal" behavior is defined and anything which varies from that is labelled as "abnormal" and something which needs to be fixed. But who defines what is "normal". Normal for whom?
6. The field of medicine is heavily influenced by pharmaceutical companies to prefer medication as the first, and sometimes, only treatment even though other treatments are available and sometimes scientifically more valid. An example: research has consistently shown that psychotherapy for depression should be the first line of treatment unless a person is actively suicidal. Antidepressants should only be added if psychotherapy is not enough by itself or if the person decompensates to the point that they are suicidal or not functioning well enough to be able to participate in therapy. Yet psychotherapy is rarely recommended. The first line of defense is typically antidepressants.
7. The field of medicine is also heavily influenced by the insurance industry which prefers the administration of a pill in 15 minutes, and a follow up appointment every three months over the administration of psychotherapy for an hour every week.
It is important to understand how the medical model affects treatment of mental health issues in our culture. It is equally important to understand that there are alternative methods of treatment. Clients should be encouraged to seek out healthy ways of affecting emotions and moods whether it be exercise, meditation, changing to a healthier diet, getting more sleep, eliminating stressors in their life, changing jobs, getting therapy, dealing with familial dysfunction, attending a yoga class, making more time for family or hobbies, expressing themselves creativily or developing their spirituality. Clients should be in charge of their mental health and their mental health treatment. It is their mind and their body which is on the line and they should be empowered to make choices about their own care and healing.