Why the Medical Model Won’t Go Away

Bob Fancher, PhD
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The idea of mental illness predates any discovery of mental illnesses. It’s a hypothesis—a proposed way of understanding mental suffering.

‘Nothing wrong with posing that hypothesis.

But how does a hypothesis become a belief? Ideally, by being confirmed. In reality, much more often, by serving our interests, fitting nicely with our wishes, jibing with our hopes, relieving uncertainty, or otherwise making us feel better.

The success and cultural authority of the mental health industries reflects both hope and need: we hope to escape suffering, and we need professions dedicated to understanding suffering and its relief.

Neither of those is a bad thing.

The idea that suffering—some sorts of suffering, at least—consists of mental illness fits both the hope and the need.

If suffering is not our natural state—if healthy people aren’t prey to certain sorts of suffering—but results from something having gone awry, we can hope to set things right. We can relieve pain by restoring health, or even avoid it altogether by good health practices. Health is, by definition, natural, so health should come easy, if we just understand what gets in the way. Ipso facto, happiness should be easy—natural—if we can just understand the impediments to good mental health.

The idea of mental illness, then, made for a nice hypothesis.

As readers of Mad in America know, it has been less-than-robustly confirmed.

But the idea just won’t die. One reason is that so many people hope it’s true. We really, really want to believe that suffering isn’t our natural lot, that just doing the right things for good mental hygiene will make for a happy life.

Another reason the idea won’t go away is the very reason it became widely accepted in the first place: When the idea arose, professions devoted to studying health and illness already existed—namely, the medical professions.

The importance of an institutional home cannot be overstated. With institutional support, a profession gains legitimacy, resources, and access to markets. And institutions, unlike scientific hypotheses, do not die from being wrong. The values and worldviews, livelihoods, and life’s meaning for countless tens of thousands of its adherents depend upon any established institution, and those people will do whatever it takes to keep their way of life alive.

When the mental health industries were aborning in the late nineteenth and early twentieth centuries, exactly two social institutions dedicated themselves to the relief of psychic pain: medicine and religion.

Whatever else was involved in medicine’s usurping the role of religion in care for the mentally anguished—and a great deal else was involved, much of it ugly and dishonest—medicine offered the possibility of new insights. Religion had pretty much said what it has to say, and anguish hadn’t vanished.  While the loving kindness some religious institutions offered to the mentally tortured and despairing may have helped—and may still help as well as anything—the cold fact was that religion had nothing new to offer. Religion simply wasn’t a good source for new professions of care.

Medicine, though, could pursue a new idea: mental illness. Maybe that would shed new light.

Medicine had the advantage, as well, of quite possibly making use of the benefits of science. The idea of mental illness arose around the same time—the latter half of the nineteenth century—as medicine began to turn toward science as a foundation for practice.

Medicine, then, could provide an institutional home for professions studying suffering from a scientific perspective, in pursuit of the hope that a normal life is a happy life.

Psychology and social work, and literally hundreds of other movements—from the “New Thought” of the late nineteenth century to many different schools of psychotherapy in the mid-twentieth century to the “New Age” of the late twentieth century—tried to offer alternate ways of understanding mental suffering. None had medicine’s big advantage: an existing profession, with the attendant institutional support, cultural status, and financial resources.

Psychology had the best opportunity to provide an alternate, with its growing institutional basis in schools, and with government imprimatur and protection—by 1977, psychologists had gained licensure in all states. But as I’ve explained before, the lure of money was too great, and psychology made itself subservient to the medical model.

(Social work never had a chance, realistically, of establishing itself as a rival profession. Identified as “women’s work” from its inception, it always suffered the lack of power and prestige that women’s work suffers in our culture. Such advances as feminism made for women came too late, in the course of the competition between mental health professions, for clinical social work to become anything other than what it now is—a devoted handmaiden to psychiatry.)

The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true. But the idea that suffering consists in the effects of mental illness remains an idea more believed than evidenced. The scope of its application, the devotion and even vehemence with which it is held, and the billions of dollars its economy circulates far outdistance its scientific support.

We believe it because it suits us, and it has found an institutional home.

The medical model has become the faith of a secular age.

More on that next time.

94 COMMENTS

  1. “The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true.”

    This sentence is the weakest link in an otherwise good article. Please elaborate on what you meant by this.

  2. I think the main reason it won’t go away is that the medical profession and a significant portion of sufferers like the idea of “no-fault” disease. The Doctors think it is good for patients to believe this, because it will encourage them to comply.

    Many patients out there (and their families) desperately want to cling to this belief because they think that without it:
    – their family/upbringing screwed them up; or
    – there’s something wrong with/weak about the sufferer.

    If people think the above are the only alternative explanations then I understand why they turn to the biological view. For me, I don’t think making some people better by telling fairy stories is a good enough reason to lie to everyone.

  3. The so called consumers and the media are as much to blame as doctors and the pharmaceutical companies.They keep running to their doctors to solve their emotional problems. Doctors are only human and it is so easy and quick to dish out a pill. The medical model won’t go away because it is so convenient: so many people want to believe in it. Also, people will always have emotional problems and will look for easy answers and someone will want to make a profit out of it: it is all part of life!

    • The question that keeps bothering me is why so many people want so badly to embrace the idea that they are “mentally ill? What is the payoff in embracing such an idea? You go to parties and everyone there is talking about how they are “depressed” and they got antidepressants from their doctor! It’s like they are proud of this. It reminds me of older people who have to show everyone their “railroad tracks” scars from heart bypass surgery. I think that you are right; the drug companies and the psychiatrists couldn’t push these damned drugs on us so easily unless we want to see ourselves as having a problem. I sometimes think that people don’t want to experience any kind of suffering at all for any reason and are willing to drug themselves to the gills to keep from having to experience it. I am not talking about survivors or people in the system here; I’m talking about the average American in our society.

  4. This clearly written article is thought provoking. I have a few questions.

    Does the idea of “mental illness” beg the question? Like someone having a hunger illness because they are starving? (Psy prescribers have a treatment handy for dampening the symptoms of any imagined illness: tranquilizers.)

    Has there been at least a third response to madness or mental suffering in addition to religion and medicine? A socipolitical one? Someone may go crazy for a biological reason such as a thyroid problem, which may be effectively addressed by medication; for an emotional or spiritual reason such as great loss, which may be addressed helpfully through one’s spiritual or religious community; but also for sociopolitical reasons such as racism, lack of housing & education, environmental degradation… which may and must be addressed by societal change and supports.

    This may be another reason we let our individual minds take the blame and the drugs: societal change is tough and can seem impossible and feel overwhelming.

  5. “We really, really want to believe that suffering isn’t our natural lot…”

    This is the key piece for me Bob. I don’t bring up religion in my blogs or comments because it’s just too divisive and I don’t think it will move the conversations forward, but I’m tempted!

    I think suffering is a natural part of life. Of course we try to minimize suffering and maximize pleasure, we are all a little Epicurean at heart no? But to imagine we’re entitled to a life “free from suffering” Not in this life. So I guess I’m one of those who doesn’t want to conceptualize normal human suffering as illness but as part of man’s condition.

  6. This is easy enough to explain, and also very easy to fix on the part of most advocates. The trouble is the word “medical model.” Because the recovery model IS a medical model – it’s evidence and science based.

    To clarify, say “disease model” for people who believe extreme emotional states come out of the blue with no previous abnormal life situations. “Disease model” says the underlying cause is permanent. It’s says mental health issues are biological, chemical or structural in origin. It says the treatment should be chemical or surgical or electrical, and we know how well those work.

    “Distress model” says that strong emotional experiences are a normal response to abnormal events, that all people can equally experience these states given enough emotional distress and not enough supports or resilience.

    Please, please people, STOP saying “medical” model. The distress model IS a Medical Model – it’s more science based and evidence based than the Disease model. Saying “disease model” points the blame squarely on those selling the disease and selling false storytelling with diseases that have no evidence base. Saying “distress model” says clearly that our problems are universal but completely resolvable.

    http://wellnesswordworks.com/category/distress-vs-disease/

  7. i don’t think that is quite what Corrina is getting at, although I could be wrong.

    It is certainly true that the normal response to being hit on the head with a baseball bat is concussion. So:

    concussion is a disorder.
    and
    concussion causes a dysfunction in biological processes in the brain.

    It does not follow, however, that concussion is a dysfunctional response to being hit over the head with a baseball hat. Or that concussion itself is a dysfunction

    This is an important distinction. At the beginning of WWII, for instance, it was believed that war neurosis, battle fatigue etc. resulted from an inherent vulnerability in the soldiers that experienced it. As a result, the U.S. Army used a screening process to exclude those deemed neurotic – from memory I think it was about 7% of draftees. After some time, however, it became clear that a large proportion of ‘fit’ soldiers continued to suffer from War neurosis and battle fatigue, when exposed to extreme battle conditions for extended periods of time. As a result, war psychiatrists hypothesized in 1942 that battle fatigue (while remaining a dysfunction) was a normal reaction to abnormal conditions, and focussed efforts instead on maintain regular periods of rotation, R&R etc. At this point psychological screening was almost totally abandoned.

    Moving back to the present topic, it should be clear that any sort of disorder, be it biological, psychological or behavioural can be judged to be either disordered or dysfunctional in itself – yet still be considered a normal response to abnormal events. Erectile dysfunction is a normal response to abnormal event such as advanced prostate cancer. Hypervigilance, reactivity and insomnia can be normal responses to abnormal events such as exposure to war and sexual abuse. Prolonged periods of sadness and depression can normal responses to abnormal events such as bereavement and loss of livelihood.

    It goes without saying (for me at least) that all judgements about disorder or dysfunction have to be made against an implicit judgement of what constitutes normal or proper function. Such a judgement is easier in some cases than others, but it is particularly hard to make in psychiatry. It’s difficult because when it comes to human behaviour we have no concept of normal or proper function that is independent of social and cultural value judgements.

    Sorry to have come the long way round to make my point, but this is why I think it is important to acknowledge that every disorder and dysfunction is a normal and natural consequence of some sort of insult, whether it is biological, psychological, social or emotional.

    When we fail to make this distinction, we implicitly place the ‘blame’ squarely on the individual experiencing psychlogical distress (i.e. genetic vulnerability, psychological pre-disposition, neurotransmitter dysregulation etc.) and fail to acknowledge the external causes of psychological suffering. It is no coincidence that a psychiatric classification system (the DSM) that is based on symptoms and not aetiology has led to medical establishment that pathologizes the person and largely ignores their circumstances and history.

    thanks for you post by the way, Bob. Totally awesome, and I look forward to part 2.

  8. Showing how psychiatry and religion have been competing to own the same problem seems a useful line of inquiry. On one hand psychiatry dismissed ~10000 years of attempts to try to understand suffering, without showing or making a scientific breakthrough that would justify that rejection, on the other hand most religions tied their own hands by claiming that the final and definitive answer was contained in a given book, or revealed by a given man.

    You are saying that a lot of people are equating most suffering with pathology. That seems quite convincing now that you said it (it never personally occurred to me that people would think that way). Your assumption is that this dubious belief (most suffering is caused by individual-dysfunction) is the main propaganda tool of the medical model, right?

    On this specific subject, is there a fundamental difference (other than vocabulary) between you and those that suggest that we distinguish the “worried-well” from the “severely mentally ill”, and redirect “medical resources” (including insurance coverage of talk-therapy) to the latter?

    http://articles.latimes.com/1993-12-13/local/me-1329_1_mental-illness

    If so, where do we draw the line? Do you believe there is a convenient empty space between mental function and dysfunction, or is there a continuum, and some (preferably independent) institution has to draw the line somewhere?

  9. “We really, really want to believe that suffering isn’t our natural lot, that just doing the right things for good mental hygiene will make for a happy life.”

    Very true. All the philosophers and poets who ever lived are laughing at this folly of modern Western thought.

  10. Sometimes I wonder if this isn’t what I’m supposed to be. I am often asked to give readings at some odd literary function or another, and lately, I’ve been writing my own story out of the random memories I regained over the last several years. They marvel at the emotion, in my works of “fiction”, because they can’t imagine my life as a reality. I catch myself wanting to tell them that it’s okay, and I will keep silent, which for the last 14 years I have done amazingly well. Of course, having no memory helped. Living in my head, is like I think Nietzsche said, “Battle not with monsters, lest ye become a monster, and if you gaze into the abyss, the abyss gazes also into you.” A normal person wouldn’t last an hour in there. I think about how normal must be easier. The thing is, I’ve also seen Van Gogh’s paintings, read Wolfe, Poe, heard Mozart, mused with Plath, and I don’t attest to be anything so iconic, but their suffering gave life to something so beautiful and innately human. I don’t know if I could see them “cured” if it meant never having experienced their gifts.

  11. Bob, your faith in science is touching, but I have to disagree with you that there is meaningful evidence that even severe “mental illnesses” are physiological in origin. You are right in saying that “The idea of mental illness predates any discovery of mental illnesses.” But the medical model proponents have assumed that this hypothesis is true and taken us on a completely unscientific pathway, leading to definitions of “mental illness” that have no relationship whatsoever to anything physiological. Once we’ve defined these unscientific categories based on social myth and prejudice, of course, no amount of research will ever prove any of them to be physiological diseases, because we defined them without bothering to check if they are diseases at all. There is no fixing that without wiping the slate clean and starting over, and genuinely asking the question, “Could SOME of these phenomena that we observe be caused by physiological events, and if so, which ones, and how do we objectively tell them apart?” and then actually test out this hypothesis against real physical evidence.

    The “medical model” as used by the mental health system today is not science, it’s closer to a religion. I always find it fascinating that the DSM is called the “psychiatric Bible.” It definitely has more in common with religious scripture than it does with science. But at least in a religious setting, they acknowledge they are dealing with the spiritual, where as in the DSM religion, there is no spirit to be found.

    —- Steve

  12. My final comment. A comment carefully drafted to conform to the guidelines. Guidelines that rightfully demand civility.

    It’s hard to respond within the guidelines to an article by a blogger who talks a good game about humanistic interpretations and responses to the problem of human distress (aka ‘mental illness’), yet seems to reserve an exception to these humanistic responses for those labeled “seriously mentally ill”.

    Bob Fancher states above in his piece that:

    “The hypothesis that mental suffering is due to illness was never a bad hypothesis—and I believe, unlike a fair number of Mad in America writers and readers, that in some instances, it is true. ”

    I tried asking Bob Fancher what these ‘instances’ were, because I suspected my own problems may have been one of these ‘instances’ where as he says “it is true” that my mental suffering was “due to illness”.

    In response I was directed by Bob to go watch the film ‘A beautiful mind’. I can only think back to the most confused and harrowing states of mind depicted in that film, and report back that I’ve had similar experiences, extreme experiences, that fit in one way or another with what is depicted in that film, not that this proves anything about alleged “illness”.

    Other commenters pressed further for Bob Fancher to give an example of where the ‘line should be drawn’, between ‘illness’ and ‘broken minds’ and the ‘machinery not working’. In response, Bob offered a link to the blog of the researcher behind the Mitchell Laboratory.

    The Mitchell Laboratory conducts animal model research with a very mainstream and standard biological determinist approach, encapsulating the presuppositions of the alleged objectivity of psychiatric labeling, behavioral genetics, and ‘brain wiring’ neuroscience. On their site they say they research “altered brain wiring in conditions such as schizophrenia”. I don’t know how many of you have had your brain wiring examined and found to be “altered”, but apparently this is what they research.

    http://www.gen.tcd.ie/mitchell/

    Now I’m sorry to say I made some hot-headed remarks in this comment thread. I don’t like to feel misled, by clicking on an article, taking the time to read it, and trusting the editors of madinamerica.com to select bloggers who are sensitive to the audience that reads this site, when I see an article titled “why the medical model won’t go away”, and the blogger recommending as ‘evidence’ for the distinction he clearly makes between those who deserve the medical model, and those who don’t, I felt offended.

    I felt degraded, objectified, and shocked, that here, in this community, this site, whose stated aim is to ‘rethink psychiatric care’, that I would be in the same environment here as a blogger who seems to believe my problems and my experiences are to be solved and explained, by cutting up rat brains in a laboratory.

    I could go and get psychotherapy from the author of this piece. But in the back of my mind, I don’t feel I could ever shake the dismay I feel, that my psychotherapist would believe rat brains being dissected, are the key to solving the problems I had in my life.

    What I find more life affirming, and more respectful of human dignity, is when people believe that the problems I experienced can be understood in human terms. When someone writes a piece apparently criticizing the medical model, yet seems to, appears to, believe that there are exclusions to the humans whose problems he is willing to understand in human terms, I feel objectified, degraded, and othered.

    I prefer to spend time in an online community where I am an equal. Not someone who “science is going to explain one day”, if only the Mitchell Laboratory gets more grant money to slice up rat brains.

    I feel I should have been more moderate in my comments. I also feel if there are any bloggers writing for madinamerica.com who believe that if someone walks into their office with a “serious mental illness” label, that they are prejudged to be biologically diseased, genetically inferior, and the rightful target of rat brain research, that they are a blogger who doesn’t understand the sensitivities of this audience here, and what we’ve been through, and how degraded and dehumanized we have felt, to be defined not as human beings with understandable problems and crises, but as biologically inferior beings, so much so that science needs to produce a genetically engineered mouse brain to slice up, to understand.

    I don’t believe Mr. Fancher’s brain is diseased, nor do I believe Mr. Fancher has bad genes that explain his behavior and thoughts. Nor do I believe a researcher purporting to have created a rat/mouse model of Mr. Fancher’s brain is a “serious scientist doing serious research”. I wish he would extend the audience of this site the same benefit of the doubt. Until that day, I will be boycotting his articles.

    • Thanks for this response. I think something significant is occurring every time these feelings and views are stated in an honest and peaceful way. I really liked your statement to me that, for you, “[linking to a biological research lab targeting schizophrenia] is like someone going into an LGBT forum linking approvingly to a reparative therapy website.” I hope I’m not crossing any lines by quoting a private communication. If so, I will remove this post.

      These tender issues of how we understand and define ourselves – and how eagerly some adherents of the medical model presume others are brain-damaged – are at the heart of the conversation on Mad in America. I often think of this environment as a place to practice refining and clarifying the personal, moral, and political ramifications of the medical model, so that we can best communicate with the mainstream world. It is not possible accurately hone our minds and language in an echo chamber where everyone generally agrees with each other. So one important facet of this community is to create space for civil dialogue between parties who disagree. As you note, Bob Fancher does state clear that his views may run contrary to the majority wisdom on this site. Therefore he is taking a risk. He could possibly feel very much in a defensive position by posting here at all. The degree to which we can all civilly and articulately communicate is precisely the degree to which we can learn from each other.

  13. I watched a video today titled, “there’s something wrong with the sun and moon”. The video went on to show pictures of distinct, observable anomalies.

    Why do changes, and processes within changes, have to indicate a disease or disorder or something “wrong”? Because of human error in thinking, right?

    If we think there is an ideal, anything that isn’t that ideal is automatically wrong or somehow not okay. And that wrong thing would need to be corrected, to restore back to that perfect model.

    Maybe the real “problem” is in human ability to think perfectly, instead of it’s mistakes.

  14. It appears my comment was deleted, although it didn’t attack anyone, and in fact began by saying that I thought the article in general was pretty good. I thought the author had touched on a lot of important points, most of which I agreed with.

    But I DON’T agree that the way to make any kind of change in the abusive enterprise that is modern psychiatry is to talk about it as if it is some kind of interesting intellectual problem, rather than an institution that destroys the lives of literally millions of people.

    Those who can afford to live their lives as one constant graduate seminar at Harvard are welcome to continue. After all, Cloudcuckooland was set up 2500 years ago (or was it 400 years ago?)to be a wonderful place for the better class of people. I sincerely hope you stay there and never leave.

    But I am not as privileged as you and have to live in the real world. That real world for me included many years of psychiatric abuse that have left me with scars and pain that will never go away.

    So my question, at least one of them, is, what is the purpose of this website? Is it to try to change psychiatry and ultimately protect its victims? Or is it to provide a forum for narcissistic intellectuals who have plenty of opportunities to bloviate elsewhere? It certainly doesn’t seem to be for people like me.

    Go ahead and delete my comment again, but you will soon find out that I won’t be silenced.

    • Hi Ted,

      The nature of psychological suffering is a lot more than an intellectual problem, it’s a human problem, which results in the pain of countless individuals, each with their own particular experience and story.

      For this situation to improve, we have to challenge the current paradigm, battering away a it until it finally falls to pieces. To do so, we need to attack it on several levels.

      If biological psychiatry is inhuman and uncaring, then we ned to fight for a more human and empathetic understanding of other people’s subjective experience.

      If biological psychiatry is conceptually flawed and full of contradiction, then we need to point out those flaws, and try to search for a better understanding.

      If biological psychiatry is based on flawed empirical evidence, then we need to challenge the interpretation of that evidence, and undertake studies that give a better account of the experiences of people treated with psychiatric medication.

      Because Biological Psychiatry is firmly established as the scientific, political and economic and conceptual paradigm of mental ‘disorder’ it has to be challenged at all levels at once. We have to use every weapon we have to break it into pieces.

      Mentally, I’ve had my own troubles, and my experiences don’t correspond to the way psychology or psychiatry have explain them. That’s why I decided to become a psychologist – so that I could do my part in trying to fix what I believe is broken.

      So I’m not writing my comments as some sort of intellectual dick-swinging exercise (and if you read Bob’s writing carefully you’ll the same is true for him). I’m trying to improve my own understanding through discussion, so that I can play my part in trying undermine Biological psychiatry.

      Everyone here is pulling in the same direction, we just have different ways of doing it.

      .

  15. Jonah, thanks for your challenging response. You raise many legitimate questions and critcisms of Fancher’s blog on the medical model. I was more focused on the method in which we carry out sharp struggle on this blog. In no way was I suggesting that we should be patient in the struggle for revolutionary change, including in the treatment of people labeled mentally ill. I will fight for reforms but I believe this system is beyond repair. In other contributions on this blog I too have challenged “go slow” partial type criticisms of Biological Psychiatry.

    What I am questioning is an “inquisition” type approach to ferreting out people still holding on to pieces of the disease model. I support the efforts that Anonymous and others have made exposing professional arrogance and those blog contributors making light of the power and control they have as doctors in the psychiatric field. But there have been some times when the line has been crossed where certain methods of struggle seem to push potential allies away from our movement. If someone defends one small aspect of the medical model they should not suddenly become no better then Dr Bierderman or Max Frank. Yes they need to be vigorously challenged, so let’s do the hard work and become more scientific and prove them wrong.

    On the issue of neurology and brain science, we should all try to become as educated as possible; we can even learn by negative example from bad science. We should not turn people away from reading contending view points on other websites. Real science is our friend, learn to wield it as valuable weopon in our struggle. I think we have enough science and experience to blow away Biological Psychiatry but right now they control all the major insitutions of power.

    • I agree, bloggers and posters are often attacked here for failure to adhere to an absolutely politically correct point of view or theoretical orthodoxy, the rules of which are known only to the attacker.

      I find this very unpleasant: People who are allies being trashed for a choice of words or prejudices arbitrarily attributed to them.

      It’s a sad reality that people who have been abused sometimes go on the lookout for opportunities to abuse others and go at it enthusiastically when they find the least opening.

      That’s what I perceive as the basis for the excesses that appear in comments on this site, and it weakens the dialog.

      • I agree, certainly, that people should not be personally attacked, nor should they be held to some standard of political correctness that doesn’t make any sense. I don’t agree with myself 100 percent either.

        And I certainly see the value of developing ideas and analyzing facts so that we have more resources in our fight to create a system that really helps people.

        But I do think that intellectualizing about things has its limits. And while I would not name anyone, I also think there is a certain air of superiority among some people who write on this website that I find very offensive.

        While as I say, refining ideas and analyzing facts can be very important, in the last analysis change will be won mostly by the people who have been abused by this system we are all talking about.

        And that is because for us these issues are not intellectual abstractions, but part of our lives that we have to live with every day.

        • I appreciate the connections I have forged with people who have experienced the full gamut of psychiatric abuse. In retrospect, I had been told the truth of this paradigm of *harm*… out of the mouths of babes locked up on a psych ward years before Bob Whitaker got intensely curious about the rise in mental illness and disability from it in America.

          You won’t find a description or definition for the *radar* psychiatric survivors have for locating a threat! I like to use the analogy “canaries in a coal mine” to describe the vital function psychiatric survivors fulfill on this site and for anyone who is determined to wipe the slate clean and start over…

          When I read the lengthy philosophical and intellectual discussions here, that Ted refers to as one long Harvard seminar, I have to overcome my response, or rather, struggle through the queasiness I feel to READ and process the arguments, debates. This happens to me because on an inpatient unit, the treatment team meanings are a forum for the multi-disciplinary approach to treatment. In this setting, I found that I was the least important to the lead clinician who was formulating treatment. My input was based on connection with the patient, and it messed up the intellectualizing and philosophizing that was given the most attention. So… multiply years of witnessing the complete disregard of a patient as a human being, and observing the damages done to patients by intellectual philosophers… and well, queasy is the radar I have developed as a psychiatric survivor— in a different category, to be sure.

          I do read and process the discussions and debates here, and find that my initial response was spot on! I mean to convey my full agreement with Ted, Anonymous and others who feel that HERE we should boldly confront reality. Because HERE we don’t have to worry about how much worse it will be for the patient or whether we will have a job at the end of the day.

          I absolutely believe that the time has come to challenge the deep thinkers in exactly the same ways that their brand of thinking has challenged both patients and committed, compassionate mental health professionals. They buckle, whine and slip way—- and have a glimpse of what it feels like to suffer a personal attack from someone who knows next to nothing about you—personally.

          It’s all about sharing the experience… learning as we grow!

        • I agree, Ted. That’s one of the criticisms I have of the UK’s Critical Psychiatry Network — a lot of philosophizing but where are the doctors are offering enlightened treatment to real people?

          Same with a lot of relatively progressive groups looking at psychiatric reform. A lot of talk, no action.

          That’s the problem with the ivory tower and its inhabitants.

          But — Thinking does have to take place before acting, and wouldn’t you want to discuss those currents of thoughts before you have to deal with the results?

  16. Forgot to offer my comments on Bob’s actual post.

    I have been unable to confirm that “Medical Model” has ever been utilized in the mental health field. My education and training in medicine before psychiatric experience, led me to question psychiatry’s claim to a medical speciality long before issues regarding drugs and diagnoses were exposed. It’s simple really. there is a selective, via the judgment of the clinician, view of the credibility of the patient as historian and story teller of their own experience. In other words the primary “Subjective” information that is key to forming a therapeutic relationship with a patient is overlooked, selectively in psychiatry.

    This is a very subtle divergence at first glance, but it has proven to be THE divergence that separates psychiatry from medicine. Consider the terminally ill, unconscious patient in an ICU who is presenting serious end of life challenges for doctors. Do the doctors assume that the patient has no quality of life and simply wean him off of life support? NO! Hell, NO! It is vital to make every effort to determine what the patient’s wishes are, in the absence of advance directives, legal guardians and/or close family members and friends to speak for the patient. EVEN when all objective signs point to a reasonably expected outcome, the doctor cannot act without regard for the individual attributes, beliefs and wishes of the non communicating human being in his care. Even when the science is totally biology driven— there is reverence for that which makes us human and defies both science and biology.

    Clearly the medical profession does not fully adhere to it’s own model, and often times there is little effort employed to illicit or ponder the subjective input of the patient, BUT the model itself contains this vital component. Psychiatry NEVER did. Once a person has become problematic for others, the model of care employed is finding the right fit between what has been objectively obtained from encountering the person and the theories of conjecture that pass for a body of *scientific knowledge*.

    This is why we should STOP saying that currently psychiatry utilizes a medical model, albeit flawed in many ways. The TRUTH is that psychiatry NEVER even pretended to use this model. And this fact is extremely important going forward in our movement. It explains why Adverse Drug Reactions have been dismissed. It explains why Adverse Drug Reactions have led to the discovery of new disorders and theories on worsening presentations of serious “mental illness”. IT explains why so many people are still being harmed.

    The really big gorilla in the room is wearing a sign. the sign says:”I am a fraud.” The letters MD after my name stand for: “Major Delusion” and I have grown big and fat exploiting the trust people place in the medical profession.” This gorilla should not be asked to address intention as at this point it is irrelevant. Let the intellectuals and philosophers spin their analysis at their leisure and we can all read their brilliant ideas at our leisure … WHEN this outrageous criminal behavior is exposed and STOPPED.

    Some of the bloggers on this site display a rather peculiar propensity that looks like ADD… they can’t seem to devote full attention to the well known fact that people are still being harmed in what they are calling a “medical model” that needs fixing.

    How does one get their attention??? Politely, we may suggest attention to semantics, but if we don’t assert that MEDICAL does not belong in any description of our current paradigm of psychiatric care, then we are just spinning our wheels and wasting precious time.

    SOME of us struggle with impulse control when the issues pertain to life and death. I can say from first hand experience that it was precisely the emotional battles that were waged from humanistic care givers in ICUs that forced doctors to revisit the medical model as it was conceived and designed. When waging a battle for justice and human rights, one need not employ (verbal) restraint. In fact, to do so is a sign of human weakness. IMO. of course.

    • Well said! Most psychiatrists don’t even think about what “model” they are using. People have “symptoms” and they prescribe drugs to dampen or eliminate the undesirable thoughts/feelings/behaviors. Of course, what is undesirable is usually filtered through their own biases or the biases of those who have determined that another person’s behavior constitutes a problem. The whole diagnostic thing is just a way to get reimbursement.

      There’s nothing “medical” about this model!

      — Steve

  17. One more thing.

    I missed the thread that was deleted from this bog. I am working again on an inpatient unit where the premise is “Recovery Model” real education… maybe even wiping the slate clean. There is potential and if it continues to blossom I am going to offer my experience on this site. My work schedule and related work-related ventures limit the time I have to visit this site.

    I do not advocate for deleting anything… but for sustaining engagement— even when it becomes painful, or especially when it becomes painful to do so. Even when commenters call each other on violations of the guidelines—- or side line discussions derail the thread from the topic of the blog itself. I don’t like censorship. Period. Here’s why:

    “The agony of breaking through personal limitations is the agony of spiritual growth.” –Joseph Campbell, “The Hero With A Thousand Faces”

    I owe a tremendous debt of gratitude to one particular commenter, Anonymous. The degree to which Anonymous has pushed me past my personal limitations is is one of the major reasons I got back into the ring… working in the trenches. I have only scratched the surface of recognizing my personal barriers to effecting change and upholding human rights and justice. But I know that without the voice of courageous people like Anonymous, I can’t even see my own barriers.

  18. To Altostrata, I don’t want you or anyone to think I am opposed to any intellectual analysis. And if you saw my comments outside this website, I am very consistent in saying that we should think about and analyze our situation before we take action.

    But I think intellectual analysis should be a tool one uses in their practical work, not an end in itself.

    By the way, are you in the UK? I am from California, though visiting Alaska at the moment.