Since mainstream “mental health” care directly affects the public, the public deserves an overview of the issues raised by the critics of these practices. For this reason, I have created a short video lecture titled The DSM and the Medical Model (embedded below). This summary of criticism of the medical model of mental distress is intended to fill a void in public information, and offer a sharp rebuke of psychiatry and its narrative. The video is also intended to give voice to the disenfranchised faced with the injustices of their interaction with the mental health care system. It lays bare the counterproductive nature of the medical model and the pseudoscience and elitism that support it.
I am seeking feedback on my video from the Mad in America community, with an eye toward re-editing it to give the most impact possible. I am especially interested in feedback about the social welfare paradigm that is introduced as a better, alternative narrative of mental distress. I am also interested in ideas about how to promote the video, which will be presented free to the public after editing.
Here is a brief synopsis of the issues discussed in the video:
The first section introduces the medical model of mental distress (the disease model) and the DSM that describes it. The American Psychiatric Association publishes the DSM; their narrative dominates mental health care in the US. The medical model narrative is a “classical paradigm” as introduced by Thomas Kuhn in his landmark book, The Structure of Scientific Revolutions. A classical paradigm is a complete worldview — it is difficult to challenge because terms have interrelated connotations and contexts that support the existing narrative.
Consistently, most people in my country (the US) assume that mental health is a medical issue; few can imagine mental health referring to a social welfare narrative of emotional suffering. It is unfortunate for the disenfranchised that few people understand the World Health Organization definition of mental health as a social welfare issue of “well-being.” It is also unfortunate for the disenfranchised that few people can imagine emotional suffering greater than their own, or distressful experience more distressful than their own.
Section Two follows the introduction of the medical model with an alternative narrative — it introduces a social welfare model of natural emotional suffering (or “anti-social” reactions to the suffering). The social welfare narrative adds some humanity to our understanding of mental health with a discussion of emotions as direct reflections of human experience. It makes assertions about emotions that should be obvious: emotional suffering (mental distress) is a natural reaction to distressful experiences, rather than a disease. The social welfare narrative also advocates that physical health directly affects mental health: physical sickness, allergies, nutritional deficits, fatigue, and environmental toxins can all lead to mental distress.
Section Three is an overview of criticism of the medical model of mental distress. It begins with a brief history of the DSM, psychiatry’s attempt to explain its medical model. Chronicling the history of DSM revisions exposes its political rather than scientific foundation — it simply categorizes behaviors the American Psychiatric Association considers “anti-social” and tags them as medical problems by committee vote. The video criticizes the DSM for: 1) its lack of validity, 2) its lack of reliability, 3) discounting personal histories, 4) discounting the intensity of distress, 5) ambiguous category boundaries, 6) using common symptoms for categories, 7) stigmatizing clients, 8) promoting self-fulfilling prophecies, and 9) ignoring its cultural biases.
Criticisms should probably also include psychiatry tagging their “anti-social” behaviors with medical-sounding terms (Greek or Latin) to reify them — that is, to imply a medical (biological) problem and medical insight. For example, psychiatrists imply medical insight into bedwetting by describing causation as enuresis — a Greek word for urinating! The video also admonishes psychiatry for continuing to advocate the chemical imbalance theory (logical causation for “mental disorders”) after most eminent psychiatrists have rejected it.
Besides summarizing popular criticisms of the DSM, this section also addresses the scientific absurdity of the new DSM-5 changing its definition of a “mental disorder” without comment or explanation. Nothing screams pseudoscience louder than the DSM-5 changing its obfuscated definition of a “mental disorder” without psychiatrists defending or even noticing the change!
Section Four discusses vested interests — obstacles to changing a narrative. The reality of the strong vested interests of psychiatrists and pharmaceutical company executives is exposed to daylight. Moreover, this section describes several other groups that are also heavily vested in the medical model. There are many reasons people become vested in the medical model. Psychiatrists invest a medical school education and medical school debt believing that they can alleviate human suffering while reversing psychiatry’s embarrassing history of harmful “treatments.” The vast resources of Big Pharma create a wide swath of vested interests; parents and siblings defensive about abusive behaviors are vested; some sufferers of mental distress are vested, and cultural leaders seeking to maintain privileged injustice are vested.
After describing obstacles to shifting from an erroneous disease narrative to a social welfare narrative, Section Five discusses the harm of treating a social welfare problem as a medical problem. It describes the current crisis in mental health care. The medical model is not just wrong; mental health is actually harmed by treating natural emotional suffering (or “anti-social” reactions to the suffering) as a disease — as a medical problem.
Robert Whitaker’s classic book, Anatomy of an Epidemic, documents how treating emotional suffering as a disease worsens outcomes. First, the medical model harms mental health by gaslighting emotional sufferers — by advocating that natural emotions related to real, distressful experiences are instead imaginary “mental disorders.” Secondly, the medical model harms mental health by stigmatizing emotional sufferers with a medical label that falsely implies a neurological dysfunction. Thirdly, the medical model harms mental health by promoting drug abuse; it is harmful to falsely describe psychiatric drugs as “medicines” treating a medical (biological) problem.
Lastly, the medical model harms mental health by promoting “coercive therapies.” The term “coercive therapy” is an oxymoron. Denying basic human rights to people suffering emotionally from unusually distressful experiences is absurdly cruel — it worsens outcomes, which include suicide.
The video should be edited to include how the medical model of mental distress harms the general population as well as the disenfranchised. There is a substantial economic as well as social cost for causing increased disabilities in a community. The epidemic of “mental disorders” caused by “drug therapy” for natural emotional suffering is promoting an epidemic of people needing public assistance (see Anatomy of an Epidemic); this is a staggering waste of public resources. The video should also include criticism of the medical model for promoting flagrant violations of The Convention on the Rights of Persons with Disabilities (the new, international UN human rights treaty).
The conclusion is an appeal to challenge the medical model narrative — to comfort the afflicted rather than add to their plight by ostracizing them and violating their human rights. It tries to voice the tragedy of the tremendous harm caused by erroneously considering natural emotional suffering to be a disease. Fortunately, psychiatry and its medical model narrative are now faltering under the increasing weight of their pseudoscience, elitism and harm to community mental health.
Perhaps the video should conclude with a more upbeat note? Replacing the false, disease model narrative of mental distress with the humanity of the social welfare narrative will promote a revolutionary improvement in the human social condition!
I welcome and value any comments from the MIA community before I re-edit The DSM and the Medical Model. (Please note: the annual profit from sales of psychotropic drugs was misstated, and will be edited to reflect the correct figure of 18 billion dollars.)
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.