The medical model ofmental illnesstreats mental disorders in the same way as a broken arm, i.e., there is thought to be a physical cause.
Supporters of the medical model consequently consider symptoms to be outward signs of the inner physical disorder and believe that if symptoms are grouped together and classified into a ‘syndrome,’ the true cause can eventually be discovered and appropriate physical treatment administered.
Assumptions
The biological approach to psychopathology believes that disorders have an organic orphysical cause. The focus of this approach is on genetics,neurotransmitters, neurophysiology, neuroanatomy, etc.The approach argues that mental disorders are related to the physical structure and functioning of the brain.
The biological approach to psychopathology believes that disorders have an organic orphysical cause. The focus of this approach is on genetics,neurotransmitters, neurophysiology, neuroanatomy, etc.
The approach argues that mental disorders are related to the physical structure and functioning of the brain.
These symptoms lead the psychiatrist to make a “diagnosis,” for example, “this patient is suffering from a severe psychosis; he is suffering from the medical condition we call schizophrenia.”
What is happening here? The doctor makes a judgment of the patient’s behavior, usually in a clinical interview after a relative or general practitioner has asked for an assessment.
Diagnostic Criteria
In psychiatry, the psychiatrist must be able to validly and reliably diagnose different mental illnesses.
Kraepelin claimed that certain groups of symptoms occur together sufficiently frequently for them to be called a disease. He regarded each mental illness as a distinct type and set out to describe its origins, symptoms, course, and outcomes.
Kraepelin’s work is the basis of modern classification systems. The two most important are:
The Diagnostic and Statistical Manual of Mental Disorders (DSM)
The International Classification of Diseases (ICD)
In order to diagnose someone, you would usually need some/all of the following:
On the basis of the diagnosis, the psychiatrist will prescribe treatment such as drugs, psychosurgery, or electroconvulsive therapy. However, since the 1970s, psychiatrists have predominantly treated mental illnesses using drugs.
Critical Evaluation
The traditional categorical diagnostic systems used in mental health, like the DSM and ICD, were developed primarily for clinical utility to categorize mental disorders.
However, researchers have identified a number of limitations of these categorical systems for research purposes (Cuthbert & Kozak, 2013; Kotov et al., 2017):
The study consists of two conditions from which a hospital was informed that patients would be coming that are not actually mentally ill, when in fact, no patients were sent at all. In this condition, the psychiatrists only diagnosed 41 out of 193 patients as being mentally ill when in reality, all patients were mentally ill.
In the other conditions, eight people were told to report at the hospital that they heard noises in their heads. As soon as they were administered, they behaved normally. The doctors in this condition still classified these patients as insane, with a case of dormant schizophrenia.
This has led to calls for approaches focused more on dimensions, mechanisms, or neurobiological correlates rather than discrete categories (Insel et al., 2010).
Approaches like theHierarchical Taxonomy of Psychopathology(HiTOP), network models, and the NIMH Research Domain Criteria (RDoC) aim to move beyond categorical diagnoses to study more fine-grained elements of mental health and illness.
Schizophrenia
The main biological explanations ofschizophreniaare as follows:
Depression
The main biological explanations ofdepressionare as follows:
OCD
The mainbiological explanations of OCDare as follows:
Drug Treatment
The filmone flew over the cuckoo’s nestdemonstrates the way in which drugs are handed out like smarties merely to keep the patients subdued.
Note also in the film that the same type of drug is given to every patient with no regard for the individual’s case history or symptoms; the aim is merely to drug them up to the eyeballs to shut them up!
The main drugs used in the treatment ofdepression, anxiety, and OCD are monoamine oxidase inhibitors (MAOIs), tricyclicantidepressants, and selective serotonin reuptake inhibitors (SSRIs).
Effectiveness
Appropriateness
Electro Convulsive Therapy(ECT)
ECT was used historically but was largely abandoned as a treatment for schizophrenia after the discovery of antipsychotic drugs in the 1950s but it has recently been re-introduced in the USA.
ECT can be either unilateral (electrode on one temple) or bilateral (electrodes on bothtemples).
Theprocedure for administering ECTinvolves the patient receiving a short-acting anesthetic and muscle relaxant before the shock is administered. Oxygen is also administered.
A small amount of current (about 0.6 amps) passed through the brain lasting for about half a second. The resulting seizure lasts for about a minute. ECT is usually given three times a week for up to 5 weeks.
ECT should only be used when all else fails! Many argue that this is sufficient justification for its use, especially if it prevents suicide. ECT is generally used in severely depressed patients for whompsychotherapyand medication have proven to be ineffective.
It can also be used for those who suffer from schizophrenia and manic depression. However, Sackheim et al. (1993) found that there was a high relapse rate within a year suggesting that relief was temporary and not a cure.
There are many critics of this extreme form of treatment, especially of its uncontrolled and unwarranted use in many large, understaffed mental institutions where it may be used simply to make patients docile and manageable or as a punishment (Breggin 1979).
ECT side effects include impaired language and memory as well as loss of self-esteem due to not being able to remember important personal facts or perform routine tasks.
ECT is a controversial treatment, not least because the people who use it are still unsure of how it works – a comparison has been drawn with kicking the side of the television set to make it work.
There is a debate on the ethics of using ECT, primarily because it often takes place without the consent of the individual, and we don’t know how it works!
There are three theories as to how ECT may work:
Psychosurgery
As a last result, when drugs and ECT have apparently failed, psychosurgery is an option. This basically involves either cutting out brain nerve fibers or burning parts of the nerves that are thought to be involved in the disorder (when the patient is conscious).
The most common form of psychosurgery is a prefrontal lobotomy.
Unfortunately, these operations have a nasty tendency to leave the patient vegetablized or ‘numb’ with a flat personality, shuffling movements, etc., due to their inaccuracy. Moniz ‘discovered’ lobotomy in 1935 after successfully snatching out bits of chimps’ brains.
It didn’t take long for him to get the message that his revolutionary treatment was not so perfect; in 1944, a rather dissatisfied patient called his name in the street and shot him in the spine, paralyzing him for life! As a consolation, he received the Nobel prize for his contribution to science in 1949.
Surgery is used only as a last resort when the patient has failed to respond to other forms of treatment and their disorder is very severe. This is because all surgery is risky, and the effects of neurosurgery can be unpredictable. Also, there may be no benefit to the patient, and the effects are irreversible.
There are four major types of lobotomy:
BBC Radio 4:The Lobotomists. This program tells the story of three key figures in the strange history of lobotomy – and for the first time, explores the popularity of lobotomy in the UK in detail.
Evaluation of The Medical Model
Strengths
Weaknesses:
Their validity and clinical utility are therefore highly questionable, yet their influence has contributed to an expansive medicalization of human experience.Click herefor more info
References
Aboraya, A., Rankin, E., France, C., El-Missiry, A., & John, C. (2006). The reliability of psychiatric diagnosis revisited: The clinician’s guide to improve the reliability of psychiatric diagnosis.Psychiatry (Edgmont),3(1), 41.
American Psychiatric Association. (2013).Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Pub.
Breggin, P. R. (1979).Electroshock, Its Brain-disabling Effects. New York: Springer Publishing Company.
Cuthbert, B. N., & Kozak, M. J. (2013). Constructing constructs for psychopathology: the NIMH research domain criteria.Journal of Abnormal Psychology, 122(3), 928–937.
Fisher, A. J., Medaglia, J. D., & Jeronimus, B. F. (2018). Lack of group-to-individual generalizability is a threat to human subjects research.Proceedings of the National Academy of Sciences, 115(27), E6106-E6115.
Fried, E. I., & Nesse, R. M. (2015). Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study.Journal of Affective Disorders, 172, 96-102.
Haslam, N., McGrath, M. J., Viechtbauer, W., & Kuppens, P. (2020). Dimensions over categories: A meta-analysis of taxometric research.Psychological Medicine, 50(9), 1418-1432.
Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2010). Research domain criteria (RDoC): toward a new classification framework for research on mental disorders.American Journal of Psychiatry, 167(7), 748-751.
World Health Organization. (1992).The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
Moniz, E. (1935). Angiomes cérébraux. Importance de l’angiographie cérébrale dans leur diagnostic.Bull. Acad. Méd.(Paris), 3, 113.
Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013). DSM-5 field trials in the United States and Canada, Part II: test-retest reliability of selected categorical diagnoses.American Journal of Psychiatry, 170(1), 59-70.
Rosenhan, D. L. (1973). On being sane in insane places.Science, 179(4070), 250-258.
Van Putten, T., May, P. R., Marder, S. R., & Wittmann, L. A. (1981). Subjective response to antipsychotic drugs.Archives of General Psychiatry, 38(2), 187-190.
Further InformationCouncil for Evidence-based PsychiatryMental Health: On The SpectrumThe Hidden Links Between Mental DisordersIn retrospect: The five lives of the psychiatry manual
Further Information
Council for Evidence-based PsychiatryMental Health: On The SpectrumThe Hidden Links Between Mental DisordersIn retrospect: The five lives of the psychiatry manual
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
