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Dr Premal Shah, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK. Email: [email protected]
Declaration of interest
None.
The term ‘medical model’ is frequently used in psychiatry with denigration, suggesting that its methods are paternalistic, inhumane and reductionist. This view has influenced mental health organisations, which in certain areas advocate a departure from the medical model, and contributes to the difficulties in leadership being played out between politicians, professionals and patients. The view has some support from within psychiatry (with some psychiatrists being apologists), from the 1960s’ anti-psychiatry movement, as well as from some in the recovery movement (Ralph et al, 2002). Although diversity is healthy, it may fuel unproductive rivalry to be recognised as the therapeutic agent between divergent therapies and agencies.
WHAT IS CURRENTLY MEANT BY THE MEDICAL MODEL?
There are various definitions. Clare (1980) suggested that it is a scientific process involving observation, description and differentiation, which moves from recognising and treating symptoms to identifying disease aetiologies and developing specific treatments. Wikipedia, the internet encyclopedia, currently defines it as ‘the predominant Western approach to illness, the body being a complex mechanism, with illness understood in terms of causation and remediation, in contrast to holistic, and social models’. The Disabled People's Movement (http://www.bfi.org.uk/education/teaching/disability/thinking/medical.html) believes that it is based on a false notion of ‘normality’, with people being judged on what they cannot do. They believe that it sees people with disabilities as the problem, focusing on impairment, provoking fear and patronising attitudes, the powerful doctor shutting the ‘disabled’ away. These definitions potentially combine to form the caricature of a reductionist, mechanistic, disability-enhancing approach, taken by powerful doctors towards patients.
Matters are aggravated in psychiatry because of the Descartian divide between biological and psychosocial psychiatry. Biological psychiatry is assumed to be mechanistic and reductionist, exclusively concerned with neuroimaging, genetics and medication. Psychosocial psychiatry, championed as being empowering, humane and holistic, is regarded as the antithesis and aligns itself to models such as Engel's (1977).
IS BIOLOGICAL REALLY REDUCTIONISTIC?
The idea that the ‘biological’ is reductionist and undesirable leads to curious contradictions. The negative view of psychiatric drugs contrasts with views of drugs in other specialties or alternatives such as homoeopathy. The parallel assumption that psychosocial treatments are without risk, are holistic and the...