Medical Model - Treating Mental Disorders (2023)

By Dr. Saul McLeod, updated 2018

The medical model of mental illness treats mental disorders in the same way as a broken arm, i.e. there is thought to be a physical cause. This model has been adopted by psychiatrists rather than psychologists.

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 relatedto the physical structure and functioning of the brain.

behaviors such as hallucinations are 'symptoms' of mental illness as are suicidal ideas or extreme fears such as phobias about snakes and so on. Different illnesses can be identified as 'syndromes', clusters of symptoms that go together and are caused by the illness.

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 judgement of the patient's behavior, usually in a clinical interview after a relative or general practitioner has asked for an assessment.

The doctor will judge that the 'patient' is exhibiting abnormal behavior by asking questions and observing the patient.

Judgement will also be influenced heavily by what the relatives and others near to the patient say and the context – is mental illness more likely to be diagnosed in a mental hospital?

Diagnostic Criteria

In psychiatry the psychiatrist must be able to validly and reliably diagnose different mental illnesses.The first systematic attempt to do this was by Emil Kraepelin who published the first recognized textbook on psychiatry in 1883.

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)

This is the classification system used by the American Psychiatric Association. The first version (DSM 1) was published in 1952. The latest version is DSM V published in 2013.

(Video) Medical Model Errors and Omissions in Treating Mental Illness

The International Classification of Diseases (ICD)

This is published by The World Health Organisation. Mental disorders were included for the first time in 1948 (ICD 6). The current version is ICD 10 published in 1992.

In order to diagnose someone you would usually need some/all of the following:

  • Clinical interview
  • Careful observation of behavior, mood states, etc.
  • Medical records
  • Psychometric tests

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.

However, studies have shown that diagnosis is not a reliable tool. Rosenhan (1973) conducted an experiment where the aim was to see whether psychiatrists could reliably distinguish between people who were mentally ill and those who were not.

The study consists of two conditions from which in one the hospital were informed that patients will 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, 8 people were told to report at the hospital that they hear noises in their head. As soon as they were administrated, they behaved normally. The doctors in this condition still classified these patients as insane, with a case of dormant schizophrenia.

Rosenhan concluded that no psychiatrist can easily diagnose the sane from insane. Though Rosenhan delivered a very accurate report on diagnoses of patients, Rosenhan was criticised for deceiving the hospital for claiming that sane patients were being sent over, though none were actually sent.

Schizophrenia

The main biological explanations of schizophrenia are as follows:

  • Genetics – there is considerable evidence of a genetic predisposition to develop schizophrenia.
  • Biochemistry – the dopamine hypothesis argues that elevated levels of dopamine are related to symptoms of schizophrenia.
  • Neuroanatomy – differences in brain structure (abnormalities in the frontal andpre-frontal cortex, enlarged ventricles) have been identified in people with schizophrenia.

Depression

The main biological explanations of depression are as follows:

  • Genetic – there is considerable evidence that the predisposition to developdepression is inherited.
  • Biochemistry, e.g. Amine hypothesis – low levels of mono amines predominantly noradrenaline andserotonin.

  • Neuroanatomy – damage to amine pathways in post-stroke patients.
  • Neuroendocrine (hormonal) factors – the importance of stress hormones (e.g. cortisol) and overactivity of the HPA axis which is responsible for the stress response.

OCD

The main biological explanations of OCD are as follows:

  • Genetic – there is some evidence of a tendency to inherit OCD, with a gene(Sapap3) recently identified.
  • Biochemistry – serotonin deficiency has been implicated.
  • Neuroanatomy – dysfunctions of the orbital frontal cortex ( OFC ) over-activity inbasal ganglia and caudate-nucleus thalamus have been proposed .
  • Evolutionary – adaptive advantages of hoarding, grooming, etc.

Drug Treatment

Medical Model - Treating Mental Disorders (1)

The film one flew over the cuckoos nest demonstrates 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 eye balls to shut them up!

The main drugs used in the treatment of depression, anxiety and OCD are mono-amine oxidase inhibitors (MAOIs), tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs).

Antipsychotic drugs can be used to treat schizophrenia by blocking d2 (dopamine) receptors. There are different generations ofantipsychotics:

  1. Typical antipsychotics – eg chlorpromazine, block d2 receptors in several brainareas.

  2. Less typical antipsychotics – eg pimozide, often used as a last resort when otherdrugs have failed.
  3. Atypical antipsychotics – eg risperidone. Some atypicals also block serotoninreceptors.

Effectiveness

  • Anti psychotics have long been established as a relatively cheap, effective treatment,which rapidly reduce symptoms and enable many people to live relatively normallives (Van Putten, 1981).

    (Video) Dr Samei Huda - The Medical Model in Mental Health

  • Relapse is likely when drugs are discontinued.
  • Drug treatment is usually superiour to no treatment.
  • Between 50 – 65% of patients benefit from drug treatments.

Appropriateness

  • Drugs do not deal with the cause of the problem, they only reduce the symptoms.
  • Anti psychotics produce a range of side effects including motor tremors and weightgain. These lead a proportion of patients to discontinue treatment.

  • Patients often welcome drug therapy, as it is quicker, easier and less threatening than talk therapy.
  • Some drugs cause dependency.
  • Ethical issues including informed consent, and the dehumanizing effects of sometreatments.

Medical Model - Treating Mental Disorders (2)

Electro Convulsive Therapy (ECT)

Electro Convulsive Therapy (ECT) began in the 1930s after it was noticed that when cows are executed by electric shocks they appear to convulse as if they are having an epileptic shock.

The idea was extrapolated to humans as a treatment for schizophrenia on the theoretical basis that nobody can have schizophrenia and epilepsy together, so if epilepsy is induced by electric shock the schizophrenic symptoms will be forced into submission!

ECT was used historically but was largely abandoned as a treatment for schizophrenia after the discovery of the antipsychotic drugs in the 1950s but has recently been re-introduced in the USA.

In the UK, the use of ECT is not recommended by NICE except in very particular cases (mainly for catatonic schizophrenia). However, it is sometimes used as a last resort for treating severe depression.

ECT can be either unilateral (electrode on one temple) or bilateral (electrodes on bothtemples).

The procedure for administering ECT involves the patient receiving a short acting anaesthetic and muscle relaxant before the shock isadministered. Oxygen is also administered. 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 whom psychotherapy and 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, under staffed 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:

  1. The shock literally shocks the person out of their illness as it is regarded as a punishment for the inappropriate behavior.
  2. Biochemical changes take place in the brain following the shocks which stimulate particular neurotransmitters.
  3. The associated memory loss following shock allows the person to start afresh. They literally forget they were depressed or suffering from schizophrenia.

Psychosurgery

Medical Model - Treating Mental Disorders (3)

As a last result when drugs and ECT have apparently failed psychosurgery is an option. This basically involves either cutting out brain nerve fibres 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’ the 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, paralysing 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, where 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.

(Video) Medical Model Errors and Omissions in Treating Mental Illness

Psychosurgery has scarcely been used as a treatment for schizophrenia since the early 1970s when it was replaced bydrug treatment.

There are four major types of lobotomy:

Medical Model - Treating Mental Disorders (4)

BBC Radio 4: The Lobotomists. This programme 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:

    • It is viewed as objective, being based on mature biological science.

    • It has given insight into the causes of some conditions, such as GPI and Alzheimer's disease, an organic condition causing confusion in the elderly.

    • Treatment is quick and, relative to alternatives, cheap and easy to administer. It has proved to be effective in controlling serious mental illness like schizophrenia allowing patients who would otherwise have to remain in hospital to live at home.

    • The sickness label has reduced the fear of those with mental disorders. Historically, they were thought to be possessed by evil spirits or the devil – especially women who were burned as witches!

Weaknesses:

    • Myth of the chemical imbalance: Psychiatric drugs have often been prescribed to patients on the basis that they cure a ‘chemical imbalance’.

    Although scientists have been testing the chemical imbalancetheory’s validity for over 40 years–and despite literally thousands of studies–there is still not one piece of direct evidence proving the theory correct.

    • The treatments have serious side-effects, for example ECT can cause memory loss, and they are not always effective. Drugs may not 'cure' the condition, but simply act as a chemical straitjacket.

    • The failure to find convincing physical causes for most mental illnesses must throw the validity of the medical model into question, for example affective disorders and neuroses. For this reason, many mental disorders are called 'functional'.

    The test case is schizophrenia but even here genetic or neurochemical explanations are inconclusive. The medical model is therefore focused on physical causes and largely ignores environmental or psychological causes.

    • There are also ethical issues in labelling someone mentally ill – Szasz says that, apart from identified diseases of the brain, most so-called mental disorders are really problems of living. Labelling can lead to discrimination and loss of rights.

    • The medical model has been the one that has been most influential in determining the way that mentally disturbed people are treated, but most psychologists would say that at best, it only provides a partial explanation, and may even be totally inappropriate.

    • There are no known biological causes for any of the psychiatric disorders apart from dementia and some rare chromosomal disorders. Consequently, there are no biological tests such as blood tests or brain scans that can be used to provide independent objective data in support of any psychiatric diagnosis. Click here for more info.

    • The reliability of diagnosing mental disorders has not improved in 30 years (Aboraya et al., 2006).

    • Psychiatric diagnostic manuals such as the DSM and ICD (chapter 5) are not works of objective science, but rather works of culture since they have largely been developed through clinical consensus and voting.

    Their validity and clinical utility is therefore highly questionable, yet their influence has contributed to an expansive medicalisation of human experience. Click here for more info

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(Video) Why The Medical Model Isn't Designed To Treat Anxiety

APA Style 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.

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.

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 Information

Council for Evidence-based PsychiatryAbnormal PsychologyPsychiatrist vs Psychologist - What's the difference?Mental HealthPhysiological PsychologyDepressionSchizophreniaMental Health: On The SpectrumThe Hidden Links Between Mental DisordersIn retrospect: The five lives of the psychiatry manual

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How to reference this article:

McLeod, S. A. (2018, August 05). The medical model. Simply Psychology. www.simplypsychology.org/medical-model.html

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FAQs

What is the medical model of mental disorders? ›

Abstract. The biomedical model posits that mental disorders are brain diseases and emphasizes pharmacological treatment to target presumed biological abnormalities. A biologically-focused approach to science, policy, and practice has dominated the American healthcare system for more than three decades.

What is the current model used in mental health treatment? ›

The recovery model is a holistic, person-centered approach to mental health care. The model has quickly gained momentum and is becoming the standard model of mental health care.

What does the medical model say about depression? ›

The biomedical model explains depression as the result of a chemical imbalance in the brain, specifically of neurotransmitters affecting our moods.

What is an example of a medical model? ›

Examples include holistic model of the alternative health movement and the social model of the disability rights movement, as well as to biopsychosocial and recovery models of mental disorders.

What are the advantages of the medical model of mental health? ›

Strengths: It is viewed as objective, being based on mature biological science. It has given insight into the causes of some conditions, such as GPI and Alzheimer's disease, an organic condition causing confusion in the elderly.

What are the five models of mental illness? ›

There are several mental health theories, but they all come from one of five schools of thought. They are behaviorism, biological, psychodynamic, cognitive, and humanistic.

What does the medical model focus on? ›

The medical model is a diagnostic approach to medicine and is the primary model of healthcare medical assistants and doctoral level physicians assistants use. The medical model focuses on cause and effect, with an emphasis on treating the symptoms as a priority to restore a patient to health as quickly as possible.

What are the 5 core elements of the recovery model? ›

Contents
  • 2.1 Connectedness and supportive relationships.
  • 2.2 Hope.
  • 2.3 Identity.
  • 2.4 Formation of healthy coping strategies and meaningful internal schema.
  • 2.5 Empowerment and building a secure base.

How does the social model treat mental illness? ›

It is a perspective that locates an understanding of mental health within the social contexts within which people exist and uses practice and evidence to work with communities and individuals to help prevent mental health problems and to help with their recovery.

What are the advantages of the medical model of disability? ›

Under this model of disability the focus is on their impairment and how this excludes them from mainstream society. This approach can lead policy makers and service managers focussing their work on compensating people with impairments for what is wrong with their bodies.

Is the DSM a medical model? ›

While the successive framers of the DSM have attempted to base it on scientific evidence, political and economic factors have also shaped the conceptualization of mental illness. These economic and institutional forces have reinforced the DSM's use of a medical model in understanding psychopathology.

Who created the medical model of disability? ›

The critique of the medical model originated in the psychiatry literature and has taken various forms since psychiatrist Thomas Szasz coined it in the mid-1950s.

What is an example of a medical model of disability? ›

Medical models of disability equate pathology with inherent disability. For example, a person with hearing loss is considered disabled, just as a person with cancer is considered disabled. In these models, the disability is viewed as a defect that the field of medicine and healthcare professionals must fix.

What are the 3 models of disability? ›

Although people have various individual perspectives on disability, these viewpoints can be categorized into three overarching models of disability—moral, medical, and social (Olkin, 2002). Each model addresses the perceived causes of disability, appropriate responses, and deeper meanings.

What is the difference between the medical model and the social model of disability? ›

The medical model says that the disability is in you and it is your problem, whereas the social model says that disability exists in the interaction between the individual and society. Disability issues stem from someone with a disability trying to function in an inaccessible society.

What is the disadvantage of the medical model? ›

 The medical model looks at what is 'wrong' with the person, not what the person needs. It creates low expectations and leads to people losing independence, choice and control in their lives.

What does the medical model rely heavily upon? ›

r, the medical model relies heavily on measures and tests of the disease process, plac- ing limited value on subjective reports of health and functioning, leading health providers to un- dervalue patient input concerning their treatment.

What are the four models of disability? ›

The handout for Module 2 Activity 2 of the Disability Inclusion Facilitator's Guide includes the definitions of the four models of disability: charity model, medical model, social model, and rights-based model.

What are the 6 models of abnormality? ›

Six different models will be examined which include, biological, cognitive-behavioral, humanistic-existential, sociocultural, and developmental psychopathology perspective (Comer, 2014). This essay will cover the six models of abnormality as well as examples of how they are applied in/to treatment.

What are the three models of psychopathology? ›

In Module 2, we will discuss three models of abnormal behavior to include the biological, psychological, and sociocultural models. Each is unique in its own right and no single model can account for all aspects of abnormality.

What are the different therapy models? ›

Approaches to psychotherapy fall into five broad categories:
  • Psychoanalysis and psychodynamic therapies. ...
  • Behavior therapy. ...
  • Cognitive therapy. ...
  • Humanistic therapy. ...
  • Integrative or holistic therapy.

Is the DSM a medical model? ›

While the successive framers of the DSM have attempted to base it on scientific evidence, political and economic factors have also shaped the conceptualization of mental illness. These economic and institutional forces have reinforced the DSM's use of a medical model in understanding psychopathology.

What does the medical model emphasize? ›

In its most extreme form, the "medical model" views the body as a machine, to be fixed when broken. It emphasizes treating specific physical diseases, does not accommodate mental or social problems well and, being concerned with resolving health problems, de-emphasizes prevention.

What is the medical model NHS? ›

The Model Health System is a data-driven improvement tool that enables NHS health systems and trusts to benchmark quality and productivity. By identifying opportunities for improvement, the Model Health System empowers NHS teams to continuously improve care for patients.

What is the medical model in human services? ›

The medical model system consists of the symptom, diagnosis, treatment, and cure. It follows these steps in order to provide well-being to the individual.

What are the advantages of the medical model of disability? ›

Under this model of disability the focus is on their impairment and how this excludes them from mainstream society. This approach can lead policy makers and service managers focussing their work on compensating people with impairments for what is wrong with their bodies.

When was the medical model of disability introduced? ›

The critique of the medical model originated in the psychiatry literature and has taken various forms since psychiatrist Thomas Szasz coined it in the mid-1950s. One version, an antireductionist view, lamented the tendency of medicine to reduce disease and disability down to physiochemical factors.

What is the difference between medical and social model of disability? ›

The social model of disability says that disability is caused by the way society is organised. The medical model of disability says people are disabled by their impairments or differences.

What are the limitations of the medical model? ›

To summarize, the medical model has serious limitations: (a) The model fails to describe accurately what actually occurs in therapy; (b) the model con- tinues to dominate the field not because of its accuracy but rather because of its questionable ties with medicine, science, and the health insurance industry; (c) the ...

What are the 3 models of disability? ›

Although people have various individual perspectives on disability, these viewpoints can be categorized into three overarching models of disability—moral, medical, and social (Olkin, 2002). Each model addresses the perceived causes of disability, appropriate responses, and deeper meanings.

What are the three models of healthcare? ›

In the broadest terms, there are four major healthcare models: the Beveridge model, the Bismarck model, national health insurance, and the out-of-pocket model.

What is the social model in mental health? ›

It is a perspective that locates an understanding of mental health within the social contexts within which people exist and uses practice and evidence to work with communities and individuals to help prevent mental health problems and to help with their recovery.

What is the NHS change model? ›

The Change Model is a framework for any project or programme that is seeking to achieve transformational, sustainable change. The model, originally developed in 2012, provides a useful organising framework for sustainable change and transformation that delivers real benefits for patients and the public.

What is the social model of health and illness? ›

The social model of health examines all the factors which contribute to health such as social, cultural, political and the environment. An example is poor housing: see diagram It is well documented that both stress and low self esteem can have a negative impact on health.

What are the advantages of the medical model? ›

Some benefits of the medical model approach to patient care include: Effective identification of symptoms and analysis to determine a root cause. A treatment-first approach to address concerns for both safety and comfort. An objective approach to narrowing potential conditions to improve diagnostic accuracy.

What are the three main service delivery models in mental health? ›

1 holistic, person-centred care 2 safe, high quality care 3 connected care.

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