Is the medical model really so evil?
Posted Friday 12 February 2010
A guest post by Zarathustra of the Mental Nurse blog.
Before I became a mental health nurse, I spent a few years as an over-educated, unemployable humanities graduate - hey, I'm not knocking that; being an over-educated, unemployable humanities graduate can be a lot of fun.
I also had quite firm views on psychiatry. I was a huge fan of RD Laing, the radical 60s psychiatrist. I'd tell anyone who would listen that psychiatric diagnoses are a subjective construct, that drugs aren't the answer, and that the medical model of mental illness is irredeemably reductionist (yes, I was the kind of humanities graduate for whom "reductionist" is the ultimate word of abuse).
Comparing these views with what I think now, I get the impression my younger self would be rather disappointed in me. Admittedly I haven't changed my views entirely. I still think there are problems with some forms of psychiatric diagnoses, and these problems are inevitable due to their subjective nature. I still regard the psychosocial aspects of mental health as absolutely vital, and I still regard the drug reps as servants of Beelzebub.
Even so, I also now think the medical model has its merits as well as its flaws. Diagnostic categories do seem to have some usefulness and validity, and psychiatric medication can at times work wonders. The twentysomething, BA-educated version of me would shake his head in sorrow.
So, what's changed my mind on the medical model? Well, the most obvious answer would be that I went into the belly of the beast and trained as a mental health nurse. Certainly cold, hard clinical experience has had a lot to do with it. I can't swan around saying that the drugs don't work, because all too frequently they do work. Admittedly the meds work haphazardly, and sadly all too often with unpleasant side effects, but the bottom line is I've seen too many people benefit from medication to be able to dismiss those benefits.
Crucially though, the people who've most effectively challenged my previous hostility to the medical model have been patients rather than doctors.
I have a friend with bipolar disorder who's also a very intelligent, independent-minded lady. Not the sort to be brainwashed by an evil cabal of shrinks and Big Pharma. She's tried yoga, mindfulness, CBT, person-centred counselling...all of which have had some benefit, but she's also learned to her cost that, unless she takes the meds, all those benefits are immediately cancelled out. Her response to anti-psychiatry is to angrily insist, "Look, I don't have a problem in living, or a social construct, or an existential crisis. I have an illness which is called bipolar disorder, for which I take medication."
"Your diagnosis is this, and we're going to treat it like this" is an explanation that works for a lot of a people. Those people shouldn't be hectored on how they're dupes of the medico-pharmaceutical complex simply for finding the medical model helpful.
While much has been written on how psychiatric diagnosis can label and stigmatise people, you can also demean, belittle and patronise people by telling them they don't have an illness, and that it's all just a social construct/problem in living/spiritual crisis.
Of the anti-psychiatric authors, Thomas Szasz in particular writes with an unpleasant moralistic tone that reeks of, "You could just snap out of it and pull yourself together if you really wanted to."
Ultimately though, any argument about, say, "medical model" versus "psychosocial model" shouldn't be an either/or issue. It's perfectly possible to make use of diagnosis and medication while also taking into account psychological and social issues. And yes, while also being aware of the political and philosophical controversies that psychiatry generates.
Any model of psychiatry, be it medical, psychosocial, existential, social contructivist etc, describes an aspect of the truth from one particular angle. We need to be able to move between the models as and when they become useful, rather than loudly privilege one model while denouncing the others.
Speaking of models, a consultant psychiatrist I know has a fondness for saying that we follow an "ecobiopsychosocial model". I'm gagging for him to say it to me so I can quip back, "That's easy for you to say."
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