Mental Illness/Bio-Medical Model
Mental Illness/Bio-Medical Model
DSM and Non-DSM Orientations of Treatment
The orientation of a treating mental health professional profoundly affects the curative effects of treatment. When patients are seen as “mentally ill” by practitioners of the biomedical model, the causative factor for their illness is seen as being biologically based brain diseases that are then treated with medications. The pathology is treated and is seen as being separate from the person. On the other hand, if patients are seen as struggling with difficult life’s problems instead, their abnormal behaviors are explained as resulting from social and environmental factors that cannot be resolved by medications. These two views of patient’s have a large effect upon patient care. Traditional western treatment will largely ignore the patient and not help them sort out their life’s stresses. Symptoms will be suppressed by pharmaceuticals and patients will be seen as being in “remission”.
A different orientation is to see patients as reacting to social and environmental issues, causing them to behave in socially deviant ways that are often misunderstood by society and mental health professionals. Encouraging the patient to integrate themselves and connect to the world enhances the person to live fully as a human being. These two views are in opposition with each other.
Disadvantages of DSM
Connor (1999) describes the disadvantages of the DSM medical model approach to psychopathology for the mental health professional. Firstly, each clinician will see part of the problem, and due to the individual differences of clinicians, each will see the problems differently. Mental health professionals will disagree on the patient’s diagnosis. Secondly, patients may or may not show a variety of symptoms from those described in the DSM. They may have symptoms from one diagnosis that my also be indicative of another category. Separating these symptoms into categories is less than scientifically based activity, but relies more on the clinicians personality, talent, experience and skill level. Clinicians often lose sight of the patient as a person, focusing instead on the client’s diagnostic label rather than on the individual.
Focusing on the person’s diagnosis is not a holistic approach to treating a patient.
Laing ( 1987) brings to our awareness that as Westerners, we are split off from each other as individuals, and so are split off from the world and the cosmos, creating a “schizoid” experience. He goes on to explain that Westerners minds are afraid of their bodies, and that we are afraid of the healthiness of being connected with ourselves. He uses Buddhism as an example of a healthy, non-totalitarian state that does not divide human beings from each other, and does not turn “our souls, our world of experience, our experience of the world, our state of consciousness into a policed state” (p. 85).
Laing’s (1987) view of the DSM orientation is that “DSM III is a comprehensive compendium of thoughts, feelings, desires, of all sorts of experiences, many usual, some unusual, deemed undesirable, to be prevented or stopped in our culture, and not only in our culture, but throughout the whole human species” (p. 82). Laing (1987) uses the DSM as an example of how we pick apart symptoms serving to fragment the person and not see the whole of the human being. He also speaks to the importance of Western defensiveness of our senses so that our ability to integrate our experience is atrophied, and we have “cultured out” our human experience. He seems to be saying that the DSM further breaks us down in to symptoms that works to further separate us from ourselves and into pieces. As one system of the human body works in concert with all other systems of the body, and healing must rely on the healthy functioning of all parts of the human body, so must the mental functioning of the person include all parts of the person, not just a separate symptom. Only with a holistic view can the person heal. To use Laing’s (1987) perspective of “All man in each man, Each man in all men” (p. 84), a whole society of humankind must be healed by each part of the world being healthy.
Laing (1987) also speaks to the absurdity of the Western view that “... magical thinking, clairvoyance, telepathy, sixth sense, sensing the presence of a force or person not actually present... (as cited in DSM III, p. 189) are mental disorders, when in our Christian-based country we speak of God who cannot be seen or proven to exist, but we as a culture accept that God “speaks” to us, and “moves in mysterious ways”.
Connor (1999) explains another problem with the DSM in that using categories to describe symptoms of the patient does not get to the cause of the problem. Diagnosis is only a label and does not give examples of successful treatments. The clinician uses a consensus model that describes some of the symptoms, leaving the professional with little to go on to actually treat the person.
Consensus is not a scientific method of diagnosis, and Connor (1999) raises the question of how exact a science is the bio-medical model when treatment is based on patients subjective complaints and vague medical terms? He explains that the DSM is not sophisticated enough to describe causes of the origins of patients problems, that may be vastly different based on race, culture, age, beliefs, etc. He makes the point that patients problems are often treated with medications, but often the problems are not medically related. This is a huge problem in the medical model’s approach to mental health issues.
Since many mental health problems are caused by outside influences such as oppressive societal roles, values, political agendas, family and relationship issues, the client is usually the one given medications that will not stop such problems. The client is given a label, seen as having a “mental problem”, and the societal issues remain. The client remains with having the symptoms and nothing is solved. The client’s mental problems are not really treated, but are buried with the suppression of symptoms by the medications they are prescribed. The client may be given “talk therapy” to help cope with the ongoing outside issues that cannot be solved by the client, but will usually be ongoing. This is the cycle the client finds himself or herself in, and so we don’t have
healed clients but people termed “revolving door clients” who go round and round through the mental health system.
Defining symptoms of the person using the DSM feeds into the HMO quick fix scheme of treatment that pays the pharmaceutical interests. This system earns profits for the pharmaceutical companies and HMO’s, but not the client. Since the pharmacological approach makes a profit from the needs of the clients, a greater societal problem exists where treatment is no longer about healing the person, but about feeding into our consumerist, capitalistic society. We are then faced with a society becoming more and more ill from our societal problems, who then go into treatment by the medical model based orientation in greater numbers. This creates a societal problem where people do not usually heal, but rely on medications to help ease their symptoms.
Szasz (1979) takes a similar view with Connor (1999) in that he argues against medications used to treat “mental illness”. Szasz sees the term “mental illness” as being a misnomer, in that the mental health professionals treat mental illness with medications as if mental illnesses were diseases of the brain. Szasz points out that diseases of the brain are biologically based problems that would more appropriately be treated with medications, but that the term “mental illness” is based upon problems with how a person should live that should not be treated with medications. Such problems in people’s lives, he explains, are related to social issues involving psychosocial, ethical and legal concepts. Szasz (1979) goes on to describe that in problems of living, people deviate from the standards of social norms, and that those deviant behaviors are then treated inappropriately with medication.
Rosenhan (1973) speaks to the depersonalization and labeling of patients in psychiatric hospitals where doctors routinely ignore the patients, setting the same example for the rest of the staff. In a hospital that is to treat patients, attributing a patient’s behavior as indicative of the patient’s “mental illness” rather than the environment, perpetuates the idea that the patient will always be ill in some way. Rosenhan (1973) talks about how detrimental labels are and how patients may be seen as being in “remission”, but they will always carry the tag. The clinicians cannot have a beneficial effect upon patients that they ignore, hence, they cannot become true healers.
Studies (Rosenhan, 1979) of how graduate students were treated when under the guise of being patients have shown that patients fight depersonalization every day while hospitalized that does little to help their problems of living. Szasz’s (1979) view would concur with Rosenhan’s that working on social and environmental stresses could not be helped by the patient’s being ignored by the people who are supposed to help them.
Benefits of DSM
Klerman (1984) believes that having an official nomenclature to describe disorders where causation cannot be proved conclusively enables a working catagory for disorders that clinicians have different theories about. He acknowledges that these descriptions of disorders have “only limited evidence for their etiologies” (p. 540). Categorizing also brought forth the idea of multiple disorders so that recognition of several mental problems occurring in conjunction with each another could be accepted by the medical community.
Klerman (1984) also sees the benefits of the DSM as being a diagnostic system that many medical practitioners have accepted for its feasibility and reliability. It has drawn the medical community together to some sort of organized view of mental disorders. The DSM also includes a multiaxial system in order to “accommodate the diverse aspects of our patients’ existence” (p. 540). Klerman (1984) also felt that the DSM is an evolving tool as more information becomes apparent. The DSM is meant to serve as providing diagnostic criteria that mental health professionals can use in an effort to understand what disease a patient has in order to find an effective medication to reduce symptoms. Since the biomedical model overwhelmingly supports the view of mental illness as being a biologically-based problem, use of pharmaceuticals fulfills the medical profession’s need to find a “cure” with medication.
Orientations that focus on DSM categorizations of patient care focus on pathology as being brain-based. The patient is often depersonalized and ignored as if the pathology is the patient that must be controlled by medications. This contrasts sharply with holistic views of interaction with the whole person who is seen as working on how to live with life’s problems.
This website is about Thomas Szasz’s being presented the Rollo May award for 1998 from the American Psychological Association that was accepted in his absence by Thomas Greening, Ph.D.
Myths about Szasz’s “The Myth of Mental Illness” are critiqued with rebuttals to criticisms of Szasz’s article. An example is the following:
Criticism: Some "mentally ill" people are dangerous and commit murders. They should be identified, diagnosed, and involuntarily confined and treated to protect innocent citizens and the social order.
Rebuttal: Society should enact laws to define and control illegal behavior. This is a legal and police issue, not a psychological or psychiatric issue. In the process, the Constitution and civil rights must be respected. Using statistical prediction to identify potential violent offenders would lead to imprisoning more young, poor black men than persons labeled "schizophrenic."
Connor, M. (1999). Criticism of America’s Diagnostic Bible - The DSM. [Online]
Klerman, G., Valliant, G., Spitzer, R., & Michels, R. (1984). A debate on DSM-III. American Journal of Psychiatry, 141(4), 539 - 553.
Laing, R. D. (1978). Hatred of health. Journal of Contemplative Psychotherapy, 4, 77 - 86.
Rosenhan, D. (1975). On being sane in insane places. In Scheff (Ed.), Labeling Madness (pp. 54-75). NJ: Prentice - Hall, Inc.
Szasz, T. (1979). The myth of mental illness. In J. Fadiman & D. Kewman (Eds.), Exploring madness: Experience, theory, and research (2nd ed.) Monterey, CA: Brooks/Cole.