Chemical Imbalances:
Is the Medical Model Accurate?
Notes from:
Abnormal Psychology
and Modern Life, 11th edition
Carson, Butcher, Mineka; 718 pages
Robert Carson, PhD clinical Psychologist, Northwestern University.
member of Medial and Arts and Sciences faculties at Duke University since 1960.
Head of Duke Medical Center’s Division of Medical Psychology
Director of doctoral program.
James Butcher. PhD in clinical
psychology University of N. Carolina Professor of psychology University of Minnesota. Associate Director of Clinical program
formerly for 19 years.
former editor o of Psychological Assessment, journal of American Psychology
Association. Currently consulting editor. Developed disaster response programs
for airline disasters in Minnesota. fellow the American Psychological Association and Society for Personality Assessment.
published 40 books and 175 articles in abnormal psychology, cross-cultural psychology and personality assessment.
Susan Mineka, PhD in experimental psychology University of PA. Northwestern
University professor since 1987. served as Editor of the Journal of Abnormal Psychology. was President of the Society of r
the Science of Clinical Psychology and Midwestern Psychological Association. Other credentials.
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Abnormal Psychology and Modern Life is a thorough, scholarly college textbook
that covers every branch of the subject.
The “medical model” view of psychiatry and psychology is one
that does not hold up under scrutiny. Mental health disorders are much more complex. It certainly is the most expedient and
easiest way of handling matters, but a more serious look at psychology and psychiatry helps us to see, that not only such
a view not logical, but also, it is not universally accepted by professionals,
although it has become something of a standard today in psychiatry.
*********
Notes:
…it [abnormal psychology] has tended to be seen as
subset of essentially medical problems. As w shall see, however, mental disorders are for the most part only loosely analogous
(connected to) medical disease as ordinarily conceive. p.4.
The central features of the various identified disorders
are often somewhat vague, as are the boundaries purporting to separate one disorder from another. Much evidence suggests that
a strict categorical approach to identifying differences among types of human behavior, whether normal or abnormal, may well
be an unattainable goal. p.8
The DSM I [this is the manual used to categorize mental
health disorders-presently in its 4th edition] appeared in 1952 and was largely an outgrowth of attempts to standardize
diagnostic practices in coping with the widespread mental breakdowns occurring among military personnel in WWII. p.8
The number of recognized mental disorders has increased
enormously from DSM-1 to DSM-IV due both to the addition of new diagnoses and the elaborate subdivisions of older ones. Since
it is unlikely that the nature of the American psyche has changed all that much in the interim period, it seems more reasonable
to assume that mental health professionals view their field in a different light than they did 40-odd years ago. It is now
both more expanded and more finely differentiated into subsets of disorders.
…validity suffers since a category so broad can give only vague hints as to the nature of the disorders within
it. [speaking of certain disorders]. p.9
The Problem of
Labeling:
These expectations can influence even clinically important interactions and treatment choices. For example, arrival
a the diagnosis Major Depressive Disorder may cut off any further inquiry about the patient’s life situation and lead
abruptly tot a prescription of antidepressant medications. (Tucker, 1998).
Once an
individual is labeled, he or she may accept a redefined identity and play out the expectations of that role. …This acquisition of a new social identity can be harmful for a variety for reasons. The pejorative
and stigmatizing implications of may psychiatric labels can mark people as second-class citizens with severe limitations,
often presumed to be permanent (Jones, et al., 1984;1987). They can also have devastating effects on a person’s morale,
self-esteem and relationships with others. The person so labeled may decide he or she “is” their diagnosis and
adopt the latter, so to speaks, as a life “career.” p. 13.
Gladys Burr (shown here with her attorney) is a tragic example
of the dangers of labeling. Involuntarily committed by her mother (apparently because of some personality problems) in 1936
at the age of 29, Ms. Burr was diagnosed as psychotic and was later declared to be mentally retarded. though a number of IQ
tests administered from 1946-1961 showed her to be of normal intelligence, and though a number of doctors stated that she
was of normal intelligences and should be released, she was confined in a residential
center for the mentally retarded or in a state boarding home until 1978. Though a court did give her a financial reward in
compensation, surely nothing can compensate for 42 years of unnecessary and involuntary commitment. p. 13.
[Labeling] is necessitated, perhaps unwisely, by medical insurance requirements
and long-standing clinical administrative tradition. p. 14.
48% of Americans will experience some type of diagnosable (DSM) mood disorder
or mental illness in their lifetime.[including substance abuse].
30.5% of women will experience an anxiety disorder
24% will experience a mood disorder of some type [major depression being the
most common]
19.2% of men
56% percent with a history of
one disorder had two or more comorbid [disorders occurring at the same time]
disorders. p.18
[Abnormal psychology is not a simple “chemical imbalance”. There
is] “an interaction of genetic, biological, psychosocial, developmental
, and environmental factors [that] operate together in some probably unique and still obscure fashion. p. 20
1. A scientific approach to abnormal behavior [includes] genetics, biochemistry
[brain chemistry], neurophysiology, sociology, anthropology and psychology. p.26
2. An awareness of our common human concerns. Insights into hope, faith, courage,
love, grief, despair, death and the quest of or values and meaning are not readily obtainable in a laboratory. We most supplement
what science with its present methods can tech by turning to literature, drama, autobiographical accounts, and even art, history
and religion to seek greater understanding of these aspects of human psychological functioning. p.26
…the validity of the diagnoses in the current DSM remains the subject
of controversy.
As you will see in the next two chapters, a medical or disease metaphor has
tended to dominate the history of the field of psychopathology and the way we view abnormal behavior. That is various types
of abnormal behavior have tended to be seen as the “symptomatic” outward manifestations of an underlying illness.
The problematic behavior cannot itself be the “dysfunction” for
that would be like saying mental disorders are due to mental disorders. p.27. [As is often the case e.g. with ADHD, the symptoms
becomes or defines the illness].
The symptom/underlying disease model is thus at once both conjectural
and potentially deceiving. p.27
Though the symptom/underlying disease model is useful for strictly physical
illness, when applied to mental disorder it ends to invite us to look for causes in places where none may exist. p.28.
The insistence on a categorical format for mental disorder diagnoses that are
primarily prototypal in nature is a source of much confusions and misdirected effort in the field at large. [mental health
disorders are not composed of] cleanly separated boundaries. …largely in the nature of a convenient fiction. 28.
[referring to the
cleanly separated boundaries of different types of disorders. e.g. Bipolar I, Bipolar II, anxiety disorder, major depressive
disorder, ADHD. there is much overlap, room for conjecture and interpretation, and in the case of ADHD and bipolar, many similar
symptoms, with two completely different types of medication, as can be said with major depression along with anxiety disorders].
The upshot seems to be that the modern DSM effort has resulted in a confusing
array of interrelated psychological difficulties that are conceived to be separate and independent entities of disorder, even
though there is massive evidence against such a view. p.28
[Again] health insurance requires “inclusion of a [specific] disorder”
[in order to pay.] p.29.
Familiarity with the system in use is thus vital for the serious student. We
hope, however, that this discussion has given you a more sophisticated perspective on the classificatory issues facing the
field. p.29
Early 1800s: Moral management
Method of treatment that focused on a patient’s social, individual and
occupational needs-became relatively widespread. [early 1800s]. moral treatment
aimed at relieving the patient by friendly association, discussion of his difficulties, and the daily pursuit of purposeful
activity (work). in other words, social therapy, individual therapy and occupational therapy [in modern terms]. more humane treatment. moral and spiritual development, rehabilitation of their “characcter”
than on their physical or mental disorders. (very littltle effective treatment was available for these conditions at the time.).
Manual labor, spiritual discussion, humane treatment.
Moral management achieved a high degree of effectiveness,
all the more amazing because it was done without the benefit of the antipsychotic drugs used today. Discharge rate was 71%.
(today it is 90%-however, much of the care after discharge is in the community and it is often repetitive, so 90% is not indicative
as a comparable percentage.) p.44.
Despite its reported effectiveness, in many cases, moral
management was nearly abandoned by the latter part of the 19th century. The reasons were many and varied. Among
the more obvious ones were the ethnic prejudice that came with the rising immigrant population, leading to tension between
staff and patients; the failure of the movements’ leaders to train their own replacements; and the overextension of
hospital facilities.
Also, the rise of the “mental hygiene movement”
which stressed physical well-being, rather than focusing on therapy of any kind, as well as advances in biomedical science.
These advances fostered the notion that all mental disorders
would eventually yield to biological explanations and biologically based treatment (drugs and brain disease). Thus the psychological
and social environment of a patient was considered largely irrelevant, and the best one could do was keep the patient comfortable
until a biological cure was discovered. Needless to say, the anticipate biological cure-all did not arrive, and by the late
1940s and 1950s discharge rates were down to about 30%. p.45
To be sure, organic mental disorders do occur, but the
vast majority of abnormal behavior is not clearly associated with [this]. Nonetheless, the medical model-a conceptual
model that is in appropriate for much abnormal behavior—became stubbornly entrenched by these early
but limited successes. It is important to note that a medical-model orientation is not limited to biological viewpoints on
the nature of mental disorder.
It has also extended into psychosocial theorizing [the
view generally held by many today] by adopting a symptom/underlying-cause point of view. This point of view assumes that abnormal
behavior, even though it may be psychological (rather than biological in nature, is a symptom of some sort of underlying,
internal pathology or “illness”—just as a fever is a symptom of an underlying infection [the diabetic/insulin
idea concerning medicine and mental illness]. p.51.
As we will sees shortly, Freud , who was a physician, took
this approach in developing his psychoanalytic theory of abnormal behavior.[Freud, in addition to psychoanalytic theory, delved
into dream analysis, and use of cocaine, which he himself used, as a therapy, as well as introspection into hidden sexual
conflicts.]
End of quotes
We can see then that the "medical model" approach towards
mental health is both shortsighted and not in the best interests of the clients. It tends to simplify treatment of mental
health disorders in favor of pharmaceutical treatment, which is often not the best way of handling things, especially with
children's disorders. In doing so, the medical model is condusive towards profit oriented medicine, but it it is
not conducive to the long-term mental health needs of persons suffering from various forms of mental distress.
