Medicine has no difficulty tackling injuries, but for some reason, people in the mental health field have to talk about the psychological injuries in an isolated, fractured manner (“trauma model” being distinct from the “medical model”… does everything have to be its own model!), as if trauma doesn’t interact with other things like one’s developmental trajectory, personality traits, genetic vulnerabilities, neurophysiology, and the sociocultural context to produce its effects. (View Highlight)
People believe in essences even if they have no idea what they are. It is a matter of faith that there must be some genes that make dogs dogs—genes that all of them share, even if one has no clue what those genes might be. Prior to modern biology, people also had that belief, though they didn’t attribute the essence to genes: Perhaps it was something in the blood or seeds. This idea is referred to as a placeholder essence (Medin & Ortony, 1989); that is, people believe that there is an essence behind some categories even when they don’t have a specific idea of what it is … because there must be one, right?” (p 46) (View Highlight)
How did “illness” come to be treated as a cause? Illness is a descriptive characterization. To call something an illness does not mean we are assuming the existence of a discrete neurobiological disease entity called “illness” that causes it. Illnesses have causes; illness isn’t the cause of anything, let alone the root cause. (View Highlight)
This seems to be the primary problem with the discourse around the medical model. The “medical model” is conflated with the idea that all medical conditions are discrete biological disease entities, an assumption that isn’t even true for much of general medicine, let alone psychiatry. (View Highlight)
If the “medical model” is simply a way of talking about all the ways in which the real-world practice of medicine falls short, then we cannot use that to dismiss the theoretical underpinnings of the medical approach to mental health problems. (View Highlight)
by understanding “medical” in this reductive way, they set up medical vs. psychological and medical vs. social dichotomies that are scientifically and philosophically untenable. (View Highlight)
I am not encouraging complacency about essentializing psychiatric categories; what I’m saying is that giving up essentialism doesn’t invalidate our clinical conceptualization and treatment. Unfortunately, various aspects of mental disorder definition and classification are so entangled in the public mind that disillusionment about one rapidly seems to generate disillusionment about the rest. (View Highlight)
It is ironic that many people who accuse medicine of presenting an overly reductive and simplistic understanding of mental health problems themselves cannot see beyond an overly reductive and simplistic understanding of the medical model (View Highlight)
I agree that most medical and psychiatric interventions are focused on the individual, but that is not because the “medical model” fails to understand context, but because the manner in which we as a society organize and reimburse healthcare makes it impossible for clinicians to do anything about the context of a person’s life other than acknowledge its relevance. The clinic often treats individual effects of sociopolitical dysfunction, but the clinic is powerless to treat the sociopolitical dysfunction itself. If we want political change, we have to undertake the difficult, messy work of politics. No model applied in the clinic will do that for you. (View Highlight)
People pay lip service to the poor and marginalized, scold psychiatrists about scientific evidence, and then go to underground psychedelic retreats where they receive powerful psychotropics that alter their brain activity in dramatic ways, and they come out with some story about “there was nothing wrong with my brain; my OCD was caused by my fear of separation.” Could the internal contradictions of such narratives be any more apparent? (View Highlight)
A hegemony of medical language—as has happened, arguably, in public communication—is undesirable. People should have access to and be exposed to a variety of epistemic perspectives (View Highlight)