Thursday, 13 June 2019

The Medical Model in Mental Health

Today's post is by Dr Ahmed Samei Huda, a Consultant Psychiatrist working mostly in Early Intervention in Psychosis for Pennine Care NHS Foundation Trust. He is introducing his book, The Medical Model in Mental Health: An Explanation and Evaluation (OUP, 2019). Huda is on Twitter (@SameiHuda), and blogs here.

I am a clinician not an academic who became increasingly frustrated with the strawman depictions of psychiatry in the fraught conflicts between different professions and ideologies in mental health. So I decided to read more about what the medical model was and the more I read the more he realised there was an absence of a book explaining from first principles what the medical model was and how it was applied in mental health. 

I’m not a world class expert but my over 20 years experience of clinical practice combined with extensive reading including several volumes of the excellent International Perspectives in Philosophy and Psychiatry series and Davidson’s Textbook of Medicine as well as several hundred papers helped qualify me to write this book and luckily OUP agreed.

The book starts with an outline of the medical model as a model of practice – using the best evidence to guide clinical decision-making – and as a model of explanation (currently biopsychosocial not biomedical) and the lack of clear-cut definitions for disease and illness in all of medicine.

Categorical diagnostic constructs are used as an easy way to acquire, learn and recall relevant information for clinical practice. Doctors match the clinical picture of the patient to the best matching clinical picture of a diagnostic construct. These constructs carry attached information such as on prognosis, complications or treatment effectiveness. 

Diagnostic constructs are classified on similarities of clinical picture, changes in structure/ process and/or causes. They are used to represent several different types of conditions such as spectrums with health, spectrums of conditions, injuries or problems thought to benefit from healthcare professionals’ interventions. Doctors work as part of teams and the medical model is not the only way and not always the best way to help people with the problems they come with to services.

The book then discusses some relevant papers to identify criticisms of psychiatric diagnostic constructs and treatments. The best comparison is with general medicine and the rest of the book analyses the relevant evidence which shows there is significant overlap between psychiatry and general medicine – for example both their diagnostic constructs often lack clear boundaries with healthy states, lack clear boundaries between each other and require additional information apart from diagnosis to guide clinical decision making, lack of knowledge of biological mechanisms or causes and the importance of social factors as well as overlapping effectiveness of their treatments which in both psychiatry and medicine which in both specialties are usually not cures or reverse diseases. 

Psychiatry is thus a member of family of the medical specialties despite the claims of its’ critics but necessarily must work in a multidisciplinary way and diagnostic constructs whilst the most useful classification for social purpose such as access to welfare and administration are often not ideal for different ways of working with mental health patients such as psychotherapy.

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