THE MEDICAL ROLE FACE OF PSYCHOLOGICAL.

The medical model of abnormal psychology treats mental disorders in the same way as a broken arm, i.e. there is thought to be a physical cause.
Supporters of the medical model consequently consider symptoms to be outward signs of the inner physical disorder and believe that if symptoms are grouped together and classified into a ‘syndrome’ the true cause can eventually be discovered and appropriate physical treatment administered.

Assumptions

• Behaviors such as hallucinations are 'symptoms' of mental illness as are suicidal ideas or extreme fears such as phobias about snakes and so on.  Different illnesses can be identified as 'syndromes', clusters of symptoms that go together and are caused by the illness.
  


• These symptoms lead the psychiatrist to make a 'diagnosis' for example 'this patient is suffering from a severe psychosis, he is suffering from the medical condition we call schizophrenia'.
  


• The model assumes biological causes, pathology of the brain, germs or genes.

What is happening here? The doctor makes a judgement of the patient's behavior, usually in a clinical interview after a relative or general practitioner has asked for an assessment.  The doctor will judge that the 'patient' is exhibiting abnormal behavior by asking questions and observing the patient.  Judgement will also be influenced heavily by what the relatives and others near to the patient say and the context – is mental illness more likely to be diagnosed in a mental hospital.

Treatment – On the basis of the diagnosis, the doctor will prescribe treatment such as drugs, psychosurgery or electro-convulsive therapy.

Drug Treatment

The film One flew over the cuckoos nest demonstrates the way in which drugs are handed out like smarties merely to keep the patients subdued.
Note also in the film that the same type of drug is given to every patient with no regard for the individual’s case history or symptoms; the aim is merely to drug them up to the eye balls to shut them up!

• Note that drugs do not deal with the cause of the problem, they only reduce the symptoms.

• Patients often welcome drug therapy, as it is quicker, easier and less threatening than talk therapy.

• Some drugs cause dependency.

• Drug treatment is usually superior to no treatment.

• Between 50 – 65% of patients benefit from drug treatments.

Psychosurgery

As a last result when drugs and ECT have apparently failed psychosurgery is an option. This basically involves either cutting out brain nerve fibres or burning parts of the nerves that are thought to be involved in the disorder (when the patient is conscious).
The most common form of psychosurgery is a prefrontal lobotomy.
Unfortunately these operations have a nasty tendency to leave the patient vegetablized or ‘numb’ with a flat personality, shuffling movements etc. due to their inaccuracy. Moniz ‘discovered’ the lobotomy in 1935 after successfully snatching out bits of chimps’ brains.
It didn’t take long for him to get the message that his revolutionary treatment was not so perfect; in 1944 a rather dissatisfied patient called his name in the street and shot him in the spine, paralysing him for life! As a consolation he received the Nobel prize for his contribution to science in 1949.
Surgery is used only as a last resort, where the patient has failed to respond to other forms of treatment and their disorder is very severe. This is because all surgery is risky and the effects of neurosurgery can be unpredictable. Also, there may be no benefit to the patient and the effects are irreversible.

There are four major types of lobotomy:

BBC Radio 4: The Lobotomists. This programme tells the story of three key figures in the strange history of lobotomy - and for the first time explores the popularity of lobotomy in the UK in detail.

ECT

Electro Convulsive Therapy (ECT) began in the 1930’s after it was noticed that when cows are executed by electric shocks they appear to convulse as if they are having an epileptic shock.
The idea was extrapolated to humans as a treatment for schizophrenia on the theoretical basis that nobody can have schizophrenia and epilepsy together, so if epilepsy is induced by electric shock the schizophrenic symptoms will be forced into submission! Bizzare train of thought, but it did seem to work to a certain extent on some patients and to this day is used as a last resort for treating severe depression.
There are many critics of this extreme form of treatment, especially of its uncontrolled and unwarranted use in many large, under staffed mental institutions where it may be used simply to make patients docile and manageable or as a punishment (Breggin 1979).
ECT side effects include impaired language and memory as well as loss of self esteem due to not being able to remember important personal facts or perform routine tasks.

The procedure for administering ECT involves giving a muscle relaxant (to minimise the violent physical reactions) followed by an anaesthetic and topped with a 80-110 volt electric shock through electrodes placed on the temples which produces an artificial Grand Mal epileptic fit (loss of consciousness and strong bodily convulsions followed by a period of coma like sleep).
There is a debate on the ethics of using ECT, primarily because it often takes place without the consent of the individual and we don’t know how it works!
There are three theories as to how ECT may work:

1. The shock literally shocks the person out of their illness as it is regarded as a punishment for the inappropriate behavior.
   
   
2. Biochemical changes take place in the brain following the shocks which stimulate particular neurotransmitters.
   
   
3. The associated memory loss following shock allows the person to start afresh. They literally forget they were depressed or suffering from schizophrenia.

Evaluation of The Medical Model

Strengths:

• It is objective, being based on mature biological science.
• It has given insight into the causes of some conditions, such as GPI and Alzheimer's disease, an organic condition causing confusion in the elderly.
• Treatment is quick and, relative to alternatives, cheap and easy to administer. It has proved to be effective in controlling serious mental illness like schizophrenia allowing patients who would otherwise have to remain in hospital to live at home.
• The sickness label has reduced the fear of those with mental disorders. Historically, they were thought to be possessed by evil spirits or the devil – especially women who were burned as witches!

Weaknesses:

• The treatments have serious side-effects, for example ECT can cause memory loss, and they are not always effective. Drugs may not 'cure' the condition, but simply act as a chemical straitjacket.
• The failure to find convincing physical causes for most mental illnesses must throw the validity of the medical model into question, for example affective disorders and neuroses. For this reason, many mental disorders are called 'functional'. The test case is schizophrenia but even here genetic or neurochemical explanations are inconclusive. The medical model is therefore focused on physical causes and largely ignores environmental or psychological causes.
• There are also ethical problems in labelling someone mentally ill – Szasz says that, apart from identified diseases of the brain, most so-called mental disorders are really problems of living. Labelling can lead to discrimination and loss of rights.
• The medical model has been the one that has been most influential in determining the way that mentally disturbed people are treated, but most psychologists would say that at best, it only provides a partial explanation, and may even be totally inappropriate.