The medical model is without merit

Today I have the pleasure of posting something that was submitted to me for publication. It’s written by an interesting man, whom I really don’t know but with whom I seem to share some quite similar ideas.

From Tim’s about page:

My work is informed by my study of coherence therapy with Bruce Ecker, its co-founder, as well as almost ten years of Buddhist meditation practice. Both of these traditions have taught me that understanding and acceptance are the path to deep and lasting change.

As a therapist, I see my clients as experts in their own experience and the ones who decide what change they want to make. My role is to help them discover what is keeping them stuck and transform whatever that is. I have found over and over again with my clients that there is a hidden emotional core at the root of each problem, and that change happens as soon as that core is recognized.

Tim Desmond offers phone counseling and training for therapists through his website

His piece follows here and is a response to an article I wrote called ‘Undiagnosing Myself.’ :

I was deeply touched by a piece on this blog called ‘Undiagnosing Myself.’ I wanted to contribute that from a scientific angle, the whole idea of using psychiatric diagnoses is profoundly flawed.  To do so, I will summarize the work of psychologist and award-winning author Richard Bentall. Over the course of his career Richard Bentall has critiqued the medical model of modern psychiatric diagnosis and proposed instead a more personalized symptom-based approach.

The basic question is this: Do people suffer from a certain number of psychiatric disorders/diseases or do people experience varying degrees of human suffering in their own idiosyncratic ways? The modern mental health establishment clearly believes in the disorder/disease model as evidenced by the structure of the DSM and the theory of ‘chemical imbalance.’ This belief is so pervasive that even people who claim to disagree with the medical model of diagnosis often think within its terms. For example, the idea that one can be ‘misdiagnosed’ presupposes that a correct diagnosis could exist. Similarly, saying that schizophrenia is partially caused by psychological factors assumes that ‘schizophrenia’ is a real condition — a valid way to group people.

The theory that psychological distress is caused by a finite number of psychiatric diseases can be attributed to Emil Kraepelin, who first published his Compendium of Psychiatry in 1883. Kraepelin believed that the psychiatric patients he treated suffered from diseases analogous to any treated by a practitioner of internal medicine. (This is reminiscent of the comparison made today between psychiatric diagnoses and diabetes forwarded by the pharmaceutical industry.)  He said that different people with the same disease should have identical symptoms, identical anatomical problems and it should be due to the same cause. According to Kraepelin, all that was needed was for these diseases to be discovered in order for diagnosis and treatment in psychiatry to catch up with the rest of medicine. Since it was far beyond the knowledge of his time (or ours for that matter) to find common anatomical problems or causes, he chose to group symptoms. He believed that if he grouped symptoms ‘correctly’ the people grouped together would be sharing the same underlying disease. They would therefore have the same anatomical problems due to the same causes and respond more or less identically to treatment. He hoped that this kind of systematizing would lead to great advances in the efficacy of treatment.

While Kraepelin’s categories have changed over time and grown from 3 to over 200, the basic idea persists to this day – that there are a finite number of psychiatric disorders/diseases people can have and if we were to somehow group symptoms ‘correctly’ we would have isolated real disorders/diseases. After over 100 years of effort, we have not gotten any better at helping people with psychological distress nor have we found any real evidence that these diseases exist. In fact, there is a large body of research that directly contradicts his theory.

For example, you would expect that if one doctor diagnosed you with Strep Throat, you would be able to go to any other doctor and get the same diagnosis – and you’d be right. The reason for this is that Strep Throat is a real disease associated with an infection of streptococcal bacteria. You either have it or you don’t and there are reliable ways to test if you do.

However, if you are experiencing severe psychological distress and one psychiatrist diagnoses you with “bipolar disorder” there is only a 50-60% chance that the next one you see would give you the same diagnosis. Why is this? Both psychiatrists would have been highly trained in diagnosis, and they would be using the same criteria to make their judgment. So if one says you have PTSD, another says bipolar and a third says brief psychotic disorder, which is the “correct diagnosis?” What do you really have?

Richard Bentall argues that the problem is Kraepelin’s main assumption – that there are a finite number of psychiatric disorders – is just not true. You don’t have any of those disorders because they are not real. They were made up and there despite looking for evidence of them for over 100 years, none has been found. Instead he argues that someone who is experiencing emotional symptoms can be better understood as showing extreme expressions of normal human responses to distress.

Bentall advocates for abandoning psychiatric diagnoses altogether. He claims that psychiatry’s stubborn attempt to treat mental distress as a medical problem is what has led to its inability to improve treatment outcomes over time. Citing a large body of research, Bentall shows that symptoms from depressed mood to hallucinations can be accounted for psychologically and that doing so is not only more in line with science but more humanizing to people. Therefore he favors what he calls a ‘complaint-oriented’ approach in which each person would be assessed according to his or her unique symptomology. The focus becomes the symptoms themselves and we avoid trying to groups them into arbitrary made-up disorders. Symptoms (such as anixety) can be understood (as fear) and treated (by helping the person to feel safe), while disorders cannot because they are not real.

To learn more about Bentall’s work, read his Madness Explained which won the British Psychological Society’s Book Award.