Throughout time, the distinction between what isperceived to be normal and what is abnormal has been an ongoing debate.
Amental disorder is an abnormal behavioural pattern that occurs in the brain,resulting in abnormal human functioning. Mental disorders are amongst otherdisorders that are perceived to be abnormal. According to the AmericanPsychiatric Association, “Mental illnesses are healthconditions involving changes in thinking, emotion or behavior (or a combinationof these). Mental illnesses are associated with distress and/or problemsfunctioning in social, work or family activities.” (Parekh,2015). The “Diagnostic and StatisticalManual of Mental Disorders Fifth Edition” (DSM-5) (American PsychiatricAssociation, 2013), is a system of classification and provides criteria to aiddoctors in diagnosing mental disorders based on symptoms.
The medical approachto mental disorders assumes mental disorders have a physical cause, and can betreated through biological treatments, for example, drugs. “The biomedicalmodel posits that mental disorders are brain diseases and emphasizespharmacological treatment to target presumed biological abnormalities.”(Deacon, 2013). The DSM-5 consists of 20 categories of mentaldisorders that are categorised by their similarities. “Thesequence of chapters in DSM-5 is based on advancements in our understanding ofthe underlying vulnerabilities as well as symptom characteristics of disorders.
This sequence reflects what has been learned during the past two decades abouthow the brain functions and how genes and environment influence a person’shealth and behaviour.” (American Psychiatric Association, 2013). The DSM-5 usesdifferent techniques to aid doctors in the diagnosis of patients, for exampleclinical interviews, observations, review of medical records and psychometrictests.
Post diagnosis, doctors then offer biological treatment to patients totreat the physical cause the medical approach assumes mental disorders obtain. Twoissues occur in the diagnosis and classification of mental disorders, which arereliability and validity. The validity refers to whether the diagnosis ofmental disorder is true and accurate to what the patient actually has, andreliability refers to whether the diagnosis is consistent across other patientswith the same symptom set, for example. Chasson et al. conducted a study to determine whethercorrect diagnosis of OCD was delivered to African-American’s using the DSM-5.Structured clinical interviews were conducted on 83 African-American adultsover a 9-and a half month period between 2009 and 2010.
74 participants werealready diagnosed with OCD and 9 were not. 42 participants were female, with anaverage age of 41.4. “Resultsindicate that the SCID-OCD lacked the ability to accurately diagnose less severeclinical levels of OCD in African Americans.” (Chasson et al., 2017). Theresults showed there were more inaccurate diagnoses on African-American’s thanaccurate diagnoses, highlighting problems with DSM-5 diagnosis of OCD. Thissuggests that if the DSM-5 is not valid in correctly diagnosing OCD, it may notbe accurate in diagnosing other mental disorders, lowering the ecologicalvalidity of the DSM-5, and the medical approach.
However, Chasson et al.reported that “AfricanAmericans seem to have less awareness that OCD represents a potentially seriousmental health condition, and about half of those in the current study had noteven realized they had a disorder or known how to get treatment for it.”This could have resulted in participants not reporting all symptoms or nottaking their symptoms serious enough as they did not have the education neededto recognize that they were symptoms of a mental disorder. A methodologicalcriticism of this study is that Chasson et al. used correlational analysis, andwe cannot assume that correlation proves causation, it merely shows a linkbetween OCD and incorrect diagnoses using the DSM-5. This reduces thereliability of the study as the same results may not be obtained every time,reducing the ecological validity of the study as the results may not beapplicable to wider settings. Also, this study only used African-Americanparticipants resulting in the lack of population validity, as we cannot be surethe results would be the same or applicable to the wider population.
Amethodological strength of this study is that African-American evaluators were usedto deliver the structured clinical interviews, meaning participants may havefelt more comfortable, possibly giving more accurate answers. Reiger at al., also conducted a study to test theaccuracy of diagnoses using the DSM-5. They used 11 academic institutions inCanada and USA where they screened 31 patients using the DSM-5.
The resultsshowed 14 out of 31 patients diagnoses were in the very good to good range, 6were in the questionable range and 11 were in the unacceptable to insufficientrange. These results show that the DSM-5 produced more correct and acceptablediagnoses than incorrect diagnoses, increasing the validity of the DSM-5meaning doctors and patients alike will be increasingly confident in givingcorrect diagnoses, and therefore receiving advice for treatment that will fittheir diagnoses. A strength of this study is that it used adult and childparticipants, increasing the population validity of the study as the resultsmay be applicable to the wider population, however the study only focused onWestern cultures, so we cannot assume the results will be applicable to othercultures, for example Eastern cultures. Another strength is that, “Patientswere randomly assigned to two clinicians for a diagnostic interview; clinicianswere blind to any previous diagnosis” (Regier et al., 2013),resulting in no demand characteristics as the clinicans could not be influencedto make any diagnoses based on the patient’s previous ones, meaning thediagnoses would have been a more true and accurate representation of theaccuracy of DSM-5. Therefore, the results support the DSM-5 in its accuracy ofdiagnoses, subsequently supporting the medical approach to mental disorders.A case studyof Johann Hari supports the medical approach to mental disorders. Hari went tothe doctors complaining of depressive moods when she was a teenager and theyprescribed her with anti-depressants which worked up to a point, then she hadto keep increasing the dosage when her depressive thoughts relapsed.
The doctorexplained to her, “There are now, thankfully, new drugs that will restore yourserotonin level to that of a normal person.” (Hari, 2018). Hari reported, “Beforelong, I felt as bad as I had at the start. I went back to my doctor, and hetold me that I was clearly on too low a dose. (…) My dose kept being jacked up,until I was on 80mg, where it stayed for many years, with only a few shortbreaks. And still the pain broke back through.” (Hari, 2018). Hari’s case studyproves that the medical model of mental disorders is correct up to a point, asthe anti-depressants she was prescribed did induce her serotonin levels for awhile.
However, they did not cure her depression, leading to questionssurrounding if the medical approach is correct indefinitely. Is it the casethat other treatments work better? There are other models and treatments thathave been proven to work for mental disorders, for example the cognitiveapproach looks at systematic desensitization instead of drugs as a technique,which has been proven to work. It could be the case that drugs don’t work inthe same way for everyone, as societies and cultures have different ways ofliving. However, we are all human and all have the same autonomy so if themedical approach was correct, surely all the biological treatment would workthe same for all humans.Culture bound syndromes are mental disorders thatare only prevalent in specific cultures. These syndromes are a way ofchallenging the medical approach to mental disorders, as if the medicalapproach is correct, treatment for culture bound disorders should work the sameas treatment for other mental disorders. “Koro isdescribed as culture bound syndrome characterized by a belief that one’s penisis retracting into the abdomen and imminent death due to same.” (Chowdhury, 1996).
As a result of this, Koro induces anxiety attacks andpsychosocial complications. Koro is prevalent amongst Chinese and East-Asiancultures, making it a culture bound syndrome. “A 24-year-old male frommiddle class South Indian household was admitted to the department with oneyear history of withdrawn behavior, believing that his penis is retracting intohis abdomen and refusal to work or socialize as he believed that theseincreased the “speed” of retraction.” (Garg, Kumar and Sharadhi, 2017).The patient was treated with electro-convulsive therapy and then given a6mg/day dose of lorazepam. This case study supports the medical approach tomental disorders as “complete remission was achieved in each case.” (Garg,Kumar and Sharadhi, 2017), meaning the medical treatment worked in curing thepatient from Koro. However, there is debate whether Koro is a true culturebound syndrome as some symptoms coincide with symptoms of other disorders, suchas Schizophrenia.
Culture bound syndromes, and case studies, lack populationvalidity as we cannot assume the results would be the same for the widerpopulation and other cultures, meaning the study is low in ecological validityas the results cannot be applied to other settings, apart from Chinese andEast-Asian cultures, subsequently lowering the medical model’s validity. (Garg,Kumar and Sharadhi, 2017). The medical approach to mental disorders offerspatients diagnosed by the DSM-5 with many treatments, including drugs. Differentdrugs are used to treat different disorders, for example anti-depressants treatdepression by increasing the levels of serotonin in the blood, and mono-amineoxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs),which both increase or decrease levels of serotonin and dopamine as required.
“Antidepressants are medications commonly used totreat depression. Antidepressants are also used for other health conditions,such as anxiety, pain and insomnia. Although antidepressants are notFDA-approved specifically to treat ADHD, antidepressants are sometimes used totreat ADHD in adults.
” (Nimh.nih.gov, 2016). This suggests drugs are a useful, widespread treatment of mental disorders. Aclinical psychology review by Deacon says, “Drugs formerlyknown as “major tranquilizers” because of their powerful sedating effects arenow classified as “antipsychotics.” “Minor tranquilizers” have become”antianxiety” agents.
” (Deacon, 2013). Astudy by Lieberman et al. on the effectiveness of anti-psychotics did not findany significant major short or long-term effects of “olanzapine, quetiapine, risperidone andziprasidone, (…) over perphenazine, a neuroleptic medication whose therapeuticbenefits for psychosis were first described in 1957.” (Lieberman et al., 2005). These drugs areall general atypical antipsychotics, so their lack of effectiveness on patientssuggests that drugs may not be the correct treatment or cure for patients withmental disorders.
This clearly questions the medical approaches validity asdrugs are the main form of treatment it offers. This may suggest anotherexplanation for mental disorders may be better suited to some patients, forexample the cognitive explanation which assumes mental disorders are caused byirrational and maladaptive thoughts created by the individual, offeringcognitive therapies as a treatment, which have been proven to work in somecases. Another study by Sikich et al.found similar results when they researched the Treatment of Early-OnsetSchizophrenia Spectrum. (Sikich et al, 2008). “In both these studies, morethan 70% of patients eventually stopped taking the assigned medication due tolack of efficacy or intolerable adverse effects.
” (Deacon, 2013). Thisagain suggests there must be different treatments for mental disorders thatwork more effectively. This reduces the external validity of drugs as atreatment for mental disorders as if they didn’t work for most participants inthese studies, they may not work for most of the wider population, lowering thereliability and validity of drugs, and the medical approach as a whole. The largestantidepressant effectiveness study conducted was “the Sequenced TreatmentAlternatives to Relieve Depression (STAR*D) study.” (Deacon, 2013). “Thisinvestigation revealed that the vast majority of depressed patients do notexperience long-term remission with newer-generation antidepressants.” (Rush et al., 2006).
Results alsoshowed, “only 3% of patients who initially benefited from antidepressantmedication maintained their improvement and remained in the study at 12-monthfollow-up.” (Pigott, 2011). These results again question the validity of drugsas they may not work for the wider population. A strength of this study is thatit used many participants, increasing the population and ecological validity ofthe study as the sample size was big, meaning the results may be applicable tothe wider population. The effectiveness of drugs has been an ongoing debate for years. Themedical approach obviously assumes drugs can cure mental illnesses, but someresearch has proven otherwise, and lots of patients relapse after finishingdrug treatment. The medical approach assumes mental disorders are caused bychemical imbalances in the brain, for example low levels of serotonin can belinked to depression, however some studies have suggested other influences formental disorders, such as genetics and environmental influences.
These assumptionsthreaten the effectiveness argument of drugs treating mental disorders, asdrugs clearly cannot treat environmental influences, like the home you live in.Some research has found, “Relapse is likelywhen drugs are discontinued. Drug treatment is usually superior to notreatment. Between 50 – 65% of patients benefit from drug treatments”, (McLeod, S. A.
, 2014), and that “Drugs do not deal with the cause of the problem,they only reduce the symptoms, and that some drugs cause dependency.” (McLeod, S. A., 2014).This suggests drugs are work in the short-term, rather than long-term period,which is not ideal for patients who want to cure their mental illnesses.
However, some research has found drugs to be successful intreating mental disorders, for example, “Antipsychotics have long been established as a relatively cheap, effectivetreatment, which rapidly reduce symptoms and enable many people to liverelatively normal lives.” (Van Putten, 1981). However, others have founddifferently.
“There is ageneral consensus that first generation antipsychotics (FGAs) do not improvecognition and may even have specific adverse effects on cognition related totheir sedative andanticholinergic properties.” (Spohn,1989). A study by John Kane, MD, Gilbert Honigfeld, PhDand Jack Singer, MD et al.
found that”clozapine compared to chlorpromazine reduced negative symptoms and improvedcognitive deficits, raised expectations that SGAs compared to FGAs might have agreater procognitive benefit.” (Kane, Honigfeld and Meltzer, 1988). Thissuggests first generation antipsychotics may not always be the best treatmentfor schizorphenia. Other methods have been proven to work, such as electro-convulsivetherapy and lobotomy surgery. Deacon found that, “Psychotropic medications work by correcting theneurotransmitter imbalances that cause mental disorders. However, thereis no credible evidence that mental disorders are caused by chemicalimbalances, or that medicines work by correcting such imbalances.” (Deacon, 2013).
The medicalapproach as a whole can be criticised for being reductionist. As most researchmentioned has found that drugs do not completely cure the illness, thissuggests different treatment could work. So, if the treatment the medical modeloffers does not always work, this may mean the theory may not always be correct.The medical model may be too simple in assuming mental disorders are cause solelyby chemical imbalances in the brain, because if this was true, drugs that alterthese imbalances would cure mental disorders 100% of the time. However, we knowthis is not the case, suggesting mental disorders may be caused by acombination of influences, for example genetics and environmental influences.
Forexample, Holland found that 9/16 of monozygotic twins and 1/14 of digyzotictwins both had anorexia nervosa, suggesting this mental disorder has a geneticinfluence. (Holland et al., 1984). Also, twins usually share the sameenvironment, so the behaviour could have been learned as we cannot separatenature and nurture. This suggests there could be an environmental influence onthe onset of anorexia nervosa too. Inconclusion, there are many strengths and criticisms of the medical approach tomental disorders.
However, the diathesis-stress model is the most likely way ofdescribing the onset of mental disorders. This model suggests patients becomepredisposed to factors that influence mental disorders, for example genetics,environmental influences, biological influences and cognitive influences,suggesting a combination of factors leads to the onset of mental disorders. Themedical approach has many strengths, and has had many successful diagnosesusing the DSM-5 and treatments using drugs, ECT and psychosurgery, however allpatients are different, so we cannot assume one treatment is going to work foreveryone, as mental disorders affect people in different ways and alter people’sthoughts in so many different ways that it is impossible for there to be onetreatment that is going to be successful for everyone.
