I don’t have precise figures, but I would guess that psychiatrists constitute less than 5% of the professional staff in the mental health system The other 95% are psychologists, counselors, social workers, case managers, behavior analysts, case aides, art therapists, occupational therapists, job coaches, etc., etc…
All of these other professions have specialized training, both theoretical and practical, and it is reasonable to suppose that they bring to their jobs a wide range of conceptual orientations, and an equally wide range of practical skills.
Yet within a short time of entering their first job, all these professionals receive the message (sometimes subtle, sometimes direct) that the medical model is the only acceptable conceptual framework, and that adherence to this model is a more or less mandatory requirement of employment.
THE MEDICAL MODEL
The basic tenets of the medical model are as follows:
- All human behavior that entails significant problems is caused by mental illness.
- These mental illnesses are real illnesses usually involving malfunction of the brain.
- These mental illnesses are best treated by psychotropic drugs, prescribed by the psychiatrist.
- All other professional activity is ancillary to the administration of drugs.
- All other professionals must encourage clients to keep taking their pills whenever this becomes an issue.
Some of the “ancillary” professionals embrace this conceptual framework happily, even enthusiastically. Others do not. During my working career I was, as you might imagine, in the latter group. I dealt with the conflicts by addressing them as best I could and helping my clients to the best of my ability. But the fact is that the spurious and destructive medical model constituted a truly dreadful work environment.
DISAGREEING WITH PSYCHIATRY
Over the years I discussed this issue with colleagues, but I don’t think I had ever seen the matter addressed in print until I recently came across an article by Lucy Johnstone, PhD. It’s called “Twenty-Five Years of Disagreeing with Psychiatry.” It’s a chapter in the book Mental Health Still Matters, eds. J Reynolds, R Muston, J Leach, M McCormack, J Wallcraft, M Walsh. Open University Press, 2009.
The article is noteworthy on two counts. Firstly, for its content; and secondly that it got written at all. The tyrannous nature of the medical model is seldom articulated. Rather it ripples beneath the surface, stifling discussion and lending unspoken and unwarranted credibility to psychiatric practice.
Here are some quotes from Lucy’s article.
“My NHS career thus consisted of long periods of suppressed frustration and relatively muted comment, interspersed with brief periods of open conflict.”
“The contributions of non-medical staff are rarely acknowledged, and their work is often regarded as a kind of fringe recreational activity…”
“Attributing all improvement to medical intervention. Since medication is constantly being adjusted, any change for the better is bound to coincide with a new dosage and can be attributed to it.”
“Belief in medical interventions is also maintained by disqualifying the counter-evidence.“
“The idea that one might not subscribe to this kind of thought-system at all is incomprehensible to many.”
“…dissenters from the orthodoxy are told not only that they are wrong, but that such views should not be held or expressed at all. The credibility of psychiatry has to be maintained by an appearance of consensus, and cracks in the façade can arouse a deeply defensive and threatened response.”
In very recent years, the anti-psychiatry movement, which continues to gain momentum, has perhaps made it easier for members of the other professions to “come out.” But economics makes cowards of us all, and we need to begin creating an environment where a social worker, for instance, can feel free to challenge in a staff meeting the prescribing of drugs for a particular individual; or where a counselor can express the belief that a client’s problem is loneliness rather than a brain illness.
Bio-psychiatry/pharma promotes its spurious and destructive ideas shamelessly. We need to become more successful at promoting our more valid and helpful concepts.
We need to come out of the closet.