Often when discussing Mental Health with others who suffer with some sort of problem or other, there comes up something we simply describe as the 'medical model'. Now those who are practising medical professionals may say that there is no such thing as a well-defined 'medical model'. From my perspective, and that of a few I have discussed things with, there are clear patterns to how typical medical professionals approach Mental Health. It is essentially these patterns (or perhaps one may even say 'anti-patterns') that we put under the umbrella heading of 'medical model'.
Analogy With Physical Medicine
There is a quote I found in Bentall's Madness Explained, attributed to Emile Kraepelin, that says the following:
Judging from our experience in internal medicine it is a fair assumption that similar disease processes will produce identical symptom pictures, identical pathological anatomy and an identical aetiology. If, therefore, we possessed a comprehensive knowledge of any of these fields — pathological anatomy, symptamatology, or aetiology — we would at once have a uniform and standard classification of mental diseases. A similar comprehensive knowledge of either of the other two fields would give us not just as uniform and standard classifications, but all of these classifications would exactly coincide.
This may make sense with physical medicine. But this sort
of thing sets myriad alarm bells ringing in my Mind. I would
certainly not expect things to be so simple once the
complexity of the brain cannot be neglected. There are
no guarantees that from an external observation of symptoms
and a few simple interactions with a patient, in the
sense that a nurse or psychiatrist would observe or interact,
especially given the limited time available, that one can
amass sufficient information to make accurate diagnoses.
To try is akin to attempting to make sense of a cryptic
error message like Error WB001 and trying random things
to see what might fix the issue. What is needed is the kind
of interactive debugging capability that software engineers
have with their software, and the simple interactions and
observations made by typical psychiatric professionals
are woefully inadequate.
So my basic issue here is that there is an underlying, often implicit assumption, that we can take an approach to Mental Health that is analogous to how things are done in mainstream physical medicine. For example, we can make diagnoses following some kind of diagnostic manual like the DSM, try out remedies for sufferers within a given diagnostic category (like e.g. 'schizoaffective disorder') using the 'gold standard' of randomised controlled trials, and expect to get good, reliable results. Now I do not doubt that some things of merit will arise in this way, but to approach Mental Health in this way drastically oversimplifies matters, and effectively assumes away the myriad way that the complexity of the brain can complicate matters.
To take the example of a randomised controlled trial, as I'll try to illustrate elsewhere with some thought experiments, such a trial will only pick up simple, statistically significant correlations between treatment and outcome. Now just as a computer is complex, so is the brain. And with that complexity comes the nightmarish possibilities that:
- Individual pieces of an overall effective strategy to remedy a Mental Health problem will appear to give no significant results (essentially, if you have some of the correct pieces, but not all of them, or else have all the correct pieces but do not have them arranged correctly, the result can be nothing).
- What appears promising for, say, 60% of people suffering a manic epsiode, may not be promising for all. The assumption that, in effect, 'mania=mania', so that the mania of all patients suffering from mania can be assumed to be the same thing, means that one can erroneously believe that what works for some works for all. (For a physical medicine analogue, consider what happens in some blood-related treatments if one ignores blood types.)
Seen another way, there are assumptions of uniformity, much as one may assume that two Covid infection are infections of the same virus.
There is a famous saying:
Extraordinary claims require extraordinary evidence.
The idea that Mental Health problems are simple enough, and uniform enough, that one can take a clinical-trial type approach of collecting people with similar diagnoses, randomising them to groups and trying out different remedies for each group, strikes me as very extraordinary. Such an idea demands an equally extraordinary justification. It is akin to somebody claiming to have a one-page proof of Fermat's Last Theory. The brain is unimaginably complex, Mental Health problems inherit that complex nature, and so claims that they can be reduced to entries in a 1000-page diagnostic manual and a collection of chemical remedies should be viewed with a heavy dose of scepticism until that extraordinary justification is exhibited. Thus far, it hasn't been.