Thursday, July 13, 2017

Giving up the disease model of mental disorder

I mentioned in my Lancet Psychiatry letter that doctors, because of their medical training, have difficulty in giving up the disease model of mental disorder. Yet this is what the Division of Clinical Psychology (DCP) would encourage them to do (see position statement). This is not a controversial argument. It fits with the WHO QualityRights initiative (see recent Lancet Psychiatry article). As the article says, "A movement to profoundly transform the way mental health care is delivered and to change attitudes towards people with psychosocial, intellectual, and cognitive disabilities is gaining momentum globally".

DCP does not totally dismiss the value of psychiatric classification if only because "these systems provide seemingly ‘tangible’ entities for use in administrative, benefits, and insurance systems". But it does argue for "an approach that is multi-factorial, contextualises distress and behaviour, and acknowledges the complexity of the interactions involved in all human experience". Read how balanced the perspective is. It is relevant to the teaching of doctors as well as clinical psychologists and others working in the mental health field.


cobweb said...

One mjor problem is that The lancet can still publish articles which deny access to those who have contributed most - ie service users - unless they can afford to pay, have no moral objection to paying, or have a subscription paid for by a relevant organisation. Are you allowed to provide a copy of the publication Duncan? How are people going to be able to contribute to these debates which will impact seriously on lives - unless they are aware of them? Mental health workers should be disseminating this information to the public, including, vitally, user organisations.
There is a massive increase in people being sectioned in UK despite the gross inadequacies of appropriate help from private and NHS psychiatric institutions, many of them simply in it for the money Psychiatrists will hang on to their questionable diagnoses in particular the catch all ' personality disorder' which gives a false legitimacy and to their practice ,so this will just continue. HOW many more labels are being conjured up to include neuropsychiatric agendas?
As for the highly disputed label of 'psychosomatic' even the BMA is investigating the validity or possible damage caused by this. Countless people have been harmed by being described as such -both by the stigma and the often years of unnecessary pain caused by the lack of humility of doctors who cannot admit that not knowing does not equate with 'psychosomatic'. Unexplained, even unexplainable is better than notes on a record hinting at mental illness-psychosomatic-frequent returner-heartsink and other insulting tags.. The fascination with brains is historical. The damage caused by those with the power to put their 'excitement' into practice is horrendous and well documented. It is about time the heart was put into practice and real healing attempted before it is too late. It probably is - the prestige of neuropsychiatry will attract trainees more than having real relationships with real human beings.

Duncan Double said...

The WHO QualityRights article is free once you've registered!

cobweb said...

Thanks very much Duncan appreciate that!