Psychologists and the medical model

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virgoox

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How many practicing psychologists believe in this model to explain mental illness? Just curious because I read an article written by my boss where he proclaimed that he subscribes to this model. Based on what he says in staffings I was very surprised but I wonder if he was just appeasing the psychiatrists we work with so as not to create waves.

What are your experiences/beliefs ?

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Can you explain what you mean by the medical model?
 
Yeah, more specifics would make this a better discussion.
 
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Essentially the assumption that abnormal behavior is related to physical symptoms that must be treated medically. It follows that mental illness is the mind in a state of disease and the disease state is of primary issue- not any environmental etc. factors. This model states that ill patients cannot be held responsive for their actions and the Dr. (psychiatrist)is the expert who should offer the first line of treatment.
 
Essentially the assumption that abnormal behavior is related to physical symptoms that must be treated medically. It follows that mental illness is the mind in a state of disease and the disease state is of primary issue- not any environmental etc. factors. This model states that ill patients cannot be held responsive for their actions and the Dr. (psychiatrist)is the expert who should offer the first line of treatment.

Um, no. Thats not really accurate description of the medical model at all.

There is, of course, considerable debate about the role of each variable, but no psychiatrist is as concrete as this.
 
Can you offer a better/aternate definition then? This is how it was explained to me.
 
Im sure google can help you...
 
Agreed, that's not quite the medical model. But anyway, not many places adhere to that model. I would say that the biopsychosocial and recovery models (especially in the VA) are the prevailing models of mental health.

And seriously, the psychiatrist as the be all, end all of mental health? At least not some of the ones I've worked with, scary.
 
Its funny, because on the whole, psychology is often at its strongest in the VA system (EBT, time-limited treatments, research productivity, good training) and psychiatry is often at its worst there. At least that has been my experience...
 
I love the collegial vibe here. No wonder this field is so screwed up.
WisNeuro are you from WI ?
 
I love the collegial vibe here. No wonder this field is so screwed up.
WisNeuro are you from WI ?

Well, you see too many people with Borderline Personality DO referred for ECT, people with PTSD misdiagnosed with ADHD and given Ritalin, Borderline misdiagnosed as bipolar, etc because of little to no evaluation, and you get a little jaded with the profession. My job is nt to be collegial with psychiatry, it's to treat my patients with best practices.

And I spent about 5 years there.
 
Its funny, because on the whole, psychology is often at its strongest in the VA system (EBT, time-limited treatments, research productivity, good training) and psychiatry is often at its worst there. At least that has been my experience...

I think part of that is the compensation issue. Psychologists are paid well enough to need minimal if any side practice and running a busy side practice is not worth the effort. Most of the psychiatrists are paid less than in private practice, are not exactly at the top if their class and often more interested in their side gig than the job. The few good ones I have seen are those that come to the VA for the hours and are not trying increase their bottom line elsewhere.
 
The funny thing is that there is a psychology vs Psychiatry thread on the Pre DO forum that's kinda the opposite of this one. Ie that most psychologists are trained poorly to treat things and spend way too much time on assessment and that they fail to identify the possibility for somatic issues like lymes disease or other issues.

That being said I'm pretty sure both groups misdiagnose equal amounts and until we start developing more bio markers like ERNs or etc it'll happen on both side.
 
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The funny thing is that there is a psychology vs Psychiatry thread on the Pre DO forum that's kinda the opposite of this one. Ie that most psychologists are trained poorly to treat things and spend way too much time on assessment and that they fail to identify the possibility for somatic issues like lymes disease or other issues.

That being said I'm pretty sure both groups misdiagnose equal amounts and until we start developing more bio markers like ERNs or etc it'll happen on both side.

That is more like one guy with a bit of analytic training who dropped out of grad school bashing all psychologists. The people there are doing a good job of bringing him back to reality. The irony is that he claims we spend too much time on assessment, but are not good at diagnosis. I have yet to see a psychiatrist catch Lyme disease. The truth is that it all really depends more on the person than the degree. Even the best clinician in the world will miss things if they are focused on squeezing in as many pts as possible to make more money and there are idiots in all fields. Do I dx pts better than the NP at my job? Yes, because I have weekly sessions with my pt and see them daily while the NP sees them once a month for 10 minutes. I would make the same mistakes if I spent that little time with the pts as well. A proper dx takes time.
 
That is more like one guy with a bit of analytic training who dropped out of grad school bashing all psychologists. The people there are doing a good job of bringing him back to reality. The irony is that he claims we spend too much time on assessment, but are not good at diagnosis. I have yet to see a psychiatrist catch Lyme disease. The truth is that it all really depends more on the person than the degree. Even the best clinician in the world will miss things if they are focused on squeezing in as many pts as possible to make more money and there are idiots in all fields. Do I dx pts better than the NP at my job? Yes, because I have weekly sessions with my pt and see them daily while the NP sees them once a month for 10 minutes. I would make the same mistakes if I spent that little time with the pts as well. A proper dx takes time.

Yeah, I can't recall ever getting a referral to npsych where they had actually already done a lyme titer. I have referred for it several times. Plus, terrible example of misdiagnosis. Unless you are in one of 5 geographical hotspots in the US, it's very rare, and also misdiagnosed extremely frequently.

And I do agree with the time aspect. I actually have the time to do a thorough history. And, due to my training I always do a chart review beforehand looking at PMH, labs, imaging, etc. I always consider medical issues along with psychiatric (e.g., BPPV in mTBI, low B12 or hypolakemia in AMS, etc).

It comes down to training. Psychologists are trained to accurately diagnose mental illness and then treat it. Yes, they can be treated in multiple ways, but I do think actually getting your diagnosis in the right ballpark first is a huge help.
 
That is more like one guy with a bit of analytic training who dropped out of grad school bashing all psychologists. The people there are doing a good job of bringing him back to reality. The irony is that he claims we spend too much time on assessment, but are not good at diagnosis. I have yet to see a psychiatrist catch Lyme disease. The truth is that it all really depends more on the person than the degree. Even the best clinician in the world will miss things if they are focused on squeezing in as many pts as possible to make more money and there are idiots in all fields. Do I dx pts better than the NP at my job? Yes, because I have weekly sessions with my pt and see them daily while the NP sees them once a month for 10 minutes. I would make the same mistakes if I spent that little time with the pts as well. A proper dx takes time.

Agreed, I think psychologists are trained properly to do a specific job and work very well side by side with psychiatrists.
 
The funny thing is that there is a psychology vs Psychiatry thread on the Pre DO forum that's kinda the opposite of this one. Ie that most psychologists are trained poorly to treat things and spend way too much time on assessment and that they fail to identify the possibility for somatic issues like lymes disease or other issues.

That being said I'm pretty sure both groups misdiagnose equal amounts and until we start developing more bio markers like ERNs or etc it'll happen on both side.

Mental illness cannot be reduced to a molecule.
 
Mental illness cannot be reduced to a molecule.
ERN is an activity of the anterior cingulate gyrus when a person makes an error. It has been found to be related to anxiety and is overactive in people with anxiety disorders of all spectrum, but not fear and is heritable.
 
ERN is an activity of the anterior cingulate gyrus when a person makes an error. It has been found to be related to anxiety and is overactive in people with anxiety disorders of all spectrum, but not fear and is heritable.

I see. And if you are depriving a patient of liberty on the basis of an anxiety disorder would you be testing for activity of the anterior cingulate gyrus to confirm your diagnosis? Probably not.
 
How many practicing psychologists believe in this model to explain mental illness? Just curious because I read an article written by my boss where he proclaimed that he subscribes to this model. Based on what he says in staffings I was very surprised but I wonder if he was just appeasing the psychiatrists we work with so as not to create waves.

What are your experiences/beliefs ?


It is really meaningless if you believe in BPS model (the current mainstream medical model). Since many mental health professionals who claim to adhere to this model are in reality hardcore reductionists.
 
I see. And if you are depriving a patient of liberty on the basis of an anxiety disorder would you be testing for activity of the anterior cingulate gyrus to confirm your diagnosis? Probably not.

Oh right, you believe psychiatry and mental health is about depriving people of their right to make choices and live. Regarding your non-senile dementia related premise, I would enjoy the prospects of using a biomarker like an ERN to confirm a diagnosis, that being said anxiety disorders are so easy to diagnose that it is mostly just research that explains integral function of the brain and its relation to function. But I suppose as a dualist you also find issue with that as well.
 
Oh right, you believe psychiatry and mental health is about depriving people of their right to make choices and live. Regarding your non-senile dementia related premise, I would enjoy the prospects of using a biomarker like an ERN to confirm a diagnosis, that being said anxiety disorders are so easy to diagnose that it is mostly just research that explains integral function of the brain and its relation to function. But I suppose as a dualist you also find issue with that as well.

I would enjoy the prospects of using a bio marker to release a patient from the shackles of psych stigma.

...So you think anxiety could never be caused by bullying could it? That would be nonsense considering a study found a biomarker with a 0.07145% correlation with anxiety to the ARN7045674939 gene.
 
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Well, you see too many people with Borderline Personality DO referred for ECT, people with PTSD misdiagnosed with ADHD and given Ritalin, Borderline misdiagnosed as bipolar, etc because of little to no evaluation, and you get a little jaded with the profession. My job is nt to be collegial with psychiatry, it's to treat my patients with best practices.

And I spent about 5 years there.
Actually I was referring to erg923 suggestion to google.:)
 
Actually I was referring to erg923 suggestion to google.:)

Ah, fair enough. And, considering the ERN as a biomarker of anxiety. I doubt the study has been done, but imagine there are some serious sensitivity/specificity problems with that method. It's like using apoe4 to say whether or not someone has Alzheimer's, terrible predictive power considering your other options.
 
Ah, fair enough. And, considering the ERN as a biomarker of anxiety. I doubt the study has been done, but imagine there are some serious sensitivity/specificity problems with that method. It's like using apoe4 to say whether or not someone has Alzheimer's, terrible predictive power considering your other options.

I've seen a few students that have examined the feasibility of it.
 
It is really meaningless if you believe in BPS model (the current mainstream medical model). Since many mental health professionals who claim to adhere to this model are in reality hardcore reductionists.

I was going to say positivism, functionalism, etc. But I learned a new term - reductionism nails it. A strict adherence to a paradigm that discounts much of anything else. I'm learning it can all too easily become a slippery slope in this field ... Some can have a heyday with this stuff, sometimes for less than altruistic ends.
 
I was going to say positivism, functionalism, etc. But I learned a new term - reductionism nails it. A strict adherence to a paradigm that discounts much of anything else. I'm learning it can all too easily become a slippery slope in this field ... Some can have a heyday with this stuff, sometimes for less than altruistic ends.

Particularly it is a strict adherence that all undesirable mental events are brain diseases caused by atoms and molecules.
 
Not sure if you are joking or not, but biological explanations for mental illness actually increase certain kinds of mental health stigma.

http://schizophreniabulletin.oxfordjournals.org/content/30/3/477.full.pdf

I suppose I meant to say I hope one day the absence of a bio marker will free those in so called 'denial' as they'll be able to prove once and for all they're not sick.

The idea that someone has a 'brain disease' is precisely the stigma, the stigma is more and more of a nuisance to the individual the healthier and the more productive/functional the individual is. For example, not much stigma if the patient is non-functional and disordered.
 
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I suppose I meant to say I hope one day the absence of a bio marker will free those in so called 'denial' as they'll be able to prove once and for all they're not sick.

The idea that someone has a 'brain disease' is precisely the stigma, the stigma is more and more of a nuisance to the individual the healthier and the more productive/functional the individual is. For example, not much stigma if the patient is non-functional and disordered.

That would be nice, but even biomarkers are not categorical in nature for the most part, most are on a continuum and involve complex interplays with a myriad of biological and environmental factors. Even gene expressions have complex gene-environment interactions that are thought to be causal factors, we'd be running those models through millions of iterations just to get a barely adequate sensitivity and specificity.
 
As someone who does research looking at biomarkers/endophenotypes, including the ERN/FRN....trust me that we are a loooonnng ways off from using these to diagnose anything.

There is undoubtedly something there, and group-level prediction even seems moderately reliable - which is actually saying something given the general biomarkers/neuroscience literature is absolutely ridden with shoddy methodology/shady statistics (fMRI perhaps being the most guilty). As others have indicated though, we are nowhere NEAR having the sensitivity and specificity for this to be useful in clinical practice. Not saying it never will, but we're definitely nowhere near there at present.
 
I was being somewhat sarcastic in my comments. There will never sensitivity/specificity I don't believe. Particularly not with 'diagnoses' that vary with culture, moral judgements (homosexuality for example), and subjective experience.

Before you can calculate sensitivity and specificity you must define healthy and sick. How can you determine the sensitivity of bio marker/ERN if you cannot even define what is sick? Some people believe moderate marijuana use is acceptable, in Qatar possession of even the most minuscule amount indicates 'brain disease'. People used to think being gay was disease. Slaves who wanted freedom was a disease.

How can you define happy and sad? How can you measure it? The problem with looking at genes and bio markers is that the concept of sick in mental health is flawed to begin with. The DSM 5 removed 5 personality disorders that were in the DSM 4. Do these diseases no longer exist? Can I still look for bio markers for those so called diseases? There is a political dynamic and no disorder in DSM is truly a real disease. I can't truly calculate sensitivity and specificity if I don't know if the disease is real.
 
I don't argue solipsism. Depression, anxiety, all exist. So does camaraderie, team spirit, courage, etc... Just because a human experience cannot be reduced to a molecule does not mean it does not exist.
 
Abnormality is relative to the observer. I think a bigot shoving down soda down his sphincter at a rate of 1.4 gal./1 day is abnormal.
 
And that's where things get touchy when you have varying definitions. Personally, if there is absolutely no impairment in functioning, hard to say it's a disorder. And, if it were a non-bigot doing that, would that make it normal?
 
Well, it could be a disorder if the person in question is distressed about the behavior, even if it isn't impairing.
 
Deviation from social norms, distress, impairment in functioning, decline in previous functioning, statistical deviation from "normality", etc.

We can define disorder in various ways, as I'm sure we all learned from Ab Psych way back when. I think we've strayed from the original discussion a bit about how terrible the medical model is when taking at face value.
 
Well one problem is bigots don't think they are bigots. But in general yes it would be nice if non-bigots were in charge of the DSM or defining abnormality.
 
I was more referring to why is a non-bigot shoved soda down their sphincter it would be normal, whereas for a bigot, it is not.

And, defining abnormality is as much a philosophic argument as a scientific one in ways. Something any decent psych grad program teaches. And yeah, the DSM is terrible, but that probably has more to do with the task force having industry interests and a seeming interest in pathologizing everything under the sun.
 
Simply because I dislike bigots is why I think its abnormal. Whereas it doesn't bother me as much if someone shoves soda down by the liters but doesn't hold intolerant opinions. I just don't like 'the way it looks' you know? Therein lies the problem.

Every time they share a stupid judgmental opinion I just want to tell them maybe they should stop shoving f&$@"' soda down their blowhole. It just irritates me
 
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As a behaviorist, I would argue that the behavior is more important than the opinions held by that individual. Is a bigot really a problem if they don't act on their bigoted beliefs?
 
If they are in a position of power over an individual they are a problem.

It is possible to suppress bigoted beliefs in order to give the patient autonomy/liberty. But then is one really a bigot if they can do that?
 
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The discussion about which group, psychologists or psychiatrists, "diagnoses" more accurately is actually a good demonstration of a belief in the medical model.
 
The discussion about which group, psychologists or psychiatrists, "diagnoses" more accurately is actually a good demonstration of a belief in the medical model.

I think despite extensive training in the biopsychosocial paradigm, people are hamstrung into naming and sometimes treating experiences of dis-ease (sadness, worry, what have you) as more or less permanent states that can be wedged into billable codes. Vs., as an evolving repertoire of (cognitive, interpersonal etc) behaviours, both shaped by and shaping their (social, neural, etc) milieu. Because I’m not sure how that would work on an insurance form, right now.

I feel the NIMH’s tentative approach to the ‘reduction’ of such “circuits” captures their stability and change, and correctly and clearly identifies them as processes. I’m fine with initially locating them in the brain, and then widening out to more of a mezzo level. The unit of analysis (and ultimate target of intervention) is the individual, who is necessarily bound and most immediately informed by a body. (Vs., ‘society’, which probably causes most of our problems. But from that point of view, the appropriate clinician is the policy-maker.)

Obviously the NIMH paradigm won’t yield a viable alternative to the DSM for a while. Meanwhile, you know, some people are in trouble right now, and there’s nothing to do but be practical about it. Therapy helps enough people to be worthwhile (at a rate somewhat better than chance. Probably not as handily as a smart move to a new city, or loving/being loved well, but the very point is, not everyone can easily do those things).

It is exam time, I am procrastinating.
 
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