The biomedical model of mental disorder: A critical analysis of its validity, utility, and effects on psychotherapy research.
TL;DR: The neglected biopsychosocial model represents an appealing alternative to the biomedical approach and an honest and public dialog about the validity and utility of the biomedical paradigm is urgently needed.
About: This article is published in Clinical Psychology Review.The article was published on 2013-11-01. It has received 425 citations till now. The article focuses on the topics: Psychological intervention & Chemical imbalance.
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TL;DR: Randomized, controlled trials have become the gold standard of medical knowledge, yet their scientific and political history offers lessons about the complexity of medicine and disease and the economic and political forces shaping the production and circulation of knowledge.
Abstract: Randomized, controlled trials have become the gold standard of medical knowledge. Yet their scientific and political history offers lessons about the complexity of medicine and disease and the economic and political forces shaping the production and circulation of knowledge.
401 citations
367 citations
TL;DR: It is found that biogenetic explanations reduce blame but induce pessimism and set the stage for self-fulfilling prophecies that could hamper recovery from psychological problems.
336 citations
Cites background from "The biomedical model of mental diso..."
...Deacon (2013) recently called for a critical examination of ‘the validity and utility of the biomedical approach’ (p.42)....
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...…expand and proliferate to include newvarieties of humanmisery and dysfunction (Conrad & Potter, 2000; Scott, 1990), and psychological treatments for these diagnoses are often conceptualized and researched in much the same way as medical procedures (Deacon, 2013; Wampold, Ahn, & Coleman, 2001)....
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...Diagnostic categories expand and proliferate to include newvarieties of humanmisery and dysfunction (Conrad & Potter, 2000; Scott, 1990), and psychological treatments for these diagnoses are often conceptualized and researched in much the same way as medical procedures (Deacon, 2013; Wampold, Ahn, & Coleman, 2001)....
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300 citations
TL;DR: Anatomy of an Epidemic is a well-written and easily understood work that provides a comprehensive but biased and dated effort to explain the rise of mental illness in the authors' society to the level of an “epidemic” of pain and suffering.
Abstract: A key core competency for medical students, residents, fellows, and practicing physicians is “lifelong learning.” Scholarly works such as Anatomy of an Epidemic represent a prime reason that we master this competency. A main stated purpose of the book is to challenge the reader to think about the biological base of mental illness and to come to conclusions about the author’s assertion that there is a hidden epidemic that has been caused by rather than successfully treated through biological agents, eg, psychotropic medications and electroconvulsive therapy. The author succeeds by this well-written and easily understood work to force the reader to take a new look at the cherished tenets of our profession and how they developed. This is accomplished through predominantly negative anecdotes of the destructive power of biological treatments and what appear to be carefully selected citations that explain how the prescribing of medication results in fostering the often irreversible chronicity of the more severe psychiatric disorders and the negative adverse effects of current and past psychotropics. The book is divided into 5 parts: The Epidemic, The Science of Psychiatric Drugs, Outcomes, Explication of a Delusion, and Solutions. The work is comprehensive, but this review will focus on the argument as it pertains to the pediatric population. Under Outcomes, the chapter “The Epidemic Spreads to Children” considers, among other topics, “The Rise of ADHD” (attention-deficit/ hyperactivity disorder), “Stimulants Flunk Out,” “Tallying up the Harm” (of stimulant medications), “Creating the Bipolar Child,” and “The Disability Numbers.” As is done throughout the book, the challenge is raised as to the established biological basis of psychiatric disorders and the conclusion drawn that no evidence exists for such a concept. The author seems to ignore the past decade of neuroimaging results that clearly demonstrate, for example, the differences between children and adolescents with ADHD and those without as well as comparisons in those treated with stimulant medications and those who are treatment naive. Moreover, the cost-benefit ratio of stimulants is asserted to be heavily weighed to their detrimental effects without reference to significant epidemiologic data to the contrary. There is similarly no reference to the documented biological underpinnings of clinically depressed or at risk individuals and the well-designed though limited studies of the comparison treatments for pediatric depression. The book fails to take into account current thinking on the interaction between biological vulnerability and the environment for the basis of psychiatric disorders that dates back to George Engel’s biopsychosocial model of disease1 and models, eg, Akiskal and McKinney’s,2 for melancholia taught to medical students and psychiatry residents. Overall, Anatomy of an Epidemic is a well-, but highly selectively, referenced, useful polemic that provides a comprehensive but biased and dated effort to explain the rise of mental illness in our society to the level of an “epidemic” of pain and suffering. It is must reading for mental health professionals because it exposes us to a different perspective on one of the cornerstones of modern psychiatry and forces us to appreciate how patients and their families can get skewed views of psychotropic medications and their acceptability to society. It is unfortunate that key advances to understanding the more severe or prevalent psychiatric disorders are omitted. Being aware of the spurious arguments that provide the base for such negative and potentially destructive views will allow readers a greater sympathy for those fearful of psychotropic medications and foster motivation to maintain familiarity with advances in the field as the best way to deal with such an attack in a thoughtful and nondefensive response to anxious questions concerning safety, efficacy, and effectiveness.
217 citations
References
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11 Jun 2013
113,134 citations
TL;DR: Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity, as shown in the recently completed US National Comorbidities Survey Replication.
Abstract: Background Little is known about the general population prevalence or severity of DSM-IV mental disorders. Objective To estimate 12-month prevalence, severity, and comorbidity of DSM-IV anxiety, mood, impulse control, and substance disorders in the recently completed US National Comorbidity Survey Replication. Design and Setting Nationally representative face-to-face household survey conducted between February 2001 and April 2003 using a fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview. Participants Nine thousand two hundred eighty-two English-speaking respondents 18 years and older. Main Outcome Measures Twelve-month DSM-IV disorders. Results Twelve-month prevalence estimates were anxiety, 18.1%; mood, 9.5%; impulse control, 8.9%; substance, 3.8%; and any disorder, 26.2%. Of 12-month cases, 22.3% were classified as serious; 37.3%, moderate; and 40.4%, mild. Fifty-five percent carried only a single diagnosis; 22%, 2 diagnoses; and 23%, 3 or more diagnoses. Latent class analysis detected 7 multivariate disorder classes, including 3 highly comorbid classes representing 7% of the population. Conclusion Although mental disorders are widespread, serious cases are concentrated among a relatively small proportion of cases with high comorbidity.
10,951 citations
TL;DR: Evidence of a gene-by-environment interaction is provided, in which an individual's response to environmental insults is moderated by his or her genetic makeup.
Abstract: In a prospective-longitudinal study of a representative birth cohort, we tested why stressful experiences lead to depression in some people but not in others. A functional polymorphism in the promoter region of the serotonin transporter (5-HT T) gene was found to moderate the influence of stressful life events on depression. Individuals with one or two copies of the short allele of the 5-HT T promoter polymorphism exhibited more depressive symptoms, diagnosable depression, and suicidality in relation to stressful life events than individuals homozygous for the long allele. This epidemiological study thus provides evidence of a gene-by-environment interaction, in which an individual's response to environmental insults is moderated by his or her genetic makeup.
7,210 citations
TL;DR: Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone.
Abstract: background The relative effectiveness of second-generation (atypical) antipsychotic drugs as compared with that of older agents has been incompletely addressed, though newer agents are currently used far more commonly. We compared a first-generation antipsychotic, perphenazine, with several newer drugs in a double-blind study. methods A total of 1493 patients with schizophrenia were recruited at 57 U.S. sites and randomly assigned to receive olanzapine (7.5 to 30 mg per day), perphenazine (8 to 32 mg per day), quetiapine (200 to 800 mg per day), or risperidone (1.5 to 6.0 mg per day) for up to 18 months. Ziprasidone (40 to 160 mg per day) was included after its approval by the Food and Drug Administration. The primary aim was to delineate differences in the overall effectiveness of these five treatments. results Overall, 74 percent of patients discontinued the study medication before 18 months (1061 of the 1432 patients who received at least one dose): 64 percent of those assigned to olanzapine, 75 percent of those assigned to perphenazine, 82 percent of those assigned to quetiapine, 74 percent of those assigned to risperidone, and 79 percent of those assigned to ziprasidone. The time to the discontinuation of treatment for any cause was significantly longer in the olanzapine group than in the quetiapine (P<0.001) or risperidone (P=0.002) group, but not in the perphenazine (P=0.021) or ziprasidone (P=0.028) group. The times to discontinuation because of intolerable side effects were similar among the groups, but the rates differed (P=0.04); olanzapine was associated with more discontinuation for weight gain or metabolic effects, and perphenazine was associated with more discontinuation for extrapyramidal effects. conclusions The majority of patients in each group discontinued their assigned treatment owing to inefficacy or intolerable side effects or for other reasons. Olanzapine was the most effective in terms of the rates of discontinuation, and the efficacy of the conventional antipsychotic agent perphenazine appeared similar to that of quetiapine, risperidone, and ziprasidone. Olanzapine was associated with greater weight gain and increases in measures of glucose and lipid metabolism.
5,437 citations
"The biomedical model of mental diso..." refers background in this paper
...For example, the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; Lieberman et al., 2005) study failed to demonstrate significantly greater short- or long-term efficacy of olanzapine, quetiapine, risperidone and ziprasidone, all blockbuster atypical antipsychotics, over perphenazine, a neurolepticmedicationwhose therapeutic benefits for psychosiswere first described in 1957 (Cahn & Lehmann, 1957)....
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...For example, the NIMH-funded Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; Lieberman et al., 2005) study failed to demonstrate significantly greater short- or long-term efficacy of olanzapine, quetiapine, risperidone and ziprasidone, all blockbuster atypical antipsychotics,…...
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