Within this report I aim to outline the biomedical model, investigating whether it can be used to assess mental illness. I will compare both social realism and social constructionism with regards to mental illness and assess the role of the psychiatric profession from the viewpoint of functionalist theory.
Firstly, the biomedical model is the scientific diagnosis of a condition which is reached by quantitative and qualitative measures, often disregarding psychological and sociological factors. That being said, can the biomedical model of health really measure a person’s mental health? Many mental health issues often have un measurable (scientifically) factors and symptoms, often having blurred lines between a common set of factors; making it hard to distinguish between a select group of illness’. In 1952 the American psychiatric association published the D.S.M. (Diagnostic and Statistical Manual of Mental Disorders) which clearly outlined the symptoms and effects of a range of mental illness’. Since its first publication, the D.S.M. has grown from featuring 22 mental disorders, to overviewing over 297 diagnosable issues.
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While there are no standardized medical laboratory tests to diagnose mental health issues (bar those classed as organic AND functional mental illness, which derive from brain impairment such as Alzheimer’s etc.), these will come into play during diagnosis to ensure there is no other causation for the patient’s symptoms. In theory these investigative measures can be argued to be the biomedical involvement for the diagnosis (in respect to solely functional mental illness such as depression etc.). The key players now would be the psychologist, psychiatrist and trained mental health professionals who are medically equipped to diagnose such issues.
While the biomedical approach focuses itself on science and the causations being objective and measurable, the theory of lay opinion coverts the ideology of social construction, economical factors and social conformity. Lay opinion focuses on behavioural patterns and socio-economical input upon a person’s life, and the subsequent impact these have upon their mental state. This theoretical approach can be seen as highly influential when determining a service users mental state, the practitioner’s diagnosis being based upon observations of an individual’s behavioural characteristics which correlate to the D.S.M and I.C.D. (international classification of diseases). Again, despite the highly theoretical methodology which leads to diagnosis, within these methods we see standardized tests and assessments, which can in fact be construed as scientific as they set about to differentiate between ‘normal’ and ‘abnormal’ using a standardized set of questions and observational directives.
There are arguments from either side as to the theoretical basis of psychiatry, on one hand Thomas Szasz famously quoted “”It’s not science. It’s politics and economics. That’s what psychiatry is: politics and economics. Behavior control, it is not science, it is not medicine…” (cchrint.org, 2017) Szasz believed that the practice of psychiatry was wholly influenced by the state, creating a mass of ‘quacks’ diagnosing with free reign. He argued that there were “two radically different kinds of psychiatric practices, consensual and coerced, voluntarily sought and forcibly imposed.” (Szasz.com, 2007) his concept was that psychiatry based itself upon the principle of interpretation and social conformity or a service users behaviour. As mentioned before questions of coercion and imposition upon a patient undergoing assessment take the forefront in Szasz’ arguments, giving his ideals a typically Marxist approach. More recently the newest edition of the D.S.M. came under fire from the psychiatric community with “a number of high-profile articles by Professor Allen Frances……. (that) highlighted changes to the manual that he argued were examples of over-medicalisation of mental health. These changes included: Asperger’s syndrome, Disruptive mood dysregulation disorder, Mild cognitive disorder, Generalised anxiety disorder and Major depressive disorder” (NHS, 2013).
While all arguments for the objective and subjective thesis of psychiatry have their merits, it can be argued that psychiatry as a whole can ONLY be deemed subjective as it uses no scientific model of approach to diagnosis, merely perception, opinion and guidance from the D.S.M and I.C.D. to decipher traits and categorize symptoms.
The social realism perspective defines mental illness and the diagnosis of, as having a defined set of abnormal behavioural patterns which can be definitively seen across cultures and societies. Realists argue that despite the fact some illnesses are not recognized or share a common name, the symptoms and actual condition are very much real and observable. That being said, on the other hand we have the perspective of social construction, where by its theorists argue that mental illness is determined by social norms and values.
For instance, the mental impairment of post-natal depression. Social realists would argue that the definitive set of symptoms being displayed by the suffering party, would be enough to determine effect. Constructionists however would argue that the individual could be presenting these symptoms due to their social environment and ideologies of social ‘norms’. Due to the nature of the illness, and its unpredictable effect on the individual either of these theories could be applied.
Because of the set of diagnosable characteristics and cross society definition, realists could argue that despite its irregularity surrounding time frame, its cause and eventual effect can be clearly categorised without outside input. That being said, constructionists can argue that the illness is purely defined by social perception of norms. As the illness can take shape both instantaneously and over a prolonged period of time, the cause and effect could actually be influenced by sociological and environmental issues experienced by the individual, causing stress and ultimately the effects and symptoms of post-natal depression to take hold.
The functionalist view of the psychiatric role is one of great social standing and status within the community and society as a whole. Due to their organizational position and social hierarchy, they, as a medical professional, hold great stature and ranking within the framework of functionalist society.
Because functionalism bases itself on the premise that each key part (the church, institutions, the family) work together to keep society running smoothly, deriving its ideologies from social consensus; it is their view that the role of the psychiatrist is “primarily motivated by the desire to heal the sick” (Moore et al, 2010)
Because functionalism focuses on categorising mental and physical illness as social deviances due to the upset of balance and roles, they put great importance on the timely rehabilitation and re conformation of individuals.
They view the rehabilitation of individuals as necessary coercion so as not to upset social structure. As psychiatrists hold the key to diagnosis of mental health and subsequent re conformity of an individual to social norms, a great precedence is put upon their work.
References
Jeffrey A. Schaler, Ph.D “defining psychiatry”, [2007] available at: http://www.szasz.com/freeman21.html accessed 20/1/17
Moore, S. et al “sociology AS for OCR – chapter 5 – sociology of health” page 172, Collins, London, [2010]
NHS Choices “news analysis: controversial mental health guide DSM-5, [2013] available at: http://www.nhs.uk/news/2013/08August/Pages/controversy-mental-health-diagnosis-and-treatment-dsm5.aspx accessed 20/1/17
Professor Thomas Szasz “Psychiatry as a Human Rights Abuse”, [2017]Â avaliable at: https://www.cchrint.org/about-us/co-founder-dr-thomas-szasz/quotes-on-psychiatry-as-a-human-rights-abuse/ accessed 20/1/17
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