The Medical Model in Mental Health [a REVIEW]

Shortly after this new text book was published I purchased it and read it over a long weekend in May. I took notes and added marginalia as I read [here are some examples]:

I then submitted an admittedly very short review on Amazon and wrote a slightly longer one on Hole Ousia. I am an NHS psychiatrist of 25 years’ experience who believes that it is vital to be able to openly question prevailing approaches.  I have  experienced significant personal harm through a prescribed psychiatric medication.

The author of this new text book on the Medical Model in Mental Health responded to my brief review by saying on social media:  “When the worst thing that people can say about your argument is they don’t like the tone of your language it’s a tacit admission that your argument is strong but they cannot bear to say it openly – a reflection on their values”.

It is both understandable and reasonable for Dr Huda to wish feedback on the content of his text book. What follows is an attempt to explain why my review was brief.

The author confirms in his introduction that this text book began with a specific starting point: to demonstrate that the approach taken to diagnosis, classification and therapeutic interventions in Psychiatry is no different to that taken in General Medicine. I would not fully disagree about this, as the Medical Model is the prevailing approach to mental health in the UK. However it is my view that any approach to Psychiatry, to be truly scientific, needs not to exclude consideration of the following:

• the harms and benefits of any single Model
• nominative and neurogenetic determinism and reductionism
• social determinants of health and wellbeing
• stigma, including iatrogenic stigma
• learning from lived experience
• where there are gaps in the evidence base (for example the limited evidence to support long term prescribing of psychotropic medications)
• “Realistic Psychiatry” (also known as “Too much medicine” and in America “Saving Normal”)
• biases introduced into  biomedical research and medical education (for example the role of commercial vested interests)

The author has argued on social media that my brief initial review was a “tacit admission” that his “argument is strong”. My difficulty as a reviewer is that I cannot consider and comment on what has not been included.

The author of this text book has robustly argued that language, and how it is used, does not matter. I stand by my view that language is the basis of communications between human beings whether personally or professionally.

I have written this longer explanation of my thoughts on this text book as I share the view of the philosopher Mary Midgley who died recently in her hundredth year. Mary Midgley often used metaphors in her writings and one of these was to talk about the windows that we each look through. In terms of our mental well-being, which can never be disembodied or separated from the life we live, we learn better when we share our window views. My blog hole ousia has no simple answers or over-arching framework but seeks to encourage shared learning. I am hopeful that the author of this book might write a second volume which considers how we might achieve this.