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. Whilst my comments on this new text book were critical, it is important to note that I am neither a ‘critical psychiatrist’ nor an ‘anti-psychiatrist’. I have though 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.

 

5 Replies to “The Medical Model in Mental Health [a REVIEW]”

  1. Dr David Foreman, Consultant Psychiatrist to Dr Samei Huda regarding his book on The Medical Model in Mental Health [9 October 2019] “you have created a medical classic, and demonstrated that scholarship still matters.”

  2. Dr Tyler Black, MD [3 November 2019] “Great book by Dr Samei Huda and a great review by Dr Daniel Winarick: Psychiatry is unfairly criticized and singled out, and this book reaffirms its place in medicine and debunks tropes long held by critics.”

  3. Professor Wendy Burn, President Of the Royal College of Psychiatrists [14 December 2019] on ‘The Medical Model in Mental Health’ “I think you will find it interesting and thought provoking. I would advise anyone to read it whatever their views. There is a copy in the College library if anyone wants to borrow it.”

    Despite long established Core Values for Psychiatrists, Professor Wendy Burn, President Of the Royal College of Psychiatrists has turned a blind eye to this online behavior by the author of ‘The Medical Model in Mental Health’.

  4. Thank you for your blog and your considered and thoughtful approach. Watching Samei Huda on social media I feel terrified of psychiatry and psychiatrists. A certainty that one view is the right view leads to ideological battles, and such battles use force to win. I think of times I have been vulnerable and terrified in my life and I am very grateful that I had more people like you in it than people like Samei.

    1. Thank you for sharing this. I find the language used by this medical professional quite terrifying. The defensiveness seems to underpin all that he writes. The Royal College of Psychiatrists has turned a blind eye to unprofessional online social media behaviour of its members. This concerns me as I fear that patients may suffer as a result and professionalism will continue to be eroded.

      aye Peter

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