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Psychiatry: Why Medical or Social Model?

Psychiatry: Why Medical or Social Model? Abstract IN RECENT years there has been an increasing controversy over the problem of mental illness. For many reasons, some of which will be discussed in this paper, a group of individuals, for the most part professionals from the behavioral and social sciences, have been attacking what they call the "medical model" of mental illness. These attacks range over a broad spectrum. At one extreme, there is a complete denial that the medical model is relevant to the manifestations, which the psychiatrist would consider to be within his realm. Perhaps the best known advocate of this view is Szasz, who wrote The Myth of Mental Illness.1 His position is a rather simple one, mainly that there is no such thing as mental illness. He has written for both the "scientific" and popular press. In an article in the New York Times Magazine, he states his References 1. Szasz, T.S.: The Myth of Mental Illness: Foundations of a Theory of Personal Conduct , New York: Paul B. Hoeber Inc., Medical book department of Harper & Row, 1964. 2. Szasz, T.S.: Mental Illness Is a Myth , New York Times magazine (June 12) , 1966. 3. Summers, M.: Malleus Maleficarum , London: Pushkin Press, 1946. 4. Albee, G.W.: " The Relation of Conceptual Models to Manpower Needs ," in Cowen, E. (ed.): Emerging Concepts of Mental Health , New York: Appleton-Century-Crofts, 1967. 5. Carroll, L.: Alice in Wonderland , New York: Tudor Publishing Co., 1944. 6. Albee, G.W.: Manpower Needs for Mental Health and the Role of Psychology , Canad Psychol 62:82-92, 1965.Crossref 7. Kepner, E.: "The Effective Delivery of Mental Health Services," mimeographed, Department of Psychology, Western Reserve University, Nov 22, 1966. 8. Community Psychology, a report of the Boston Conference on the Education of Psychologists for Community Mental Health, Boston, 1966. 9. Smith, M.B., and Hobbs, N.: The Community and the Community Mental Health Center , Washington, DC: American Psychological Association, 1966. 10. American Psychological Association: " The Community and the Community Mental Health Center ," Washington, DC: American Psychological Association Press Service, 1966. 11. Hippocrates: " Epidemic ," in Adams, A. (trans.): The Genuine Works of Hippocrates , New York: Williams Wood and Co., 1928. 12. Kallman, F.J.: The Operation of Genetic Factors in the Pathogenesis of Mental Disorders , New York J Med 41:1352-1357, 1941. 13. Rainer, J.D., and Kallman, F.J.: The Role of Genetics in Psychiatry , J Nerv Ment Dis 126:403-414, 1958.Crossref 14. Wittkower, E.D., and Kipowski, Z.J.: Recent Developments in Psychosomatic Medicine , Psychosom Med 28:722-737, 1966.Crossref 15. MacLean, P.D.: Contrasting Functions of Limbic and Neocortical Systems of the Brain and Their Relevance to Psychophysiological Aspects of Medicine , Amer J Med 25:611-626, 1958.Crossref 16. Fisher, C.; Gross, J.; and Zuch, J.: Cycle of Penile Erection Synchronous With Dreaming (REM) Sleep , Arch Psychiat 12:29-45, 1965.Crossref 17. MacLean, P.D.: Psychosomatic Disease and the Visceral Brain , Psychosom Med 11:338-353, 1949.Crossref 18. MacLean, P.D.: Mean and His Animal Brains , Modern Med 32:95-106, 1964. 19. Whatmore, G.B.: Some Neurophysiologic Differences Between Schizophrenia and Depression , Amer J Psychiat 123:712-716, 1966. 20. Papez, J.W.: Human Growth and Development , Ithaca, NY: The Cornell Cooperative Society, 1948. 21. Blumer, D., and Walker, A.E.: Sexual Behavior in Temporal Lobe Epilepsy , Arch Neurol 16:37-43, 1967.Crossref 22. Carpenter, W.B.: Principles of Mental Physiology With Their Applications to the Training and Discipline of the Mind and the Study of Its Morbid Conditions , London: Henry S. King & Co., 1877. 23. Kety, S.S.: Current Biochemical Approaches to Schizophrenia , New Eng J Med 276:325-331, 1967.Crossref 24. Fries, M.E., and Lewi, B.: Interrelated Factors in Development , Amer J Orthopsychiat 8:726-752, 1938.Crossref 25. Fries, M.E., and Woolf, P.J.: " Some Hypotheses on the Role of the Congenital Activity Type in Personality Development ," in The Psychoanalytic Study of the Child , New York: International University Press, 1953. 26. Grinker, R.R.: The Effect of Infantile Disease on Ego Patterns , Amer J Psychiat 110:290-295, 1953. 27. Levine, S., and Mullins, R.F., Jr.: Hormonal Influences on Brain Organization in Infant Rats , Science 152:1585-1592, 1966.Crossref 28. Rosenblatt, S.: Differences in the Metabolism of Norepinephrine in Depressions , Arch Gen Psychiat 13:495-502, 1965.Crossref 29. Schildkraut, J.J.: The Catecholamine Hypothesis of Affective Disorders: A Review of Supporting Evidence , Amer J Psychiat 122:509-522, 1965. 30. Jakobson, T., et al: The Excretion of Urinary 11-Deoxy- and 11-Oxy-17-Hydroxy-Corticosteroids in Depressive Patients During Basal Conditions and During the Administration of Methopyrapone , J Psychosom Res 9:363-374, 1966.Crossref 31. Bunney, W.E., et al: A Psychoendocrine Study of Severe Psychotic Depressive Crises , Amer J Psychiat 122:73-79, 1965. 32. Bunney, W.E., and Hartmann, E.L.: Study of a Patient With 48-Hour Manic-Depressive Cycles: 1. An Analysis of Behavioral Factors , Arch Gen Psychiat 12:611-618, 1965.Crossref 33. Sloane, R.B.; Hughes, W.; and Haust, H.L.: Catecholamine Excretion in Manic-Depressive and Schizophrenic Psychosis and Its Relationship to Symptomatology , Canad Psychiat Assoc J 11:6-19, 1966. 34. Sachar, E.J., et al: Corticosteroid Responses to Milieu Therapy of Chronic Schizophrenics , Arch Gen Psychiat 15:310-319, 1966.Crossref 35. Health, R.G., and Krupp, I.M.: Schizophrenia as an Immunologic Disorder: I. Demonstration of Antibrain Globulins by Fluorescent Antibody Techniques , Arch Gen Psychiat 16:1-9, 1967.Crossref 36. Heath, R.G., et al: Schizophrenia as an Immunologic Disorder: II. Effects of Serum Protein Fractions on Brain Function , Arch Gen Psychiat 16:10-23, 1967.Crossref 37. Heath, R.G., et al: Schizophrenia as an Immunologic Disorder: III. Effects of Antimonkey and Antihuman Brain Antibody on Brain Function , Arch Gen Psychiat 16:24-33, 1967.Crossref 38. Persky, H., et al: Psychoendocrine Effects of Perceptual and Social Isolation , Arch Gen Psychiat 15:499-505, 1966.Crossref 39. Ruesch, J., et al: Duodenal Ulcer: A Sociopsychological Study of Naval Enlisted Personnel and Civilians , Los Angeles: University of California Press, 1948. 40. Kraines, S.H.: Meanic Depressive Syndrome: A Physiologic Disease , Dis Nerv Syst 27:3-19, 1966. 41. King, S.: Perceptions of Illness and Medical Practice , New York: Russell Sage Foundation, 1962. 42. Simmons, L.W., and Wolff, H.G.: Social Science in Medicine , New York: Russell Sage Foundation, 1954, pp 13-14. 43. Hertzig, M.E., and Birch, H.G.: Neurologic Organization in Psychiatrically Disturbed Adolescent Girls , Arch Gen Psychiat 15:590-598, 1966.Crossref 44. Rogler, L.H., and Hollingshead, A.B.: Trapped: Families and Schizophrenia , New York: John Wiley & Sons, 1965. 45. Grinker, R.R., Sr.: Normality Viewed as a System , Arch Gen Psychiat 17:66-70, 1967. 46. Saper, B.: Current Trends in Comprehensive Community Mental Health Services , Ment Hyg 51:100-107, 1967. 47. Meyer, A.: In Winter, E. (ed.): Collected Papers: Mental Hygiene , Baltimore: Johns Hopkins Press, 1952, vol 55. 48. Haviland, C.F.: Mental Disease as a Social Problem , Ment Hyg Bull 6:1-8, 1928. 49. Dohrenwend, B.P.: Social Status and Psychological Disorder , Amer Sociol Rev 31:14-34, 1966.Crossref 50. Wynter, A.: The Borderlands of Insanity and Other Papers , London: Robert Hardwicke, 1875. 51. Bucknill, J.C., and Tuke, D.H.: A Manual of Psychological Medicine: Containing the History, Nosology, Description, Statistics, Diagnosis, Pathology, and Treatment of Insanity; With an Appendix of Cases , Philadelphia: Blanchard and Lea, 1858. 52. Wittkower, E.D., and Rins, H.: "Recent Developments in Transcultural Psychiatry" in Ciba Foundation Symposium: Transcultural Psychiatry, New York: Little, Brown and Co., 1965. 53. William, C.: " Applied Anthropology in Medicine ," in Kroeber, A.L. (ed.): Anthropology Today , Chicago: University of Chicago Press, 1953, pp 771-806. 54. Zusman, J.: Sociology and Mental Illness , Arch Gen Psychiat 15:635-648, 1966.Crossref 55. Basch, S., and Basch, L.: Observations on Patients in a Mental Hospital in East Africa , E Afr Med J 43:359-365, 1966. 56. Kaufman, M.R.: Factors Contributing to Causes of Mental Illness and Health: The Viewpoint of Psychiatry and Psychoanalysis , J M Sinai Hosp 28:451-459, 1961. 57. Peterson, O.L., et al: An Analytical Study of North Carolina General Practice, 1953-1954 , J Med Educ , (part 2) , 31:1-165, 1956. 58. Grinker, R.R., Sr.: The Sciences of Psychiatry: Fields, Fences and Riders , Amer J Psychiat 122:367-376, 1965. 59. Freud, S.: The Question of Lay Analysis , New York: W.W. Norton & Co., Inc., 1950. 60. Joint Commission on Mental Illness and Health: Action for Mental Health , New York: Basic Books, Inc., 1961. 61. Grinker, R.R., Sr.: GAP's Next 20 Years , Arch Gen Psychiat 16:133, 1967.Crossref 62. Kaufman, M.R.: The Problem of Psychiatric Symptom Formation , J Mich Med Soc 57:71-76, 1958. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Psychiatry: Why Medical or Social Model?

Archives of General Psychiatry , Volume 17 (3) – Sep 1, 1967

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American Medical Association
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Copyright © 1967 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1967.01730270091013
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Abstract

Abstract IN RECENT years there has been an increasing controversy over the problem of mental illness. For many reasons, some of which will be discussed in this paper, a group of individuals, for the most part professionals from the behavioral and social sciences, have been attacking what they call the "medical model" of mental illness. These attacks range over a broad spectrum. At one extreme, there is a complete denial that the medical model is relevant to the manifestations, which the psychiatrist would consider to be within his realm. Perhaps the best known advocate of this view is Szasz, who wrote The Myth of Mental Illness.1 His position is a rather simple one, mainly that there is no such thing as mental illness. He has written for both the "scientific" and popular press. In an article in the New York Times Magazine, he states his References 1. Szasz, T.S.: The Myth of Mental Illness: Foundations of a Theory of Personal Conduct , New York: Paul B. Hoeber Inc., Medical book department of Harper & Row, 1964. 2. Szasz, T.S.: Mental Illness Is a Myth , New York Times magazine (June 12) , 1966. 3. Summers, M.: Malleus Maleficarum , London: Pushkin Press, 1946. 4. Albee, G.W.: " The Relation of Conceptual Models to Manpower Needs ," in Cowen, E. (ed.): Emerging Concepts of Mental Health , New York: Appleton-Century-Crofts, 1967. 5. Carroll, L.: Alice in Wonderland , New York: Tudor Publishing Co., 1944. 6. Albee, G.W.: Manpower Needs for Mental Health and the Role of Psychology , Canad Psychol 62:82-92, 1965.Crossref 7. Kepner, E.: "The Effective Delivery of Mental Health Services," mimeographed, Department of Psychology, Western Reserve University, Nov 22, 1966. 8. Community Psychology, a report of the Boston Conference on the Education of Psychologists for Community Mental Health, Boston, 1966. 9. Smith, M.B., and Hobbs, N.: The Community and the Community Mental Health Center , Washington, DC: American Psychological Association, 1966. 10. American Psychological Association: " The Community and the Community Mental Health Center ," Washington, DC: American Psychological Association Press Service, 1966. 11. Hippocrates: " Epidemic ," in Adams, A. (trans.): The Genuine Works of Hippocrates , New York: Williams Wood and Co., 1928. 12. Kallman, F.J.: The Operation of Genetic Factors in the Pathogenesis of Mental Disorders , New York J Med 41:1352-1357, 1941. 13. Rainer, J.D., and Kallman, F.J.: The Role of Genetics in Psychiatry , J Nerv Ment Dis 126:403-414, 1958.Crossref 14. Wittkower, E.D., and Kipowski, Z.J.: Recent Developments in Psychosomatic Medicine , Psychosom Med 28:722-737, 1966.Crossref 15. MacLean, P.D.: Contrasting Functions of Limbic and Neocortical Systems of the Brain and Their Relevance to Psychophysiological Aspects of Medicine , Amer J Med 25:611-626, 1958.Crossref 16. Fisher, C.; Gross, J.; and Zuch, J.: Cycle of Penile Erection Synchronous With Dreaming (REM) Sleep , Arch Psychiat 12:29-45, 1965.Crossref 17. MacLean, P.D.: Psychosomatic Disease and the Visceral Brain , Psychosom Med 11:338-353, 1949.Crossref 18. MacLean, P.D.: Mean and His Animal Brains , Modern Med 32:95-106, 1964. 19. Whatmore, G.B.: Some Neurophysiologic Differences Between Schizophrenia and Depression , Amer J Psychiat 123:712-716, 1966. 20. Papez, J.W.: Human Growth and Development , Ithaca, NY: The Cornell Cooperative Society, 1948. 21. Blumer, D., and Walker, A.E.: Sexual Behavior in Temporal Lobe Epilepsy , Arch Neurol 16:37-43, 1967.Crossref 22. Carpenter, W.B.: Principles of Mental Physiology With Their Applications to the Training and Discipline of the Mind and the Study of Its Morbid Conditions , London: Henry S. King & Co., 1877. 23. Kety, S.S.: Current Biochemical Approaches to Schizophrenia , New Eng J Med 276:325-331, 1967.Crossref 24. Fries, M.E., and Lewi, B.: Interrelated Factors in Development , Amer J Orthopsychiat 8:726-752, 1938.Crossref 25. Fries, M.E., and Woolf, P.J.: " Some Hypotheses on the Role of the Congenital Activity Type in Personality Development ," in The Psychoanalytic Study of the Child , New York: International University Press, 1953. 26. Grinker, R.R.: The Effect of Infantile Disease on Ego Patterns , Amer J Psychiat 110:290-295, 1953. 27. Levine, S., and Mullins, R.F., Jr.: Hormonal Influences on Brain Organization in Infant Rats , Science 152:1585-1592, 1966.Crossref 28. Rosenblatt, S.: Differences in the Metabolism of Norepinephrine in Depressions , Arch Gen Psychiat 13:495-502, 1965.Crossref 29. Schildkraut, J.J.: The Catecholamine Hypothesis of Affective Disorders: A Review of Supporting Evidence , Amer J Psychiat 122:509-522, 1965. 30. Jakobson, T., et al: The Excretion of Urinary 11-Deoxy- and 11-Oxy-17-Hydroxy-Corticosteroids in Depressive Patients During Basal Conditions and During the Administration of Methopyrapone , J Psychosom Res 9:363-374, 1966.Crossref 31. Bunney, W.E., et al: A Psychoendocrine Study of Severe Psychotic Depressive Crises , Amer J Psychiat 122:73-79, 1965. 32. Bunney, W.E., and Hartmann, E.L.: Study of a Patient With 48-Hour Manic-Depressive Cycles: 1. An Analysis of Behavioral Factors , Arch Gen Psychiat 12:611-618, 1965.Crossref 33. Sloane, R.B.; Hughes, W.; and Haust, H.L.: Catecholamine Excretion in Manic-Depressive and Schizophrenic Psychosis and Its Relationship to Symptomatology , Canad Psychiat Assoc J 11:6-19, 1966. 34. Sachar, E.J., et al: Corticosteroid Responses to Milieu Therapy of Chronic Schizophrenics , Arch Gen Psychiat 15:310-319, 1966.Crossref 35. Health, R.G., and Krupp, I.M.: Schizophrenia as an Immunologic Disorder: I. Demonstration of Antibrain Globulins by Fluorescent Antibody Techniques , Arch Gen Psychiat 16:1-9, 1967.Crossref 36. Heath, R.G., et al: Schizophrenia as an Immunologic Disorder: II. Effects of Serum Protein Fractions on Brain Function , Arch Gen Psychiat 16:10-23, 1967.Crossref 37. Heath, R.G., et al: Schizophrenia as an Immunologic Disorder: III. Effects of Antimonkey and Antihuman Brain Antibody on Brain Function , Arch Gen Psychiat 16:24-33, 1967.Crossref 38. Persky, H., et al: Psychoendocrine Effects of Perceptual and Social Isolation , Arch Gen Psychiat 15:499-505, 1966.Crossref 39. Ruesch, J., et al: Duodenal Ulcer: A Sociopsychological Study of Naval Enlisted Personnel and Civilians , Los Angeles: University of California Press, 1948. 40. Kraines, S.H.: Meanic Depressive Syndrome: A Physiologic Disease , Dis Nerv Syst 27:3-19, 1966. 41. King, S.: Perceptions of Illness and Medical Practice , New York: Russell Sage Foundation, 1962. 42. Simmons, L.W., and Wolff, H.G.: Social Science in Medicine , New York: Russell Sage Foundation, 1954, pp 13-14. 43. Hertzig, M.E., and Birch, H.G.: Neurologic Organization in Psychiatrically Disturbed Adolescent Girls , Arch Gen Psychiat 15:590-598, 1966.Crossref 44. Rogler, L.H., and Hollingshead, A.B.: Trapped: Families and Schizophrenia , New York: John Wiley & Sons, 1965. 45. Grinker, R.R., Sr.: Normality Viewed as a System , Arch Gen Psychiat 17:66-70, 1967. 46. Saper, B.: Current Trends in Comprehensive Community Mental Health Services , Ment Hyg 51:100-107, 1967. 47. Meyer, A.: In Winter, E. (ed.): Collected Papers: Mental Hygiene , Baltimore: Johns Hopkins Press, 1952, vol 55. 48. Haviland, C.F.: Mental Disease as a Social Problem , Ment Hyg Bull 6:1-8, 1928. 49. Dohrenwend, B.P.: Social Status and Psychological Disorder , Amer Sociol Rev 31:14-34, 1966.Crossref 50. Wynter, A.: The Borderlands of Insanity and Other Papers , London: Robert Hardwicke, 1875. 51. Bucknill, J.C., and Tuke, D.H.: A Manual of Psychological Medicine: Containing the History, Nosology, Description, Statistics, Diagnosis, Pathology, and Treatment of Insanity; With an Appendix of Cases , Philadelphia: Blanchard and Lea, 1858. 52. Wittkower, E.D., and Rins, H.: "Recent Developments in Transcultural Psychiatry" in Ciba Foundation Symposium: Transcultural Psychiatry, New York: Little, Brown and Co., 1965. 53. William, C.: " Applied Anthropology in Medicine ," in Kroeber, A.L. (ed.): Anthropology Today , Chicago: University of Chicago Press, 1953, pp 771-806. 54. Zusman, J.: Sociology and Mental Illness , Arch Gen Psychiat 15:635-648, 1966.Crossref 55. Basch, S., and Basch, L.: Observations on Patients in a Mental Hospital in East Africa , E Afr Med J 43:359-365, 1966. 56. Kaufman, M.R.: Factors Contributing to Causes of Mental Illness and Health: The Viewpoint of Psychiatry and Psychoanalysis , J M Sinai Hosp 28:451-459, 1961. 57. Peterson, O.L., et al: An Analytical Study of North Carolina General Practice, 1953-1954 , J Med Educ , (part 2) , 31:1-165, 1956. 58. Grinker, R.R., Sr.: The Sciences of Psychiatry: Fields, Fences and Riders , Amer J Psychiat 122:367-376, 1965. 59. Freud, S.: The Question of Lay Analysis , New York: W.W. Norton & Co., Inc., 1950. 60. Joint Commission on Mental Illness and Health: Action for Mental Health , New York: Basic Books, Inc., 1961. 61. Grinker, R.R., Sr.: GAP's Next 20 Years , Arch Gen Psychiat 16:133, 1967.Crossref 62. Kaufman, M.R.: The Problem of Psychiatric Symptom Formation , J Mich Med Soc 57:71-76, 1958.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Sep 1, 1967

References