Hi laura
I've found a paper about this by Michael white to be useful, it's called 'saying hullo again' (can't remember the year- 1988?), do you have any other papers to recommend to help us think outside of the standard frameworks?
suzanne
-----Original Message-----
From: The UK Community Psychology Discussion List [mailto:[log in to unmask]] On Behalf Of Lauren BREEN
Sent: 22 July 2009 03:16
To: [log in to unmask]
Subject: Re: [COMMUNITYPSYCHUK] why does the medical model persist?
Hi,
I was very interested in Alison's points about "despair and torment being described and prescribed within a medical framework" and "anger and fear are contained within a medical discourse which ignores that fact that the city I live in has under-funded resources and I am on a waiting list for treatment".
I have been doing research for a few years on grief and loss. I have written about the domimant discourse of grief where: a) grief follows a relatively distinct pattern; b) grief is short-term and finite; c) grief is a quasi-linear process characterised by stages/phases/tasks/processes of shock, yearning, and recovery; d) the grief process needs to be "worked through"; e) for people bereaved through illness, the work of grief begins in anticipation of the death; f) meaning in and/or positives gained from the death must be found; g) grief culminates in the detachment from the deceased loved one; and h) the continuation of grief is abnormal, even pathological.
I have also done some projects looking at grief and loss counselling/service provision following cancer, and it too is very much influenced by medicalised and psychologised discourses with little/no regard to context. For instance, there is so much emphasis on the 'good death', 'the right way to die' and the need to 'openly discuss death' in order for the dying and their families to do their 'anticipatory grief work'. Dying people and their families can be implicitly labelled as either 'good' or 'bad' depending on how well they fit or conform with professional definitions of a 'good death'. Further any resistance to the professional's point of view is characterised by the professionals as a form of denial, maladaptive behaviour, a disturbance in their necessary anticipatory grief or failure to engage in the 'proper' preparation for death. Most services don't offer post-bereavement supports....
I am also very concerned about the increasing medicalisation of grief experiences, the push to have "Prolonged Grief Disorder" appear in the next edition of the DSM, and the resulting requirement for "an equivalent of morphine for these people" as one of the key researchers in the field has said.
Lauren
---
<https://staffmail.ecu.edu.au/exchweb/bin/redir.asp?URL=http://www.groups.psychology.org.au/ccom/2009_conference/>
Lauren Breen, PhD MAPS
Postdoctoral Research Scholar
Social Justice Research Centre
School of Psychology and Social Science
Edith Cowan University
Western Australia
________________________________
From: The UK Community Psychology Discussion List on behalf of alison smith
Sent: Wed 22/07/2009 6:23 AM
To: [log in to unmask]
Subject: Re: [COMMUNITYPSYCHUK] why does the medical model persist?
Hi,
This discussion seems to have moved from the context of mental health (which Emma's inital posting related to) to a much broader discussion of the medical model as a discrete framework. The medical model, the ethical code of medics relates to power. The power to diagnose and treat others according to scientific knowledge of illness and medicine. If I go to a doctor because I have cancer, I welcome the power they have in knowledge- of what is going on in my body, of what course of action is most likely to keep me alive. I may not even want to know much about what is happening in biological terms, I may just want to put my faith in their knowledge and will consent to what treatment they prescribe. I would be thankful for their power. What I would find oppressive however is if the context of my emotional and existential reaction to the knowledge that I have a disease from which i may die is similarly fed into this medical framework. If my despair and torment is described and prescribed within a biological framework. If my anger and fear are contained within a medical discourse which ignores that fact that the city I live in has under-funded resources and I am on a waiting list for treatment.
I have moved from a stance that found the medical model in these 'greyer' contexts (mental health for example) totally abhorant (Szaz) to understanding a little (and i emphasise little!) more deeply the complexity of it's persistence.
It is based in power and, in mental health certainly, this power is linked with social control. It serves the stakeholders (the pharmaceutical industry, the psy-organisations, the insititutions that always-have-been). It fits in with our cost-effective consumerist society- it offers the cheapest 'solution'. It is also more able than any of the other models (currently) to offer access to services and benefits and in someways more able to present these services as 'deserved' and 'necessary' rather than dependent on the individual to be able to make positive changes in their lives (CBT for example).
It is not, I personally believe, just down to this unjustifiable politcal power that some individuals experiencing distress find the framework a relevant one to describe their experiences although it is because of this power that an individual cannot use a medical discourse to describe their experiences without becoming disempowered and dehumanised in the process.
Pitting a debate about the medical model in this context between 'for and against' heightens the models oppressive power while at the same time dis-allowing us from appreciating the complex relationship between our physical and emotional experiences.
Alison (with a rather common surname!!)
> Date: Tue, 21 Jul 2009 21:16:32 +0100
> From: [log in to unmask]
> Subject: Re: [COMMUNITYPSYCHUK] why does the medical model persist?
> To: [log in to unmask]
>
> Dear all, while I am not wanting to exculpate medics too much, for me the essence of the medical model is a strong ethical code, adhered to with varying degrees of strictness but it is there all the same, with journals and the like. So I would just like to balance the equation a bit because the other e-mail I think is pure prejudice, though an understandable prejudice. My comments are in the text of the e-mail in bold:
>
> Picking up on the recent emails to the list by Alison and Emma (both
> Smiths - are they related? Is this the Matrix?), maybe it would be
> helpful for us as a group to specify together some of the many reasons
> we think that the medical model persists? Here are some:
>
> SURELY THE MOST IMPORTANT REASON FOR TE PERSISTENCE OF THE 'MEDICAL MODEL' IS THE AGE-OLD DICHOTOMY BETWEEN CATEGORIES AND THE FUNCTIONAL PRINCIPLE OF DISTRIBUTION ON A CONTINUUM. WITHOUT THIS NO DIAGNOSIS, AND NO 'MEDICAL MODEL'. NOW THERE ARE A LARGE NUMBER OF SITUATIONS WHERE CATEGORICAL KNOWLEDGE AND PATERNALISTIC ACTION IN THE BEST INTEREST OF THE PATIENT IS ESSENTIAL. FOR INSTANCE ANYONE, INCLUDING PSYCHOLOGISTS WILL BE GLAD FOR THE DIAGNOSTIC CAPACITY AND THE TREATMENT COMPETENCE OF A DOCTOR IN A LIFE-THREATENING SITUATION. NOW NOT ALL OF MEDICINE IS BEST CONEPTUALISED IN SUCH A WAY BUT WHENEVER PEOPLE NEED SOMEONE TO ACT, THIS WAY OF CONSTRUCTING PERCEPTIONS AND REALITIES IS ESSENTIAL.
>
> .- it is superficially 'scientific' and so gains some of the authority
> and prestige accorded to scientific explanations generally
> I THINK THAT NO 'MODEL' IS SCIENTIFIC, BUT SCIENCE CAN BE FURTHERED BY A MODEL, IE A WAY OF THINKING. THE AUTHOR OF THESE LINES IS CONFUSING EPISTEMOLOGY IE PHILOSOPHICAL CONTRIBUTIONS, AND NATURAL SCIENTIFIC WORK. OF COURSE DOCTORS AS PEOPLE GET DRAWN INTO THEIR PROFESSION FOR SOMETIMES VERY SPECIFIC REASONS, AS DO PSYCHOLOGISTS, AND AS A RESULT BOTH GROUPS HAVE THEIR SHARE OF ARROGANT AND POMPOUS REPRESENTATIVES.
>
> - it accords with our culture's ready preference for technological
> solutions to problems of various kinds
> THIS MIGHT BE TRUE BUT IS A GENERAL STATEMENT WHICH WOULD BE FASCINATING TO PICK APART.
>
> - it thus appears within an optimistic arc of possible future progress,
> so offering (misplaced) hope
> IT WILL ONLY BE A QUESTION OF TIME WHEN WE MOSTLY WORRY ABOUT WHETHER OR NOT WE CAN AFFORD THE NEWER TECHNOLOGIES JUST LIKE IN DENTISTRY. AS SUCH THIS IS AGAIN AN OVERGENERALISATION. HOPE IN GENERAL IN MY MIND IS A GOOD THING THAT WE NEED FOR SURVIVAL. DOES MISPLACED MEAN 'FALSE'?
>
> - it promises a quick, simple, expert solution to people's problems.
> MY MEDICINE DOES NOT BUT MAYBE SOME PEOPLE DO OR HAVE SUCH AN EXPECTATION. HOWEVER THAT IS WISHFUL THINKING AND A PROJECTION, NOT A FACT OF MEDICAL LIFE.
>
> - it minimises the blame, guilt, and shame of individuals by presenting
> their difficulties as purely technical 'hardware faults'.
> YES, THAT IS SO, AND SOMETIMES IT PREVENTS PROGRESS OF PEOPLE BUT SOMETIMES IT ALSO ENABLES IT. SO LIKE ANY EXPLANATORY SYSTEM IT NEEDS TO BE USED WISELY AND IN THE BEST INTEREST OF THE PATIENT.
>
> - it reduces potential conflict between those distressed and those
> working with them, by generating an (illusory, inappropriate) focus for
> consultations and interventions.
> IT REALLY DEPENDS ON THE SITUATION. IF THE AUTHOR WERE A PATIENT IN INTENSIVE CARE FIGHTING FOR SURVIVAL THIS STATEMENT WOULD PROBABLY NOT SEEM AS RIGHT. IN MENTAL HEALTH SYSTEMS, IF AN EXCULPATION ALLOWS PEOPLE TO UNFREEZE AND MOVE ON MAYBE IT IS NOT SUCH A BAD THING AFTER ALL.
>
> - it similarly allows families and relatives to more readily absolve
> themselves of responsibility.
> MY MAIN EXPERIENCE OF FAMILIES IN MENTAL HEALTH SERVICES IS THAT THEY END UP FEELING BLAMED NO MATTER WHAT THE PROFESSIONAL INTENDED. THE RESULTING GUILT IS MAKING IT OFTEN VERY DIFFICULT FOR THER FAMILY MEMBERS TO TAKE EFFECTIVE RESPONSIBILITY FOR THEIR ACTION.
>
> - it is shored up by the immense resources of powerful institutions,
> whose various interests it serves. PROVIDED WE HAVE AN AGREEABLE DEFINITION OF WHAT THE EVIL IS WE WISH TO ATTACK I MIGHT BE ABLE TO WHOLEHEARTEDLY UNDERWRITE THIS STATEMENT, ESPECIALLY IF IT IS DIRECTED AT HTE CORRUPTING INFLUENCES OF SOME BIG PGARMA COMPANIES.
>
>
> And I'm sure there's much more than can be said than this...
> THAT IS ALMOST CERTAINLY TRUE AND I HOPE THAT MY CONTRIBUTIONS HAVE STIRRED THE POT A BIT. I AM NOT CLAIMING TRUTH THOUGH.
>
> MICHAEL.
> J.
> ********************************************************
> John Cromby
> School of Sport, Exercise and Health Sciences
> Loughborough University
> Loughborough, Leics
> LE11 3TU England
> Tel: 01509 223000
> Email: [log in to unmask]
> Personal webpage: http://www-staff.lboro.ac.uk/~hujc4/
> Co-Editor, "Subjectivity": www.palgrave-journals.com/sub
> ********************************************************
>
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