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.
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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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