I really don't think The Medical Model is about Medicine or Ethics. It
is about Deficit.

Keith Venables 

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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