On 3 Dec 2004, Scott Lilienfeld wrote:
> As a number of authors, including Paul Meehl and Paul
> Blaney, have noted, the term "medical model" actually refers to a large
> number of quite different models, many of which bear little or no
> conceptual relation to each other.
When I was young and na�ve (as opposed to being old and na�ve, as I
am now), I was mightily confused about this term. I understood that
the medical profession (naturally) used the medical model (good) but
that traditional psychotherapy also used it (bad). Why was it good in
one case but bad in the other?
I eventually stumbled upon the difference. What I call the "true
medical model" is what doctors use in treating patients. They
observe symptoms (signs) of the sick patient (e.g, "headache") and
from them draw a conclusion about the underlying cause of the
disorder ("brain tumour"). Generally (although there are exceptions)
the symptom isn't treated (the doctor doesn't prescribe aspirin) but
uses the symptoms to determine the true cause so that effective
treatment can be given (surgical excision of the tumour).
Traditional psychotherapy does the same, sort-off. The therapist
observes the patient for symptoms (depression, anxiety) and diagnoses
the underlying cause (repressed memories of child sexual abuse).
He/she then treats the underlying cause (e.g. with recovered memory
therapy) rather than the symptom. But there's a critical difference
in the way that a doctor uses the model and the way that the
psychotherapist does. The difference is that in the true medical
model, the postulated cause is a real, structural one (a tumour,
bacterium, or virus). In its use in psychotherapy, the postulated
cause is a fictitious, metaphoric one, a "psychic" one, which no one
expects to observe under a microscope (try detecting a repression in
the way you detect a tumour). So I call its use in psychotherapy a
"quasi-medical model". I have no doubt that the enthusiastic
endorsement of the quasi-medical model by traditional psychotherapy
is based on its association with the prestige and effectiveness of
the true medical model with which it is confused. Unfortunately,
while the use of the true medical model to treat disease has been
strikingly successful, the use of the quasi-medical model to treat
psychological disorders has been less so.
Once I realized the need for a distinction between the two kinds of
medical model, things made sense for me again. I'm not sure where
this distinction originated, so I just spent some time trying to dig
up sources. What I found was that Ullmann and Krasner (1965), in a
classic early collection of behavior modification readings, discuss
much of what I've said above in their introduction under the heading
"medical model". But they don't distinguish between the two kinds. I
also have a discussion from Lovaas (1979) where he calls it the
"disease model" and points out that there are two kinds, one which
postulates psychic damage and the other, structural damage. But so
far I haven't found anyone but myself referring to the two as the
"true medical" and "quasi-medical" models, a distinction I find very
helpful. Is it mine, or does anyone know of a source?
Stephen
References
Lovaas, O. (1979). Contrasting illness and behavioral models for the
treatment of autistic children: a historical perspective. Journal of
Autism and Developmental Disorders, 9, 315--323.
Ullmann, L, & Krasner, L. (1965). Introduction: What is behavior
modification? In: Case studies in behavior modification. New York:
Holt, Rinehart.
_______________________________________________
Stephen L. Black, Ph.D. tel: (819) 822-9600 ext 2470
Department of Psychology fax: (819) 822-9661
Bishop's University e-mail: [EMAIL PROTECTED]
Lennoxville, QC J1M 1Z7
Canada
Dept web page at http://www.ubishops.ca/ccc/div/soc/psy
TIPS discussion list for psychology teachers at
http://faculty.frostburg.edu/psyc/southerly/tips/index.htm
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