“improved, diseases sub classified, and applicable treatments administered.” (p50)
Investigators of psychological problems and abnormal behaviour were so impressed by the success of these diagnostic procedures; they sought to develop classification schemes where different symptoms could be placed in different categories to establish diagnosis. Nowadays the health professional would use either the International Classification of Disease (ICD), which recently had its tenth revision (ICD-10), and the Diagnostic and Statistical Manual for Mental Disorders (DSM), which is now modified to its fourth revision (DSM-IV). The World Health Organisation (1992) and the American Psychiatric Association (1994) published both respectively. Tyrer et al (1992)
Countless psychiatric disorders do not have clear-cut diagnostic descriptions; however, this does not indicate that diagnosis is a waste of time. Diagnoses are useful to identify groups of disorders that have the same clinical characteristics, analogous outcomes, and establish treatments. Furthermore, they permit mental health professionals and research worker to communicate effectively (Tyrer, et al 2005). The need for diagnosis and treatment has become paramount in today’s medical arena, however, Grosky et al (1981) suggests,
“we seem unable to acknowledge what we simply do not know” (p.317)
Health professionals fail to acknowledge that they are only just embarking on understanding, nonetheless, patients are labelled ‘schizophrenic,’ ‘manic-depressive,’ or ‘insane,’ without considering the consequences a diagnosis can have on an individual (Grosky et al 1981).
Psychotic disorders are far more stigmatizing than neurotic disorders (Pilgrim et al 1999). For example, Fernando, (1988) suggests psychiatrists have an ethnocentric view resulting in the misattribution of labels, such as schizophrenia, by having little regard for the cultures of non-western people and imposing western concepts. When some black people display disturbed behaviour, diagnosis such as ‘cannabis psychosis,’ and ‘schizophrenia’ are used, where as depression is under diagnosed. This evidence that psychiatrists have difficulty fixing the appropriate label derived from the assessment that more black people have had their diagnosis changed over time than white people, resulting in the wrong treatments being administered and stigmatization. Stigmatization can itself lead to mental health problems as Grosky, et al (1981) points out,
“The label sticks as a mark of inadequacy forever.” (p.317)
Moreover, there is now evidence available concerning the usefulness of prescribed treatments.
The bio-medical approach dictates that physical treatment is paramount. Gournay, (1995) asserts, schizophrenia is essentially a brain disease and requires physical treatments. Moreover, he states recent studies into brain structure provide compelling evidence of a reduction in grey matter or nerve cell loss. However, Bentall, (1998) argues since schizophrenia ‘was discovered’ no one has succeeded in demonstrating it to be reliable or a valid diagnosis. Furthermore, not only has no specific cause been identified but also no progress has been made to show it has any specific symptoms, or that it responds to any particular treatment. Nonetheless, since drugs were first introduced psychiatrists and pharmacologists have claimed that major drug treatments, namely tranquillisers, relieve psychotic symptoms .However, Warner (1997) claims a lot of symptoms displayed by the patient, could be due to ‘drug induced dopamine super sensitivity’ caused by long term use of major tranquillisers. The association of British Pharmaceutical Industry state that the availability of modern medicine has greatly improved the quality of life for people living with schizophrenia. For example, Tyrer, et al (2005) puts forward,
“It is known that most patients with the clinical syndrome of schizophrenia are dramatically reduced with treatment of one or more of the antipsychotic group of drugs (there are atypical and typical members) and will relapse if these drugs are withdrawn or reduced to half their original dose.” (p.29)
In contrast to the medical model, dynamic psychotherapy has had an enormous influence on most western thought and cultures, more importantly it has been a vital component, in many situations, when treating people with mental health problems (Davidson, et al 1975). Psychodynamic, according to Jacobs (2004) refers to a way that the psyche relates to three aspects of a person: thought, feeling, and spirit. These are active aspects and not static, and can be seen as dynamic in the sense that movement and change occurs between them.
Large proportions approximately one third, of all patients who visit their doctor present themselves with emotional problems. Furthermore, a very small number of patients, diagnosed with identifiable psychiatric conditions, are referred on to psychotherapy within the National Health Service (Bateman et al 2000). In contrast to the bio-medical model and physical methods of treatment, psychotherapy relies on talking and relationship between patient and therapist as a form of treatment for emotional and psychotic disorders. Moreover, many forms of disturbance within the psyche are sometimes best treated with physical methods, for example, as discussed earlier ‘schizophrenia,’ however, less acute disturbances, for example depression, anxiety, or extreme shyness, are in some cases best helped by psychotherapeutic methods, or a mixture of both physical and psychotherapeutic methods (Tyrer, et al 2005)
All forms of dynamic psychotherapy, states Bateman et al (2000), originate from the work of Freud and psychoanalysis, which has produced many separate branches, for example, earlier in the century Anna Freud, and Melanie Klien, developed child analysis. Foulkes and others developed group psychotherapy after exploring the use of analytic ideas in groups. However, despite this apparent diversity, all schools of dynamic psychotherapy have in common key concepts of a certain nature.
People, according to Bateman, et al (2001)
“become troubled and may seek help with symptoms or problems when they are in conflict over unacceptable aspects of themselves or their relationships” (p.3).
In contrast, the bio-medical model would view this statement solely as an expression of disordered autonomy and physiology. It would not consider that psyche pain or anxiety that may be consciously rejected and become more or less unconscious, as the psychodynamic model does. All human beings according to psychodynamic theory employ a number of defence mechanisms, these help to deny, suppress, or disown what consciousness finds unacceptable. (Howard 1996)
Freud believed that the root of all psychological problems was caused by conflict among different parts of the personality: the Id, Ego, and Super-Ego. According to Howard, (1996) the Id is the animal side of a personality, which seeks pleasure and avoids pain. The Super-Ego addresses the mind as a concerned parent; it is preoccupied with principles and ideals. However, the Ego, which in Latin means ‘I am’, has the hardest job of the three. It is sandwiched between the Super Ego and Id. It attempts to create a balance between our pleasure (animal) and perfection (parent) seeking tendencies when both are reluctant to compromise. Psychological health is therefore the ego’s ability to manage conflicting pressures between the Id and the Super-Ego. Psychoanalysis engages to try to bring the concerns and motives of the unconscious mind to the surface, and then the ego can develop coping arrangements in dealing with them. (Hayes, 1994) Thoughts, feelings, and memories that have been rendered unconscious by a previous relationship can, with a therapist, be rendered conscious and treated without the need for medication. For example, when people are having difficulties within the personality, psychodynamic therapy has stuck by these people even when other parts of psychiatry had doubts about whether these problems were viable. Care integrated in a psychodynamic framework has, according to Bateman, et al (2004),
“now been shown to be of considerable value in at least one group, those with the complex and diffuse personality organisation known as borderline personality disorder.”
In comparison to the biomedical model, the psychoanalyst assumes the client is ill to some degree. It still uses, according to Pilgrim, et al (1999),
“terminology of pathology (‘psychopathology’ and its ‘symptoms’); assessments are ‘diagnostic’ and its clients ‘patients’. (p.6)
The discourse as demonstrated above is saturated with medical terms. It can consequently be said that psychoanalysis lies somewhere in between psychology and psychiatry.
The limitations of ‘The Psychodynamic Approach’ claims Grusky, et al (1981) is that it does not differentiate ordinary problems of mental adjustment and social adjustment from mental illness such as, alcoholism, homosexuality, marital dissatisfaction, and feelings of lack of fulfilment. Although the model is attuned to some extent to the social aspects of these problems, they are defined as problems of the personality and not social aspects of a patient’s environment. Moreover, a greater limit of this model is as a frame of reference, psychodynamic theory can do no more than be wise after the event. Unlike the bio-medical model, it has never reached the standing of a predictive science. (Pilgrim et al 1999) However, the psychodynamic model does alleviate many personality disorders without the need for physical treatment, both models can and do work well together in the battle of helping people with mental health problems.
In conclusion, this piece has shown there are differences as well as similarities in both the bio-medical and psychodynamic models. Moreover, it has compared and contrasted each model against each other and discussed the limitations. The bio-medical model seeks to treat with physical methods. It one of the longest standing models within the arena and has greatly improved the quality of life for people living with mental health problems. However, misdiagnosis and categorising illness does, as shown, lead to stigmatization. In addition, a patient could be administered drugs with side effects, for no apparent reason; this can manifest as ‘symptoms’ of illness. In contrast, the psychodynamic model relies on talking therapy as a form of treatment, which does alleviate the need for physical treatments; its essence however is largely bio-medical in nature. The bio-medical model defines mental health in a purely medical nature; however, the psychodynamic model looks further into the unconscious mind to find and treat the illness. Nonetheless, they are both worthy of their own merit when treating people with psychological health problems.
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