The medical model would argue that Kraeplin’s (1856-1926) discovery that certain symptoms occurred together suggests that types of disorder do exist., and that classification systems such as the DSM IV and ICD 10 have useful in the diagnosis and treatment of many disorders since 1952. One of these illnesses is depression. The DSM IV states the criteria for diagnosing depression as:
- Persistent low mood for at least 2 weeks
- Poor appetite/weight loss
- Loss of energy/ fatigue/ tiredness
- Body slowed down/observed by others
- Loss of interest/ pleasure in sex/ socialising
- Self reproach/ excessive guilt
- Lack of concentration/ indecisiveness
- Recurrent thoughts of death and suicide
(SEE APPENDIX 1 FOR AN EXACT COPY OF CRITERIA)
After the diagnosis of an illness such as depression, a treatment plan is needed, however before treatment can be administered it is essential that the right treatment is given. In order to give the right treatment, the cause of the disorder must be identified and this is why there is much research into the mental illness of depression. In the 1960’s Joseph J. Schildkraut suggested that a deficiency of norepinephrine caused depression however a deficiency of this chemical does not affect mood in everyone and it was discovered at a later time that the cause of depression also involves the depletion of serotonin at the synapse. A new suggestion is that dopamine plays the final part in the role of depression however dopamine has only been found to be a cause in a small sample of sufferers. (Schimelpfening, 2004) Another suggestion comes from (Duman et al., 1997 cited in Satcher, D et al, 1999) who say that depression may derive from reductions in neurotrophic factors needed for certain neurons to survive. These causes are all biological and are what the medical model assumes causes depression.
In contrast Thomas Szasz believes that most psychological disorders are just alterations or an exaggeration of normal behaviour his view on depression is that it is one of many ‘manifestations of disturbances in the social structure’ (Joseph. S, 2001, 142) Szasz suggests that “The mental illness of depression is a dramatisation of the proposition ‘I am unhappy’” (Szasz. T, 1961/1972 p.202) Schildkraut and Duman provide evidence for the fact that there is a biological basis for depression. The view taken by Thomas Szasz also has some research to back up theory. Brown and Harris (1978) interviewed women living in London and found that there were four social factors contributing to depression: Women from lower social classes are more vulnerable to depression than middle class women, absence of a confiding relationship, 3+ children at home under 14 yrs, Loss of own mother at age 11 or under (Brown and Harris, 1978, cited in Harry Brignull, 2000) The fact that social class appears in the above list, indicates that not only our day to day experiences have an influence, but also as Szasz suggested, society as a whole.
After the process of diagnosis, it is only logical that treatment will follow, and both models possess very different ideas on treatment. Persons suffering from depression who are perceived to be neglected themselves can be sectioned under the Mental Health Act (SEE APPENDIX 2 FOR CRITERIA) this is supported by the medical model. However Thomas Szasz believes that mental illness is something that a person does and that a sufferer is responsible for there own actions and should have a right to freedom. If the person decides they do not want to seek help then they should be left to get on with their lives and should they harm anyone, be punished in the same way as a person of stable mind.
Should they choose to be treated, Szasz believes that self knowledge is the key to treatment, and that a psychiatrist’s job ought to be to help the person realise what they are doing. The client should define when the therapeutic relationship should end. Ultimately this would happen when the person believes their problem has been solved and they are happy with the changes made to their lives. It could be said that cognitive behavioural therapy may be similar to Szasz’s idea of how someone should be treated. In cognitive behavioural therapy the therapists job is to help the client realise how absurd their thoughts actually are and then help them to change their behaviour. However Szasz, depending on how the therapist goes about helping, may dispute the fact that the therapist is to help change the client’s behaviour as his view is that no coercion should be involved. (ed. Cutting. P, Hardy. S & Thomas. B, 2002, 25) The treatment he suggests is the same for every disorder including depression, as Szasz does not believe in the classification of mental illness
This view of treatment heavily contrasts with the medical model’s view of treatment (SEE APPENDIX 3 FOR A CAREPLAN FOR DEPRESSION) There are three types of treatment suggested for depression; drug therapy, electroconvulsive therapy and psychosurgery. Drug therapy is the most widely used it is used on moderate to mild depression and the patient is prescribed either monamine oxidase inhibitors, tricyclic antidepressants or selective serotonin reuptake inhibitors. The job of these types of drug is to influence activity at the synapses in the brain and make the neuron more likely to fire and release neurotransmitters like serotonin however the MOI’s and the TCA’s also influence other neurotransmitters and side effects are a problem. Another problem with TCA’s are that they cannot be given to: people with ideas of suicide, the elderly and people with heart disease or narrow glaucoma. SSRI’s are the most effective of the antidepressants and the side effects are kept to a minimum as they only affect the neurotransmitters involved in depression. However SSRI’s do not work for all people suffering depression. Also all of the above drugs take up to two weeks to begin to work, if a patient is suicidal or all possible drug therapy has been exhausted then treatment would move on to electro convulsive therapy. (Moore B, Moore P & Wilkinson G, 1999 59-69)
ECT is where the brain (either one or both sides) is stimulated by an electric pulse causing a shock, it has immediate affects and the reason for this is unknown. However when ECT was first introduced it did cause damage to many people and now everyone having ECT must have a muscle relaxant to prevent and muscular damage and it has been shown to cause short term memory loss (ed. Brewin C R, 1997, 134-136) A new treatment similar to ECT has just been introduced Transcranial Magnetic Stimulation, this is where a hand held electromagnetic coil is placed at specific parts of the head causing magnetic stimulation without inducing a seizure like ECT. It has been tested successfully in treating severe depression however it is still being researched and developed and like ECT is not free of side effects. (Citrome L, 1999) The final treatment used is that of psychosurgery however it is very rarely used as it involves a serious operation in which parts of the brain concerned with depression are altered. ECT, TMS and psychosurgery can all be described as inhumane and unnecessary however they have been proved successful as a last resort.
In summary the medical model assumes ‘psychopathology is the result of physical imbalances, and that psychological problems represent some underlying cause’ (Joseph S, 2001, 56) Biological treatments for depression have been proved a success however they do not tackle the underlying cause of the depression and we cannot take on board the deterministic view that ‘anatomy is destiny’ (Joseph S, 2001, 57) On the otherhand Thomas Szasz believes that the society we live in, the people around us and all their morals and beliefs are what shape personality and that psychiatrists deal with ‘personal, social and ethical problems in living’ (Szasz T, 1974, 262) However his views about treatment and a persons right to freedom of choice are not without flaw as many mentally ill people are danger to themselves and some a danger to others and we cannot ignore the fact that biological research has shown the links between neurotransmitters and depression.
To conclude it is felt that a more eclectic approach is needed for the diagnosis treatment and care of people with depression and the bio-psychosocial-spiritual model used in mental health practice today, is indeed the best option. It gives people a chance to be treated biologically, deal with the underlying cause of depression and keeps in mind their morals, beliefs and to some extent allows freedom of choice.
Brewin, C. R. (ed.), (1997), Clinical Psychology A MODULAR COURSE Depression, Psychology Press Ltd, East Sussex
Brignull H, 2000, Social factors in depression [Online] Available from: [Accessed 16/01/04]
Citrome L, (1999), What is Transcranial Magnetic Stimulation? Can it be used to treat depression?, [Online] Available from: [Accessed 16/01/04]
Cutting, P, Hardy, S & Thomas, B (2002), Stuart and Sundeen’s MENTAL HEALTH NURSING PRINCIPLES AND PRACTICE, Mosby, Edinburgh
Joseph, P, (2001), Psychopathology and Therapeutic Approaches An Introduction, Palgrave, New York
Satcher, D et al, (1999), Mental Health: A Report of the Surgeon General [Online] available from [Accessed 16/01/04]
Moore, B, Moore P & Wilkinson, G (1999), Treating People with DEPRESSION a practical guide to primary care, Radcliffe Medical Press, Oxon
Schimelpfening N, (2004), The Chemistry of Depression [Online] available from: [Accessed 16/01/04]
Szasz, T., (1961/1972), The Myth of Mental Illness. Foundations of a Theory of Personal Conduct, Hoeber-Harper, New York
Szasz, T. S, (1974), THE MYTH OF MENTAL ILLNESS Foundations of a theory of Personal conduct (Revised edition), Harper & Row Publishers, Cambridge
APPENDIX 2
Admission to Hospital
-
. Admission for assessment for up to 28 days.
Admission for Assessment
Summary
Section 2 provides the authority for someone to be detained in hospital for assessment. It requires an which is based on two .
Duration
Up to 28 days. There is no provision for this section to be renewed or extended. The imposition of a second Section 2 immediately after the end of the initial 28 days is not explicitly prohibited in the Act, but would be extremely bad practice. The 28-day period is intended to give sufficient time for an assessment of the person's mental health difficulties to be made. If continued detention is required, then should be used.
Conditions
The grounds for the Application, as stated in the Act, are that the person:
is suffering from of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) for at least a limited period; and
he ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons.
Notes
This Section will typically be used when someone is compulsorily admitted to hospital for the first time, or on subsequent admissions where there is a considerable gap of time between periods in hospital. If a person is well known to a psychiatric service and relatively little specific assessment is needed, then they may be admitted under - for treatment. Section 2 also provides for treatment during or following the assessment, but for the limited 28-day period .
Taken from: Turner N, 1996-1998, Nigel Turners HyperGuide to the Mental Health Act, [Online], Available from: , [Accessed 23/01/04]
