Model medical

Carroll et al. (2004) conducted another study examining psychotherapy and disulfiram treatment for cocaine dependence. In this randomi2ed, doubleblind, placebo-controlled study, patients (iV=121) were assigned to one of four conditions 1) disulfiram plus CBT 2) disulfiram plus interpersonal therapy (IPT), which addressed adherence to a medical model of psychiatric problems, interpersonal functioning, and supportive therapeutic exploration 3) placebo plus CBT or 4) placebo plus IPT. The patients who received disulfiram reduced their cocaine use, relative to those who received placebo, and the patients who received CBT reduced their cocaine use, relative to those who received IPT. Cocaine abstinence among the patients who received CBT plus placebo was not statistically different from that of the patients who re-... 

O Malley SS, O Connor PG, Fatten C, et al Comparison ofnaltrexone in combination with either CB therapy or medical model counseling (abstract). J Addict Dis 17 160, 1998... 

The term alcoholism as a disease entity was coined by the Swedish physician, Magnus Huss, in the mid-19th century to describe the harmful physical and mental effects of chronic excessive alcohol consumption. This strictly medical model held sway for almost a century before it became apparent that a variety of psychosocial factors also influence the onset and course of the disorder. Indeed, drinking behavior and the problems attributable to excessive drinking, including alcoholism, vary widely within and across different cultures and population groups, and even within the same person across the fife span. In the last 30 years, basic and... 

Years ago problematic behavior was explained simply as evidence of sinfulness or evil. This vocabulary of sinfulness has largely been superseded by a sickness vocabulary. These days when people behave strangely or do things that impinge on our moral sensibilities, we immediately question their mental health Why aren t these people acting normal What s wrong with them Consequently, an ever-increasing variety of behaviors now fall under the rubric of the medical model. ... 

The advent of somatic treatments and more particularly the advent of effective psychopharmacology gave an impetus to a conceptual change in the approach to psychiatric illness, focusing on a more medical model. This resulted from the discovery of improved and more efficacious treatments. These gave more credibility to the approach and served as instrumentation for further progress. 

The effect of psychopharmacology on psychiatry has essentially been a return to the medical model where clinical history and examination lead to the formulation of a diagnosis. The diagnosis thus allows the development of prognosis, course of illness, and prediction of ultimate outcome. Most impor-... 

The gradual rediscovery of the medical model of mental illnesses, associated with research into pathological anatomical causes. 

It is clear that these trends are contradictory to some extent. A spatially segregated patient cannot lead a normal life in society. The medical model of mental illnesses, with its objective of detecting and, where applicable, correcting anatomical or functional disorders in the patient s body, contradicts a socially orientated concept of the illness underpinning treatment by educational methods. Modem psychiatry has grown up with these contradictions and still lives with them today (Rosen, 1969). 

A comparison between the medical model of methadone treatment and a model of methadone as a so-called heroin substitute is outlined in Table 1.2, and these concepts will now be considered. 

Table 1.2 Medical model and substitution model of methadone treatment...

The medical model serves as the foundation for the treatment of psychiatric disorders. 

Adopting a medical model when evaluating the patient s complaints... 

The founders of AA introduced the medical model first to alcoholics, later to society, and finally to the medical pro-... 

Medical expectations. Some ill-prepared subjects unconsciously impose a medical model on the experience. They look for symptoms, interpret each new sensation in terms of sickness/health, place the guide in a doctor-role, and, if anxiety develops, demand chemical rebirth - i.e., tranquilizers. Occasionally one hears of casual, ill-planned, non-guided sessions which end in the subject demanding to be hospitalized, etc. It is even more problem- provoking if the guide employs a medical model, watches for symptoms, and keeps hospitalization in mind to fall back on, as protection for himself. 

The medical model represented by germ theory—that major diseases are the result of bacterial, viral (or prion) action—is slowly evolving into a more complex view of medicine. 

Industry response to the pressures described above—particularly the pressures for individualized medicine and for a new and more complex medical model—will be a diversification of product lines. As NDA and ANDA reviewers require more extensive testing and offer more restricted labels, industry will be forced to offer a brand extension of products. For example, look for a manufacturer of an allergy medication to introduce a variant for men, for women, for children, for older individuals, etc., much as vitamins are currently marketed. 

Indeed, the term therapy itself is misleading, lending itself too easily to a medical model with artificial diagnoses, manipulation, and medication. The term counseling is in many ways preferable and arises out of a tradition that is more respectful of the autonomy and human needs of the individual. Similarly, the word patient is also potentially misleading and might better be replaced with client. But since I am a physician and psychiatrist and do not wish to add undue confusion to this book, with these caveats I will continue to use the terms therapist and patient. 

Do humans die of old age Certainly, the bioscientific medical model assumes that death always results from a single disease/event (e.g., acute myocardial infarction) or a combination of diseases (e.g., stroke followed by pneumonia). Although this model is generally believed to be true, on occasion it is difficult to defend since several diseases may be identified at autopsy but none appear severe enough to cause death, at least in a younger person, either singly or in combination. Perhaps aging predisposes one to the extent that a combination of mild diseases can result in death. 

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