The Medical Model: What Is It, Where Did It Come from and How Long Has It Got?

Abstract

This chapter takes ‘Beyond the current paradigm’ – a paper published in the British Journal of Psychiatry by members of the UK Critical Psychiatry Network (Bracken et al. 2012) – as a starting point. The essence of the paper was a reiteration of critical reviews of clinical research, which conclude that the evidence base upon which psychopharmaceuticals are promoted is seriously flawed (Moncrieff 2008, 2013), and that the so-called Dodo bird verdict concerning psychological therapies remains as supportable now as it was when it was first conceived (Budd and Hughes 2009; Rosenzweig 1936; Stiles et al. 2008). Fully realised, these criticisms of the evidence supporting professionalised mental health services and practices have profound implications. At face value they can be read as: ‘There is no conclusive science supporting claims that any of the psychopharmaceuticals work as claimed, and when they do help, it is as likely as not that “help” is the result of complex phenomena not indistinguishable from placebo’ and ‘Useful outcomes of a psychological therapy are primarily the result of a helpful relationship, rather than the result of any identifiable psychotherapeutic technique.’ If these conclusions were to be widely acknowledged, then much of what conventional mental health services are commissioned to do would have to be seen as acts of faith rather than fact. In the event, few have reacted to ‘Beyond the current paradigm’ with any rebuttal of these underpinning conclusions, despite the fact that it was published in the house journal of the Royal College of Psychiatrists