The Medicalization Of Mental Illness

The other day I was flipping around the channels on my television
when I came across a sign of the times. A major pharmaceutical company
was advertising one of their medicines for use as a treatment for a
psychological disorder. Now, normally this wouldn't catch my eye at
all. Pharmacy companies have been doing this sort of thing for a while
now. What grabbed my attention was the fact that the medicine (Paxil I
think) was being hawked for use against that most common of all mental
disorders - Social Anxiety. Social anxiety, it seemed, had been
declared a Medical Disorder and there was now a drug with which to
treat it.

Now, it's not hard to accept that medicines can
impact anxiety. We've known for years that drugs can take away people's
anxiety and fear. Any shy boy or girl drinking for courage at a social
gathering can tell you that. Anti-anxiety medicines like Valium and
Xanax have been available for years, as have Buspar and beta blockers.

is sobering is that, even though we have hard-won, elegant and well
supported scientific theories that explain anxiety in biological,
psychological and social terms; even though we have excellent
psychological treatments for anxiety with high "cure" rates; even
though fair minded scientists know darn well that the data do not
support an exclusively medical model of the nature of anxiety; it still
seems that a few well-coordinated and beautifully slick advertising
campaigns will be more able to shape public perception of how anxiety
should be treated than all of this psychological science. I cannot
avoid drawing the following conclusion: As a society we are moving ever
closer towards an exclusively medicalized vision of mental illness.
With the TV telling me that social anxiety is a medical disorder, how
likely am I to ask about alternative non-medical treatments?

The Medical Model vs. The Psychological Model

those of you who don't know this - the different doctoral level
professions that deal in the treatment of mental illness (medicine and
clinical psychology) have very different models of the causes and
proper ways to treat mental illness. Medicine has one way of looking at
things, and Psychology has a different one. I attempt to lay out some
of the key differences below. In the process I've had to paint a
stereotyped and a bit caricatured picture of both medicine and
psychology. I hope both parties will forgive me my license.

Mix of Mechanistic and Subjective approaches
Best Patient Attitude
Method of Intervention
Cognitive, Emotional, Behavioral and Social
Nature of Cure
External to the Patient
Internal to the Patient
Responsibility for Cure falls most on:
The Intervention (use of medicine or surgery which will correct the problem)
The patient's active practice and participation in the therapy relationship
Goal of Intervention
To cure existing disease
To cure existing disease, but also to prevent future disease and to promote growth
Solution Focus
Process focus
Crisis Management
Promotion of growth and learning

I've perhaps used some confusing terms in my table. Let me explain in English.

takes a mechanistic approach to illness. This means that the physician
tends to view a patient in a detached way, as a body with a problem,
much like an actual mechanic might try to figure out what was wrong
with a car. The physician's goal is to understand the nature of the
body's problem so that this problem can be addressed and fixed. The
physician determines a diagnosis based upon her analysis of symptoms.
Her prescription is designed to fix the diagnosed problem. Nowhere in
this chain of events is the physician encouraged to be particularly
interested in the experience of the person behind the problem.

the medical model, the prescription (almost always a biological or
body-focused intervention such as medicine, or surgery) is the active
ingredient that will solve the patient's problem. The physician is the
authority in the doctor patient relationship. The patient's role is to
accept what the physician has prescribed and to minimally meet the
demands of the prescription. It doesn't matter if the patient
understands why the treatment should work or not. So long as the
patient minimally complies with the prescribed treatment regime, the
treatment should be able to do its corrective work. The subjective
experience of the patient is not really relevant to this process.

the medical model tends to rely on cures that are external to the
patient (like medicine), the psychological model tries to cure by
getting the patient to use internal resources they already possess in a
different way. Because the patient (and not a pill) will be doing the
work, psychotherapists must act in fundamentally different ways towards
patients than physicians would. Psychotherapists are interested in
forming a relationship with the patient and in using this relationship
to help along the process of change. In working to foster this process
of change, psychotherapists become more like motivational guides than
white coated authorities. Their goal is to actively involve and
motivate their patients to make the specified changes that will improve
the patients' functioning. Good patients become active partners in the
process of change; the psychotherapist and the patient work together
collaboratively over time to solve the patient's problems.

The Continuing Need For Both Models

models I've outlined above are inseparably tied to the ways that the
medical and psychotherapy professions operate. Therefore, when an
advertisement sells a medicine as a solution to a mental health
disorder, part of what is being sold is also the correctness of the
medical model. The failure of this advertisement to even mention
psychotherapy or counseling as an important adjunct treatment
(understandable as this is in a commercial advertisement) makes an even
stronger (if unstated) claim: that the psychological model is

The reality is that the psychological model is far
from irrelevant. There are real strengths and weaknesses to both
models; Both are 'correct' but also incomplete at the same time. Where
medicine excels at crisis management and biological manipulation,
psychology excels at behavior change and growth. Despite their
incompatibilities, these two models need each other desperately.
Without the other model present as a balancing force, any one of these
models would ignore vital facets of the human condition.

One Reason Why Medicine Is Becoming So Dominant

The medical model has become more prominent, in part, because medicine sells products
and psychotherapists do not. There are powerful pharmaceutical
companies behind the medical model who make billions of dollars each
year selling their medicines. These companies have the money to spend
on research and development of new drugs, and they also have the money
to spend on advertising.

Psychotherapists don't sell anything
except their services. They are a disorganized bunch made up of
multiple different professional groups. They use different therapy
approaches, only some of which have actually been researched and found
to work well. As a group, therapists have difficulty agreeing upon
anything more than that psychotherapy is important.

There is no
real business or professional interest behind therapists who would fund
the costs of even a modest advertising campaign. A few years ago, the
APA piloted an advertising campaign that would have helped to educate
the public about what psychologists do. Despite a reasonable public
reception in the markets that it did run in (so I understand) the
psychologist members of the state associations who needed to pay for
half of the fees associated with the media buys were unwilling or
unable to come up with the cash needed to launch the campaign. As far
as I am aware, the project never really got off the ground.

can't fault the pharmacy companies for promoting their products. Their
products work (mostly), they help people and they make money for the
shareholders. Of course they're going to advertise their stuff. They
want to sell as much of it as possible. As much as I'd like to see them
co-promote the benefits of psychotherapy when they talk about social
anxiety, I suppose that this is too much to ask them for.

responsibility to keep the good news about psychotherapy alive, then,
falls back upon psychotherapists (psychologists, social workers,
counselors, etc.) and those who have benefited from psychotherapy. The
writing is on the TV. Without some strong advocacy program to promote
the benefits of therapy, I think we will see a further decline on the
part of public knowledge and confidence in therapy.

We know
therapy works. We even know what sorts of therapy work and when they
are best applied. We have a good product. But a good product without
public awareness is not a good business proposition. It remains to all
of us invested in the psychotherapy enterprise to find a way to

  • bernard

    I agree that it is safe to follow the medical approach because the psychiatric do give wrong medicine and wrong diagnosis. I have severe hallucinations after taking fluvoxamine and people stigmatised me as mad and crazy. life has become more unbearable and I feel very miserable and very sad and angry, and hurt and disappointed because nobody understands me and my feelings. It is very cruel of them to label me when I am a mental patient now. I hope there is a cure and I don't have to go through this suffering, that I can be like normal person. I really hate my life because I don't like to be label mentally insane and crazy and everyday I feel there is no hope and my family does not support and care for me. Nobody understands the stress and suffering I am going through. The people seems to laugh at me and throw very insensitive remarks at people who are mad. I feel very hard and difficult to carry on in life.

  • Anonymous-1

    This article misses the whole point of psychiatric medicalisation. It defines psychiatric medicalisation as the process by which mental illnesses become defined as biochemical disorders treatable by the administration of drugs of neurosurgery. This is not the entire picture of psychiatric medicalisation. Medicalisation in psychiatry in general is the process by which an increasing area of human behaviour becomes defined in terms of mental illness. Psychiatric medicalisation therefore includes the invention of new "mental illnesses" within the psychological paradigm of mental illness. This article, however, tries to conceptualise the issue so that the psychological model of mental illness is spared from the scrutiny of the critics of medicalisation.

  • Bridget

    i have a therapist, couselor, pschiatrist, and a doctor. i still need help. the talking doesnot seem to help me, but the medicine covers up the problem... still leaving a problem. so what do these people do? i guess some people are "crazy" because talking and drugs don't help. i've been labelled Bi Polar and have social anxiety. i also suffer from insomnia which results in hallucinations. i can describe my illness and talk about it all day. its still there whether i do or don't. i take medicine and it disappears, but my personality is then altered. what do you do if you want to keep, but fix yourself?

  • Ruth

    My son recovered from schizophrenia due to finding the right psychotherapy, the right vitamins/supplements and getting off the psych meds, I agree that mental illness has been medicalized to the exclusion of psychotherapy. I also agree with the reader's comment that individual behaviours have been medicalized - this is widespread. Then there is the individual's response to this. The individual person can allow himself or herself to be labelled/become medicalized or they can fight back. How do you fight back? By opting out. Get off the drugs (very slowly, never cold turkey), and every self-limiting thing you are told or read. Do not accept a label for yourself (e.g. patient, disabled, brain diseased) Build up your own knowledge base about alternative therapies. Get a psychiatrist who will work for you and who is not part of an institutional hierarchy. If you allow yourself to become a professional patient (ie "medicalized) you will be forever managed, never cured.

  • Anonymous-2

    I believe that the majority of people with "mental illnesses" have the power within themselves to solve their own problems. Obesity has now been given the title of a disease. I mean, really? Is depression as common in other countries? We're already the fattest continent in the world so I could summize that we are also the most depressed. How many doctors or psychotherapists have 'real' discussions with their patients? I was obese for 3 years and my doctor said nothing. My doctor saw me go from a 5'8", 160 pound sexy, vivacious young woman, to a 249 pound depressed binge eater-- and said nothing. I've seen psychologists for stress because I thought that I'd be getting some answers, some guidance... Instead, I was asked several questions and not one of them offered me any real insight... No brutal truth. Nothing that jolted me out of my path of self-destruction. Instead I had to fall several times and pick myself back up. People are lazy these days, particularly my generation (aged 25-35). People don't go out and get enough fresh air. People buy into everything they see on T.V. People can't accept that life is never perfect, or easy. No one seems to understand that life is a battle between pleasing yourself and society-- and really, why don't doctors and psychologists tell people the ultimate truth?- That you live once (until proven otherwise), that they are the only ones who can improve their own lives, and that life is about choices. My compulsion is to eat when I feel stress. I have had to train myself to deal with stress in other ways. I made a choice. I've also lost 68 pounds since I made the choice to regain control. How about this let's explain to people what "short-term pain, long-term gain" really means.

  • Anonymous-3

    if your answer is no, then there is no room for you to talk about it. You may be a Ph. D in your field, however, it doesn't bring you any closer to living with anxiety. I find your article judgemental and one-sided.

  • Anonymous-4

    I have GAD and mdicen helped me get back on my feet after 3 month of bad sleep, stress and nausha and crying almost 2 times as week or more.that was my only way to relive the stress. I dont think all medicen is bad. It all depend on if you are ok with the side affects that come with the medication and if your are ok with being dependent on a medication. I went to taripy for the 3 month befor i went on the medication and the taripy did not help me at all, i just got worse and worse but once on the meds I could funtion in my life agen and learn the skill to deal with my GAD without the meds. I have now been slowly going off the meds and will most likly be of them by summer. Its all depends on what works for you. some people can deal with it with just tharipy but i could not. i needed the meds to get on with my life. its not just about tufining up and the worlds hard. Meds are there for a reason and the reason is to help people!