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| "Twelfth-century Byzantine manuscript the oath written out in the form of a cross, relating it visually to Christian ideas" from the Folio Biblioteca Vaticana. The source is page 27 of Surgery: An Illustrated History by Ira M. Rutkow, M.D. |
Felix qui potuit rerum cognoscere causas.
Virgil
A psychiatrist who practices within the confinements of the medical model thinks of psychiatric symptoms as indicative of a pathological process. In other words, there is an underlying structural or functional deficit that manifests through a cluster of signs and symptoms, with a certain course and prognosis that will unfold over time.
From this perspective, brain pathology and mental illness are inter-changeable terms, as any brain pathology with necessarily produce mental/psychiatric symptoms, and any mental illness also necessarily implies an underlying brain pathology.
The implicit assumption at work here is that even though the underlying deficit might be hidden, its existence is certain and proved by unchanged pattern of events that unfold either at the same time and/or over a given period of time. Ideally one would hope to understand what is the underlying deficit and how it translates into symptoms, however such understanding is neither necessary nor sufficient to inform assessment and intervention.
Huntington disease is a type of mental illness where directly looking at the brain tissue under the microscope is neither necessary to make a diagnosis (for a patient with a family history and specific symptoms) nor in any way informative for an intervention, which at this time remains palliative and supportive, not etiological.
On the other hand, bipolar disorder is a type of mental illness where a lack of understanding of the underlying brain pathology does not preclude a clear diagnosis and intervention.
Medicalized psychiatry (in lack of a better name) main effort is to build an ideal nosology made of discreet categories, where different levels of description (molecular, genetic, cellular, circuitry, brain, mind, behavior) come together based on discernible patterns. Medical psychiatry operates in an essentially descriptive manner, where the most important classification criterion is temporal relatedness of events. I.e. events that occur together belong together; where "occur together" might mean either an horizontal, synchronous temporal relationship or a vertical, longitudinal, sequential relationship. As a result, for same category data, medical psychiatry would collapse different data levels and tend to see correlation as causation.
For example, a medicalized psychiatry formulation would conclude that a consistent succession of events, such as administering a dopamine antagonist followed by improved auditory hallucinations, is evidence that excess dopamine is the cause of auditory hallucinations. Consistent temporal correlations would be seen as strongly indicative of causation. The lack of understanding of how a perceptual experience (or any other mind function for that matter) emerges from a soup of molecules and action potentials is not seen as either problematic or a subject worth of further inquiry in the eyes of medicalized psychiatry.
This pragmatic approach allows the medically-minded psychiatrist to efficiently categorize things, make recommendations, and quantify outcomes; in other words, operate in a sensible manner in an environment where sheer size and complexity, if properly sized, would otherwise overwhem and paralyze.
In summary, the strength of this medical model type of approach is its power to simplify. That is true for medicine in general and psychiatry in peculiar.
But it is in this very strengh that the perils and limitations of medicalized psychiatry also lie.
While simple is informative, simplistic is misleading; this is the first temptation that an excesively medicalized psychiatrist should avoid at all costs.
Second, clusters of data, no matter how complex, lack meaning. Reducing human experience to data clusters, as proposed by the medical model, regardless of how valid the clustering operation might be, inherently implies taking the meaning out of the equation. The inherent tension here is that no matter what philosophical approach one favors, at the end of the day, moving away from meaningless and emptiness and toward meaningfullness is as much part of the job description for a medicalized psychiatrist as it is for a logotherapy-existential analyst. The second temptation then is to fall back on meaningless biological explanations at the cost of sacrificing meaningfull explorations.
In conclusion, as long as the medicalized psychiatrist abides by the principles of cultivating a simple, but not simplistic, human and meaningfull practice, a medicalized interpretation of mental health and distress will continue to add an informative and pragmatic perspective on mental health and disease.
© Copyright Adrian Preda, M.D.
