Throughout emphasizes pharmacological treatment to target presumed

Throughout time, the distinction between what is
perceived to be normal and what is abnormal has been an ongoing debate. A
mental disorder is an abnormal behavioural pattern that occurs in the brain,
resulting in abnormal human functioning. Mental disorders are amongst other
disorders that are perceived to be abnormal. According to the American
Psychiatric Association, “Mental illnesses are health
conditions involving changes in thinking, emotion or behavior (or a combination
of these). Mental illnesses are associated with distress and/or problems
functioning in social, work or family activities.” (Parekh,
2015). The “Diagnostic and Statistical
Manual of Mental Disorders Fifth Edition” (DSM-5) (American Psychiatric
Association, 2013), is a system of classification and provides criteria to aid
doctors in diagnosing mental disorders based on symptoms. The medical approach
to mental disorders assumes mental disorders have a physical cause, and can be
treated through biological treatments, for example, drugs. “The biomedical
model posits that mental disorders are brain diseases and emphasizes
pharmacological treatment to target presumed biological abnormalities.”
(Deacon, 2013).



The DSM-5 consists of 20 categories of mental
disorders that are categorised by their similarities. “The
sequence of chapters in DSM-5 is based on advancements in our understanding of
the underlying vulnerabilities as well as symptom characteristics of disorders.

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This sequence reflects what has been learned during the past two decades about
how the brain functions and how genes and environment influence a person’s
health and behaviour.” (American Psychiatric Association, 2013). The DSM-5 uses
different techniques to aid doctors in the diagnosis of patients, for example
clinical interviews, observations, review of medical records and psychometric
tests. Post diagnosis, doctors then offer biological treatment to patients to
treat the physical cause the medical approach assumes mental disorders obtain. Two
issues occur in the diagnosis and classification of mental disorders, which are
reliability and validity. The validity refers to whether the diagnosis of
mental disorder is true and accurate to what the patient actually has, and
reliability refers to whether the diagnosis is consistent across other patients
with the same symptom set, for example.


Chasson et al. conducted a study to determine whether
correct diagnosis of OCD was delivered to African-American’s using the DSM-5.

Structured clinical interviews were conducted on 83 African-American adults
over a 9-and a half month period between 2009 and 2010. 74 participants were
already diagnosed with OCD and 9 were not. 42 participants were female, with an
average age of 41.4. “Results
indicate that the SCID-OCD lacked the ability to accurately diagnose less severe
clinical levels of OCD in African Americans.” (Chasson et al., 2017). The
results showed there were more inaccurate diagnoses on African-American’s than
accurate diagnoses, highlighting problems with DSM-5 diagnosis of OCD. This
suggests that if the DSM-5 is not valid in correctly diagnosing OCD, it may not
be accurate in diagnosing other mental disorders, lowering the ecological
validity of the DSM-5, and the medical approach. However, Chasson et al.

reported that “African
Americans seem to have less awareness that OCD represents a potentially serious
mental health condition, and about half of those in the current study had not
even realized they had a disorder or known how to get treatment for it.”
This could have resulted in participants not reporting all symptoms or not
taking their symptoms serious enough as they did not have the education needed
to recognize that they were symptoms of a mental disorder. A methodological
criticism of this study is that Chasson et al. used correlational analysis, and
we cannot assume that correlation proves causation, it merely shows a link
between OCD and incorrect diagnoses using the DSM-5. This reduces the
reliability of the study as the same results may not be obtained every time,
reducing the ecological validity of the study as the results may not be
applicable to wider settings. Also, this study only used African-American
participants resulting in the lack of population validity, as we cannot be sure
the results would be the same or applicable to the wider population. A
methodological strength of this study is that African-American evaluators were used
to deliver the structured clinical interviews, meaning participants may have
felt more comfortable, possibly giving more accurate answers.


Reiger at al., also conducted a study to test the
accuracy of diagnoses using the DSM-5. They used 11 academic institutions in
Canada and USA where they screened 31 patients using the DSM-5. The results
showed 14 out of 31 patients diagnoses were in the very good to good range, 6
were in the questionable range and 11 were in the unacceptable to insufficient
range. These results show that the DSM-5 produced more correct and acceptable
diagnoses than incorrect diagnoses, increasing the validity of the DSM-5
meaning doctors and patients alike will be increasingly confident in giving
correct diagnoses, and therefore receiving advice for treatment that will fit
their diagnoses. A strength of this study is that it used adult and child
participants, increasing the population validity of the study as the results
may be applicable to the wider population, however the study only focused on
Western cultures, so we cannot assume the results will be applicable to other
cultures, for example Eastern cultures. Another strength is that, “Patients
were randomly assigned to two clinicians for a diagnostic interview; clinicians
were blind to any previous diagnosis” (Regier et al., 2013),
resulting in no demand characteristics as the clinicans could not be influenced
to make any diagnoses based on the patient’s previous ones, meaning the
diagnoses would have been a more true and accurate representation of the
accuracy of DSM-5. Therefore, the results support the DSM-5 in its accuracy of
diagnoses, subsequently supporting the medical approach to mental disorders.

A case study
of Johann Hari supports the medical approach to mental disorders. Hari went to
the doctors complaining of depressive moods when she was a teenager and they
prescribed her with anti-depressants which worked up to a point, then she had
to keep increasing the dosage when her depressive thoughts relapsed. The doctor
explained to her, “There are now, thankfully, new drugs that will restore your
serotonin level to that of a normal person.” (Hari, 2018). Hari reported, “Before
long, I felt as bad as I had at the start. I went back to my doctor, and he
told me that I was clearly on too low a dose. (…) My dose kept being jacked up,
until I was on 80mg, where it stayed for many years, with only a few short
breaks. And still the pain broke back through.” (Hari, 2018). Hari’s case study
proves that the medical model of mental disorders is correct up to a point, as
the anti-depressants she was prescribed did induce her serotonin levels for a
while. However, they did not cure her depression, leading to questions
surrounding if the medical approach is correct indefinitely. Is it the case
that other treatments work better? There are other models and treatments that
have been proven to work for mental disorders, for example the cognitive
approach looks at systematic desensitization instead of drugs as a technique,
which has been proven to work. It could be the case that drugs don’t work in
the same way for everyone, as societies and cultures have different ways of
living. However, we are all human and all have the same autonomy so if the
medical approach was correct, surely all the biological treatment would work
the same for all humans.

Culture bound syndromes are mental disorders that
are only prevalent in specific cultures. These syndromes are a way of
challenging the medical approach to mental disorders, as if the medical
approach is correct, treatment for culture bound disorders should work the same
as treatment for other mental disorders. “Koro is
described as culture bound syndrome characterized by a belief that one’s penis
is retracting into the abdomen and imminent death due to same.” (Chowdhury, 1996). As a result of this, Koro induces anxiety attacks and
psychosocial complications. Koro is prevalent amongst Chinese and East-Asian
cultures, making it a culture bound syndrome. “A 24-year-old male from
middle class South Indian household was admitted to the department with one
year history of withdrawn behavior, believing that his penis is retracting into
his abdomen and refusal to work or socialize as he believed that these
increased the “speed” of retraction.” (Garg, Kumar and Sharadhi, 2017).

The patient was treated with electro-convulsive therapy and then given a
6mg/day dose of lorazepam. This case study supports the medical approach to
mental disorders as “complete remission was achieved in each case.” (Garg,
Kumar and Sharadhi, 2017), meaning the medical treatment worked in curing the
patient from Koro. However, there is debate whether Koro is a true culture
bound syndrome as some symptoms coincide with symptoms of other disorders, such
as Schizophrenia. Culture bound syndromes, and case studies, lack population
validity as we cannot assume the results would be the same for the wider
population and other cultures, meaning the study is low in ecological validity
as the results cannot be applied to other settings, apart from Chinese and
East-Asian cultures, subsequently lowering the medical model’s validity. (Garg,
Kumar and Sharadhi, 2017).


The medical approach to mental disorders offers
patients diagnosed by the DSM-5 with many treatments, including drugs. Different
drugs are used to treat different disorders, for example anti-depressants treat
depression by increasing the levels of serotonin in the blood, and mono-amine
oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitors (SSRIs),
which both increase or decrease levels of serotonin and dopamine as required. “Antidepressants are medications commonly used to
treat depression. Antidepressants are also used for other health conditions,
such as anxiety, pain and insomnia. Although antidepressants are not
FDA-approved specifically to treat ADHD, antidepressants are sometimes used to
treat ADHD in adults.” (, 2016). This suggests drugs are a useful, widespread treatment of mental disorders. A
clinical psychology review by Deacon says, “Drugs formerly
known as “major tranquilizers” because of their powerful sedating effects are
now classified as “antipsychotics.” “Minor tranquilizers” have become
“antianxiety” agents.” (Deacon, 2013).


study by Lieberman et al. on the effectiveness of anti-psychotics did not find
any significant major short or long-term effects of “olanzapine, quetiapine, risperidone and
ziprasidone, (…) over perphenazine, a neuroleptic medication whose therapeutic
benefits for psychosis were first described in 1957.” (Lieberman et al., 2005). These drugs are
all general atypical antipsychotics, so their lack of effectiveness on patients
suggests that drugs may not be the correct treatment or cure for patients with
mental disorders. This clearly questions the medical approaches validity as
drugs are the main form of treatment it offers. This may suggest another
explanation for mental disorders may be better suited to some patients, for
example the cognitive explanation which assumes mental disorders are caused by
irrational and maladaptive thoughts created by the individual, offering
cognitive therapies as a treatment, which have been proven to work in some
cases.  Another study by Sikich et al.

found similar results when they researched the Treatment of Early-Onset
Schizophrenia Spectrum. (Sikich et al, 2008). “In both these studies, more
than 70% of patients eventually stopped taking the assigned medication due to
lack of efficacy or intolerable adverse effects.” (Deacon, 2013). This
again suggests there must be different treatments for mental disorders that
work more effectively. This reduces the external validity of drugs as a
treatment for mental disorders as if they didn’t work for most participants in
these studies, they may not work for most of the wider population, lowering the
reliability and validity of drugs, and the medical approach as a whole.


The largest
antidepressant effectiveness study conducted was “the Sequenced Treatment
Alternatives to Relieve Depression (STAR*D) study.” (Deacon, 2013). “This
investigation revealed that the vast majority of depressed patients do not
experience long-term remission with newer-generation antidepressants.” (Rush et al., 2006). Results also
showed, “only 3% of patients who initially benefited from antidepressant
medication maintained their improvement and remained in the study at 12-month
follow-up.” (Pigott, 2011). These results again question the validity of drugs
as they may not work for the wider population. A strength of this study is that
it used many participants, increasing the population and ecological validity of
the study as the sample size was big, meaning the results may be applicable to
the wider population.


The effectiveness of drugs has been an ongoing debate for years. The
medical approach obviously assumes drugs can cure mental illnesses, but some
research has proven otherwise, and lots of patients relapse after finishing
drug treatment. The medical approach assumes mental disorders are caused by
chemical imbalances in the brain, for example low levels of serotonin can be
linked to depression, however some studies have suggested other influences for
mental disorders, such as genetics and environmental influences. These assumptions
threaten the effectiveness argument of drugs treating mental disorders, as
drugs clearly cannot treat environmental influences, like the home you live in.

Some research has found, “Relapse is likely
when drugs are discontinued. Drug treatment is usually superior to no
treatment. Between 50 – 65% of patients benefit from drug treatments”, (McLeod, S. A., 2014), and that “Drugs do not deal with the cause of the problem,
they only reduce the symptoms, and that some drugs cause dependency.” (McLeod, S. A., 2014).

This suggests drugs are work in the short-term, rather than long-term period,
which is not ideal for patients who want to cure their mental illnesses. However, some research has found drugs to be successful in
treating mental disorders, for example, “Anti
psychotics have long been established as a relatively cheap, effective
treatment, which rapidly reduce symptoms and enable many people to live
relatively normal lives.” (Van Putten, 1981). However, others have found
differently. “There is a
general consensus that first generation antipsychotics (FGAs) do not improve
cognition and may even have specific adverse effects on cognition related to
their sedative and
anticholinergic properties.” (Spohn,
1989). A study by John Kane, MD, Gilbert Honigfeld, PhD
and Jack Singer, MD et al. found that
“clozapine compared to chlorpromazine reduced negative symptoms and improved
cognitive deficits, raised expectations that SGAs compared to FGAs might have a
greater procognitive benefit.” (Kane, Honigfeld and Meltzer, 1988). This
suggests first generation antipsychotics may not always be the best treatment
for schizorphenia. Other methods have been proven to work, such as electro-convulsive
therapy and lobotomy surgery. Deacon found that, “Psychotropic medications work by correcting the
neurotransmitter imbalances that cause mental disorders. However, there
is no credible evidence that mental disorders are caused by chemical
imbalances, or that medicines work by correcting such imbalances.” (Deacon, 2013).


The medical
approach as a whole can be criticised for being reductionist. As most research
mentioned has found that drugs do not completely cure the illness, this
suggests different treatment could work. So, if the treatment the medical model
offers does not always work, this may mean the theory may not always be correct.

The medical model may be too simple in assuming mental disorders are cause solely
by chemical imbalances in the brain, because if this was true, drugs that alter
these imbalances would cure mental disorders 100% of the time. However, we know
this is not the case, suggesting mental disorders may be caused by a
combination of influences, for example genetics and environmental influences. For
example, Holland found that 9/16 of monozygotic twins and 1/14 of digyzotic
twins both had anorexia nervosa, suggesting this mental disorder has a genetic
influence. (Holland et al., 1984). Also, twins usually share the same
environment, so the behaviour could have been learned as we cannot separate
nature and nurture. This suggests there could be an environmental influence on
the onset of anorexia nervosa too.


conclusion, there are many strengths and criticisms of the medical approach to
mental disorders. However, the diathesis-stress model is the most likely way of
describing the onset of mental disorders. This model suggests patients become
predisposed to factors that influence mental disorders, for example genetics,
environmental influences, biological influences and cognitive influences,
suggesting a combination of factors leads to the onset of mental disorders. The
medical approach has many strengths, and has had many successful diagnoses
using the DSM-5 and treatments using drugs, ECT and psychosurgery, however all
patients are different, so we cannot assume one treatment is going to work for
everyone, as mental disorders affect people in different ways and alter people’s
thoughts in so many different ways that it is impossible for there to be one
treatment that is going to be successful for everyone.