Academic journal article Ethical Human Psychology and Psychiatry

Time for a Paradigm Change: Pervasiveness and Dangers of the Medical Model in Adolescent Psychology

Academic journal article Ethical Human Psychology and Psychiatry

Time for a Paradigm Change: Pervasiveness and Dangers of the Medical Model in Adolescent Psychology

Article excerpt

This article focuses on concerns of the medical model which links life struggles in adolescents with Diagnostic and Statistical Manual of Mental Disorders (DSM)-delineated diagnoses, a belief in an underlying biochemical disorder, accepted treatment by a doctor considered to be an expert and a healer, and the standard practice use of medication as part of the treatment. With a grounding in biophysical issues rather than existential life choices, we are silently diminishing responsibility and empowerment and thereby establishing a dangerous passivity. With the release of the new DSM-5 and the publishing of The Book of Woe by Greenberg (2013) and Saving Normal by Frances (2013b), these concerns have been brought to the fore. I examine concerns of this approach including the difficulty adolescents have accepting their therapist as someone who understands their lives in a real way and the dangerous epidemic use of prescribed medications. Specific alternative approaches of empowerment, high expectations of responsibility, positive peer culture, and a structure that builds person-to-person respect as opposed to a therapist-to-patient hierarchy will be shown to be a critical and significant paradigm shift needed by our profession.

Keywords: adolescent psychotherapy; psychotropic medication; diagnosing; medical model; humanizing psychotherapy

Psychiatry is conventionally defined as a medical specialty concerned with the diagnosis and treatment of mental diseases. I submit that this definition, which is still widely accepted, places psychiatry in the company of alchemy and astrology and commits it to the category of pseudoscience. (Szasz, 1974, p. 1)

Forty years after first reading those words, I am the head of the John Dewey Academy, a residential therapeutic school for bright, troubling/troubled adolescents founded by the late Dr. Thomas Bratter, an internationally known psychologist, with the mission of developing a personal and humanistic way to deal with adolescents. I came to the Academy 25 years ago from a unique background. I received a PhD in Existential and Phenomenological Philosophy with a dissertation entitled "Thinking Language and Being in the Works of Martin Heidegger." After publishing articles on the connection of philosophy and psychotherapy, I returned to graduate school, earned an MSW, and worked in various therapeutic settings. It is because of my philosophical background that I focus on the ground of our professional beliefs and therapeutic interventions and have become convinced that the mainstream of our profession has a false foundation. Historically, the field of medicine involves particular notions of illness, symptoms, and cure based in the ideas of scientific rationality and objectivity. Science is a discipline dedicated to understanding the world based on mathematical certainty and universal laws of cause and effect. This universality of science gives rise to predictability and allows for formulaic structure of applications but is contrary to an understanding of the individuality of human beings and their freedom, uniqueness, and ability to interpret and create meaning. Although scientific psychological theories can study the macro-level statistics and discuss probabilities and tendencies of human reactions and behaviors, when dealing with the adolescent before us, we need to respect their unique individuality and remember the fundamental significance of this particular relationship. The belief that troubled adolescents have some kind of mental disorder of biochemical or neurological origin continues to have widespread influence despite the fact that both as a theoretical paradigm and at the pragmatic level of therapeutic practice, the medical model is wrought with problems. With medicine and hard science, we do not have a paradigm that effectively speaks to the emotional, social, and existential problems adolescents face.

With the release of the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the issues of diagnosing and medicating have acquired a new urgency. …

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