The Medical Model
Sunday, July 27, 2008

For change to be possible we must understand each other

Further Genetic Causes of Mental Retardation Discovered

A ‘model’ is a social construct or framework in which one can examine society’s understanding and interpretation of social behaviours (Cunningham and Davies, 1985).

Medical Model

• dominant in special education and that, no matter how some might wish otherwise, it “still dominates the conceptualizing of the problems students face in schools” (Booth, 1998)

• the dominant view of disability is medical, and people are regarded as disabled, ‘as a result of their physiological or cognitive impairments’ (Drake 1996)

• the medical model emphasizes deficits and personal and functional limitations that are the responsibility of the person concerned (Barnes and Mercer, 1996) .

The functional limitations cause any disadvantage the person experiences and it is assured these can be put right only by treatment or cure. The notions of individual loss and ability are seen as linked with the idea of dependency on society. In turn, such a dependency model (Campbell and Oliver, 1996) is considered to affect the identity of many disabled people.

• medical model is described as viewing disability “as a problem of the person, directly caused by disease, trauma or other health condition, which requires medical care provided in the form of individual treatment by professionals.” - International Classification of Functioning, Disability and Health (World Health Organization, 2001)

• Bailey (1998) characterizes the medical model as a professional orientation that focuses on:

rPathology and sickness

rThe nature of the aetiology (causal factors) and the presenting problem; and

rDealing with the problem.

• medical model focus is NOT normalcy, wellbeing, the person with the problem or the social or ecosystem that surrounds the problem.

• the center of attention is NOT the patient, the patient’s family nor the social and financial circumstances;

• the focus are NOT values and attitudes.

The center of attention is
patient pathology

Pathology is viewed from a lens similar to that of organic medicine, in which presenting symptoms that commonly co-occur are grouped together into syndromes; these are the diagnostic units of psychiatry. This conceptualization is referred to as the medical model of mental illness (Frances, First, & Pincus, 2005).

What is a medical model?

medical model of disability (wikipedia.org)

• a model by which illness or disability is the result of a physical condition;

• is intrinsic to the individual (it is part of that individual’s own body);

• may reduce the individual's quality of life; and

• causes clear disadvantages to the individual.

• Curing or managing illness or disability revolves around identifying the illness or disability, understanding it and learning to control and alter its course.

medical model of disability (wikipedia.org)

• a compassionate or just society invests resources in health care and related services in an attempt to cure disabilities medically, expand functionality and/or improve functioning thus allowing disabled persons a more "normal" life.

• The medical profession's responsibility and potential in this area is central.

Implication of the Scientific Approach

• The medical model may be seen as an example of a scientific approach to SEN. Such an approach may come to regard the process of discovering objective truth as being predominantly about accumulating knowledge, without being sufficiently critical about the limitations of the process.

Criticisms of the medical model

r Is insufficiently holistic;

r Is insufficiently concerned with patient participation; and

r Violates patient’s rights to be responded to as a person, not an object

insufficiently holistic

•The medical model can appear reductionist and narrow, leading to patients being viewed in terms of their pathology.

•Care tends to be described in terms of physiology and disease and, therefore the patient as a whole is overlooked and psychological and social factors are not taken sufficiently into account.

•Research has suggested that more holistic approaches improve health care.

insufficiently concerned with patient participation

• medical model does not pay attention to the role of the patient in managing his or her medication, and that patients are made to feel too compliant.

• suggests patients should be more responsible for their own health and should recognize that they have an impact on their own health (Chewning and Sleath, 1996).

Violates patient’s rights to be responded to as a person, not an object

• Under medical model, the patient might be viewed more as an object than a person. The ability and potential of patients might be given insufficient attention, while the model itself promotes patient helplessness.

• However, this argument seems to be circular. Certain ‘rights’ appear to be invented when it is claimed that patient should not be viewed in the light of a model that treats them as objects. As the model is judged to treat patients as objects, patients ‘rights’ are therefore being violated.

• An important point, however, is the extent to which the model ignores patients’ abilities and potential. In using the model, it is important that doctors retain an awareness of what patients can do.

• however, the extent to which a patient feels helpless and lacking in power is likely to be related to the manner of the doctor-patient interaction. It can be argued that this is not inevitable within the intrinsic features of the model.

Adopting the medical model can also lead to problems with treatment. Clinicians may tend to treat the disorder and not the client, for example by unduly focusing on "typical" symptoms and ignoring other issues or concerns. They may recommend or apply particular treatment techniques based on the diagnosis.

‘Mental disorders’
Classification and Deficit views

American Diagnostic and Statistical Manual of Mental Disorders 4^th edition

(American Psychiatric Association, 1994)

sometimes referred to as the DSM-IV

The disorders specified in the DSM-IV that are most relevant to special education:
(NOS refers to ‘not otherwise specified’)

• Mental retardation (mild, moderate, severe, profound, severity unspecified).

• Learning disorders (reading disorder [dyslexia], mathematics disorder, disorder of written expression, learning disorder NOS).

• Motor skills disorder (development co-ordination disorder).

• Communication disorders (expressive language disorder, mixed receptive-expressive language disorder, phonological disorder, stuttering, communication disorder NOS).

• Pervasive developmental disorders (autistic disorder, Rett’s disorder, childhood disintegrative disorder, Asperger’s syndrome, pervasive developmental disorder NOS).

Disorders specified in the DSM-IV relevant to special education:

• Attention deficit and disruptive behaviour disorders (attention deficit hyperactivity disorder, attention deficit hyperactivity disorder NOS, conduct disorder, oppositional defiant disorder, disruptive behaviour disorder NOS).

• Feeding and eating disorders in infancy or early childhood (pica, rumination disorder, feeding disorder of infancy or early childhood).

• Tic disorders (Tourette’s disorder, chronic motor or vocal tic disorder, transient tic disorder, tic disorder NOS).

• Elimination disorders (encopresis, enuresis not due to medical condition).

• Other disorders of infancy, childhood or adolescence (separation anxiety disorder, selective mutism, reactive attachment disorder of infancy or early childhood, stereotypic movement disorder, disorders of infancy childhood or adolescence NOS).

In the DSM-IV, the conditions are often described in terms of what the child cannot do – that is, in terms of deficit

“mental retardation is characterized by ‘significantly sub-average intellectual functioning’ as well as ‘deficits or impairments’ in adaptive functioning. Learning disorders are typified by academic functioning that is ‘substantially below’ what is expected, given the child’s age, intelligence level and age-appropriate educations. In motor skills disorders, skills are ‘substantially below’ similar expectations. Pervasive development disorders involve ‘severe deficits and pervasive impairment’ in many areas of development.”

A postmodern alternative and its implications for special education

• postmodern views offer a different understanding of disability and learning difficulty

• Foucault suggests that individuals are constructed as social objects who are knowable through disciplines and ‘discourses’.

• ‘Hierarchical observation’ is seen by Foucault as a form of power which categorises the individual and imposes upon him or her a ‘law of truth’ which the individual has to recognize and which others have to recognize in the individual.

• In SEN, the term ‘normalising judgements’ may be interpreted as the judgements made by professionals and others to determine which children have SEN and which do not. In some instances, being identified as having SEN can be seen as advantageous.

• The postmodern approach suggests that one should examine discourses and consider the way these might explain how the identities of children with SEN are constructed. This would include analyzing such formal discourses as policies, statements of SEN, individual education plans and so on. It would also involve examining the day-to-day interactions of children with SEN and others, including teachers, other professionals, parents and other children.

• The method might encourage teachers and others to move away from viewing individuals as having fixed identities or of being included or excluded.

Post modern alternative could lead to the ‘wishing away’ of disability (Cheu, 2002)

“If you do not believe there is a disability, if you do not believe there is anything that needs to be “cured” or genetically prevented – that disability is indeed little more than a social construction – then you will likewise be freed from the need for cure.”

Integration of the medical model with another alternative –
the social model

The International Classification of Functioning, Disability and Health (World Health Organization, 2001) (or ICF) aims to provide a common language and a shared framework for describing health and health-related matters. It defines the terms ‘functioning’ and ‘disability’ distinctive, and lists environmental factors that interact with these constructs.

• Functioning refers to all bodily functions.

• Disability refers to impairments (problems in body function or structure such as a significant deviation or loss), activity limitations and participation restrictions

ICF is not intended to be exclusively about disabled people but about all people.

It is organized in two parts.

• Part one concerns components ‘functioning and disability’ and has two aspects:

1.The body (functions of body systems; body structures).

2. activities and participation.

• Part two is to do with components of ‘contextual factors’ and also has two aspects:

1. Environmental factors.

2. Personal factors

According to the ICF the social model of disability sees the issue:

• ‘mainly as a socially created problem, and basically as a matter of the full integration of individuals into society’.

• Disability is a ‘complex collection of conditions’, many of them created by the social environment.

• The management of the problem requires social action. Society should be responsible for making the environmental modifications necessary so that people with disabilities can participate fully in all areas social life.

• The key issue is one of attitude or ideology that requires social change.

• Politically, this concerns human rights.

Thinking point

Practitioners may wish to consider the respective functions of the medical model and social approaches in empirically identifying influences in individual circumstances for children with learning difficulties and disabilities and responding accordingly.

The Emerging Medical Model

• Atomic Biology

• This field is more fundamental than the prevailing medical model of molecular biology

• This new model is supported by the most fundamental science of all - physics (not chemistry). In this new paradigm, atoms and the elementary particles constitute the most fundamental dimension of our cells and their functioning

The New Medical Model

In this new paradigm, atoms and the elementary particles constitute the most fundamental dimension of our cells and their functioning.

New Medical Model

• Disease can be viewed as the aberrant and desynchronized atomic-molecular fields.

• The same criteria, besides the somatic organs, apply also to the mental-emotional aspect of our physiology and their mutual interactions.

• In essence, instead of concerning oneself with how a given specialty-paradigm calls for a treatment of a D-I-S-E-A-S-E, a health practitioner, under this model, ought to pay attention only to the few key issues. One — diagnostic ability to determine the factors responsible for the aberrant fields; and the other — therapeutic means that are capable of correcting them.

Posted byDoc Junhel at 7:09 PM  

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