How the Medical Model of Psychopathology

Table of Contents

1. Introduction definition of schizophrenia
2. The medical model
3. Possible medical causes for schizophrenia
4. Symptoms of schizophrenia
5. Discussion of the dsm-iv-tr
6. The family systems perspective
7. Conclusion

Introduction

In this assignment I will show how the medical model of Psychopathology and the family systems model reflect linear and circular causality respectively by referring to the causes of Schizophrenia. Schizophrenia is characterised by a broad spectrum of cognitive and emotional dysfunctions that include delusions and hallucinations, disorganized speech and behaviour and inappropriate emotions.

It disrupts social, occupational and recreational functioning and almost every other aspect of daily functioning. It is usually chronic with a high relapse rate and recovery from Schizophrenia is rare.

Medical Model

The DSM-IV-TR is based on the medical model. The basic assumption is that psychological disorders are diseases and are treated as such. In his definition of the medical model, Blaney (1975) stated that mental disorders are in fact organic diseases. He further explained that the visible evidences of disorders are merely manifestations of an underlying condition.

According to him, the individual has no responsibility for his/her behaviour. The medical/biological model reflects a linear view of the causes of Psychopathology. Linear causality means that a particular cause (or more than one cause in combination) leads to a specific effect (e. g. a virus causes an illness). Thus, from this perspective, event A causes event B (A -> B) in a linear (unidirectional) fashion. In this linear way of thinking, our reality is considered to be separate from us. We are thus seen as reacting to our reality rather than creating it (Becvar, 2003).

Possible medical causes for Schizophrenia

Genetic influences – Inherited tendency (multiple genes) are responsible for making some individuals vulnerable to Schizophrenia Neurotransmitter imbalances .This refers to brain chemistry such as abnormalities in the dopamine and glutamate systems . Developmental disruptions such as prenatal / birth complications . A viral infection during pregnancy or a birth injury can affect a child’s brain cells Brain structure – Research by Eve Johnstone (Johnstone et al, 1976) showed, by using computed tomography (CT), that there is an enlargement of the lateral ventricles in some patients with chronic Schizophrenia. Psychological stressors have also been named as a possible medical cause.

Symptoms of Schizophrenia

Positive symptoms: delusions are false personal beliefs that are firmly and consistently held despite disconfirming evidence or logic, for instance: delusions of grandeur or persecution. Perceptual distortions (hallucinations) e. g. hearing voices, seeing people or objects and smelling peculiar odours. It is important to remember when diagnosing a patient that hallucinations aren’t pathognomonic. Disorganized thought and speech as a symptom comes through when communicating with the Schizophrenic person.

The individual may jump from topic to topic, talk illogically or reply tangentially to questions. Disorganized motor disturbances such as extreme activity levels, strange gestures and grimaces, catatonic immobility, waxy flexibility and peculiar body movements and posture. More examples of behavioural problems are bad personal hygiene, inappropriate dress and affect. Negative symptoms would be to not show emotional expression (flat affect), avolition (an inability to become goal-orientated or to take action) and alogia (a lack of meaningful speech).

DSM-IV-TR

DSM-IV-TR recommends that clinicians examine and evaluate the individual’s mental state with regard to five factors (axes). Axes I, II and III addresses the individual’s present mental and medical condition. Axes IV and V provide additional information about the person’s life situation and functioning. The DSM-IV-TR is based on a prototypical approach. Axis I – Clinical syndromes and other conditions that may be a focus of clinical attention Axis II – Personality disorders and Mental retardation Axis III – General Medical conditions Axis IV – Psychosocial and Environmental problems Axis V – Global Assessment of Functioning When using the medical model, the focus is always on the individual. If an individual has a possible psychological disorder, they need to be assessed clinically. This is done by systematically evaluating and measuring the individual’s psychological, biological and social factors. This can be done by interviewing the individual and taking an informal mental status exam of the ‘patient’. This can be followed by psychological tests, personality inventories and neuropsychological testing.

Before a diagnosis can be made and before one can classify anything on Axis I, it is imperative to determine that the above factors (psychological, biological and social factors) meet all the criteria for a specific psychological disorder. The DSM-IV-TR distinguishes 5 types of Schizophrenia – paranoid, disorganised, catatonic, undifferentiated and residual Schizophrenia. The DSM-IV-TR criteria for Schizophrenia needs to be met before one can diagnose an individual as Schizophrenic on Axis I. Taken from Sue et al (2006) the DSM-IV-TR criteria for Schizophrenia are as follows.

At least two of the following symptoms lasting for at least one month in the active phase: delusions; hallucinations; disorganized speech; grossly disorganized or catatonic behaviour; negative symptoms (exception: only one symptom if it involves bizarre delusions or if hallucinations involve a running commentary on the person or two or more voices talking with each other). B. During the course of the disturbance, functioning in one or more areas such as work, social relations and self-care has deteriorated markedly from premorbid levels. C. Signs of the disorder must be present for at least 6 months.

Schizoaffective and mood disorders with psychotic features must be ruled out. E. The disturbance is not substance-induced or caused by organic factors. The medical model subscribes to linear causality. It is thus based on a cause-effect relationship as mentioned previously. Schizophrenia as a disorder can be used to illustrate linear causality within the medical model. One or more of the causes of Schizophrenia (i. e. genes) causes the individual to become schizophrenic (cause) and then the individual is diagnosed as Schizophrenic because he/she displays certain symptoms (effect) such as hallucinations, voices talking etc.

Thus, cause-effect (A causes B) = linear causality. Let’s say our ‘patient’ meets the DSM-IV-TR criteria to be classified on Axis I as Schizophrenic. As a Schizophrenic, the individual will probably show certain behaviour such as difficulty in maintaining social relationships which could lead to social isolation, experiencing problems with his/her primary support group, education, occupation, housing, health care and economic problems. These problems will be indicated on Axis IV of the DSM-IV-TR as they are psychosocial and environmental problems.

These problems will most probably affect the individual’s psychological, social and occupational functioning. The patient will be given a rating for the level of functioning at the time of the evaluation. This rating is displayed on Axis V of the DSM-IV-TR – the Global Assessment of Functioning which is used to report the clinician’s judgement of the individual’s overall level of functioning and carrying out activities of daily living. This information is useful in planning treatment and measuring its impact, and in predicting outcome.

A 100-point scale is used for the rating in which 1 indicates severe impairment in functioning and 100 indicates superior functioning with no symptoms.

Family Systems Perspective

The family systems model is based on cybernetics (circular thinking). Circular causality places emphasis on reciprocity, recursion and shared responsibility. A and B exist in the context of a relationship in which each influences the other and both are equally cause and effect of each others’ behaviour (Becvar et al, 2003).

Thus, circular causality means that two or more elements reciprocally cause each other (A causes B and B causes A). So where the medical model makes use of linear causality, the language of systems theory is based on the notion of circularity (A and B mutually influence each other). The contrast between linear and circular causality has to do with the direction of cause. Linear causality = A -> B. Circular causality = A B. Example of circular causality: A teenager (A) with Schizophrenia begins to withdraw socially as she has difficulty forming relationships.

Her sister (B) starts mocking her because she has no friends and isn’t popular. Because her sister (B) mocks her and breaks her self-confidence even more, the teenager (A) withdraws even more and becomes even more isolated (even within her own family system because her sister is ‘against’ her as well). A loop forms (circular causality) where A causes B and B causes A and so on. Thus, the one ‘feeds’ the other. There are a few systems concepts that are important to the systems theory. Boundaries are formed by a system’s rules and it is these rules that distinguish a system from other systems.

These boundaries (rules) are invisible but do exist and are inferred from the repeated patterns of behaviour of a system, it is what makes each family unique. It delineates individuals and subsystems and also defines the amount and kind of contact allowable between members of a family. The ideal boundaries for a family to have are clear boundaries as they are firm yet flexible. Feedback occurs in systems theory and also emphasis the circular causality in the theory. Feedback is the process whereby information about past behaviours is fed back into the system in a circular manner.

There is positive and negative feedback, but it must be understood that both processes may refer to something that is good and/ or bad. Positive feedback acknowledges that a change has occurred and has been accepted by the system (error-activated process). Negative feedback indicates that the status quo is being maintained (stability). When working with a Schizophrenic patient, systems theorists see the Schizophrenia as symptomatic of family disturbance. Thus, the symptom of Schizophrenia is not abnormal in a dysfunctional context.

Actually, the maintenance of a system is associated with complex reciprocal feedback mechanisms with and between systems (Becvar 2003). So, every symptom has a function in the system. In a Schizophrenic person’s family system, his Schizophrenia (the symptom) helps maintain the system, as all the blame for the dysfunction of the family falls to the Schizophrenic family member. The other members do not look to their own dysfunctions and issues. It is clear then that the dysfunctional pattern the family is carrying out, is maintained by the Schizophrenic family member who is targeted as the only problem or reason for the problems in the system.

This way of doing things gives the family a dysfunctional homeostasis, which refers to the tendency of the family to regulate its internal environment.

Conclusion

I believe that both the medical model and the family systems perspective can contribute towards an accurate and successful diagnosis and treatment process for the Schizophrenic individual.

References

1. Barlow, D. H. , & Durand, V. M. (2005). Abnormal Psychology: An integrated approach. (4th ed. ). Belmont: Wadsworth/Thomson Learning
2. Becvar, D. S. & Becvar, R. J. (2003). Family therapy: A systemic integration. (5th ed. ). Boston: Allyn & Bacon.
3. Blaney, P. H. (1975). Implications of the medical model and its alternatives. American Journal of Psychiatry, 132, p. 911-914.
4. Johnstone, E. C. , Crow, T. J. , Frith, C. D. , Hurhard, J. & Kreel, L. (1976). Cerebral ventricular size and cognitive impairment in schizophrenia. Lancet, ii, p. 924-926.
5. Sue, D. , Sue, D. , & Sue, S. (2006). Understanding abnormal behaviour. (8th ed. ). Boston: Houghton Mifflin.