Defining Medical and Social Models of Mental Health Disability

by Catherine Jenkins

The medical model of disease or disability tends to reduce “abnormal” states to their physio-chemical or genetic components–something to be remedied. It is often criticized as reductionist for excluding the patient’s lived experience. As clinical psychologist George Albee (1975) charged, the medical model can pathologize people’s “problems of living” (as cited in Hogan, 2019). Labeling someone with a mental health disability (for instance bipolar) can be perceived as oppressive and stigmatizing; these kinds of labels are difficult to shake once applied, and can lead to reduced opportunities when people feel doors closing. The medical model relies heavily on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (2013). This manual has been criticized as overdiagnosing and medicalizing elements of human diversity (e.g, autism; earlier editions of the DSM considered homosexuality a mental disorder).

Social models of medicine and mental health tend to focus on psychosocial aspects impacting health and illness, creating an anti-reductionist view. “Cures” are seen to lie in social reform, rather than individual treatment. Medical declarations of illness are viewed as a damaging status imposed on people by medical practitioners; the path to resolution is through social and political reform, rather than individual treatment. Here, disability is perceived “as the product of an unaccommodating and oppressive society, rather than an individual and medical problem” Hogan, 2019 para. 1). While this is an interesting point of theoretical debate, it may have limited impact for individuals and their mental health concerns.

Since the 1970s, various medical theorists have tried to merge these opposing views into a biopsychosocial model that acknowledges both biological and psychosocial factors. Although still rooted in the medical model, the acknowledgement of social and environmental factors encourages practitioners to listen to patients’ experiences, rather than prioritizing lab results. This hybrid model works to combine what might be negatively perceived as disability, to become positively perceived and valued as human diversity. People with disabilities are invited into the conversation to express their views, rather than feeling further stigmatized and disabled by the medical system’s attitudes. One way to invite students with diagnosed mental health disabilities into the conversation is to normalize accommodations for all students through alternative creative assignments.

Mary Krohnert, Art Therapist, Founder of The Living Room Community Arts Studio

Society’s assumptions about madness, reinforced by dominant medical conventions to pathologize, have been challenged in recent years by alternative theories of madness. Medicalization, or psychiatrization, can lead to a sense of just being assigned a label, becoming an objectified case. This is an alienating experience in which one can feel erased from one’s experiential self (Russo, 2014).

Seeking emancipation from this kind of reductionism, people who’ve experienced the mental health system have been publishing survivor narratives for over twenty-five years. Danielle Landry’s (2016) survey article examines twenty such mental health survivor narratives. As Landry (2016) suggests, “these texts represent a collective effort to develop survivor knowledge and reclaim the meaning of madness and distress” (p. 1448) in a way that challenges the dominant colonialist and patriarchal medical discourse. Here, the focus is on well-being, recovery, and respect for people’s experiences and self-identity.

Alternative theories of madness have also become part of arts and academic discourses. For instance, Ekaterina Netchitailova (2019) argues that the reductionist biomedical view of madness ignores both the perennial mystery of madness, as well as the lived experiences of artists. McWade, Milton, and Beresford (2015) place mad studies in dialogue with neurodiversity to find mutual support within academe, recognizing the value of the experiences of both groups, as well as recognizing that they are often dismissed.

Neurodiversity (ND), a term coined by Judy Singer in 1998 (Armstrong, 2011), recognizes the wide genetic variation in mental processing. ND includes the autism spectrum, ADHD, dyslexia, Tourette syndrome, and other variations in socializing, learning, thinking, and attention (Raj, 2021). Some people are just wired differently from the majority; this doesn’t mean they should be pathologized. It also doesn’t mean that they aren’t smart or that they’re lazy. It may, however, mean that in an academic context some people require additional time, support, and understanding to achieve success.

Mary Krohnert, Art Therapist, Founder of The Living Room Community Arts Studio