The medical or biomedical

model of health and illness

 Today’s lecture

 start by looking at what factors affect health

 start by looking at what factors affect health

 then look at the development of the:

 then look at the development of the:

 biomedical model of health/illness

 biomedical model of health/illness

 biopsychiatric model of mental illness

 biopsychiatric model of mental illness

 medical model of disability

 medical model of disability

 ‘new’ science of genetics and genetic determinism

 ‘new’ science of genetics and genetic determinism
 What factors affect health?
Biology/Genetics/hereditary traits

 Biology/Genetics/hereditary traits
 Individual behaviours
 Individual behaviours
 Food/water
 Food/water
 Education
 Education
 Safety – physical/emotional
 Safety – physical/emotional
 Financial – poverty/wealth & its distribution
 Financial – poverty/wealth & its distribution
 (Un)Employment, job type, working environment
 (Un)Employment, job type, working environment
 Social group – gender, class, age, ethnicity, sexuality, disability and so on
 Social group – gender, class, age, ethnicity, sexuality, disability and so on
 Social – home, community living environment; social support networks or lack thereof
 Social – home, community living environment; social support networks or lack thereof
 Politics/Government/infrastructure
 Politics/Government/infrastructure
 Health and social care services
 Health and social care services
 Legislation
 Legislation
 Media
 Media
 Technology
 Technology
 Global/International factors
 Global/International factors
 Models of health and illness

Before the 18 th
/19 th
century
Before the 18 /19 century
th th

 Galen (c.129- 199 AD) attempted to systemise the human body -

 Galen (c.129- 199 AD) attempted to systemise the human body - th
theory of 4 ‘humors’/fluids dominated Western medicine until 18 C
theory of 4 ‘humors’/fluids dominated Western medicine until 18th C
Humors: Black & Yellow bile, Blood & Phlegm
 Humors: Black & Yellow bile, Blood & Phlegm
 produced by various organs in the body - had to be in balance to
 produced by various organs in the body - had to be in balance to
remain healthy: if flow of humors was blocked in anyway it could lead
remain healthy: if flow of humors was blocked in anyway it could lead
to illness
to illness

18/19 th
C onwards
18/19 C onwards
th

 rise of laboratory medicine – ‘germ theory’

 rise of laboratory medicine – ‘germ theory’
 saw the rise of biomedicine and the medical or biomedical model of
 saw the rise of biomedicine and the medical or biomedical model of
health and illness which continues to dominate Western medicine
health and illness which continues to dominate Western medicine
today
today
 Quick questions?

This is a picture of the English Doctor

This is a picture of the English Doctor
Edward Jenner in 1796: what is he best
Edward Jenner in 1796: what is he best
known for?
known for?
The smallpox vaccine; the word vaccine
The smallpox vaccine; the word vaccine
comes from the name he gave the
comes from the name he gave the
cowpox he used - variolae vaccinae
cowpox he used - variolae vaccinae

Do you know whose experiment disproved

Do you know whose experiment disproved
the theory of ‘spontaneous
the theory of ‘spontaneous
generation’? The ‘father’ of Germ
generation’? The ‘father’ of Germ
Theory?
Theory?

Louis Pasteur in
Louis Pasteur in
1859
1859
 Medical/Biomedical Model
by the turn of the century the body was being divided up into systems in which doctors began to specialise
by the turn of the century the body was being divided up into systems in which doctors began to specialise
- new ‘model’ based on some assumptions
- new ‘model’ based on some assumptions

1. mind/body dualism
1. mind/body dualism
2. a mechanical metaphor
2. a mechanical metaphor
3. adopts a technological imperative
3. adopts a technological imperative
4. reductionism
4. reductionism
5. the doctrine of specific aetiology
5. the doctrine of specific aetiology
6. the assumption of generic disease
6. the assumption of generic disease
7. the assumption that illness or disability is a deviation from the normal – thus to
7. the assumption that illness or disability is a deviation from the normal – thus to
return the body to health just have to treat the ‘abnormality’
return the body to health just have to treat the ‘abnormality’
8. based on the principle of scientific neutrality – not only is medicine based on
8. based on the principle of scientific neutrality – not only is medicine based on
rational science but it is also objective and neutral (impartial/unbiased)
rational science but it is also objective and neutral (impartial/unbiased)
By embracing reductionism, medical models of illness combine several closely
related sets of beliefs

 health is the absence of disease

 health is the absence of disease

 all illness & all symptoms arise from an underlying

 all illness & all symptoms arise from an underlying
abnormality within the body (usually in the functioning or
abnormality within the body (usually in the functioning or
structure of specific organs), referred to as a disease
structure of specific organs), referred to as a disease

 all diseases give rise to symptoms, eventually if not initially

 all diseases give rise to symptoms, eventually if not initially

 mental phenomena, such as emotional disturbance or

 mental phenomena, such as emotional disturbance or
delusions, are separate from & unrelated to disturbances of
delusions, are separate from & unrelated to disturbances of
bodily function
bodily function

 The patient is a passive recipient of treatment, although cooperation

 The patient is a passive recipient of treatment, although cooperation
with treatment is expected
with treatment is expected
 Limitations of this approach to health and illness

 the body is isolated from the person

 the body is isolated from the person

 the social and material causes of disease are neglected

 the social and material causes of disease are neglected

 the subjective interpretations and causes of health and

 the subjective interpretations and causes of health and
illness are deemed irrelevant
illness are deemed irrelevant

 it ignores the close link between mental well-being, illness or even stress and physical health/well-being
 it ignores the close link between mental well-being, illness or even stress and physical health/well-being

 it assumes that Western medicine is based on objectivity and is not influenced by personal feelings or
 it assumes that Western medicine is based on objectivity and is not influenced by personal feelings or
opinions
opinions
 Biopsychiatry: Medical model & Psychiatry

 rise of asylum saw the rise of psychiatry; rise of scientific medicine saw a shift from custodial care to an
 rise of asylum saw the rise of psychiatry; rise of scientific medicine saw a shift from custodial care to an
exploration of the biological basis of mental illness
exploration of the biological basis of mental illness

early 20 th
C laboratory science allowed scientists to examine the brain to reveal the ‘mysteries’ of mental
 early 20 C laboratory science allowed scientists to examine the brain to reveal the ‘mysteries’ of mental
th
illness
illness

 neurologists concluded mental illness = a disorder of the nervous system

 neurologists concluded mental illness = a disorder of the nervous system

 psychiatric diseases were now being viewed as medical problems requiring medical solutions and
 psychiatric diseases were now being viewed as medical problems requiring medical solutions and
biopsychiatry was born
biopsychiatry was born

 Biopsychiatry: field of medical practice that proposes biological reasons as the cause of mental illness e.g.
 Biopsychiatry: field of medical practice that proposes biological reasons as the cause of mental illness e.g.
deficits in the make up of or the ‘wiring’ of the brain
deficits in the make up of or the ‘wiring’ of the brain

 beliefs about deficits in the ‘wiring’ of the brain led to the rise of a number of ‘medical’ treatments
 beliefs about deficits in the ‘wiring’ of the brain led to the rise of a number of ‘medical’ treatments
 Rise of biopsychiatric beliefs led to treatments
Rise of biopsychiatric beliefs led to treatments
such as:
such as:
Ice-shock ‘therapy’; Insulin Coma ‘therapy’;
Ice-shock ‘therapy’; Insulin Coma ‘therapy’;
Lobotomies & Electroshock therapy
Lobotomies & Electroshock therapy

After his wife Vivien Leigh underwent repeated ECT Sir Lawrence Olivier said
After “…she
his wifewas
Vivien Leigh same
not…the underwent repeated
girl I had fallen ECT Sirwith…She
in love Lawrence was
Olivier
nowsaid
“…she
more was
of a not…the
stranger tosame
me girl
thanI had fallen
I could in imagine
ever love with…She was
possible. now
Something
more
hadof a stranger
happened toto mevery
her, thanhard
I could ever imagine
to describe, possible. Something
but unquestionably evident.”
had happened to her, very hard to describe, but unquestionably evident.”
 Biopsychiatry and the rise of medical treatments
 mental illness later seen as a deficiency or imbalance in the brain chemistry or neurotransmitters. This led
 mental illness later seen as a deficiency or imbalance in the brain chemistry or neurotransmitters. This led
to psychiatrists seeing medications as the solution
to psychiatrists seeing medications as the solution
 a belief that balance of neurotransmitters = biological regulator of mental health
 a belief that balance of neurotransmitters = biological regulator of mental health
 view emotions within a "normal" spectrum reflect a proper balance of neurochemicals
 view emotions within a "normal" spectrum reflect a proper balance of neurochemicals
 abnormally extreme emotions, such as clinical depression, reflect an imbalance
 abnormally extreme emotions, such as clinical depression, reflect an imbalance
 this led to beginning of psychopharmacology:
 this led to beginning of psychopharmacology:
 1949 – Lithium
 1949 – Lithium
 1952 – Chlorpromazine
 1952 – Chlorpromazine
 1955 – Imipramine
 1955 – Imipramine
 1963 – Valium
 1963 – Valium
Any Questions?
 Medical Model of Disability: based on 1976 WHO definition of impairment & disability
Medical Model of Disability: based on 1976 WHO definition of impairment & disability

impairment = loss or abnormality of psychological, physiological or anatomical structure or function; disability

impairment = loss or abnormality of psychological, physiological or anatomical structure or function; disability
= impact of impairment on everyday living
= impact of impairment on everyday living

 Medical Model of Disability: locates

 Medical Model of Disability: locates
disability in the body which needs to be
disability in the body which needs to be
treated, remedied, cared for & cured –
treated, remedied, cared for & cured –
disability is an ‘individual problem, a condition
disability is an ‘individual problem, a condition
within the subject… a product of biological
within the subject… a product of biological
determinism or personal tragedy’ (Reindal, 2000, p.92) .
determinism or personal tragedy’ (Reindal, 2000, p.92) .

 sees disability as different to impairment but

 sees disability as different to impairment but
disability is seen to be largely caused by
disability is seen to be largely caused by
impairment.
impairment.
 Medical Model of Disability continued
Medical Model of Disability continued
 aims: remove the disability by changing the person
 aims: remove the disability by changing the person
This means treatments aimed at: Normalisation, Correction & Rehabilitation
 This means treatments aimed at: Normalisation, Correction & Rehabilitation

© Science Museum, London

 The ‘new’ science of genetics & genetic determinism

 Charles Darwin: On the Origin of Species (1859) and ‘natural selection’ based on his
 Charles Darwin: On the Origin of Species (1859) and ‘natural selection’ based on his
1830s/40s research
1830s/40s research

 Gregor Mendel: uncovered the idea of genetic inheritance through plant breeding
 Gregor Mendel: uncovered the idea of genetic inheritance through plant breeding
experiments – btw 1856 & 1863
experiments – btw 1856 & 1863

 ideas of natural selection and genetic inheritance adopted by the Eugenic movement
 ideas of natural selection and genetic inheritance adopted by the Eugenic movement
in the 1890s
in the 1890s

 James Watson & Francis Crick - 1953 discovery of the DNA double helix
 James Watson & Francis Crick - 1953 discovery of the DNA double helix

 meant addition of genetics and genetic diseases/disorders to the biomedical and

 meant addition of genetics and genetic diseases/disorders to the biomedical and
biopsychiatric model
biopsychiatric model

 April 2003 the Human Genome Project was completed which identified, mapped and
 April 2003 the Human Genome Project was completed which identified, mapped and
sequenced all human genes
sequenced all human genes
 Geneticization of health: a new form of social control?

‘“Geneticization” is a term used to describe the ways in which the science of genetics is influencing society at large
‘“Geneticization”
and medicine inisparticular
a term used to(Stempsey,
[…].’ describe the ways in which the science of genetics is influencing society at large
2006, p.193)
and medicine in particular […].’ (Stempsey, 2006, p.193)
 according to Lippman (1991), geneticization describes the way in which ideas about health and disease are
 according to Lippman
increasingly (1991),
told in the geneticization
language of geneticsdescribes the way in which ideas about health and disease are
increasingly told in the language of genetics
 discourse is reductionistic in its description of the human condition
 discourse is reductionistic in its description of the human condition

Genetic determinism
Genetic determinism
 directs how resources are spent
 directs how resources are spent
 important influence on our attitudes and values
 important influence on our attitudes and values
 profound impact on the practice of diagnostics
 profound impact on the practice of diagnostics
 profound social and ethical impact
 profound social and ethical impact
 arguably the new ‘eugenics’?
 arguably the new ‘eugenics’?
If you want to do further reading on this subject
– see the introductory chapter entitled
‘Introduction: understanding the social aspects
of health’ of the book Social Aspects of Health,
Illness and Healthcare by Mary Larkin
Any Questions/concerns?
 Referenc es

Blaxter, M. (2010) Health, Cambridge: Polity Press

Gabe, J., Bury, M. & Elston, M.A. (2004) Key Concepts in Medical Sociology, London: Sage
Lippman, A. (1991) ‘Prenatal Genetic Testing and Screening: constructing needs and
reinforcing inequities’, American Journal of Law and Medicine, 17(1-2), pp.15–50
Nettleton, S. (2006) The sociology of health and illness, Cambridge: Polity Press
Reindal, S.M. (2000) 'Disability, gene therapy and eugenics - a challenge to John Harris',
Journal of Medical Ethics, 26(2), pp.89–94
Shakespeare, T. (1998) ‘Choices and Rights: eugenics, genetics and disability equality’,
Disability & Society, 13(5), pp.665-681
Shakespeare, T. (1999) ‘‘Losing the plot?’ Medical and activist discourses of contemporary
genetics and disability’, Sociology of Health & Illness, 21(5), pp.669-688
Stempsey, W.E. (2006) ‘The Geneticization of Diagnostics’, Medicine, Health Care and
Philosophy, 9(2), pp.193–200
Strong, P. (1979) ‘Sociological imperialism and the profession of medicine: a critical
examination of the thesis of medical imperialism’, Social Science and Medicine, 13A(2),
pp.199-215
Wade, D.T. & Halligan, P.W. (2004) ‘Do biomedical models of illness make for good healthcare’
systems?’, BMJ: British Medical Journal, 329(7479), pp.1398-1401