The Medicalisation of Distress
Diagnosis, Formulation, and Relational Psychotherapy
Saturday 4 March 2023
With keynote speaker Dr Nancy McWilliams, with James Barnes, James Davies, and Lucy Johnstone
CPD Credits: 4.5 hours
In the US and UK — and increasingly the rest of the world — our language, thinking, and responses to emotional and psychological distress have become almost completely framed in medical terms in the last few decades.
READ MORE...Along with this shift, psychiatric drugs and limited formulaic psychotherapy have become the default modes of care. Born out of the rejection of psychoanalysis and social psychiatric models in the 1980s, the shift was explicitly intended as a biomedical ‘revolution’. With the “decade of the brain,” a new era of enlightened mental health medicine was supposed to ensue. Yet, after decades of research and countless billions of dollars spent, not only has very little of scientific value resulted in terms of treatments, we are increasingly hearing about mental health “crises” and even “pandemics.” At the same time, more and more research has been supporting the centrality of the social and interpersonal factors that have traditionally been neglected by the medical model and medicalised therapies. Could the medical framing have been contributing to the problem? Has the power behind the medical model occluded the issues at hand and contributed to ongoing social injustice? Our presenters will try to address these and other questions in the hopes of starting this important conversation afresh.
FULL PROGRAMME
Dr Nancy McWilliams
Diagnosis for Therapy’s Sake: Inferential and dimensional assessment of psychological suffering
Dr. McWilliams will review her involvement over many years in trying to articulate and preserve clinically relevant ways of understanding people and their psychological problems. She argues that in recent decades, diagnostic taxonomies have reflected the interests of insurance companies, pharmaceutical corporations, governmental cost-cutters, and some academic researchers more fully than the needs of patients and clinicians. Despite empirical evidence that what matters most for therapy outcome are personality and relationship factors, contemporary diagnostic conventions have lent themselves to treatment that is increasingly objectifying and impersonal. She offers the Psychodynamic Diagnostic Manual (PDM-2) as an example of a clinically oriented classification system that is dimensional, inferential, and contextual.
Dr James Davies
Mental Health, Capitalism, and the Sedated of a Nation
Why has the medical model continued to expand and dominate mental health provision and public discourse while presiding over poor outcomes since its ascendancy in the 1980/90s? Why does this model continue to spread and institutionally thrive? Whose interests does it really serve: people in need or the deeper interests of our political economy? This seminar will propose some potential answers.
Lucy Johnstone
The Power Threat Meaning Framework: a conceptual alternative to diagnosis
The Power Threat Meaning Framework is a co-produced document published by the British Psychological Society in 2018. It offers an alternative to models based on psychiatric diagnosis by demonstrating the links between wider social factors such as poverty, discrimination and inequality, along with traumas such as abuse and violence, and the resulting emotional distress. The Framework can be used as a way of helping people to create more hopeful narratives about their lives and their difficulties, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’. Our speaker will briefly outline its core principles.
James Barnes
The relational model in psychotherapy and the challenge to the medical model.
James Barnes will talk about the relational model in psychotherapy and the problems this poses for the medical model. He will suggest that the inherent individualism of the medical model not only makes it incompatible with relational thinking, but that the evident need for relational thinking means that the medical model has run its course. In response to the 1980s and the biomedical shift in psychiatry, psychoanalysis and psychotherapy turned relational. It is this model that should have won the day, he will argue, and it is this model that needs to be at the forefront of change going forward.