The medical model

Question 1

Who is still one of the most controversial figures in medicine and the human sciences?

Answer 1

Freud

Question 2

What are some of the criticisms leveled against Freud?

Answer 2

pseudoscientist - non-disprovable anecdotal theories

cocaine addiction

intellectual dishonesty over the “seduction error” - attributed his female patients’ neuroses to childhood fantasies and penis envy while ignoring childhood sexual abuse

undertaking unusually extreme interventions (e.g. bombarding Princess Alice’s ovaries with X-rays)

Question 3

What do Alexander and Shelton say about whether Freud was a psuedoscientist?

Answer 3

He was an accomplished medical scientist who published several important articles on microanatomy prior to his psychological work – he lived up to the scientific standards of his time

Question 4

What was Freud’s true history with cocaine?

Answer 4

Freud did spend considerable time studying cocaine, and does seem to have thought it might be a miracle drug (wonder drugs were widely sought in Freud’s time, and still believed in by some doctors in our day - Cocaine at the time was thought of in the way that Prozac was in the 1990s or gluten-free diets now).

He took cocaine himself, and reported carefully on its effects.

He believed that cocaine is only likely to cause addiction if the person has previously been addicted to something else.

When his friend experienced serious negative consequences of cocaine use, Freud changed his mind and started studying something else.

Freud found that cocaine would make you feel strength as you do on your very best days

Question 5

The medical model is largely what type of model? Why?

Answer 5

sociological

It divides people into three types: mentally healthy lay people, mentally ill people, and medical professionals.

Question 6

What is the sociological component of the medical model?

Answer 6

Medical model as a sociological model (hierarchy):

When an individual starts behaving in unusual ways that lay people consider “crazy”, mental health professionals diagnose the individual as having a psychological disorder.

Goal is to somehow eliminate the disease process

Mentally healthy people are responsible for caring for themselves and mentally ill people are cared for by medical professionals

Question 7

Who was a major critic of the medical model? Why?

Answer 7

Thomas Szasz - worries that this model takes away the autonomy of ordinary people once they start showing “symptoms.”

Said that people were labelled as mentally ill as a form of social control - Once you are labeled as mentally ill you lose autonomy/individual human rights

Believed that ‘mental illness” was either some kind of physiological illness or a “problem of living” which could be managed by living well (practice)

Question 8

When did the medical model become dominant in society? This is especially true in what realm?

Answer 8

Though the medical model has been occasionally followed for thousands of years, it only started to become dominant around Freud’s time.

This is especially true in the realm of psychological problems.

Question 9

Who were three people of Freud’s time who were experimenting with treating hysteria? What were their methods?

Answer 9

Martin Charcot was sometimes able to help hysterical patients with hypnosis.

Hippolyte Bernheim found that authoritative suggestions by the doctor could fulfill the same function.

Joseph Breuer found that a “talking cure” could also be helpful for hysterical patients.

Question 10

How did Freud and Breuer work together?

Answer 10

Breuer probably had the most influence on Freud - he had the “Anna O” case study - some hysterical symptoms were relieved through talking about it - they wrote a book about it together

Question 11

Freud’s model centered around the repression of what?

Answer 11

unwanted thoughts, feelings, urges, and conflicts

Question 12

Why did Freud center so much on sexual urges?

Answer 12

largely because sex, being the only important human motivation that can be more or less permanently suppressed without serious health consequences, is the one most commonly controlled by various societies

Question 13

In his later works, Freud emphasized what type of urges in addition to sexual urges?

Answer 13

aggressive instincts

Question 14

Why did Freud argue that psychoanalysis was the only way to address repressed urges?

Answer 14

Because repression occurs even in very smart people, people cannot find out much about their own mental processes by simple introspection.

Question 15

Why did Freud’s perspective likely succeed?

Answer 15

because it helped people address issues that were otherwise mysterious and deeply troubling

Question 16

Why were people in Freud’s time struggling and looking for the type of answers that he was providing?

Answer 16

Progress had seemed to promise widespread prosperity and untold wonders.
Though many of the wonders had in fact materialized and prosperity became more widespread (though not universal), people did not seem to be happy.

World War I was a particularly shocking event.

Freud’s explanation (that society only functioned by causing people to suppress natural urges, and that the resulting repression caused many of the problems people were observing) made sense to many people and helped them understand what was going on.

Question 17

What was an essential element of Freud’s approach (that is still important today)?

Answer 17

the therapeutic relationship -
The relationship was not just a vehicle for technique, but something that was expected to be therapeutic in its own right.

Question 18

What began as a major concern for Freud but was something he later tried to use to his advantage in his treatment process? What is it and why did he use it later?

Answer 18

transference

some of the psychic baggage associated with a childhood relationship of the client was imposed on the therapist.

Early in his career, Freud thought of this as a nuisance, but he eventually realized that this could be a source of insight into the patient’s relationships.

Question 19

What did Freud originally believe were the origin of neurosis but quickly changed his mind about?

Answer 19

He originally thought that the origin of neurosis was childhood sexual traumas, but quickly changed his mind.

Question 20

Freud thought psychoanalysis could lead people to what? But not to what else?

Answer 20

health

happiness

Question 21

How did Freud describe dreams? What did he use them for? Why?

Answer 21

He described dreams as “the royal road to the unconscious.”

He thought dream analysis provided the most insight - lays out repression and unconscious mental concepts - can be accessed through dreams

Repression is an energy-requiring process and this energy is lessened by way of sleep so these repressed things will be released in dreams

Question 22

What are three things that Freud believed could be revealing about the unconscious?

Answer 22

Superstitions, déjà vu, and slips of the tongue

Question 23

Did Freud claim to be a monist or dualist? Did he believe in free will or determinism?

Answer 23

Though he claimed to be a strict determinist and a monist, he often talked like a dualist and a believer in free will.

Maybe he just wasn’t that interested in metaphysics.

Question 24

In his book, Civilization and Its Discontents, what did Freud argue?

Answer 24

In Civilization and Its Discontents, Freud argued that civilization itself might be sick.
The issue is that, in order to get along with each other, we have constrained each others’ behaviour.

This constraint tends to lead to repression and neurosis.

Question 25

What did Freud think that psychologists of the future might be able to do?

Answer 25

diagnose the ills of civilization and come up with better ways of doing things (recommend social changes to alleviate repression and neurosis)

Question 26

What are some of the lasting effects of Freud’s work in modern society?

Answer 26

The medical model has become extremely pervasive in our own time, including in the domain of mental health.

Freud’s specific language has found its way into pop psychology and thence into the wider culture.

Psychoanalysis itself is still widely practiced.

Question 27

What are some examples of how the medical model has changed how we think about psychological problems?

Answer 27

More and more deviations from the “normal” way of feeling are being medicalized

Depression - meaning of this has changed over time – situational depression did not used to be classified as depression (as the result of a life event) - but should this condition be medicalized? Sometimes religions have a long process of practices and events to guide you through the grief process (e.g., Judaism) - these people are not medicalized

This makes us think of “moral therapy” which was based on moral principles rather than medical ones – this also medicalizes treatments (e.g., being in nature, etc.)