Models of Madness, Models of Medicine By Miriam Siegler and Humphry Osmond (review)

BOOK REVIEWS Models of Madness, Modeh of Medicine. By Miriam Siegler and Humphry Osmond. New York: Macmillan Co., 1975. Pp. 287. $8.95. Adjustments to the vicissitudes and constraints of society may break down, create frictions, produce malfunction, or lead to the fear of frustration and worry. In primitive tribes and throughout much of history it has been assumed that a sick person has been invaded by some evil spirit or been bewitched or punished by the deity for encroachment on prerogatives, failure to observe taboo, or other breach of decorum. Such persons were isolated from their general environment, locked in prisons or dungeons, burned at the stake, or punished in less definitive ways. Ultimately, because of a few brave, humane, and enterprising physicians, the shackles were removed and humane treatment became available for the emotionally and mentally upset. Through the years, as different ideas have appeared, achieved prominence, and then either disappeared or assumed an appropriate place in our thinking, we have seen various classifications of mental illness in Freudian, psychosomatic, psychopharmacological , or naturalistic biological categories. We have concluded that what we have called mental illness does not of necessity arise from sin, visitation by spirits, or even jarring imbalances amongst ego, super ego, and id. Because precise definitions of biological processes are always difficult and often impossible, we cannot apply rigid statistical laws or double-blind experiments in most circumstances dealing with disorders of mental health. The entire thrust of the valuable study by Miriam Siegler and Humphry Osmond leads to a similar conclusion about mental illness in general. It is best comprehended and best treated if looked upon as a medical illness rather than an illness of any other kind. In their study eight models are used to try to understand madness. The medical model has the doctor determining and diagnosing the disease, explaining to the patient, and providing treatment, which may attempt to remove a cause, if it can be found. In the moral model, the moral practitioner describes and measures the degree of asocial, dysfunctional, or amoral behavior, observing that it was learned somehow, somewhere. In the impaired model the person with mental illness is looked upon as mentally crippled or handicapped and the cause is not looked upon as particularly important. The psychoanalytical model looks upon mental illness or madness as arising somewhere along a continuum of emotional difficulties which range from severe and crippling psychoses to mild and tolerable neuroses. Each case is unique. The etiology becomes the key to the whole matter, and the reconstruction of the whole of the past life, together with the ability to confront it, constitutes management. The social model looks upon mental illness as the reaction of a person to the sick society, the person himself being normal and society being sick. Perspectives in Biology and Medicine · Summer 1975 | 573 Poverty, crime, and discrimination may be viewed in similar ways; the etiology indicates that families with social handicaps produce for their members a great many psychological problems because the rate of social change is either too fast or too slow. Thepsychedelic model looks upon madness as a mind-expanding trip, and, under this rubric, the clarification thought to come in the psychedelic state indicates how wrong "normal" society is. Under such a model, a schizophrenic person may be thought to have been driven mad by the futile but nonetheless ferocious efforts of a family to get the victim to conform. Conspiratorial modeh make madness a subjective feeling existing only in the beholder; thus naming or labeling victimizes the person labeled. In this kind of paranoid view of etiology, people become identified as mentally ill because others actually conspire to thus classify them, the conspirators themselves being unable to put up with an aberration or deviation from their standards. In thefamily interaction model the whole family is ill. Thus, to get treatment, one who might be the healthiest member of the family becomes the "index" patient, almost by lottery. The index patient, in some way, is supposed to "act out the family pathology." This is a self-fulfilling prophecy since, as the sick patient acts out pathology, he does so because the family is sick because their parents...