What is the Clinical Model of Personal Experiences?
The word 'psyche' means soul. Yet this word - used to create the terms psychiatry, psychology and psychotherapy - has become a depersonalised, soulless reference to thinking and behaviour. Psychiatry and Psychology in particular, denied the soul's existence over a hundred years ago, in a vain attempt to appear scientific by association with the medical profession. In reality, these disciplines are pseudo-scientific derivatives of ideas taken from physical medicine (see article "Psychology; 'Science' Without a Soul").
Of clinical psychology - built on the clinical model - Professor of Psychology, Margaret Hagen, Ph.D comments "There are a great many ways to do science badly, and the junk science that makes up the bulk of the body of knowledge of clinical psychology manages to exemplify every one of them...Our legal system has been told that clinical psychology is a scientific discipline, that its theories and methodology are that of a mature science, and our legal system has believed it. Given the deplorable state of the 'science' of clinical psychology, that is truly unbelievable." (Hagen 1997)
The clinical, health or medical model originally developed as a way of viewing and treating physical ailments, not the troubles of the human soul with its profoundly individual, emotional, non-rational, unscientific and spiritual nature. Used by a physician to treat physical ailments, the clinical model's value is evident. However, in the name of 'science' and 'objectivity' most psychiatrists and psychologists - and now many therapists - attempt to apply the clinical model to personal experiences, emotions and relationship difficulties because it simplifies these complex, subtle aspects of everyday life into neat logical categories of symptoms, health, illness, diagnosis and treatment. Such simplification is often carried off with the appearance of scientific authority; the use of jargon and statistics and 'evidence' to support the illusion that emotions, personality, relationship, needs and hopes can all be viewed as the products of bio-chemistry, genes and mental 'programming'. In this way, psychology and psychiatry have reduced Human Beings to mechanical status, encouraging us to relate to our experiences as though we are machines or computer software that can be adjusted by pills and techniques when there is a problem.
Existential Psychotherapy vehemently opposes the application of the clinical model to personal thoughts, feelings and behaviours, arguing that this means of responding to individuals typically and subtly dehumanises, devalues, manipulates and stigmatises personal experiences; such views largely serving the needs of the psychiatrist, psychologist or psychotherapist holding them, often without the patient knowing it.
The Scientific Basis for the Clinical Model of Personal Experiences
There is no scientific basis for claiming that personal experiences, thoughts, distress or behaviours are illnesses or the results of brain chemical imbalances (see video below).
Financial and Power Interests and the Clinical Model
In line with present government policies that attempt to regulate our everyday life according to behavioural, economic and social control interests, there has been a recent upsurge in standardised technique-based therapies that attempt to use the clinical or 'illness' model to categorise and treat the unscientific realm of human meaning, unhappiness, personal differences and distress. Economists, who openly admit to knowing little about emotional disturbance (e.g. see lecture by the economist Lord Layard), also favour these kinds of therapies and therapists above others because they are easier to measure, convert into monetary statistics, and fit with the government's policies of 'target-setting' whilst reducing staff and patients to the status of numbers in places like the NHS. Behind the apparent concern to end suffering, such 'evidence-based therapies' are in reality promoted on the grounds of profit-making, treating and discharging NHS patients quickly, whilst appearing to save the State money in welfare payments. Indeed, at its most cynical, plans are being suggested to use such therapies in an effort to alter the thoughts of the unemployed to get them back into work, thus stigmatising the disenfranchised; effectively giving 'unemployment' the status of an illness.
As a simplified model, technique-based therapies can be taught to anyone, quickly and cheaply and used on patients from an instruction manual. The patient's meaning, life experiences and complexities are reduced to the level of a 'problem'. However, economist Lord Layard also omits to point out evidence of the proven ineffectiveness of such therapies on some of the most common difficulties (e.g. see Health Report for Anxiety and Psychosis).
In the therapy world, use of 'the clinical model' assures financial advantage, whilst granting privileges and a degree of elitist status to those who attempt to align themselves with the kudos of the scientific, psychiatric and medical establishments.
What the Clinical View of Human Experiences Doesn't Mention
One of the largest independent studies, spanning forty years of research, has shown that the biggest factor in therapeutic change is the quality of the relationship between psychotherapist and patient, not the type of science, model or techniques used (see HUBBLE et al 1999, "The Heart and Soul of Change: What Works in Therapy"). Yet standardised therapies are most often offered by practitioners who are not extensively or specifically trained in psychotherapy and the relationship skills central to it. Instead clinical model therapies focus almost entirely on the patient's compliance with the therapist's techniques and way of formulating the patient's difficulties in terms of illness. By applying the clinical view of emotional disturbance, these approaches attempt to use the authority of medical or psychology jargon to reframe personal experiences in terms of clinical 'problems', 'symptoms', 'abnormality' and 'illness', with 'dysfunctional or negative thoughts' often blamed as the root cause.
Practitioners using the clinical model in this way, thus rely on your compliance with their way of seeing you. This subtly involves your moving from a place of trusting yourself, into trusting the viewpoint and directives of what usually amounts to a rigid, logical, institutional authority. Therapies using the clinical model typically view the problem as lying within your mind and 'negative' (irrational or unpleasant) feelings and behaviours. This view does not, for example, seek to understand the validity of your relationship with the external world and the multitude of adverse influences which may be upon you from within an increasingly conformist, narcissistic and acquisitive society in which individuals are continually being influenced by some institutional authority or other.
The clinical view thus fails to challenge the complex, subtle, non-clinical realities which may have affected you as a child, and continue to affect you as an adult, citizen or patient, or the demands upon you from our culture, the workplace or relationship. Viewed as simple illness, you can then be promised 'treatments' that are literally taken from an instruction manual that makes little or no reference to your actual life as you see, hear, taste, smell and feel it. In our fast-food culture, these kinds of therapies can be delivered quickly and are thus favoured by profit-driven institutions like insurance companies, private health firms, economists, legal firms, and public health services, where patients can be seen for a few sessions then sent home, having been temporarily 'adjusted' to fit back into an unchallenged social context.
The Relief of a Clinical Label
A medical-sounding diagnosis can offer relief in itself when we feel most vulnerable, lost and confused. By being simplified into an 'illness' it can make immediate sense of experiences that feel too complicated, confusing and overwhelming to cope with, especially when we also want to help our friends and family understand our troubles. An 'illness' can also take away any sense of blame we may have felt from going through something others don't understand.
However, most unsuspecting patients are completely unaware of what a 'clinical' viewing of their personal experiences can mean for them at a deeper level. Many are just relieved to have their upsetting thoughts, problems and feelings given a simplified explanation and an official name. When we feel most vulnerable, typically we can feel frightened and have a child-like need to be taken care of. The authority figure's claims to expertise can seem like the wise parent figure we crave to value, understand or save us at such times. It is this dependence upon authority on which the clinical model of relationship relies. A diagnosis can thus feel like a form of recognition and validation of our deepest, oldest needs whilst feeding the power interests of the clinician holding the clinical view.
In reality, treating personal experiences in the same way doctors treat disease fails to respect or value us as persons; with such treatment being typically "marketed as an anti-biotic when it's really an aspirin" (see article quoting Fonagy). Additionally, viewing aspects of our personal experiences as clinical ailments to be eliminated - as one might 'get rid of' a cold - can reinforce the idea that certain feelings are abnormal or 'bad' instead of, for example, natural, humane expressions of our unmet needs.
Social Control and Stigma
The clinical model of personal experiences has a bloody and cruel history. In the Victorian era, minorities and unmarried pregnant women were locked up in insane asylums as a stigmatising clinical response to people who were troublesome or different from what was considered 'normal'. Patients up until the middle of the last century were routinely tortured using electrocution, surgery, intentional brain damage and a variety of pain-inflicting devices believed to help 'cure' mental illness. Electrocution, surgery and highly toxic psychiatric drugs are still used today. Yet none of us would believe that such crude forms of social control and punishment of those citizens who dared to be different from the crowd had anything to do with administering a cure to a suffering, vulnerable person.
In today's world, the medicalising or psychologising of suffering remains a form of social control, carrying the presumption of personal failing or defect lying within the individual, not the dysfunctional society in which he/ she lives. Anyone who has been given a clinical label - even one as common as 'depression' - will also know how this can stigmatise and disadvantage them in society. Psychiatric diagnostic labels issued by psychiatrists, psychologists and some therapists, if made part of your medical records, will remain there permanently. Such diagnoses can be extremely stigmatising and can contribute to the way you are viewed on further visits to your doctor or in reference to employment, immigration, mortgage and insurance applications which require a medical reference.
The clinical model of personal experiences implies that if we aren't happy in the way others are or if we find ourselves markedly different from others then we must be in the grip of a medical or psychological condition. Unhappiness, distress and difference - as human conditions - are repackaged as if they were physical ailments. Some real life examples:
• A man who works all week and hates the monotony of his underpaid job and feels chronically miserable, trapped or stressed-out as a result. The clinical response was to call this 'clinical depression' or 'anxiety disorder'. What the man needed was an employer who valued him and paid him a decent wage.
• An older woman who has never felt loved in her life and becomes so anxious and lost in her search that she now feels that life has no meaning. The clinical response was to simplify this to a 'mood disorder'. What the woman needed was to feel that another human being cared about her.
• A young woman becomes distressed after being sexually harassed and bullied by her boss for a number of years; the boss resigns without charge, but the woman becomes suicidal as she feels other managers - unhappy with the company's tarnished reputation - now de-value the woman and favour her colleagues. The clinical response was to simplify this to 'adjustment disorder'. What the woman needed was to be valued for her integrity in reporting a corrupt workplace.
• A woman starves herself because 'fitting in' and being accepted means owning the latest mobile phone she can't afford and looking like a 'supermodel'. The clinical response was to call this 'anorexia nervosa' and 'clinical depression'. What the woman needed was encouragement to be the person she really is rather than trying to make herself fit into a conformist social group that views natural body shape as undesirable.
• A person who knows there's something not quite right, but doesn't know what and is afraid to talk about it for fear of being laughed at. The clinical response was to call this 'social phobia'. What this person needed was to recognise that he is inherently valuable.
An Alternative to the Clinical Model
We can see distressed persons in the manner of 'there's something medically or psychologically wrong with your thoughts or personality' or we can understand that our suffering may be a sensible if not complex personal and very human response to adversity; past and present. As such it may be intimately bound up with a context that may also need to change - the family secrets, the abusive partnership, the oppressive job, the dismal housing estate, the corrupting messages sent by the media and advertising industry, the false political and social climates we live in, and many other non-clinical influences which can contribute both to our highest hopes and deepest despairs. Many of our needs can only be met by accepting our differences and difficulties as legitimate responses to a questionable social world, rather than forcing ourselves to conform to the robotics of its so-called 'normality'.
The clinical view of unhappiness, difference and distress can be very powerful and seductive when we are in need. It can raise the hopes of some whilst stigmatising others. A growing number of psychiatrists and psychotherapists have the integrity to disagree with the clinical model of human experiences. See the works of Viktor Frankl, R.D. Laing, A. Esterson, Peter Breggin ("Toxic Psychiatry") and Thomas S. Szasz, all of whom argue that finding personal meaning, purpose, identity and being valued are what we need above all else.
It is worthwhile doing your own research to find out what type of approach might best suit you.
Articles on the flaws of the Clinical Model: Diagnoses
The Problem With Diagnosis
Absence of Scientific Evidence to Support Clinical Model Diagnoses
Diagnosis and Drug Treatment
The Impact of Diagnosis
Alternatives To Diagnosis
Copyright © 2006 Stephen Forrest. All rights reserved.
Page updated June 8, 2007
The word 'psyche' means soul. Yet this word - used to create the terms psychiatry, psychology and psychotherapy - has become a depersonalised, soulless reference to thinking and behaviour. Psychiatry and Psychology in particular, denied the soul's existence over a hundred years ago, in a vain attempt to appear scientific by association with the medical profession. In reality, these disciplines are pseudo-scientific derivatives of ideas taken from physical medicine (see article "Psychology; 'Science' Without a Soul").
Of clinical psychology - built on the clinical model - Professor of Psychology, Margaret Hagen, Ph.D comments "There are a great many ways to do science badly, and the junk science that makes up the bulk of the body of knowledge of clinical psychology manages to exemplify every one of them...Our legal system has been told that clinical psychology is a scientific discipline, that its theories and methodology are that of a mature science, and our legal system has believed it. Given the deplorable state of the 'science' of clinical psychology, that is truly unbelievable." (Hagen 1997)
The clinical, health or medical model originally developed as a way of viewing and treating physical ailments, not the troubles of the human soul with its profoundly individual, emotional, non-rational, unscientific and spiritual nature. Used by a physician to treat physical ailments, the clinical model's value is evident. However, in the name of 'science' and 'objectivity' most psychiatrists and psychologists - and now many therapists - attempt to apply the clinical model to personal experiences, emotions and relationship difficulties because it simplifies these complex, subtle aspects of everyday life into neat logical categories of symptoms, health, illness, diagnosis and treatment. Such simplification is often carried off with the appearance of scientific authority; the use of jargon and statistics and 'evidence' to support the illusion that emotions, personality, relationship, needs and hopes can all be viewed as the products of bio-chemistry, genes and mental 'programming'. In this way, psychology and psychiatry have reduced Human Beings to mechanical status, encouraging us to relate to our experiences as though we are machines or computer software that can be adjusted by pills and techniques when there is a problem.
Existential Psychotherapy vehemently opposes the application of the clinical model to personal thoughts, feelings and behaviours, arguing that this means of responding to individuals typically and subtly dehumanises, devalues, manipulates and stigmatises personal experiences; such views largely serving the needs of the psychiatrist, psychologist or psychotherapist holding them, often without the patient knowing it.
The Scientific Basis for the Clinical Model of Personal Experiences
There is no scientific basis for claiming that personal experiences, thoughts, distress or behaviours are illnesses or the results of brain chemical imbalances (see video below).
Financial and Power Interests and the Clinical Model
In line with present government policies that attempt to regulate our everyday life according to behavioural, economic and social control interests, there has been a recent upsurge in standardised technique-based therapies that attempt to use the clinical or 'illness' model to categorise and treat the unscientific realm of human meaning, unhappiness, personal differences and distress. Economists, who openly admit to knowing little about emotional disturbance (e.g. see lecture by the economist Lord Layard), also favour these kinds of therapies and therapists above others because they are easier to measure, convert into monetary statistics, and fit with the government's policies of 'target-setting' whilst reducing staff and patients to the status of numbers in places like the NHS. Behind the apparent concern to end suffering, such 'evidence-based therapies' are in reality promoted on the grounds of profit-making, treating and discharging NHS patients quickly, whilst appearing to save the State money in welfare payments. Indeed, at its most cynical, plans are being suggested to use such therapies in an effort to alter the thoughts of the unemployed to get them back into work, thus stigmatising the disenfranchised; effectively giving 'unemployment' the status of an illness.
As a simplified model, technique-based therapies can be taught to anyone, quickly and cheaply and used on patients from an instruction manual. The patient's meaning, life experiences and complexities are reduced to the level of a 'problem'. However, economist Lord Layard also omits to point out evidence of the proven ineffectiveness of such therapies on some of the most common difficulties (e.g. see Health Report for Anxiety and Psychosis).
In the therapy world, use of 'the clinical model' assures financial advantage, whilst granting privileges and a degree of elitist status to those who attempt to align themselves with the kudos of the scientific, psychiatric and medical establishments.
What the Clinical View of Human Experiences Doesn't Mention
One of the largest independent studies, spanning forty years of research, has shown that the biggest factor in therapeutic change is the quality of the relationship between psychotherapist and patient, not the type of science, model or techniques used (see HUBBLE et al 1999, "The Heart and Soul of Change: What Works in Therapy"). Yet standardised therapies are most often offered by practitioners who are not extensively or specifically trained in psychotherapy and the relationship skills central to it. Instead clinical model therapies focus almost entirely on the patient's compliance with the therapist's techniques and way of formulating the patient's difficulties in terms of illness. By applying the clinical view of emotional disturbance, these approaches attempt to use the authority of medical or psychology jargon to reframe personal experiences in terms of clinical 'problems', 'symptoms', 'abnormality' and 'illness', with 'dysfunctional or negative thoughts' often blamed as the root cause.
Practitioners using the clinical model in this way, thus rely on your compliance with their way of seeing you. This subtly involves your moving from a place of trusting yourself, into trusting the viewpoint and directives of what usually amounts to a rigid, logical, institutional authority. Therapies using the clinical model typically view the problem as lying within your mind and 'negative' (irrational or unpleasant) feelings and behaviours. This view does not, for example, seek to understand the validity of your relationship with the external world and the multitude of adverse influences which may be upon you from within an increasingly conformist, narcissistic and acquisitive society in which individuals are continually being influenced by some institutional authority or other.
The clinical view thus fails to challenge the complex, subtle, non-clinical realities which may have affected you as a child, and continue to affect you as an adult, citizen or patient, or the demands upon you from our culture, the workplace or relationship. Viewed as simple illness, you can then be promised 'treatments' that are literally taken from an instruction manual that makes little or no reference to your actual life as you see, hear, taste, smell and feel it. In our fast-food culture, these kinds of therapies can be delivered quickly and are thus favoured by profit-driven institutions like insurance companies, private health firms, economists, legal firms, and public health services, where patients can be seen for a few sessions then sent home, having been temporarily 'adjusted' to fit back into an unchallenged social context.
The Relief of a Clinical Label
A medical-sounding diagnosis can offer relief in itself when we feel most vulnerable, lost and confused. By being simplified into an 'illness' it can make immediate sense of experiences that feel too complicated, confusing and overwhelming to cope with, especially when we also want to help our friends and family understand our troubles. An 'illness' can also take away any sense of blame we may have felt from going through something others don't understand.
However, most unsuspecting patients are completely unaware of what a 'clinical' viewing of their personal experiences can mean for them at a deeper level. Many are just relieved to have their upsetting thoughts, problems and feelings given a simplified explanation and an official name. When we feel most vulnerable, typically we can feel frightened and have a child-like need to be taken care of. The authority figure's claims to expertise can seem like the wise parent figure we crave to value, understand or save us at such times. It is this dependence upon authority on which the clinical model of relationship relies. A diagnosis can thus feel like a form of recognition and validation of our deepest, oldest needs whilst feeding the power interests of the clinician holding the clinical view.
In reality, treating personal experiences in the same way doctors treat disease fails to respect or value us as persons; with such treatment being typically "marketed as an anti-biotic when it's really an aspirin" (see article quoting Fonagy). Additionally, viewing aspects of our personal experiences as clinical ailments to be eliminated - as one might 'get rid of' a cold - can reinforce the idea that certain feelings are abnormal or 'bad' instead of, for example, natural, humane expressions of our unmet needs.
Social Control and Stigma
The clinical model of personal experiences has a bloody and cruel history. In the Victorian era, minorities and unmarried pregnant women were locked up in insane asylums as a stigmatising clinical response to people who were troublesome or different from what was considered 'normal'. Patients up until the middle of the last century were routinely tortured using electrocution, surgery, intentional brain damage and a variety of pain-inflicting devices believed to help 'cure' mental illness. Electrocution, surgery and highly toxic psychiatric drugs are still used today. Yet none of us would believe that such crude forms of social control and punishment of those citizens who dared to be different from the crowd had anything to do with administering a cure to a suffering, vulnerable person.
In today's world, the medicalising or psychologising of suffering remains a form of social control, carrying the presumption of personal failing or defect lying within the individual, not the dysfunctional society in which he/ she lives. Anyone who has been given a clinical label - even one as common as 'depression' - will also know how this can stigmatise and disadvantage them in society. Psychiatric diagnostic labels issued by psychiatrists, psychologists and some therapists, if made part of your medical records, will remain there permanently. Such diagnoses can be extremely stigmatising and can contribute to the way you are viewed on further visits to your doctor or in reference to employment, immigration, mortgage and insurance applications which require a medical reference.
The clinical model of personal experiences implies that if we aren't happy in the way others are or if we find ourselves markedly different from others then we must be in the grip of a medical or psychological condition. Unhappiness, distress and difference - as human conditions - are repackaged as if they were physical ailments. Some real life examples:
• A man who works all week and hates the monotony of his underpaid job and feels chronically miserable, trapped or stressed-out as a result. The clinical response was to call this 'clinical depression' or 'anxiety disorder'. What the man needed was an employer who valued him and paid him a decent wage.
• An older woman who has never felt loved in her life and becomes so anxious and lost in her search that she now feels that life has no meaning. The clinical response was to simplify this to a 'mood disorder'. What the woman needed was to feel that another human being cared about her.
• A young woman becomes distressed after being sexually harassed and bullied by her boss for a number of years; the boss resigns without charge, but the woman becomes suicidal as she feels other managers - unhappy with the company's tarnished reputation - now de-value the woman and favour her colleagues. The clinical response was to simplify this to 'adjustment disorder'. What the woman needed was to be valued for her integrity in reporting a corrupt workplace.
• A woman starves herself because 'fitting in' and being accepted means owning the latest mobile phone she can't afford and looking like a 'supermodel'. The clinical response was to call this 'anorexia nervosa' and 'clinical depression'. What the woman needed was encouragement to be the person she really is rather than trying to make herself fit into a conformist social group that views natural body shape as undesirable.
• A person who knows there's something not quite right, but doesn't know what and is afraid to talk about it for fear of being laughed at. The clinical response was to call this 'social phobia'. What this person needed was to recognise that he is inherently valuable.
An Alternative to the Clinical Model
We can see distressed persons in the manner of 'there's something medically or psychologically wrong with your thoughts or personality' or we can understand that our suffering may be a sensible if not complex personal and very human response to adversity; past and present. As such it may be intimately bound up with a context that may also need to change - the family secrets, the abusive partnership, the oppressive job, the dismal housing estate, the corrupting messages sent by the media and advertising industry, the false political and social climates we live in, and many other non-clinical influences which can contribute both to our highest hopes and deepest despairs. Many of our needs can only be met by accepting our differences and difficulties as legitimate responses to a questionable social world, rather than forcing ourselves to conform to the robotics of its so-called 'normality'.
The clinical view of unhappiness, difference and distress can be very powerful and seductive when we are in need. It can raise the hopes of some whilst stigmatising others. A growing number of psychiatrists and psychotherapists have the integrity to disagree with the clinical model of human experiences. See the works of Viktor Frankl, R.D. Laing, A. Esterson, Peter Breggin ("Toxic Psychiatry") and Thomas S. Szasz, all of whom argue that finding personal meaning, purpose, identity and being valued are what we need above all else.
It is worthwhile doing your own research to find out what type of approach might best suit you.
Articles on the flaws of the Clinical Model: Diagnoses
The Problem With Diagnosis
Absence of Scientific Evidence to Support Clinical Model Diagnoses
Diagnosis and Drug Treatment
The Impact of Diagnosis
Alternatives To Diagnosis
Copyright © 2006 Stephen Forrest. All rights reserved.
Page updated June 8, 2007
Stephen Forrest
Existential Analysis, Psychotherapy & Personal Development
Existential Analysis, Psychotherapy & Personal Development
the soul can no longer exist in the face of our present-day physiological knowledge
- Psychologist Wilhelm Wundt 1911
