Questioning the Medical Model of Trauma: Reclaiming Human Experience from Pathologisation

The medicalisation of early diagnosis not only hampers and discourages preventative health care but it also trains the patient-to-be to function in the meantime as an acolyte to his doctor. He learns to depend on the physician in sickness and in health. He turns into a life-long patient. Ivan Illich, Limits to Medicine (1976)

"The public is indoctrinated to believe that skills are valuable and reliable only if they are the result of formal schooling."  Ivan Illich, Deschooling Society (1971) 

Ivan Illich profoundly criticised the institutionalisation and professionalisation of learning and healing processes. He argued that society's reliance on formal institutions - such as schools and medical establishments - monopolises knowledge and diminishes individual autonomy.

Illich believed that this monopolisation leads to the pathologisation of normal human experiences, including trauma, by framing them as medical issues that require professional intervention. He contended that meaningful learning and healing often occur outside institutional settings through personal initiative and community engagement. By challenging the dominance of state-sanctioned professionals, Illich's position supports the idea that lay practitioners and alternative methodologies play a vital role in addressing human needs and that over-medicalization can hinder natural coping and recovery processes.

The contemporary medical model of mental health, dominant in many Western societies, posits that psychological trauma and mental distress are primarily medical issues requiring intervention by highly trained and state-registered healthcare professionals. This approach often emphasises diagnosis, medication, and clinical therapies as the primary means of treatment. While this model has undoubtedly contributed to advancements in understanding and treating mental health conditions, it raises critical questions about the ownership of human experience and the role of lay practitioners in providing effective support.

The Medicalisation of Trauma

Trauma, as a profound human experience, encompasses a wide range of reactions to distressing events. The medical model tends to categorise these reactions into diagnostic criteria, often leading to labels such as Post-Traumatic Stress Disorder (PTSD). While such classifications can facilitate treatment plans and insurance processes, they may also inadvertently pathologise normal human responses to abnormal situations. The risk lies in reducing complex emotional and psychological experiences to clinical symptoms, potentially overlooking the individual's narrative and personal coping mechanisms.

Furthermore, the reliance on diagnostic manuals such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) in clinical practice can contribute to the medicalisation of trauma. Licensed therapists are often incentivised to assign specific diagnoses according to the DSM-5 to fulfil insurance billing requirements. 

It may surprise many people to learn that electro-convulsive therapy (ECT/electroshock) is often used in the treatment of an otherwise healthy person who has experienced grossly traumatising events. Yet, in the eco-system of psychiatry, this would be regarded as perfectly rational.

This necessity for diagnosis can pressure clinicians to categorise an individual's experiences into predefined diagnostic labels, even when these labels may not accurately reflect the person's unique situation. As a result, normal human reactions to adverse events might be pathologised, reinforcing the notion that trauma is exclusively a medical issue needing clinical intervention. This practice influences how individuals perceive their own experiences and highlights how systemic factors can drive the expansion of medicalised interpretations of human suffering.

Exclusivity in Mental Health Care

The stringent regulation of mental health services means that only those with specific qualifications and registrations can legally offer certain types of support. This exclusivity can create barriers to accessing care, especially when waiting lists for state-registered professionals are lengthy. Moreover, it marginalises the contributions of lay practitioners, coaches, and community helpers who, despite lacking formal credentials, possess valuable skills and methodologies that can aid in trauma recovery.

The Role of Lay Practitioners

Lay practitioners often employ holistic and integrative approaches that resonate with individuals seeking help. Techniques such as mindfulness, peer support groups, and eye movement therapies can be taught effectively outside traditional academic settings. These methods emphasise personal empowerment and self-healing, aligning with many individuals' preferences for more personalised and less clinical interventions.

For instance, Integral Eye Movement Technique (IEMT) is a modality that has shown promise in helping individuals process traumatic memories and emotions. Practitioners of IEMT, who may not always be formally registered healthcare professionals, provide accessible support that complements or, in some cases, offers an alternative to conventional treatments.

The Pathologisation of Everyday Life

“Man is not like other animals in the ways that are really significant: Animals have instincts, we have taxes.”  Erving Goffman

The expansion of diagnostic categories in mental health has led to increasing numbers of everyday experiences being classified as disorders. Normal variations in mood, behaviour, and personality are sometimes medicalised, prompting unnecessary interventions. This trend burdens healthcare systems and influences individuals to perceive themselves as ill when experiencing typical human emotions. One only needs to spend a short while perusing the videos on TikTok where countless healthy teenagers are telling the world of their alphabet diagnostics (ADD/ADHD/BPD, etc) and neurodivergence (autism/Aspergers, dyspraxia, dyslexia, empath, etc) in an ever-escalating competition for likes and views.

Erving Goffman, a renowned sociologist, critically examined how societal institutions impact individuals labelled as deviating from social norms, particularly in mental health. In his seminal work "Asylums" (1961), Goffman introduced the concept of "total institutions," describing how places like psychiatric hospitals can strip individuals of their autonomy and identity.

He argued that the institutionalisation of mental health care often leads to the dehumanisation of patients, where they are subjected to rigid routines and control that undermine their self-agency.

Additionally, in "Stigma: Notes on the Management of Spoiled Identity" (1963), Goffman explored how society stigmatises those with mental health diagnoses, effectively labelling and marginalising them. This stigmatisation reinforces the pathologisation of behaviours and experiences that might otherwise be considered within the spectrum of normal human reactions.

These institutions, long abandoned by the state, are no longer necessary to perform this process of stigmatisation. The advent of the internet and mass communication has reduced the human experience to bite-sized data and memes that inform and brainwash the populace into self-diagnostics. Psychopathology is celebrated and even demanded, with employment application forms frequently requesting the applicant provide details of their "lived experience" of mental health. It is as though such an experience serves as a qualification. Undoubtedly, such information is requested so the employer can fulfill their Diversity, Inclusivity and Equality obligations. Such actions move historical suffering into a statement about the person's identity and suitability for the work; it forces the individual to consider past suffering not as historical events but as an all-pervasive quality by which they will be judged.

Goffman's work highlights how the medical model can perpetuate social control and exclusion, emphasising the need to recognise and value alternative, non-clinical approaches to understanding and supporting individuals dealing with trauma.

Implications for Mental Health Care

Questioning the dominance of the medical model invites a re-examination of how society addresses mental health. Recognising the value of non-clinical support systems can lead to more inclusive and diverse care options. It challenges the notion that state-sanctioned clinicians are the sole proprietors of mental health expertise and opens the door for collaborative approaches that integrate medical and lay perspectives.

While the medical model of mental health has its merits, an overreliance on this approach may overlook the richness of human experience and the potential of alternative support systems. Embracing a more pluralistic view of mental health care acknowledges the contributions of lay practitioners and empowers individuals to seek the type of support that best suits their needs. By doing so, society can move towards a more holistic and accessible framework for addressing trauma and mental well-being.