In this book, Dr Huda situates the question of the role of the medical model in mental health firmly within a scrupulous examination of that model in medicine as a whole. When, how far and even whether the medical approach has a place in helping people with psychological problems has long been a matter of debate, and there is no doubt that often psychiatrists have overpromised and underperformed. The question then is whether the perils of psychiatry are unique to this branch of the medical profession or are part of the limitations of medicine as a whole. For some of those who are keen to challenge, and if possible replace, psychiatrists and their medical model, the problem is that the application of this model to people with mental health problems is incoherent and does more harm than good, in contrast to its apparently conceptually clear and unproblematic results in the rest of medicine.
Huda tackles this romantic misunderstanding head on, first through a careful consideration of the medical consultation and the diagnostic process that develops from it. He then identifies 20 questions about the application of the medical model in mental health and in general medicine, for example regarding the reliability of diagnosis, the distinction from normality, the identification of causal mechanisms, the associated stigma, prognosis, and the effectiveness and harmfulness of treatment. Each question is then subjected to detailed scrutiny, supported by exhaustive reference to the literature. The answers that emerge show consistently that, although psychiatry lags behind general medicine, there is nevertheless a significant overlap between psychiatric diagnostic constructs and treatments and their general medical equivalents on all the points considered.
Huda concludes with the sensible caveat that the medical model and perspective is not the answer to everything in mental health, and that psychiatrists need to learn from patients and from other professionals.
The book places some demands on the reader; it is partly a work of intellectual clarification, and as such necessarily exhaustive in its assembly of sources and materials, although Huda takes the reader carefully through the thickets of critical appraisal.
As Huda notes, he did not have space to consider psychological factors in the aetiology of mental health problems, or the influence of social factors on biology (the influence of maternal health in pregnancy, and other prenatal factors, would be of particular interest). Since the debates that in part led him to write this book will be with us for some time, a second edition will probably be needed in due course, and a slightly leaner text might allow these other subjects to be included.
Declaration of interest
I work for the same National Health Service trust as Dr Huda, also in early intervention psychiatry but based at a different hospital.
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