Are we disordered? Should we subscribe to the medical model of counseling?

Debating the legitimacy of mental health counseling and disorders... I feel that it is important to be knowledgeable of both sides of this debate, is psychology just a bunch of assumptions or is it "science?"
In a post that I wrote, which positioned that disorders do not exist, someone responded by saying… “It is obvious through your writings that you are against the medical model of counseling. However, I wonder how you will then base your research of symptoms, settle on an approach, or bill an insurance company”. While, I myself believe that there is biological and physiological causes for mental disorders, it is important to understand that the positions of the other camp. Here is my response...
The question itself is circular. If I do not believe that existential human problems are illnesses, then I will not “research symptoms” at all, since a symptom is, by definition, the outward sign of an illness. It is like asking an atheist “Well, if you do not believe in God, how, then, are you going to pray?” In terms of settling on an approach, surely this will follow from talking and listening to the client and his/her description of the problem(s). A person has come for help of a certain kind and for a certain problem, and I will do my best to understand the problem from the client’s perspective and offer what is asked for. For this, it is certainly not necessary to believe that psychological conflicts are diseases or follow any sort of “medical model”. Perhaps an example will serve to clarify what I mean by this.

Carl Jung tells the story of a woman who had been incarcerated in his hospital, and with whom he worked for quite a long time. After trying every treatment approach he knew to try and seeing no appreciable progress, the famous Swiss psychiatrist finally ran out of options. Feeling completely stumped and having no idea what to do next, Jung actually went to the woman and said: “I’m sorry, but we’ve been at this a long time, we’re obviously not getting anywhere, and quite frankly, I don’t know what else to do for you. What would YOU like me to do?” The woman responded with elegant simplicity: “Read to me,” she said, “from the Bible.”

Now, Jung had grown up under the cold, authoritarian hand of a fundamentalist Christian minister, and he had no use whatsoever for the Christian scriptures. If anything, he resented them and wished to have nothing to do with them ever again. But, in a show of genuine humility and openness that seems all but completely absent from modern psychiatry and would probably scandalize his colleagues today, Jung consented to do as his patient requested, got himself a Bible, and began reading to her from it. A few weeks later, she had improved so dramatically that she was discharged from the hospital as “cured”.

This story, to me, offers a powerful insight into the real nature of counseling. Carl Jung read to his patient from the Bible. Was this a radical new “treatment” for the woman’s “illness”? Should we now send researchers off with fists full of grant money to find out why the words in the Bible are “therapeutic”, and if so, for which DSM disorders they are “indicated”? Of course not. The woman had no illness, and Jung gave her no treatment. What the woman wanted was help on her own terms, that is, in a form that she could recognize and accept. She did not want to be the object of some expert’s “treatments”; she wanted to be heard, understood, accepted, and given the help SHE wanted. And once she got it, she no longer needed help. Strip away all the pseudo-scientific mumbo-jumbo and medical-sounding hokum in which the mental health professions are awash today, and this is what remains: a simple human exchange in which one asks to be heard, and the other truly listens.

Of course, insurance companies, as you indicate, are not interested in paying for people to sit and talk to each other, nor should they be. As noble as it may appear to “help” the poor by classifying counseling as a form of medical treatment and making it insurable, in the end it merely places the insurance bureaucracy in charge of counseling, where it most definitely does not belong. What is my answer to this conundrum? As things stand now, I have none, except to suggest that those who can go into private practice and refuse all third-party payers, substituting a sliding scale fee schedule instead. For those not licensed for private practice, however, it is a real problem with no easy answers. I certainly do not have a magic solution.

What the whole thing comes down to in the end is this: people who are in psychological pain, who behave in bizarre ways, and whose lives are a shambles either have diseases or they do not. Since medicine is a branch of science, the burden of proof falls on those who advocate the disease theory to prove their case. Yet despite the endless repetitions in the literature that (mis)behaviors and destructive thoughts are illnesses just like heart disease or cancer, not one shred of credible empirical evidence has been produced to back up this claim in over a century of looking.

Ironically, that this is true is demonstrable even in the very literature that argues for the medical model. Take the text you quote in your reply to me: “The DSM-IV does follow a medical model--if you are a medical practitioner. If you are a counselor, the DSM may not be a manual of diseases, but simply a description of harmful behaviors, dysfunctions, mental disorders, developmental roadblocks, or whatever one chooses to call them. The DSM does not recommend the prescription of medication or hooking clients up to electrodes, or any other treatment method for that matter” (Hinkle, 1998). Now I ask you, in simple honesty, is the absurdity of this statement not obvious to anyone who is willing to look at it objectively? Can you imagine, say, the American Medical Association making such a statement about its own publications? Can you envision them coming out and saying “Our medical reference is a medical book, if you look at it from perspective X. If you look at it from perspective Y, it is something else”? A medical reference is always a medical reference, no matter who happens to be reading it, and real diseases are always diseases, not “whatever one chooses to call them”. In stating that what the DSM is depends on how one looks at it, Hinkle is merely admitting that it can, in fact, mean whatever the reader wants it to mean. And this is the very opposite of legitimate science.

Hinkle’s concluding statement that the DSM “does not recommend” any treatment methods is irrelevant at best, and disingenuous at worst. Whether it recommends specific “treatments” for its “illnesses” or not, it is most certainly the foundational justification for all mental health diagnoses, and therefore, for all treatments as well. Indeed, it really cannot recommend specific treatment modalities for the “mental disorders”, since the number of these so-called treatments is growing steadily year by year, and the effectiveness of each depends on whom you talk to. To recommend one treatment approach for disorder X over the other dozen or so available for it would put half the counselors (and, if the recommended treatment did not include drugs, almost all psychiatrists) out of business overnight.

If you are wondering how such obvious medical fraud on such a grand scale is possible, simply do what any good investigator would do: follow the money. Like it or not, medicine and counseling are both businesses, and the marriage of the two has made a small consortium of people extremely wealthy. Consider: if depression, for example, is an illness (i.e., a brain chemical imbalance) and not the result of, say, an interpretation of the self and its circumstances, then the answer is not to deal with the person or his life, but rather simply to correct the chemical imbalance. This, of course, requires not human empathy, communication and understanding, but pharmaceuticals, and these, in turn, are synthesized mostly from petroleum. Hence, by convincing both counselors and the public that anger, sadness, confusion, despondency, “inappropriate” euphoria, hallucinations, “dysfunctional” relationships, employment instability, and other concomitants of the contemporary human condition are really problems of brain chemistry, the drug and oil companies have made profits that you and I (and most other industries outside of banking) could scarcely conceive of. This is why these industries have spent such inordinate sums of money on public advertising (“Sex with your wife of 36 years isn’t so exciting anymore? Ask your doctor!”), impressive-sounding (and often ghostwritten) studies and media reports that upon analysis offer no substantive evidence, political lobbying, and even direct marketing to physicians. Repeated over and over ad nauseam from every corner, sooner or later the message was bound to be accepted as gospel, and the baldly obvious lack of proof and breathtakingly illogical argumentation behind it overlooked. And so it has been.

And let us not forget that we counselors receive a few “benefits” of our own. Accepted now as quasi-medical “mental health professionals”, we are guaranteed payment by insurance companies and/or the government and are accorded a social status (and, in many cases, income) that would be impossible for a profession in which it was openly admitted that the only activities in which its practitioners engaged were talking and listening.

And so today we have the “medical model of counseling”, despite the fact that the concept is no more logical than, say, the “theological model of fly-fishing”. Fishing has nothing to do with theology, and counseling has nothing to do with medicine, but no one wants to see that the emperor has no clothes, because everyone benefits so richly from praising his lavish new garments.

Everyone, that is, except the client.