Medical Model vs Integral Model
I wrote this reflection for my problem identification class at the University of Rochester. The professor asked us to reflect on a particular reading, the reading for this reflection was Chapter 1, Introduction, from Ingersoll and Marquis textbook, Understanding Psychopathology: An Integral Exploration. I have included my reflection below.
Medical Model vs Integral Model
This week, I chose to reflect on Ingersoll & Marquis (2014), Chapter 1, Introduction from Understanding Psychopathology: An Integral Exploration. Ingersoll and Marquis start by stating their desire to assist us in defining what is normal versus abnormal (pathological) in the psychiatric field. They argue that it is difficult to define this, especially in comparison to traditional medical diagnoses, because mental illness has no physiological markers, has many paths of manifestation, and is very dependent on nuanced context. They also argue that the DSM, with its categorization, is insufficient; it only offers one perspective, the medical model, and it only diagnoses; it does not explain why the disease arose nor options to treat it. They advocate for combining the DSM with an approach that also considers a rich etiology, a subjective history of the individual and their context, to understand how the mental illness came about, from which should be established a diverse set of options for personalized treatment.
Ingersoll & Marquis invoke philosophy, including the mind-body problem and metaphysics, to remind us that we cannot be certain of anything, even science is a leap of faith, and that there is merit in considering diverse perspectives to maximize the treatment of the client. They then offer us their Integral Model as a method to do this. The Integral Model assesses the client in four major quadrants, with two dimensions of the individual and two dimensions of the environment. The two dimensions of the individual are the interior of the individual, their subjective phenomenological feelings and thoughts, and the exterior of the individual, their objective physiological traits, leveraging the traditional medical model. The two dimensions of the environment are the social objective environment and the subjective cultural or group interior environment.
The Integral Model also considers a developmental perspective. Modern researchers have criticized developmental stage psychology for being too rigid; Ingersoll and Marquis offer a more flexible perspective of innumerable "lines" of development instead of fixed paths and stages. They offer us examples of lines of development, such as the cognitive and the ego lines, linking growth in these two to the potential of higher states of consciousness. They also discuss the concept of one's inherent personality, critiquing fixed-type theories but allowing for more flexible personality styles to inform therapy. They then discuss spirituality and explore ways in which it can be operational, distinct from religion, and usable in therapy. They end with a case study using their Integral Model.
My initial reactions upon reading this piece were extremely positive. I have felt for a long time that science cannot solve the really complex problems of human existence. I have been feeling like an outcast in a world that touts scientism dogmatically and neglects, in my view, the most important aspects of subjective human experience: how we feel and what things mean to us. I especially like the idea that to know something, it is not enough to observe and measure it; we also must know how it came about, how it feels, and what to do with it. I also like Ingersol and Marquis' idea of the etiology and treatment of mental illness being just as important as a diagnosis.
I especially liked their philosophical perspective and the humility that goes with it, being open to the idea that we can never be certain about things we know and that integrating many diverse perspectives is superior to just one lens. I appreciated how they break the individual into objective and subjective parts and further include the group environment with an understanding of the cultural and social contexts. I also liked their discussion of spirituality and their contrast of it with religion. In the same way, I have felt excluded, objectified, and controlled by modern science, I have also felt similarly towards modern religion, which tends to have too many judgments and requirements for me to participate. Trying to define spirituality as something apart from religion that can offer a sense of profound self-worth, meaning, and connectedness to a whole seems like a worthy life task. As a counselor in training, I can learn from this Integral approach and seek out diverse sources of information related to my client's condition.
I have questions about this approach: How much subjective data is enough? It seems that given enough time and budget, a counselor could be stuck in analysis paralysis with their client and not move to real practical results. Furthermore, if we elevate subjectivity in our techniques, how can we ensure quality in our outcomes? In a subjective world, what do we agree upon to measure success? Or is each individual's opinion enough? Or is that just a state of isolated delusion? Also, who is paying for all of this? Spending so much more time gathering rich information in our own subjective ways will take a lot of time and money. Either the government would pay for this, so more tax, or this technique would only be available to the upper classes, which then further increases the gap between rich and poor.
Lastly, in therapeutic approaches like this, we artificially create commercial relationships between client and counselor, which would have been done in the past by friendship. A good friend can listen to all the richness of your life story and be someone to offer sage counsel; now, with this therapeutic relationship, we have clients paying people to be their friends, which may make them dependent, more isolated, and less self-sufficient. Part of me wants to force people to connect with each other and figure out their problems in a decentralized community-driven manner, not via a commercialized model. Overall, I very much enjoyed the reading; it made me feel like I had met kindred spirits in reading this work. However, I did worry that it could be overly idealistic and impractical to implement on a large scale and make its clients dependent instead of self-sufficient within their own communities.
