Disease Model in Psychiatry

The disease model in psychiatry utilizes a biopsychosocial (BPS) conceptualization in understanding human functioning. Previously, the accepted ideology in treating psychiatric illness pertained to a biomedical view of human functioning. A psychiatric illness was conceptualized, and focus was placed solely on the biological factors that may be causing the individual’s suffering, omitting other factors such as psychological, social, and environmental issues. The BPS model is used to better understand humans and their behaviors by incorporating the biological, psychological, and social factors that are present in a person’s life that may affect his or her current functioning. The biological aspect incorporates the physical aspects of human functioning (physical health and genetics). The psychological aspect incorporates the psychological factors that affect functioning (coping skills and self-esteem). The social aspect incorporates the environmental factors affecting functioning (family, socioeconomic status, and work). The interplay among these three aspects of human functioning makes up the BPS model. While expanding the information included in the BPS model, the practice of storing and accessing medical information digitally can lead to privacy concerns. In this entry, the BPS and the disease model in psychiatry are examined, along with concerns regarding potential oversight of and access to medical records by government agencies, particularly with regard to electronic record keeping.

Medicalization is the process by which nonmedical human conditions and problems come to be defined and treated as medical conditions or in a disease model. Medicalization of psychiatry at present relates to the medicalization of potentially common experiences—for example, feeling sad is considered depression, being shy is called social anxiety. A disease model in psychiatry relates to the difference between disease and illness. An illness represents a complete person and incorporates the biological, physical, psychological, and cultural aspects of the individual. It has been argued that the BPS model favors the medicalization of the psychiatric field. The focus is shifted from a patient-oriented approach to a more scientific, hard-science model. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013, is used by many clinicians to determine and classify mental health disorders. Utilizing tools such as the DSM-5 allows for classification of disorders, diseases, and illnesses, but it also allows for conditions that were previously not considered disorders to now be described as pathologies.

Critics of the BPS and the disease model in psychiatry note that the more formalized and systematic the approach utilized within the BPS model, the higher the potential for governing agencies to survey and deny coverage, access to treatment, or medical and social care. The gatekeeping by governing agencies could be due to the larger amount of information recorded in patients’ health files, and the greater chance for problems to be found and coverage to be denied. Supporters of the medicalization of psychiatry note that this model allows for physicians, psychologists, and other health care professionals to provide a higher level of care than in non-medical-based settings and for those who cannot afford health care coverage.

The product of electronic record keeping relating to the medical field is commonly known as an electronic medical record (EMR). An EMR is a digital version of a paper chart and can be accessed through a desktop computer, laptop, or tablet. It allows for tracking of progress, medications, and medical history. A frequently used method of identifying a patient is to use the patient’s Social Security number. This provides a quick and accurate model for identifying a patient; however, it can be an additional avenue to gain access to potentially sensitive information contained within a health file stored electronically. EMRs are required to comply with the Health Insurance Portability and Accountability Act of 1996, which protects the privacy of an individual’s identifiable health information. With the EMR, there are potential security and privacy concerns that arise. Records that are stored electronically have the potential to be stolen. By bypassing company security measures, a hacker may be able to access sensitive information of anyone contained within that database. Improved security measures such as encryption or renewing passwords regularly provide an increased level of security. Furthermore, governing bodies utilizing a technique known as data mining (analyzing data to detect patterns or relationships) may have access to these records and can potentially identify patterns to be utilized.

Debra Warner and Brandon Chuman

See also Data Mining and Profiling in Social Network Analysis ; Dataveillance ; Digital Passwords ; Patient Protection and Affordable Care Act of 2010 ; Privacy, Medical

Further Readings

Barrows, Randolph C. and Paul D. Clayton. “Privacy, Confidentiality, and Electronic Medical Records.” Journal of the American Medical Informatics Association, v.3/2 (1996).

Borrell-Carrió, Francesc, et al. “The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry.” Annals of Family Medicine, v.2/6 (2004).

Chaum, David. “Achieving Electronic Privacy.” Scientific American, v.262/2 (1992).

Ghaemi, S. Nassir. “The Rise and Fall of the Biopsychosocial Model.” British Journal of Psychiatry, v. 195 (2009).

Green, Alexander, et al. “Why the Disease-Based Model of Medicine Fails Our Patients.” Western Journal of Medicine, v.176/2 (2002).

Manchikanti, L. and J. A. Hirsch. “Obamacare 2012: Prognosis Unclear for Interventional Pain Management.” Pain Physician, v.15/5 (2012).

Meingast, M., et al. “Security and Privacy Issues with Health Care Information Technology.” In Proceedings of the 28th Annual International Conference of the IEEE Engineering in Medicine and Biology Society, New York, NY, August 30 to September 3, 2006.