MEDICAL MODEL The medical model dominates much of modern psychiatric care.
Other health
professionals may be involved in interagency referrals, family assessment and health teaching, but
physicians are viewed as the leaders of the team when this model is in effect. A positive contribution
of the medical model has been the continuous exploration for causes of mental illness using the
scientific process. Basic assumptions of medical model are: • Medical model believesthat deviant
behavior is a manifestation of a disorder of the central nervous system. • It suspects that psychiatric
disorders involve an abnormality in the transmission of neural impulses, difficulty at the synaptic
level, and neurochemicals such as dopamine, serotonin and norepinephrine. • It focuses on the
diagnosis of a mental illness and subsequent treatment based on this diagnosis. • Environmental and
social factors are also considered in the medical model. They may be either predisposing or
precipitating factors in an episode of illness. • Another branch of research focuses on stressors and
the human response to stress. These researchers suspect that humans have a physiological stress
threshold that may be genetically determined. Medical Therapeutic Process The physician's
examination of the patient includes history of the present illness, past history, socialhistory, medical
history and review of systems, physical examination and mental status examination. Additional data
may be collected from significant others, and past medical records are reviewed if available. A
preliminary diagnosisisthen formulated pending further diagnostic studies and observation ofthe
patient's behavior. After the diagnosis is made treatment isinstituted. Somatic treatments including
pharmacotherapy, electroconvulsive therapy and occasionally psychosurgery, are important
components ofthe treatment process. Roles of the Patient and the Medical Therapist • The physician
as the healer identifies the patient'sillnessandinstitutesa treatmentplan. • Physician admits the
patient in a psychiatric institution. • The role ofthe patient involves admitting that he is ill. • Patient
practices prescribed therapy regimen and reports the effects of therapy to the physician. Application
to Nursing Psychiatric-mental health nurse uses this model for assessment, diagnosis, planning and
implementing nursing care to the patient. This model helps psychiatric-mental health nurses to
understand the physiological changes occurring due to psychiatric disorders. NURSING MODEL
Nursing focuses on the individual's response to potential or actual health problems. Under the
nursing model, human behavior isviewed from a holistic perspective. Nursing View of Behavioral
Deviations • Behavior is viewed on a continuum from healthy adaptive responses to maladaptive
responses that indicate illness. • Each individual is predisposed to respond to life events in unique
ways. These predispositions are biological, psychological, sociocultural, and the sum of the person's
heritage and past experiences. • Behavior is the result of combining the predisposing factorswith
precipitating stressors. Stressors are life events that the individual perceives as challenging,
threatening or demanding. The nature of the behavioral response depends on the person's primary
appraisal of the stressor and his secondary appraisal ofthe coping resources available to him
