CBT is heralded as the treatment of choice by NICE, because it is based on randomised controlled trials of ‘effective’ disorder specific protocols, but most CBT practitioners have paroxsyms at the mere mention of a medical model! This makes it inevitable that there is going to be a yawning gulf between treatment in the rct’s and in routine practice. In this context it simply is not credible that the generally positive findings from research will be effectively translated. There is a pressing need to build a bridge between practitioners and those who were involved in high quality rct’s:
A way forward is to acknowledge that there is more than one Medical Model, Dominic Murphy [ The Medical Model and the Philosophy of Science (2013) in The Oxford Handbook of Philosophy and Psychiatry] recommended the minimalist version of the model which asserts that ‘…. mental illnesses are regularly co-occurring clusters of signs and symptoms that doubtless depend on physical processes but are not defined or classified in terms of those physical processes’. It is this version of the model that largely underpins the DSM criteria. The minimalist version is in fact quite different to the strong version of the model and rejection of this is not synonymous with rejection of the medical model – the strong version is in many ways a caricature. But caricatures are good for uniting people in what they are against and avoids the difficult question of what they are for.
Dr Mike Scott