Cure and control: Medical model dominance and empowerment-based philosophy in American mental health care

Using historical analysis, empirical research, and review of contemporary thought in mental health care, this dissertation examines issues of life control, or personal empowerment, and social control , or authority held over the service recipient. It suggests that an optimal balance should be sought between these two forms of control, and discusses how each can effect recovery from mental illness. Several cross-cutting themes emerge throughout the dissertation.; The first relates to mental health care paradigm. Care in asylums and mental hospitals from the nineteenth to the mid-twentieth century was based largely on the medical model assumption that cure from mental illness can facilitate life control. This “institutional era” paradigm is compared to the subsequent “empowerment era” approach, one based on the reciprocal assumption that life control can facilitate cure. This enhanced personal control, however, can lead more often to chronic welfare dependency, homelessness, or incarceration—outcomes indicating a social neglect. In earlier interventions, abuse was more common inside the walls of institutions, yet the facilities nevertheless guaranteed access to shelter, food, and clothing. In both paradigms it is clear that there are varieties of social control in mental health care. A “professional control” is held over service recipients and over the mental health field, and a “community control” is held over citizens that are thought to be disruptive to the social order.; The dissertation also explores the continuity in psychopathology conceptualization and treatment. Many current interventions and beliefs that are thought to be new or unique have origins that extend much further back in time. In addition to empowerment-based thought, traceable to the early nineteenth century are treatments that resemble modern psychotherapy, behaviorism, and electroshock therapy, for example. This provides historical context for exploring the development of an empowerment-based ideology, one that has shaped two alternative service delivery strategies, including the “strengths model” (based on personal asset development), and the “recovery model” (based on self-guided healing). The dissertation introduces a new service delivery approach—a more empowering system that combines medical, strengths, and recovery model strategies in self-help agencies and community mental health centers.