title: The social structure of the medical model of madness and the physician's role.
abstract: In this paper the origins of the medical model of madness are traced in the sociohistorical context of institutional and professional development. The paper establishes the emergence of the three primary conditions necessary for the medical model to exist: (a) the view that madness is a separate ontological reality which can be differentiated from the insane person; (b) the concept that insane people do not have a completely free will and therefore cannot be held responsible for their actions; and (c) the creation of specific criteria to classify the disease into empirically derived nosologies. These conditions and their acceptance as an explanatory paradigm of insanity result from the political economy of the late Middle Ages and are reflected in the institutional arrangement for insane persons of the 17th and 18th centuries. Finally, the role of the physician-psychiatrist is explained in terms of an ability to (a) serve as a technician for the new political forces, and (b) dislodge the moral entrepreneurs and become the only profession able to offer a proper scientific and secular treatment of madness. The psychiatrist is presented as a by-product of the dominance of the medical model rather than as the agent who created it.
mesh_terms: D049668:History, 15th Century; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D001523:Mental Disorders / Q000266:history*; D010819:Physician's Role; D011570:Psychiatry / Q000266:history*; D012380:Role; D012924:Social Conditions