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Models of Mental Health

Clinical professionals use many tools to make determinations about mental health. Psychological assessments are based on models that describe behavior that is considered abnormal and behavior that is considered typical. These models can be helpful, but they can have potentially racist implications when applied to people of color.

Deficit Model

The deficit model views people of color as inherently inferior. This model was historically used to ascribe low status to people from ethnic minority groups and to explain perceived pathologies in people of color.

For example, according to the deficit model, people of color are described as having a genetic deficit. Psychological problems or behavior that differs from expectations is attributed to a deficiency in the genetic makeup of the individual. In this view, people of color were thought to be born with inferior brains and therefore were considered genetically less competent.

The deficit model is also at work when behavior is attributed to a cultural deficit. Specifically, when people of color are described as having a culture that is inferior to the mainstream culture or no culture at all, the deficit model suggests that cultural practices are responsible for psychological problems. That is, when so-called aberrant behavior is thought to be the result of the lifestyle of people of color, culture is targeted as the source of deviant functioning. Using this model, some describe people of color as “disabled under the weight of oppression” and therefore unable to adjust to the demands of mainstream society.

Racist Implications of the Deficit Model

The deficit model is a clearly racist model. Clinical professionals who hold this view are likely to be intentional in their racism (i.e., they believe the genetic deficit hypothesis), but they may also practice unintentional racism. It is likely that clinicians who subscribe to the cultural deficit position are at risk for making one of two treatment errors: (1) lowering expectations, or (2) setting unrealistically high expectations for clients of color. By setting expectations too high, clients are set up for failure. Conversely, setting expectations too low may encourage clients to under achieve, and their failure in therapy only reinforces their feelings of inadequacy. The deficit model clearly does not empower ethnic minority clients.

Medical Model

The medical model is based on the association between mental problems and physical problems, and psychological problems are viewed just like physical diseases (i.e., “suffering from depression, afflicted by phobias”). The implications of this model are that mental health is the absence of symptoms and that successful treatment is the diagnosis and removal of the disease.

The medical model emphasizes the classic doctor–patient relationship. The therapist is considered to be an expert, and he or she is expected to be highly trained. Clients, however, are seen as needy recipients of the doctor's help, and they are expected to accept the doctor's diagnosis and treatment recommendations without question. According to this view, treatment is a verbal process: Clients are expected to self-disclose, and to be successful, the client must be highly verbal and capable of discussing his or her thoughts and feelings.

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