Medical Model

History

In order to understand the medical model of criminality, we must examine the medical model itself more generally. The medical model, which claimed to be rational, objective, and value-free, became the dominant method of health care within the West during the 19th century. Shaped by the scientific method, it was based on five key assumptions. The first, mind-body dualism, sees a clear division between the mind and the body. This view diminishes patients' own accounts and management of their illnesses and encourages the “clinical gaze,” whereby the body is thought to be something that may be observed, manipulated, and treated by an expert. The second assumption, physical reductionism, reduces illness to physical or organic causes while omitting social, psychological, and spiritual aspects.

Specific etiology, the third pillar of the medical model, proposes that every disease has one specific, identifiable cause, such as a parasite, virus, or bacterium. It dismisses the complexity of illness as well as broader contributing factors. The fourth supposition, mechanical metaphor, views the body as a machine whose periodic breakdown or malfunction results in disease. Finally, due to the technological imperative, practitioners usually seek to cure illnesses rather than prevent them. This view also underpins the use of drugs, surgery, and other medical interventions.

The Medical Model of Crime

During the 19th century, the medical model became increasingly applied to an expanding number of social problems. In particular, at this time, both madness and crime came to be understood as diseases requiring medical treatment. Thus, one of the earliest applications of ideas from the medical model in the criminal justice system was with offenders thought to be insane. It was argued that since this group was mad, they could not be held accountable for their crimes and therefore deserved treatment rather than punishment. Alienists (nascent psychiatrists) established their field, in part, through their legal testimonies regarding the sanity and dangerousness of accused criminals and their professed expertise in classifying, understanding, and treating the criminally insane. In response, jurisdictions began to found specialized institutions for the criminally insane. In the United States, the first of these was established in 1855, adjacent to the Auburn State Prison in New York.

The application of the medical model to crime was also apparent in the work of various 19th-century scholars who linked physical attributes to criminal behavior. The most famous of these was Cesare Lombroso. In his 1876 study of Italian prisoners, he concluded that criminals had particular physical traits that signaled their “atavism” or reversion to a primitive state of evolution. Likewise, he proposed that they were subject to “degeneration,” in which their criminality indicated that they were reverting to a racially primitive state of development.

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