The Rise and Fall of the Biopsychosocial Model

alex3619;239879 said:

Subtitle: Reconciling Art & Science in Psychiatry
S. Nassir Ghaemi, M.D., M.P.H.
The Johns Hopkins University Press, 2010

I have just finished reading part one of this book, called "The Rise of the Biopsychosocial Model". Part two which I am about to start is called "The Fall of the Biopsychosocial Model".

According to Ghaemi, BPS has its origin in the theories of Freud. Earlier accounts of psychosomatic medicine, indeed up to at least the 1950s, merely refered to illness that had mental issues as a component. Lets face it, even if you just stubbed your toe you have a mental component to it. So the early accounts presumed it was physical, but then explored the mental/psychological issues that went with it.

Freud pushed the idea of psychosomatic as primarily mental. Adolf Myer introduced the term psychobiology. This was a man who endorsed surgical removal of the colon and frontal lobotomies as treatment for psychiatric disorders.

The 1950s saw the rise of psychiatric eclecticism. I would sum this attitude up with the phrase "If it works use it". However the trend in eclecticism seems to have been the embracing of dogmatism, the undue influence of authority, even though it rose as a way to avoid dogmatism.

Roy Grinkler was interested in using General Systems Theory as a framework to advance psychiatry. He created the term biopsychosocial, although in his earlier 1952 work it was called psycho-somatic-social. It was an attempt to create a holistic psychiatric approach, and avoid excessive psychoanalytic dogmatism, by putting emphasis on all three areas that can give rise to mental problems. By 1966 somatic had become bio-.

In 1977 George Engel appropriated the term for his paper on a systems theoretic view toward all of medicine, not just psychiatry, although I think it was about 1951 he started talking about such issues. He was interested in the mental aspects of physical disease, but was attracted to psychoanalytic theory. The origins of the formal BPS model we know today are with Engel, first really expounded in his Science paper "The need for a new medical model: a challenge for biomedicine."

http://www.healtorture.org/files/files/englearticle.pdf

Engel is quoted as saying: "All three levels, biological, psychological, and social, must be taken into account in every health care task."

In the several decades that followed, the pharmacological advances put the psychoanalytic models in perspective as outdated theories. However, the rise of the cognitive behaviourial model has replaced it as the dominant -psycho- aspect of BPS.

Ghaemi is critical of DSM-IV though he doesn't say much about it in this book. He is also not impressed with DSM-V.

Ghaemi claims the BPS model rose in significance because the dying psychoanalytic approach, which was increasingly being rejected, could find a haven in the -psycho- aspect of the BPS model. Gaemi also claims, as do I, that BPS has undue emphasis on the P part, while paying lip service to the B and S.

My analysis is a little different. The BPS model is based on GST. Its a system theoretic model. What has happened, in my view, is that the BPS proponents are treating the model as reality on the one hand, and not taking it seriously on the other. One of the oldest maxims in systems theory is "The map is not the territory". The model is not reality, its an abstraction of reality. While it is fair to say that a systems theoretic view is a good antidote to excessive reductionism, it is also fair to say, as I see it, that its still reductionism, just not as extreme.

Where I think this is heading, for me (although I have lots of work to do still) is that CBT/GET (for ME) proponents of BPS have used it to give themselves an air of acceptability. They pay lip service to the model, they fit it like ticking a checklist, but violate the spirit and wider meaning of the model. This checklist criticism I think also applies to evidence based medicine, but it will be months before I talk about that.

More to follow.

Bye, Alex
Click to expand...

PS I have said this before but I think it is worth repeating: if we have a psychosomatic illness because a physical illness cannot be objectively shown, how is a psychosomatic illness any more valid since it cannot be objectively shown?

The thread for this is: http://forums.phoenixrising.me/showthread.php?16139-SOMATISATION-DEPRESSION-AND-ME

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The Rise and Fall of the Biopsychosocial Model

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