Where we agree is that the strength of Engel's model is its critique of biomedical reductionism. David accuses the model of being naive about medical knowledge. He argues that the model needs to be more of a theory about health and illness.
I do not think that David’s view sufficiently acknowledges the extent to which the model was not only a challenge to psychiatry, but also to medicine in general, creating the basis for patient-centred medicine (see previous post). As I said in my article:-
In his original paper, Engel talked about neutralizing ‘the dogmatism of biomedicine’ (1977, 135). He commented on the enormous investment in diagnostic and therapeutic technology that emphasizes ‘the impersonal and the mechanical’ (Engel 1977, 135). He quoted from Holman (1976), who argued that:
[T]he Medical establishment is not primarily engaged in the disinterested pursuit of knowledge and the translation of that knowledge into medical practice; rather in significant part it is engaged in special interest advocacy, pursuing and preserving social power. (Engel 1977, 135)
Engel acknowledged the interest in the biopsychosocial model amongst a minority of medical teachers, but also emphasized the difficulties in overcoming the power of the prevailing biomedical structure.
None of my comments should detract from David’s contribution to recognising the importance of critical realism as a metatheory for psychiatry and clinical psychology (see his chapter in Routlege International Handbook of Critical Mental Health, a book which I have mentioned in a previous post).