Thursday, October 17, 2019

Psychiatry's reductionist tendencies

Rebecca Roache (who I’ve mentioned previously) has a useful PPP article which discusses the different forms of reductionism in relation to psychiatry. I’ve tried to make my view clear that critical psychiatry’s anti-reductionism is primarily explanatory (see eg. previous post).

Roache says that psychiatrists writing about the biopsychosocial model often contrast it with reductionism. Indeed I did so in my article (as did George Engel originally). I wish, though, that Roache had been clearer that Engel’s biopsychosocial model and Meyer’s Psychobiology are not eclectic (see eg. previous post).

Roache also seems to go along with Nassir Ghaemi that Roy Grinker originated the term 'biopsychosocial'. There is no use of the term in the reference she gives (viz. Grinker 1994), which she says was a 1954 lecture by Grinker. In fact, it's a paper that was first presented in October 1952. I'm grateful to an unpublished review of Ghaemi's The rise and fall of the biopsychosocial model by Neil Vickers that points out that Grinker used the near synonym ‘psycho-somatic-social’, not 'biopsychosocial' in this presentation. He first used the term ‘the biopsychosocial model’ in 1962, some eight years after Nathan Ackerman (1954). It was also used in two papers by F. A. Weiss in 1958. As Neil says, "In short, the case for Grinker’s priority is not credible." John Romano and George Engel had been talking about an integration of biological, psychological and social factors in psychosomatic medicine at least since 1945. True, Engel may well have had Grinker in mind when he linked the biopsychosocial model to systems theory, but I don't think his biopsychosocial model is dependent on systems theory as such.

I agree with Roache's critique of the confusion in the psychiatric academic literature about reductionism. There is widespread hope in psychiatry that neuroscience will explain mental illness. As I keep saying, critical psychiatry's challenge to this 'disease' model of mental illness is legitimate (see eg. previous post). I'd be interested to know if Rebecca Roache agrees with me.

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