Monday, February 03, 2020

Psychosomatic medicine and the biopsychosocial model

Nassir Ghaemi has added to the debate in Psychiatric Times on the biopsychosocial (BPS) model (see his article). From his point of view, "the BPS model for the past half century has served as a postmodernist excuse for eclecticism".

I have been critical of Ghaemi's book The rise and fall of the biopsychosocial model (see previous post and my book review with response and reply). However, I do essentially agree with his statement that the "BPS of the past half century is not the same BPS of George Engel in 1977" (see previous post). I can't really accept Ghaemi's simplistic definition of postmodernism as eclecticism (or nihilism), but I think he is right that modern psychiatry is eclectic and that "[m]ental health clinicians ... claim support [for eclecticism] ... in the BPS approach".

As Ghaemi indicates, Engel's BPS model comes from psychosomatic medicine. Ghaemi seems to define psychosomatic medicine as "the idea that unconscious psychology affect[s] ... the body to cause disease". Certainly this idea is present in the history of psychosomatic medicine from Franz Alexander. However, psychosomatic medicine is a wider concept and it now tends to emphasise excessive attention towards physical symptoms rather than stress as such or even unconscious motivation. Ghaemi is essentially anti-psychoanalysis (see previous post), which is why he calls the BPS model a "disproven psychosomatic medicine" model.

But the point of Engel's BPS model is that it promotes an integrated mind-brain understanding. It provides an explanatory anti-reductionist position for psychiatry (see eg. previous post).

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