Limitations of the biopsychosocial model in psychiatry

Tony B Benning Maple Ridge Mental Health Centre, Maple Ridge, BC, Canada Abstract: A commitment to an integrative, non-reductionist clinical and theoretical perspective in medicine that honors the importance of all relevant domains of knowledge, not just “the biological,” is clearly evident in Engel’s original writings on the biopsychosocial model. And though this model’s influence on modern psychiatry (in clinical as well as educational settings) has been significant, a growing body of recent literature is critical of it - charging it with lacking philosophical coherence, insensitivity to patients’ subjective experience, being unfaithful to the general systems theory that Engel claimed it be rooted in, and engendering an undisciplined eclecticism that provides no safeguards against either the dominance or the under-representation of any one of the three domains of bio, psycho, or social. Keywords: critique of biopsychosocial psychiatry, integrative psychiatry, George Enge

Psychosomatic and Biopsychosocial Medicine: Body-Mind Relationship, Its Roots, and Current Challenges

The basis of psychosomatic medicine is a fundamental philosophical debate between mind (a subjective phenomenon that is linked to a sense of consciousness) and body (which is empirically demonstrable). Starting from the Greek tradition to the Cartesian res cogitans-res extensa dichotomy, the chapter illustrates the role and importance of a biopsychosocial approach in all the spheres of medicine as a way to contrast the still evident modern medicine reductionism. The evidence coming from biological, psychological, and social science, merging in biopsychosocial (or psychosomatic) integrated view in medicine, is also discussed. Although the term psychosomatic can be misleading, since, as Alexander underlined in the first issue of the journal Psychosomatic Medicine in 1939, it may imply dichotomy between psyche and body (soma). If however we understand psychic phenomena as nothing but the subjective aspect of certain bodily (brain) processes, this dichotomy disappears, becoming medicine of the whole person, away from scientistic reductionism and toward the embrace of the complex in clinical practice