The Postmodern Assumptions of the Biopsychosocial Approach

“If PM [postmodernism] is accepted, there are two options: nothing is true-nihilism; or anything can be true-eclecticism.”

This commentary by Dr. S. Nassir Ghaemi has been published in Psychiatric Times. It begins:

“I appreciate my friend Dr Ron Pies’ thoughtful essay,Can We Salvage the Biopsychosocial Model? A Reformulated Biopsychosocial Paradigm Can Be Clinically Useful, where he accepts some of my central criticisms of the biopsychosocial (BPS) model. However, I think the problem goes beyond the issue of whether it was a model in a scientific sense, as opposed to a more general approach to a worldview.

The key problem, if I were to simplify it in one sentence, is that the BPS model for the past half century has served as a postmodernist excuse for eclecticism.2 Let me explain this sentence.

The first half of the sentence:

The BPS of the past half century is not the same BPS of George Engel in 1977, or for that matter Roy Grinker of 1954, when the term was first coined. Grinker and Engel were psychoanalysts who specialized in ‘psychosomatic medicine,’ which meant finding unconscious emotional causes for medical diseases. Engel was a gastroenterologist who specialized in ulcerative colitis and worked on a consultation-liaison psychiatry service. In the 1950s and 1960s, their views were mainstream. Psychiatry was highly psychoanalytic so it accepted the idea that unconscious psychology affected the body to cause disease. By the 1970s, the rise of the new psychiatric drugs was pushing the field in a biological direction, and by the 1980,s psychoanalysis was in full retreat, at least in the halls of psychiatric power (chairmen of departments, funding, organizational leaders). Engel and Grinker were nearing the end of their careers, and Engel’s famous 1977 paper3 was a cri de couer to turn the clock back to 1957. He was, essentially, seeking to preserve a place for psychoanalytic ideas in medicine …”

You can read more from here.

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