The Rise and Fall of the Biopsychosocial Model: Reconciling Art and science in Psychiatry

摘要

Ghaemi's book substantiates my perception that the vast majority of American psychiatrists never access scientific research emanating from Europe. Ghaemi's aim is to trace the origins of the biopsychosocial model, which, he asserts in his preface, 'rose from the ashes of psychoanalysis and is dying on the shoals of neurobiology'. He demonstrates convincingly that Roy Grinker, who was in analysis with Freud, introduced the term 'biopsychosocial' years before it was used by George Engel, to whom it is usually attributed. He identifies the main source of the model as psychosomatic medicine and the psychoanalytic community, whose passing he certainly does not mourn. He reminds the reader that for decades.one could not be a chairman of a department of psychiatry in the USA without being a psychoanalyst. This position of power enabled the analysts to promote the biopsycho-social model, which Ghaemi criticises for being so broad and eclectic that it could not stimulate the development of focused treatments or useful research. On the other hand, he is conscious of the limitations of a purely neurobiological approach. His solution is breathtaking: to combine the method-based epistemology of Jaspers with a thorough grounding in poetry and literature. A quote will convey the flavour of his synthesis: 'One takes a biologically reductionist model of disease and applies it where appropriate, but always with a humanistic awareness of the person, the individual, who has the disease ... This humanism is individual and existential; it is not captured by another scientific discipline (like psychology or sociology) tacked onto the discipline of biology' (p. 209).