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

S. Nassir Ghaemi: The Rise and Fall of the Biopsychosocial Model: Reconciling Art & Science in Psychiatry. Baltimore: The John Hopkins Press, 2010, 253 pp., $50.00, ISBN 978-0-8018-9390-2.

In The Rise and Fall of the Biopsychosocial Model: Reconciling Art & Science in Psychiatry, S. Nassir Ghaemi offers a historical analysis of psychiatry’s conventional philosophy, the biopsychosocial (BPS) model. Reporting from his own critique and archival research, Ghaemi suggests there is an alternative to the BPS model, that of medical humanism, based on the work of Olser and Jaspers. This new methods-based psychiatric perspective is driven by the German word verstehen, which implies having a meaningful understanding. As a result, the discussion of this new perspective as well as the “ins and outs” of the BPS model is analyzed within three parts of this book: (1) the rise of the biopsychosocial model, (2) the fall of the biopsychosocial model, and (3) the methods-based approach.

The first part of the book draws the reader’s attention to the historical foundation of Adolf Meyer’s psychobiology and the eclectic approach of psychotherapy. Three different types of eclecticism are discussed: (1) the mixing of different types of theories (e.g., cognitive-behavioral and existential), (2) the integration of methods, and (3) evidence-based medicine or empirical eclecticism. All three types of approaches seem to have some problems, as Ghaemi explains. The first issue involves determining which theories to choose and how to combine them. As Ghaemi points out “there are over one hundred schools of psychotherapy, for instance, the number of possible combinations is endless. Such eclecticism borders on anarchy (p. 15).” The second approach involves the absence of science. For example, it ignores the theoretical perspective and solely relies on mixing methods or blending interventions. The third approach of empirical eclecticism focuses on the question: how does a psychiatrist settle on a strategy to explain a particular phenomenon with all the different theories to choose from? In contrast, the last part of this section talks about George Engel, the creator of the BPS model as well as aspects of the Diagnostic and Statistical Manual (DSM), and the controversy regarding psychopharmacology. Essentially, part one is laid-out in a straightforward and easily comprehensible format that offers a thought-provoking discussion.

The second part of this book brings attention to the flaws of the BPS model. In particular, its eclecticism, policy making, hypothetically a blueprint for research, and not being fully complete. On the other hand, the third part discusses the need for the psychiatric field to move forward with a new perspective encompassed around a methods-based approach. Here, Ghaemi carefully provides the reader with a rationale of why the BPS model needs to be addressed into a more holistic and comprehensive model involving methods-based psychiatry. Within the second and third sections of the book, Ghaemi goes into much depth regarding the issues surrounding the current BPS model. In particular, he describes why it has not been working for the past two decades and what can be done at the current moment. These two sections provide a quick read, and, on the whole, provide insightful information.

Overall, this book is primarily geared towards psychiatrists, psychiatric residents, physicians, and other medical professionals. Some key features include (a) an afterward describing the authors view of how the BPS was never a scientific model but rather a slogan whose fundamental basis was eclecticism; (b) an appendix on a proposal for the education of psychiatrists and physicians; (c) notes relevant to the discussions of the book that provides a more in-depth analysis, and (d) a brief glossary of concepts. The book is arranged in a clear and concise way so that information can be easily found. The author has met his underlying objective of introducing the reader to an alternative of the BPS model with providing an overview of how the BPS model was started and where the psychiatric/medical field could be better off today.