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(More customer reviews)The Rise and Fall of the Biopsychosocial Model is Dr. Ghaemi's brave and impassioned attempt to meaningfully distinguish the Biopsychosocial (BPS) Model from the Perspectives on historic and philosophical grounds. After my own Hopkins psychiatry residency training, having read McHugh & Slavney's book, "The Perspectives" cover-to-cover at least six times, it still remained unclear how the two diagnostic approaches differed in theory and in practice. Ghaemi's book succeeds, much like a 17th Century Rembrandt group portraiture, to put all those distinguished historic characters, seated or standing, in period costume within the same shadowy-lit room. Accordingly, the philosophical leanings, ulterior motives, and professed intentions of key contributors of each model are sketched and colored by Ghaemi's detailed interpretation of their work captured in it's timeframe. Still after this skillful exercise in argumentation, this reader felt the author had somehow missed the central dilemma and, consequently, the direction towards meaningful resolution.
The reality of psychiatry today is that individuals trained in either of these approaches are not meaningfully different appearing from each other in practice. Competent psychiatric practitioners from both camps compassionately collect similar data regarding the individual's life story, family history, disease history, and descriptions of recent behavior. Following from this process, neither the Biopsychosocial Model or the Perspectives offer a firm and reproducible methodology for connecting the dots or assigning value to those connections derive the essential 'meaning' or reframe a patient's view of themselves in the world in a manner that leads to greater personal effectiveness. Debates of whether a particularly difficult case was bipolar I or a borderline personality, whether they are suffering from major depression or a dependent personality, would not be informed by either model, as practitioners were arguing by which factoids were deemed more consequential.
Only the few inspired practitioners can craft and communicate a view both persuasive and capable of durable healing, which most likely results in the modulation of the weighted connections within the cortical network of the patient. Institutions, like Johns Hopkins Hospital, despite having the Perspectives and entrance processes which guarantee a population of bright individuals, the residency process yields variable results regarding psychiatric skills. The immersion in "The Perspectives" does not guarantee that there will be some who remain more influenced by their own penchants and prejudices than by their connection with the patient. There is still much that is required to conceive of a good psychiatrist than whether they are of a biopsychosocial or `perspectives' orientation.
Regarding a psychiatrist's academic preparation, the author exalts the importance of a cultural literacy. Ghaemi celebrates his recollection of some obscure latin term raised to consciousness by both a patient's challenge and the author's own pride in a certain erudition. But psychiatry has a generous share of individuals whose skewed interpretation of literature, to their patient's disadvantage, is inappropriately applied. Oral histories or works of literature have an ephemeral capacity of capturing life's multidimensionality or wisdom. Spoken language, however, is linear with limited capability to depict accurately the relative valuation of objects within a particular frame of reference. Thus, whereas for one patient their tattoos are an aspect of their antisocial personality, for another tattoos might represent exactly the opposite, as the culture they belong to may see a tattoo as representing high social standing. Neither The Perspectives or the Biopsychosocial model is sufficiently detailed to provide direction as to how much data is sufficient to make meaningful conclusions or what to conclude through the process of giving each detail it's appropriate weight in the greater context.
Where literature may attempt to represent the relative valuation of nodes within a complex network of objects, mathematics can be the embodiment of a poetry of precision. Though the author makes short shrift of parallel processing, chaos, nonlinear [making mention in a single line of these milestones of modern thinking] it will be neuroscience and systems theory which will lead to improved models with greater consistency in conceptualization and treatment of our psychiatric patients.
Anyone reading this book will tire by the third chapter's end of hearing the author repetitiously dismiss the Biopsychosocial model as dogmatic and eclecticism. But you would have several chapters more to hear the chant repeated to what end but to inculcate it's value in the unwary. In practice, despite the glowing terms used for "the Perspectives" approach, the practitioner's interpretation of what is salient in the data can be just as dogmatic or reflective of eclecticism ... or elitism by either approach. For all this book's richness in recounting history, reciting from fundamental psychiatric tomes, and his philosophic argumentation, although the underlying intentions of the writers of each view may have differed, the ends in either BPS model or the Perspectives, seem as valuable and incomplete. Good psychiatry remains the marriage of science and art embodied in the practices of a talented few.
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This is the first book-length historical critique of psychiatry's mainstream ideology, the biopsychosocial (BPS) model. Developed in the twentieth century as an outgrowth of psychosomatic medicine, the biopsychosocial model is seen as an antidote to the constraints of the medical model of psychiatry. Nassir Ghaemi details the origins and evolution of the BPS model and explains how, where, and why it fails to live up to its promises. He analyzes the works of its founders, George Engel and Roy Grinker Sr., traces its rise in acceptance, and discusses its relation to the thought of William Osler and Karl Jaspers. In assessing the biopsychosocial model, Ghaemi provides a philosophically grounded evaluation of the concept of mental illness and the relation between evidence-based medicine and psychiatry. He argues that psychiatry's conceptual core is eclecticism, which in the face of too much freedom paradoxically leads many of its adherents to enact their own dogmas. Throughout, he makes the case for a new paradigm of medical humanism and method-based psychiatry that is consistent with modern science while incorporating humanistic aspects of the art of medicine.Ghaemi shows how the historical role of the BPS model as a reaction to biomedical reductionism is coming to an end and urges colleagues in the field to embrace other, less-eclectic perspectives. (May 2010)
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