Abstract
The biopsychosocial (BPS) model has been of considerable utility to those researching health and illness. This has been particularly the case for critical realists and those with a systemic orientation to their work. Whilst the strengths of the model are conceded in this article, its limitations are also examined. These relate to its ontological sophistication being compromised by its proneness to epistemological naivety. It is a model to explain the emergence of disease and disability, not a reflexive theory applicable to the whole field of health research. This tension is linked to the emergence of a re-orientation of medical knowledge away from bio-medical reductionism. From the outset the model was not about a general critique, or a grand theory, of health and illness. Instead it was a useful intervention, on the part of medical practitioners, like George Engel and Adolf Meyer, to create a reformed medical model on behalf of their profession. Case studies of the problematics of diagnosis and medicalization are offered to illuminate the limitations of the BPS model for health researchers.
Notes
Elder-Vass, D. 2012. The Reality of Social Construction. Cambridge: Cambridge University Press. Scambler, G., and Scambler S., eds. 2010. ‘New Directions in the Sociology of Chronic and Disabling Conditions’. Basingstoke: Palgrave. Higgs, P., Jones J. R., and Scambler G.. 2004. ‘Class as Variable, Class as Generative Mechanism: The Importance of Critical Realism for the Sociology of Health Inequalities’. In Making Realism Work: Realist Theory and Empirical Research, eds Carter B. and New C., 52–63. London: Routledge. Williams, S. 1999. ‘Is Anybody There? Critical Realism, Chronic Illness and the Disability Debate’. Sociology of Health and Illness 21: 797–819. Kelly, M. P., and Field D.. 1996. ‘Medical Sociology, Chronic Illness and the Body’. Sociology of Health & Illness 18(2): 241–57. Benton, T. 1991. ‘Biology and Social Science: Why the Return of the Repressed Should be Given a (Cautious) Welcome’. Sociology 25(1): 63–8. Alexander, S. [1914] 1960. ‘The Basis of Realism’. In Proceedings of the British Academy. Reprinted in Realism and the Background in Phenomenology, edited by Chisholm D., 43–60. Glencoe: Free Press. Wolman, B. B. 1981. Contemporary Theories and Systems in Psychology. New York: Free Press. Axelrod, R. A., and Cohen M. D.. 2000. Harnessing Complexity: Organizational Implications of a Scientific Frontier. New York: The Free Press. Walby, S. 2007. ‘Complexity Theory, Systems Theory and MultipleIntersecting Social Inequalities’. Philosophy of the Social Sciences 37(4): 449–70. Petticrew, M. 2011. ‘When are Complex Interventions ‘Complex’? When are Simple Interventions ‘Simple’?’. European Journal of Public Health 21(4): 397–8. Bhaskar, R., and Danermark B.. 2006. ‘Metatheory, Interdisciplinarity and Disability Research: A Critical Realist Perspective’. Scandinavian Journal of Disability Research 4: 278–97. Brown, T. M., and Fee E.. 2006. ‘Rudolf Carl Virchow’. American Journal of Public Health 96(12): 2104–5. Illich, I. 1976. Medical Nemesis. London: Marion Boyars. Bertalanffy, L. von. 1969. General System Theory: Foundations, Development, Applications. New York: Braziller. Mingers, J. 2011. ‘The Contribution of Systemic Thought to Critical Realism’. Journal of Critical Realism 10(3): 303–30. Pilgrim, D. 2015. Understanding Mental Health: A Critical Realist Exploration. London: Routledge. Bateson, G. 1980. Mind and Nature: A Necessary Unity. New York: Bantam. Wilden, A. 1972. System and Structure: Essays in Communication and Exchange. London: Tavistock. Offe, C. 1993. Structural Contradictions of the Welfare State. Cambridge: MIT Press. Ashton, J. and Seymour H.. 1988. The New Public Health. Milton Keynes: Open University Press. Dahlgren, G., and Whitehead M.. 1992. Policies and Strategies to Promote Equity in Health. Stockholm: Institute of Futures Studies. Engel, G. 1977. ‘The Need for a New Medical Model: A Challenge for Biomedicine’. Science 196(4286): 129–36. Meyer, A. 1952. The Collected Works of Adolf Meyer. New York: Basic Books. Engel, G. 1977. ‘The Need for a New Medical Model: A Challenge for Biomedicine’. Science 196(4286): 129–36. Pilgrim, D. 2007. ‘The Survival of Psychiatric Diagnosis’. Social Science & Medicine 65(3): 536–44. Healy, D. 1997. The Anti-Depressant Era. London: Harvard University Press. Sedgwick, P. 1982. PsychoPolitics. London: Pluto Press. Parsons, T. 1951. ‘Illness and the Role of the Physician: A Sociological Perspective’. American Journal of Orthopsychiatry 21: 452–60. Goffman, E. 1961. Asylums. New York: Anchor. Libow, J. A. 1995. ‘Munchausen by Proxy Victims in Adulthood: A First Look’. Child Abuse and Neglect 19(9): 1131–42. Seligman, M. E. P. 1975. Helplessness: On Depression, Development and Death. San Francisco: Freeman. Scott, J., and Dickey B.. 2003. ‘Global Burden of Depression: The Intersection of Culture and Medicine’. British Journal of Psychiatry 183: 92–4. Ioannidis, J. P. A. 2008. ‘Effectiveness of Anti-depressants: An Evidence Myth Constructed from a Thousand Randomized Trials?’. Philosophy, Ethics and Humanities in Medicine 3(14) Kramer, P. 1993. Listening to Prozac. New York: Viking. Breggin, P., and Breggin G.. 1994. Talking Back to Prozac. New York: St Martin's Press. Herzberg, D. 2009. Happy Pills in America: From Miltown to Prozac. Baltimore: Johns Hopkins University Press. Whitaker, R. 2005. ‘Anatomy of an Epidemic: Psychiatric Drugs and the Astonishing Rise of Mental Illness in America’. Ethical Human Psychology and Psychiatry 7: 23–35. Greenberg, P. E., Kessler R. C., Birnbaum H. G., et al., 2003. ‘The Economic Burden of Depression in the United States: How Did it Change between 1990 and 2000?’. Journal of Clinical Psychiatry 64: 1465–75. Lakoff, A. 2005. Pharmaceutical Reason: Knowledge and Values in Global Psychiatry. Cambridge: Cambridge University Press. Wittchen, H., Jacobi F., et al., 2010. ‘The Size and Burden of Mental Disorders and Other Disorders of the Brain in Europe 2010’. European Neuropsychopharmacology 21(9): 655–79. Layard, R., Bell S., Clark D. M., Knapp M., Meacher M., and Priebe S.. 2006. ‘The Depression Report: A New Deal for Depression and Anxiety Disorders’. London School of Economics Centre for Economic Performance Report. http://cep.lse.ac.uk. Garcia-Toro, M., and Auirre I.. 2007. ‘Biopsychosocial Model in Depression’. Medical Hypotheses 68(3): 683–91. Read, J. 2005. ‘The Bio-bio-bio Model of Madness’. The Psychologist 18(40): 596–7. Fromm, E. 1955. The Sane Society. New York: Holt, Rinehart and Winston. Wakefield, J. 2011. ‘Should Uncomplicated Bereavement Related Depression be Reclassified as a Disorder in DSM-5: Response to Kenneth S. Kendler's Statement Defending the Proposal to Eliminate the Bereavement Exclusion’. Journal of Nervous and Mental Disease 199(3): 203–8. Ahmed, S. 2010. The Pursuit of Happiness. London: Duke University Press. Pilgrim, D. 2015. Understanding Mental Health: A Critical Realist Exploration. London: Routledge. Moynihan, R., Cooke G. P. E., Doust J. A., Bero L., Hill S., and Gasciou P. P.. 2013. ‘Expanding Disease Definitions in Guidelines and Expert Panel Ties to Industry: A Cross-sectional Study of Common Conditions in the United States’. PLOS Medicine 10(8): e1001500. Smith, R. 2002. ‘In Search of ‘Non-disease’’. British Medical Journal 324: 883–5. Clarke, A. E., Mamo L., Fishman J. R., Shim J. K., and Fosket J. R.. 2003. ‘Biomedicalization: Technocentric Transformations of Health and Illness, and US Biomedicine’. American Sociological Review 68: 161–98. Zola, K. 1972. ‘Medicine as an Agent of Social Control’. Sociological Review 20(4): 487–504. Conrad, P. 2007. The Medicalization of Society: On the Transformation of Human Conditions into Treatable Conditions. Baltimore: John Hopkins University. Angell, M. 2004. The Truth about the Drug Companies: How They Deceive Us and What to Do about It. New York: Random House. Moynihan, R., and Cassels A.. 2005. Selling Sickness: How the World's Biggest Pharmaceutical Companies are Turning Us All into Patients. New York: Nation Books. Bhaskar, R., and Danermark B.. 2006. ‘Metatheory, Interdisciplinarity and Disability Research: A Critical Realist Perspective’. Scandinavian Journal of Disability Research 4: 278–97. Ghaemi, N. 2009. ‘The Rise and Fall of the Biopsychosocial Model’. British Journal of Psychiatry 195: 3–4. Bhaskar, R. [1975] 1997. A Realist Theory of Science. London: Verso. Additional information
Notes on contributors
David Pilgrim
David Pilgrim is Professor of Health and Social Policy at the University of Liverpool. His career has been divided between working as a clinical psychologist in the British NHS and researching and writing about mental health policy and the history of psychiatry and clinical psychology.
Correspondence to: David Pilgrim, School of Law and Social Justice, Eleanor Rathbone Building, Liverpool L69 7ZA. Email: [email protected]
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