When I mentioned signing up for my next degree soon, I complained to someone that it’d be time to go back to arguing about the ‘biopsychosocial’ model of mental health. They asked what exactly my problem with it is, and suggested this as a good platform. Here goes!
So the biopsychosocial model of mental health is one that suggests that there are multiple factors at work in any mental illness: the biological, the social, and the psychological. It’s a holistic view, and if you know me a little, you’d think I’d be jumping at that. I do think it’s undeniable that factors of all kinds are at work in any individual when they’re mentally ill: it’s never just a deficit of serotonin, and it’s never just a poor work environment. Other factors impact those, reinforce them and are reinforced by them. I have absolutely no arguments with that aspect of the biopsychosocial model, in fact! Taken at face value, it reminds us that these factors are all there.
However, there are definitely problems with it and this is where it really drove me bananas during my degree. For example, some people are born with a short gene for serotonin, which (to cut a long story short) can lead to serotonin deficits. Right! That’s a biological factor. Job done.
Turns out it’s more complicated than that. Many people with that gene have no issue at all. Turns out that you only have issues when you’re also abused or subjected to some other massive trauma when you’re young. If you aren’t, you remain as versatile in your response to trauma as any other person; it’s only if you have that history of abuse that the issue is triggered. Ah! It’s psychological then.
My problem, then, with the biopsychosocial model, is that it often leads to people spending waaaaaay too much time worrying about classifying where exactly something falls in the biopsychosocial model, and it can also lead to people privileging parts of the model over others despite the fact that it is, on the surface, holistic. And this is important because if a medical professional is choosing someone’s treatment based on the biopsychosocial model and they think the biological aspect is the most important, they’ll prescribe SSRIs for someone with the short gene, viewing that as the source of all the problems. If they think the history of trauma is more important, they’ll withhold antidepressants and focus on appropriate therapy.
It’s fine, to my mind, as a reminder of all the different factors that inform mental illness. It does not go far enough, though. I am convinced that the social and the psychological are not separate from the biological: the model treats them as separate-but-linked, but I think they are all symptoms of the same thing. A “psychological” (as defined under the biopsychosocial model) event changes your brain chemistry and becomes biological[, and biological therapies should thus be considered in treatment, in my view].
Needless to say, my marker did not enjoy me refusing to separate things into these categories, or disagreeing with her on her classifications when I dutifully went along and pretended to believe there is any psychology not rooted in biology. [For example, she expected me to consider the issue of someone with a short serotonin gene and a history of trauma to be an entirely psychological one, and I lost marks for stating that it was both psychological and biological. These separations simply are not useful.]
The biopsychosocial model is a tool for understanding mental health, perhaps — a way of demonstrating that a holistic model is necessary, because within the model’s limits it is easy to demonstrate that these factors are interdependent — but it shouldn’t be a box we can’t see out of. And for heaven’s sake, stop trying to convince me there is some free-floating “psychology” that does not have a physical explanation unless you can bring me data, which right now (to my knowledge) no one has.
I bet my mother, a practising psychiatrist, is gonna turn up in the comments. I’m 50/50 on whether she’ll think I’ve torn enough holes in the biopsychosocial model, despite her commitment to holistically caring for her patients (insofar as the NHS makes that possible)… Do let me know, Mum.
[Edited 06/11/2019 to slightly clarify some sentences.]