Abstract

In lieu of an abstract, here is a brief excerpt of the content:Psychiatric Practice and the Living Force of the Social in the BiopsychosocialGeorge Ikkos, BSc, FRCPsych (bio) and Giovanni Stanghellini, MD, DPhil (HC) (bio)One of the handful of universally acknowledged founders of his discipline, sociologist Emile Durkheim (1857–1917; see Fournier, 2013) is best known to psychiatrists for his seminal “Suicide: A Study in Sociology” (1897/2002). Arguably, he should have been at least as well known for his last completed work “The Elementary Forms of Religious Life” (1912/1995), the best book of sociology ever written according to some (Bellah, 1995). In this magisterial work, through a comprehensive survey of the anthropological evidence available at the time and fine conceptual analysis, Durkheim came to define from a strictly secular perspective phenomena such as the sacred and the profane, soul and magic, but also “mana” (a penetrating and connecting force) and collective “effervescence” (wild gesticulating, copulating, or aggressing when aboriginal family groups came together). The last two concepts can help us to understand the origin and persistence of the living force of the social in our daily experience, that is, what it is, what it feels like and how it plays itself out in relationships (Ikkos & McQueen, 2019). Although he makes no reference to Durkheim, nor to mana nor effervescence, social anthropologist Ongaro’s welcome ambition is to lift the social out of the shadow of the dominating bio- and psychological in the use of the biopsychosocial model and, thus, bring it to bear as an immediately experienced and enacted living force akin to mana and effervescence in contemporary psychiatric practice.In this commentary, we first review issues relating to the biopsychosocial model, Ongaro’s externalist foundations, and predictive processing and functional neurological, somatic and mental symptoms. We then discuss our formulation of contemporary anorexia nervosa and hysteria as examples of our attempts at enhanced engagement with the social. We conclude by suggesting the work of social historian and cultural critic Walter Benjamin (1892–1940) as a vital resource for better engagement with the social in biopsychosocial practice in the future. [End Page 325]The Biopsychosocial ModelMany find that in current practice the biopsycho-social model is simply the biomedical cloaked in another name (Mohtashemi et al., 2016). Those most expert in it acknowledge doubts about what it is exactly (Bolton, 2022). Most would agree with Ongaro and Williamson that though not yet dead, if it is to survive as a clinical force in practice, it needs clarification and revival (Williamson, 2022). Bolton suggests that “we can make use of the term ‘biopsychosocial model’ as a shorthand for methodological assumptions that causes and/or cures of specific conditions at specific stages, including matters of adjustment and quality of life, will generally—across a wide range of conditions—include biological, psychological and social factors, and interactions between them. The contrast here is with the ‘biomedical model’, which deals with biological factors only” (Bolton, 2022). Bolton then discusses the utility and advantages of his definition of the model specifically in relation to research on the social determinants of disease and on pain. That is fine, as far as it goes, that is, research methodology and clinical theory. Ongaro, however, wants to ensure that the social is understood as a more immediately experienced and directly enacted force in clinical encounters. To achieve his aim, he argues, we need a more balanced and persuasive integration of all three components of the model: bio-psycho-social. In effect what he proposes is to vitalize psychiatry with something related to Durkheim’s ideas of mana and effervescence.Externalist FoundationsIn his first paper, Ongaro argues that he can partly achieve his aims by using the tools provided by our contemporary neuroscience research on “predictive processing” and philosophical theories of “enactivism” (Ongaro, 2024a). In his second paper he reports on his anthropological experience of living for 19 months with the Akha, a group of swidden farmers in highland Laos. Here he investigated how they respond to functional neurological disorders (FNDs), functional somatic symptoms (FSS) (Burton et al., 2020), also to what Western medicine defines as (functional) mental disorders (FMDs) and what the Akha and he sometimes conceive as spiritual...