According to the biopsychosocial model, developed by the late Dr. George Engel, how physicians approach patients and the problems they present is very much ...

Important philosophical work has gone into debunking thoroughly entrenched positivist notions that objective science proceeds in a value neutral manner. Dr. Tamara Kayali Browne's article "A Role for Philosophers, Sociologists, and Bioethicists in Revising the DSM" admirably takes the next step. Given the evaluative elements that permeate, in this case, the science of nosology—how do we deal responsibly with those evaluative elements? She correctly, in my opinion, concludes that dealing with evaluative issues responsibly is tantamount to dealing with them ethically. (...) But, as her concrete example of the ethics of premenstrual dysphoric disorder demonstrates, dealing with the ethics of the science of... (shrink)

Aggression and Its Causes explores the causes and control of aggression from a broad scientific perspective, offering many recent findings on aggression and integrating several perspectives often viewed as incompatible. Its balanced approach combines biological, environmental, and social components to illustrate how these bases contribute to the problems of aggression. The biological section describes the possible contributions of genetic mechanisms, gender, and sexual hormones, including investigations of the premenstrual syndrome. There is also a discussion of the roles that brain (...) mechanisms may play in aggressive behavior, as well as the problems with human brain dysfunction and drug use. The environmental section describes stimuli and environmental conditions that may produce aggression, and the effects of conditioning and learning. Finally, social psychological factors are described, along with the media's effect on aggression. The author covers various applied areas of special contemporary concern, such as juvenile delinquency, sexual and physical abuse of children, spousal abuse, and rape, concluding with a final chapter that discusses various psychiatric disorders that may involve aggression. Appropriate for upper-level undergraduates in psychology, sociology, social work, criminal justice, and education, and for professionals who encounter aggression, this text offers an excellent basis for understanding the causes of aggression and many ideas for how it may be controlled. (shrink)

The biopsychosocial model was initially proposed to overcome the normative assumption that human diseases are exclusively due to disordered biochemical and/or neurophysiological processes. The model attempts to explain how expectations, thoughts and feelings modify the patient’s motivations to deal with illness and recovery. By considering the physical health in this perspective, healthcare professionals may test the importance of socially and culturally shared principles in alleviating illness experience. The entire biopsychosocial hierarchy may thus appear as a complex network of relationships between (...) the strict logic of scientific explanations and the emotional sustainability with which beliefs may either be defended, changed or even refused. In this paper, we aim at reviewing some of the evidence-based biomedical and psychological findings that provide a unified framework for the biopsychosocial model as a multilevel integrative process. To tackle this objective, we propose to approach the model in biosemiotic terms. It is our contention that the entire biopsychosocial hierarchy could be better understood if approached biosemiotically and the multilevel interconnection of this hierarchy re-examined in the light of a collaborative meaning-making process. (shrink)

The for addiction proposed by Redish and colleagues is only unified at a reductionist level of analysis, the biological one relating to decision-making. Theories of addiction may be complementary rather than mutually exclusive, suggesting that limitations of individual theories might be unified through the combination of ideas from different biopsychosocial systems perspectives.

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when considering (...) pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

Psychiatry uncomfortably spans biological and psychosocial perspectives on mental illness, an idea central to Engel's biopsychosocial paradigm. This paradigm was extremely ambitious, proposing new foundations for clinical practice as well as a non-reductive metaphysics for mental illness. Perhaps given this scope, the approach has failed to engender a clearly identifiable research programme. And yet the view remains influential. We reassess the relevance of the biopsychosocial paradigm for psychiatry, distinguishing a number of ways in which it could be (re)conceived.

The original article unfortunately contains error in footnote 2 due to its double entry and interchanged figures 1 and 2.

I respond to the 4 commentaries by Awais Aftab & Kristopher Nielsen, Hane Htut Maung, Diane O’Leary and Kathryn Tabb under 3 main headings: “What is the BPSM really?” & Why update it?; “Is our approach foundationally compromised?”, and finally, “Antagonists or fellow travellers?”.

BackgroundCo-creation allows to develop tailored interventions in chronicity and to increase patients’ engagement. Considering the interacting nature of physical, psychological, and social domains in multiple sclerosis, a biopsychosocial approach to care is crucial.AimsThis paper aims to present an example of a co-creation process in the context of chronic diseases preferences and perspectives of young adults with multiple sclerosis and healthcare professionals on the relevance, objectives, and modalities of a biopsychosocial intervention and on strategies/barriers to participation.MethodsA participatory mixed-method approach (...) in three consecutive steps was implemented: online surveys with YawMS and HCPs, online focus groups with YawMS, consultation with an advisory board composed by YawMS, HCPs and researchers. For the survey, descriptive statistics and inductive content analysis have been used for quantitative and qualitative analysis, respectively. FGs and AB were used to deepen the understanding of the survey’s results.ResultsAn integrated intervention is extremely relevant according to the perspectives of the main stakeholders. Helping disease acceptance, providing stress management strategies, and supporting emotional expression emerged as the most relevant psychological objectives according to participants. Having tangible benefits, being tailored, and fostering interpersonal relationships emerged as the main preferred characteristics of physical activity. Preferences emerged on the modalities and timing of the intervention, with a venue unrelated to the disease strongly supported. Both HCPs and YawMS highlighted as the most valuable advantages of conducting the intervention online the increased accessibility, while the main limit was the restriction to social interaction. Accessibility and lack of time resulted as the main barriers to participation.ConclusionThe co-creation process gave valuable information on preferences and perspectives of main stakeholders on objectives, modalities, and strategies to improve participation which has been used in the design of the ESPRIMO biopsychosocial intervention. Those results might inform future intervention development in the field of chronicity. The current paper outlined a co-creation methodology which might be replicated in future research on other conditions of vulnerability. (shrink)

Evidence-Based Medicine has little consideration for mechanisms and philosophers of science and medicine have recently made pleas to increase the place of mechanisms in the medical evidence hierarchy. However, in this debate the notions of mechanisms seem to be limited to 'mechanistic processes' and 'complex-systems mechanisms,' understood as 'componential causal systems'. I believe that this will not do full justice to how mechanisms are used in biological, psychological and social sciences and, consequently, in a more biopsychosocial approach to medicine. (...) Here, I propose, following (Kuorikoski, 2009), to pay more attention to 'abstract forms of interaction' mechanisms. The present work scrutinized review articles on depression and medically unexplained pain, which are considered to be of multifactorial pathogenesis, for their use of mechanisms. In review articles on these disorders there seemed to be a range of uses between more 'abstract forms of interaction' and 'componential causal system' mechanisms. I therefore propose to expand the notions of mechanisms considered in medicine to include that of more 'abstract forms of interaction' to better explain and manage biopsychosocial disorders. (shrink)

The biopsychosocial model is characterized by the systematic consideration of biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. This model opposes the biomedical model, which is the foundation of most current clinical practice. In the biomedical model, quest for evidence based medicine, the patient is reduced to molecules, genes, organelles, systems, diseases, etc. This reduction has brought great advances in medicine, but it lacks a holistic view of the person. To solve (...) the problem, we propose an early team based approach where the primary care physician leads a group of people that can help her/him address the psychosocial issues while she/he attends to the biomedical issues. This article addresses one case where the clinical ethicist facilitating a team based biopsychosocial model for the care of a patient worked as a bridge between the primary team, the critical care team, and the psychosocial team to advance the argument that good communication among the groups can lead to a true biopsychosocial model where the collaboration of the social worker, psychologist, chaplain, ethicist and the different medical teams can improve the overall patient experience. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Integrating the Parts of the Biopsychosocial ModelMichael A. Westerman (bio)Keywordsbiopsychosocial approach, pragmatism, participatory framework, functionalist accounts, mind-body-behavior integrationEngel’s (1977, 1980) call for replacing the biomedical model with his biopsychosocial approach pointed in the right direction. Bradley Lewis recognizes this, but argues that Engel’s framework does not provide us with everything we need to develop the biopsychosocial approach. Lewis attempts to add what is missing by reinterpreting (...) Engel as a pragmatist. As I see it, he is on the right track. We need to add something more to Engel’s position, and Lewis’s reinterpretation is an intriguing attempt to respond to this need. Nevertheless, I believe Lewis’s article only takes us so far. Something is still missing. In what follows, I identify what is missing, make suggestions about additional steps we can take to remedy the situation, and raise the possibility that pragmatism can be helpful in this venture in ways that Lewis does not consider.It should come as no surprise that it will take a lot to accomplish Engel’s objectives, because those goals are extremely ambitious. For one thing, Engel offered his biopsychosocial model as an alternative framework for all of medicine, not just psychiatry. Furthermore, he believed that it was not enough to augment the technological focus of the biomedical model by simply tacking onto it more humane concern with the patient as a person and more attention to the patient–physician relationship (although he certainly advocated changes along those lines). Engel maintained that psychosocial factors play an intrinsic role in the etiology of disease, its assessment, and treatment. He based his biopsychosocial model on general systems theory because he believed that it provides a framework for dealing with disease in a way that reflects this view.This is where Lewis enters the arena. He endorses Engel’s goal of developing a biopsychosocial approach to medicine and psychiatry, but he takes issue with Engel’s belief that we can reach this goal by following along the lines of general systems theory. Indeed, he claims that Engel’s biopsychosocial model was “doomed from the start” because of this idea. At a later point, I will turn to Lewis’s arguments against employing a systems theory framework. I first consider what Lewis proposes we bring to the biopsychosocial endeavor in its place.Lewis argues that pragmatism can get us where we want to go and that it makes sense to reinterpret Engel as a pragmatist because there [End Page 321] are a number of noteworthy similarities between pragmatism and Engel’s work. First, Lewis points out that both Engel and the pragmatists believed that inquiry should start with real problems, that is, with something that is not working. Another similarity is that, like the pragmatists, Engel believed that it is important to be aware of the impact theories and philosophical perspectives have on the ways we deal with problems, even though their influence may not be readily apparent. The third similarity Lewis points to is that even though Engel at times justifies beliefs by taking recourse to idealized notions about “The Method” of science (which, Lewis notes, parallels Peirce’s own early idealization of science), Engel ends up holding the pragmatists’ view that the justification of beliefs rests on their usefulness. Finally, Lewis argues that Engel and the pragmatists (in particular, Dewey) have similar views of nature, or the world, in that they believe nature can be characterized by a hierarchy of “levels” (Engel) or “plateaus” (Dewey).What do we gain from lewis’s reinterpretation?There is a lot to recommend this new reading of Engel. I agree with Lewis that Engel did not provide us with all the tools we need for developing his biopsychosocial approach. I also think that Lewis is right when he asserts that, in particular, we have to place Engel’s ideas about the biopsychosocial model in the context of a richer philosophical perspective. In addition, Lewis has identified a number of interesting similarities between Engel’s work and pragmatism. Hence, there is a basis for reinterpreting him as a pragmatist—and, in my opinion, this brings in a philosophical perspective that does indeed... (shrink)

How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. CiteULike Connotea Del.icio.us What's this?

The biopsychosocial (BPS) model in psychiatry has come under fire for being too vague to be of any practical use in the clinic. For many, its central flaw consists in lack of scientific validity and philosophical coherence: the model never specified how biological, psychological and social factors causally integrate with one another. Recently, advances in the cognitive sciences have made great strides towards meeting this very ‘integration challenge.’ The paper begins by illustrating how enactivist and predictive processing frameworks propose converging (...) accounts of biopsychosocial integration that are far superior to those of previous theories. It argues, however, that the main problem of implementing the BPS model has less to do with integration than with the lack of a social etiology. Psychiatric practice leans heavily towards ‘bio’ and ‘psycho’ approaches, without an equally developed set of explanatory and therapeutic resources for dealing with the ‘social’ dimension of illness. This leaves psychiatry essentially internalist in orientation. As illustrated most poignantly by conditions such as functional neurological disorders, internalism comes with the risks of stigma and the curtailment of therapeutic possibilities. The paper argues that the answer to the failings of the BPS model lies in combining the integration challenge with the development of an ‘externalist psychiatry,’ which casts both causes and treatment of psychiatric illness onto the social environment. The following two papers explore the conditions that might make this idea a reality. (shrink)

AimsSport specialization is an actual trend in youth athletes, but it can increase injury risk. The aim was to determine the eventual correlation between sports specialization and injury risk in various sports, using a biopsychosocial approach.Methods169 sport-specialized athletes completed [; overall,, ] a self-reported questionnaire regarding sociodemographic, physical-attitudinal, injuries and psychological-attitudinal To analyze data univariate and correlate analyses were used.ResultsOf 169 athletes enrolled, 53% were single-sport specialized. In team sports a high risk of having to remain at rest for (...) up to 1 month because of overuse was observed. Males who suffered direct trauma in the team group were more exposed to that type of injury, and also the type of specialization figured significantly. In addition, interoceptive awareness correlates with injury. This study shows that, even though young athletes seem to be at a high risk of becoming injured, early team sport specialization and a high performance level cannot be considered to be the only risk factors. (shrink)

Psychiatry and Religious Studies have common interests in extreme and extraordinary states when articulated in the languages of religions. For Religious Studies the problems with the category of religious experience are philosophical and profound; whilst the resurgence of interest in religion by psychiatrists (three meta-analyses in the past five years) has not repaired the damaging legacy of reductionist interpretations. In this paper I adopt an interdisciplinary approach to the religious experience discourse. From psychiatry I apply the new idea of (...) Disruption, which makes its first appearance in the US psychiatric textbook DSM-5 (APA, 2013); and the older Biopsychosocial model (Engel, 1977). From Physiology I apply the language of ‘ictal’ (Adachi, 2002, 2010) to privilege a dynamic idea of time. These concepts involve particular epistemological presuppositions and, as this is an interdisciplinary, rather than a multidisciplinary contribution, these will be critically developed. The approach I propose provides a way of holistically addressing the categories of Mysticism, Possession and Altered States of Consciousness, as acute or extreme categories of experience. I propose that the idea of ‘Disruption’ can act as a pre-interpretive placeholder for a real existential experience which might (or might not) result in a non-pathological diagnosis of religious experience. The outcome depends on the socialisation of interpretation. I hope to show that the idea that there might be alternative interpretations removes the need for a sui generis defence of religious experience. By insisting on a biopsychosocial approach within an ictal framework, a way beyond the linguistic impasse of interpretation is proposed; the essentialism, implicit in the mysticism discourse, is questioned; and the non-medicalisation of Possession confirmed. The limitations of this paper point to the opportunity for further conversations between interested parties, including people with experiences of Disruption. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Adolph Meyer’s Psychobiology in Historical Context, and Its Relationship to George Engel’s Biopsychosocial ModelEdwin R. Wallace IV (bio)Keywordspsychobiology, integrative models of psychiatry, biopsychosocial modelBefore addressing the importance of Adolf Meyer and the question of his impact on the biopsychosocial model of the psychoanalytical internist George Engel, let us tersely sketch the history of functionalism in medicine/psychiatry, and of the nineteenth/early twentieth century’s progressive abandonment of it in favor of (...) basic science reductive models of “disease,” not illness.FunctionalismWhereas Hippocratic physicians diagnosed diatheses in terms of humoral excesses or deficiencies, their primary emphasis was on the ill person. They began with careful histories of the patient’s complaints and his or her daily life course, customary activities, typical foods and beverages imbibed, and the exacerbation or relief of symptoms associated with any or all of these. They also asked questions about his physical and social environment. They carefully looked for any clinically pertinent signs, and might physically examine the patient or his excretions. When they arrived at a diagnosis (say, an excess of yellow or black bile, or of blood or phlegm), they would educate the patient about it and discuss possible approaches. Although leeching, emetics, or purgatives might be prescribed, “dietetics” was the core of the treatment. Much more than recommendations about dietary intake, this involved conversations about “lifestyle” management in general: exercise, fresh air, habit changes, and perhaps bathing in mineral waters or spas. If the patient were “melancholic” (which then included what we would now consider a variety of psychiatric disorders), he or she might be prescribed daily swimming and other forms of vigorous exercise, conversations with a philosopher, [End Page 347] attendance at theatrical comedies, or even referral to an Asklepian temple for “incubation sleep” and priestly dream interpretation. Often doctors worked closely with physical trainers, to whom they sent their patients. In short, their orientation was holistic (“mind”/”body” integration), directed first and foremost toward an individual ill person.In the second century, C.E. Galen, despite his humoral and anatomical pathologies, was similarly holistic or functionalist. He resorted to a variety of physical examinational methods while also attending to the patient’s mental/emotional status. He described one case where he was attending a woman for syncopal episodes. His examinations of her included his customary attention to the pulse. During one evening session, a servant entered and happened to mention that he had just seen the handsome Pylades dancing. Suddenly her pulse became irregular and she fainted straight away. This led Galen to consider love sickness, and perhaps not humoral or organ pathology. He tested his hypothesis during subsequent visits. Whenever another dancer or actor was mentioned, her pulse remained regular and her sensorium alert, but when Pylades was mentioned the irregular pulse and fainting recurred. Because she was married, Galen realized her insoluble conflict, and treated her accordingly.From the fall of Rome until the rise of University Medicine in the later Middle Ages, medical lore and doctoring was in monastic hands—each monastery had its clerical medic, who might also attend outsiders. They were attuned to the traditional triad of major mental disorders—mania, melancholia, and phrenitis—which they explained somatically. However, they also encountered lesser mental/emotional disorders for which they developed their own nosology. “Scrupulosity,” for example, characterized a committed monk with an unrealistic sense of sinfulness and guilt—which often drove him to self-mortification such as flagellation, hair shirts with chains underneath, and so forth, for which the remedy was kindly pastoral counseling. “Accedia” was akin to our “dysthymia,” whose sufferer was affected by sadness, lassitude, and impaired capacity to carry out the monastic routine. This was viewed as straddling the boundary between sickness and sin. Routine physical labor (“occupational therapy”) and prayers, confession, penance, and “pep talks” were prescribed.When universities with medical schools arose in the latter Middle Ages, students’ educations were mostly bookish and theoretical. Hippocratic and Galenic somatic orientations were still preeminent. (Vesalius would not publish his illustrated anatomical text until 1543.) Dietetics and purgatives, bloodletting, and so on were still favored treatments. Nevertheless, doctors gave considerable time and attention to their patients as ill... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Post-Genomic RevolutionA Paradigm Shift for Biopsychosocial SystemsClaude Robert Cloninger, MD, PhD (bio)The pstchologist Danielle Dick and psychiatrist Kenneth Kendler (DK) began an ongoing study in 2011 called Spit for Science (S4S) in which they obtained saliva as a peripheral source of DNA along with assessment of detailed self-report information on alcohol and other substance use, selected personality traits, and psychosocial history about the students entering a large university (...) (Dick et al., 2014). They hoped to identify the genes underlying the heritability of alcohol use and related behaviors to inform students about their individual risk, and thereby to promote increased self-awareness and health. The students were highly cooperative volunteers, and many peer-reviewed research papers have been published from these data.Eric Turkheimer, a psychologist who studies how genes and environments shape the development of human behavior (Harden et al., 2007; Loehlin et al., 2009; Turkheimer et al., 2003), reviewed all the resulting publications coming from S4S along with coauthor Sarah Greer (Turkheimer & Greer, 2024). Turkheimer and Greer (TG) were surprised to find the study has failed to identify any genes that have substantial (“nontrivial”) effects on reported levels of consumption or problems related to their use of alcohol or other substances, except for a variant of the gene for aldehyde dehydrogenase (ALDH2), which was already known to cause many people of Asian descent to flush when they drink alcohol. TG state that, “Again and again, the results of S4S investigations demonstrated tiny, and frequently null, contributions of genetics to differences in drinking and related behaviors among college students. GWAS [genome-wide association studies] revealed practically no genome-wide significant SNPs [single nucleotide polymorphisms], and the SNPs identified at less stringent levels of significance were never mentioned more than once” (Turkheimer & Greer, 2024).TG concluded that the design, execution, psychometric measures, and analysis of the data were excellent. However, they also discuss facts that raise doubts about the adequacy of the design and methods. Namely, it is an inconvenient fact, [End Page 429] but widely known, that approaches to GWAS that are frequently used in psychiatric genetics require huge samples (often hundreds of thousands) to detect statistically significant genes because the observed effects have consistently been weak whenever genes are assumed to act independently, as did DK. Consequently, polygenic risk scores are weak and inconsistent predictors of behavioral phenotypes (Zwir et al., 2020c). Nevertheless, TG fault DK and their coauthors for an overemphasis on statistical significance in large samples rather than prominently reporting that the observed effect sizes of genes were only weakly and inconsistently associated with any measured features of substance use.TG report that they were surprised by the weak and inconsistent findings from genetic variants from this GWAS because they knew that twin and family studies (i.e., what they call “genetics at altitude”) have previously found strong and consistent evidence of the heritability of phenotypes like those measured by DK. For example, in my own research with adoptees separated from their biological parents at an early age and reared by adoptive parents, the risk of alcohol abuse in adoptees was strongly predicted by alcohol abuse and related behaviors in their biological, but not adoptive, parents (Bohman et al., 1981; Cloninger et al., 1981; Sigvardsson et al., 1996) and by their childhood personality, particularly novelty seeking, when the children were followed into young adulthood (Cloninger, 1987; Cloninger et al., 1988). However, it is well-known that the methods used by DK for GWAS consistently fail to detect most of the heritable variance for behavioral phenotypes estimated in twin studies, which include much variability from complex patterns of gene–gene interaction (Table 1) (Cloninger & Zwir, 2022). This consistent observation in GWAS studies that assume genes act independently is called the missing or hidden heritability problem.Nevertheless, DK expressed optimism in 2011 that genome-wide measurement of genetic variants would identify genetic markers to predict risk of alcohol-related phenotypes in college students. They do so because they assume that all the information about heritable processes can be extracted from genome-wise scans of SNPS. The heritable phenotypes of interest in S4S included patterns of use of alcohol and other recreational... (shrink)

While often dubbed “the bible of contemporary psychiatry” and widely hailed as providing “a benchmark” for the profession, on closer inspection the DSM is seen to be shot through with philosophical assumptions that restrict its theoretical cogency and limit it clinical efficacy. Hence, in the interests of enhanced patient-care it is important to think critically about the DSM, with a view to maximising its diagnostic strengths while minimising its weaknesses. The critical analysis undertaken in the present paper underscores the importance (...) of not construing the DSM as a self-contained diagnostic tool but of viewing it, rather, as an indispensable component in a more comprehensive, multidimensional diagnostic process. More specifically, the contention is that the DSM’s diagnostic limitations evoke a biopsychosocial framework of application as their necessary corrective, notwithstanding the entrenched tendency to construe these approaches as oppositional. Further, it is contended that a hermeneutically informed biopsychosocial template has particular advantages as an integrating framework. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Better to Have No Deep Cut Anywhere in the Biopsychosocial SystemDerek Bolton, PhD (bio)It is very good to see theoretical work on the biopsychosocial model, acknowledging the causal role of these three kinds of factors in health and disease. I think Ongaro is right to argue that the biopsychosocial model requires an account of these three also being one—integrated—and that systems theoretic concepts such as dynamic, nonlinear causation are (...) helpful for capturing this. In a recent paper (Bolton, 2023) I have described Engel’s original (1997) paper as visionary but programmatic: visionary in seeing radical theory change afoot, citing von Bertalanffy’s new general system theory, but programmatic because the changes had not happened. The systems theoretic approach applies across the life, behavioral and social sciences, and typically envisages multiple interacting systems and causal pathways, including feedback and feedforward mechanisms, within and between systems. However, linear mechanisms are less complicated to research, and early social epidemiology used standard linear regression models (e.g., see the Whitehall II study [Marmot et al., 1991]). Such models do not capture non-linear connections in which the dependent variable also functions over time as an independent variable. However, the background theory typically would not exclude nonlinear dynamic causation, but on the contrary envisages it. Lower social status raises risk of ill health in a linear model, but it is also a plausible hypothesis that ill health in turn raises risk of lowering social status, which is testable in another or in a composite linear model. As well as social epidemiology, another large-scale theory change was underway at the time Engel wrote, the so-called cognitive revolution in psychology. Axiomatic in this shift was the idea that behavior is a response to the environment as perceived, thus merging the psychological/behavioral with the environmental, including the social. This latter point bears on Ongaro’s main proposal that the biopsychosocial model should envisage social causes as externalist, distinguished from the bio-psychological orientation of current psychiatry—and will be picked up below.Paper 2 makes some bold claims about the positive therapeutic value of construing causes [End Page 321] of mental health problems in external terms that have shared social meaning. These claims are made for functional neurological problems, but with extension to other kinds, in relation to a culture in which the shared social meanings refer to spirit possession, which, as a general type, is found in many non-modern Western cultures, as well as now, in our globalized world, in subcultures worldwide. One of the author’s claims is that within the spirit possession framework the shared framework of external causes enables society to adapt to the problem of living, to make it manageable, by shifting the social environment around the patient. As appropriate for ethnomethodology, there is no reference to controlled studies of outcome or mechanisms and I follow this immersed observational methodology here, with an experiential story that illustrates absence of personal and social acceptance and manageability of problematic conditions. While wandering recently with a friend in the mountains in the northern part of Africa, the local guide, in conversation in the local language and in English, having found out that two of us worked in “psychiatry/psychology,” asked us what we knew about; our brief reply included “obsessive-compulsive disorder” (OCD) and “anxiety”; the guide responded by asking whether OCD was washing hands a lot, and then wanted to discuss with us two people he knew well. One was a relation engaged, since many years, for many hours a day washing and cleaning, avoiding many daily tasks, sometimes childcare; friends and wider kinship structures had tried everything, except modern Western psychiatry (which was unavailable anyway), and, to put it briefly and colloquially, they were not at all happy about the person’s state and wished the person would get better. This person lived at a distance and we could not see them, so we do not know their view, but to judge by people with definite or probable OCD that we are familiar with, they may or may not have been happy in their reclusive state. Also to mention that the local healer had investigated... (shrink)

People maintain systems of beliefs that provide them with a sense of belongingness, control, identity, and meaning, more generally. Recent research shows that when these beliefs are threatened a syndrome of negatively valenced arousal is evoked that motivates people to seek comfort in their ideologies or other personally valued beliefs. In this paper we will provide an overview of this process and discuss areas for future research. Beginning with the neural foundations of meaning violations, we review findings that show the (...) anterior cingulate cortex (ACC) is responsible for detecting inconsistencies, and importantly, that this is experienced as aversive. Next, we evaluate the evidential support for a psychophysiological arousal response as measured by cardiography and skin conductance. We discuss how current theorizing proposes that subsequent behavioral approach ameliorates the negative arousal and serves as an effective, well-adapted coping response, but we also aim to further integrate this process in the existing threat-compensation literature. Finally, we speculate on whether approach motivation is likely to result when one feels capable of handling the threat, thereby incorporating the biopsychosocial model that distinguishes between challenge and threat into the motivational threat-response literature. We believe the current literature on threat and meaning has much to offer and we aim to provide new incentives for further development. (shrink)

The arts provide openings for symbolic expression by engaging the sensory experience in the body they become a source of insight through embodied cognition and emotion, enabling meaning-making, and acting as a catalyst for change. This synthesis of sensation and enactive, embodied expression through movement and the arts is capitalized on in The BodyMind Approach®. It is integral to this biopsychosocial, innovative, unique intervention for people suffering medically unexplained symptoms applied in primary healthcare. The relevance of embodiment and arts (...) practices in TBMA are discussed in relation to the views of participants in the pursuit of self-management. If widely employed TBMA could have an enormous impact, reach, and significance for patients and global health services. This original pre-clinical trial of qualitative research reports on the perceptions of participant patients with generic MUS, a world-wide issue usually treated by either psychological therapy or physiotherapy. TBMA is not a therapy but a health education program founded upon the concept of an integration of psychological elements with physiological, bodily, and sensory experiences. Thematic analysis of qualitative data sets from open-ended questions in semi-structured interviews and a written questionnaire post intervention is presented. Five aspects which appear to be key to learning self-management were derived from analyzing the data: body with mind connections; importance of facilitation; potential benefits; preparedness for change; self-acceptance/compassion. This article advances the discourse on the nature of self-management for MUS through changing the mind-set and the relationship participants have with their bodily symptom/s through employing embodied methods and arts practices, challenging current, and solely verbal, psychological conceptual frameworks. Rigor lies in the method of data analysis using cross verification of credibility between reported findings and scrutiny by stakeholders. We conclude that facilitated TBMA groups employing embodied methods and arts practices can act as a method for developing the self-management of MUS and improving wellbeing. (shrink)

The status quo: dogmatism, the biopsychosocial model, and alternatives -- What there is: of mind and brain -- How we know: understanding the mind -- What is scientific method? -- Reading Karl Jaspers's General Psychopathology -- What is scientific method in psychiatry? -- Darwin's dangerous method: the essentialist fallacy -- What we value: the ethics of psychiatry -- Desire and self: Hellenistic and Islamic approaches -- On the nature of mental illness: disease or myth? -- Order out of chaos: from (...) insanity to DSM-III to a pluralistic nosology -- A theory of DSM-IV: ideal types -- Dimensions versus categories -- The perils of belief: psychosis -- The slings and arrows of outrageous fortune: depression -- Life's rollercoaster: mania -- Being self-aware: insight -- Calvinism or hedonism? -- Truth and statistics: problems of empirical psychiatry -- A climate of opinion: what remains of psychoanalysis -- Being there: existential psychotherapy -- Beyond eclecticism: teaching psychotherapy in the twenty-first century -- Bridging the biology/psychology dichotomy: the hopes of integrationism -- Why it is hard to be pluralist. (shrink)

Most writers now recognize that mental health policy and the mental health system are extremely resistant to real changes that reflect genuine biopsychosocial paradigms of mental disorder. Writers bemoaning the intransigence of the mental health system tend to focus on a small analytical level, only to find themselves mired in the rationalities of the existing system. Problems are acknowledged to be system-wide, yet few writers have used a method of analysis appropriate for systemic problems. Drawing upon the General System Theory (...) (GST) analytical perspective, this article advances a systematic approach to understand the mental health system and to facilitate the development of reform strategies that recognize the system's complexity and changing nature. The article first discusses the failure of major reform efforts in the mental health system and the limitations of mainstream analysis of mental health politics and policies with respect to the objectives of analysis and reform. This article describes how systems thinking has thus far influenced the study of the mental health policy and politics system, and argues that a systemic perspective is profitable for reconceiving the mental health system, enabling a fresh basis for the development of reform strategies. The mental health system should be seen as a social system influenced by larger political and economic dimensions, not just as a 'delivery system' scientifically constructed by neutral experts. Furthermore, the policy planning process should be viewed as part and parcel of a mental health system modeled as complex and dynamic. The systemic perspective outlined here should help both to clarify the value-based objectives that we hold for the system and, consequently, to plan for the strategic reforms that have so far eluded us. (shrink)

In this study, experiments were conducted on 30 subjects by means of electrocardiogram and electroencephalogram methodologies as well as a money game to examine the effects of stress on creativity in business problem-solving. The study explained the relationship between creativity and human physiological response using the biopsychosocial model of challenge and threat. The subjects were asked to perform a cognitive mapping task. Based on the brain wave theory, we identified the types of brain waves and locations of brain activities that (...) occurred during the creative problem-solving process in a business environment and studied the effects of stress on creativity. The results of the experiments showed significant differences in creativity in business problem-solving depending on whether or not stress was triggered. Differences were found in the time domain and frequency domain of heart rates, a physiological stress indicator, between the stress group and the no-stress group. A brain wave analysis confirmed that alpha waves increased in the frontal lobe of the brain during creative business problem-solving but decreased when the subjects were under stress, during which beta waves in the brain increased. This study seeks to examine creativity in business problem-solving by studying the effects of stress on human physiological response and cognitive functions in the hope of providing a new and objective interpretation of existing research results. (shrink)

Eating disorders are evolutionarily novel conditions that lead to some of the highest mortality rates of all psychiatric disorders. Several evolutionary hypotheses have been proposed for eating disorders, but only the intrasexual competition hypothesis is extensively supported by evidence. We present the mismatch hypothesis as a necessary extension to the current theoretical framework of eating disorders. This hypothesis explains the evolutionarily novel adaptive metaproblem that has arisen when mating motives and readily available food rewards conflict with one another. This situation (...) is exacerbated in contemporary environments characterized by sedentary lifestyles, caloric surplus and the ubiquity of social comparisons that take place via social media. Our psychoneuroimmunological model connects ultimate-level causation with proximate mechanisms by showing how the adaptive metaproblem between mating motives and food rewards leads to chronic stress and, further, to disordered eating. Chronic stress causes neuroinflammation, which increases susceptibility to OCD-like behaviors that typically co-occur with eating disorders. Chronic stress upregulates the serotonergic system and causes dysphoric mood in patients with restricting-type anorexia nervosa. Dieting, however, reduces serotonin levels and dysphoric mood, leading to a vicious serotonergic-homeostatic stress/starvation cycle whereby cortisol and neuroinflammation increase through stringent dieting. Between-individual and within-individual variation in eating disorders partially arises from (co)variation in gut microbiota and stress responsivity, which influence neuroinflammation and the serotonergic system. In binge-related eating disorders, even a short period of fasting drops serotonin levels, a state alleviated by binge eating. Eating disorder treatments should aim to reduce the chronic stress, neuroinflammation, stress responsivity and gut dysbiosis that fuel the disorders. We review the advances that have been made in recent years in understanding how to best treat eating disorders, outlining directions for future clinical research. Connecting ultimate causes with proximate mechanisms and treating biopsychosocial causes rather than manifest symptoms will enable more effective and sophisticated long-term interventions for the millions of people who suffer from eating disorders. (shrink)

Mazur & Booth provide life scientists with an example of the multilevel biopsychosocial approach. Research paradigms have to become more flexible and multidisciplinary if we are to free ourselves from the nature–nurture dichotomy that we have long agreed was simplistic and shortsighted. I point out a variety of kinds of interactions that may be the next frontier for behavioral scientists.

La formación profesional tiene un carácter contextualizado que responde a las exigencias que la época, la sociedad y el país reclaman a las universidades. La Estomatología en Cuba no se encuentra al margen de estos preceptos por lo que desarrolla un plan de estudio que acentúa la flexibilidad para realizar modificaciones necesarias y pertinentes. El estudiante al culminar la carrera debe brindar una atención estomatológica integral donde las anomalías dentomaxilofaciales constituyen la tercera línea de trabajo. Estas ocasionan afectaciones estéticas que (...) repercuten en la autoestima y adaptación social de niños y adolescentes por lo que se necesita de una orientación sicoeducativa, acción para la cual el profesional deberá estar preparado. A partir de las insuficiencias detectadas en el proceso formativo del estomatólogo, el objetivo del presente trabajo es proponer un curso propio sobre la temática para favorecer la graduación de un profesional capaz de resolver los problemas que afectan el complejo estomatognático con un enfoque biosicosocial. Los métodos empleados fueron el histórico-lógico y análisis-síntesis. Professional training has a contextualized nature which reflects the demands that the time, society and the country require from universities. In Cuba, Stomatology is not out of these precepts and therefore it carries out a syllabus that emphasizes flexibility to make necessary and appropriate changes. When students graduate, they must provide a complete stomatological care where dental maxillofacial anomalies are the third line of work. They cause aesthetic harm that affects children and teenagers' self-esteem and social adaptation which makes psych educational guidance necessary; a situation professional must be prepared for. Starting from the weak points discovered in the training process of stomatologists, a crash course in the subject is suggested in order to favor the graduation of professionals who are able to solve problems that affect the stomatognatic complex with a biopsychosocial approach, through the use of required methods, techniques and procedures. (shrink)

The biopsychosocial model of challenge and threat posits that resource and demand appraisals interact in situations of acute stress to determine affective responses, and concomitant physiological responses, motivation, and decisions/behaviors. Regulatory approaches that alter appraisals to regulate challenge and threat affective states have the potential to facilitate coping. This reply clarifies the conceptualization of one such regulatory approach, arousal reappraisal, and suggests avenues for future research. However, it is important to note that arousal reappraisal is not a “silver bullet” (...) for improving stress outcomes, nor should this strategy be expected to positively impact all individuals. More work is needed to better elucidate how psychological and biological stress processes interact to shape health. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hildegard: Medieval Holism and ‘Presentism’—Or, Did Sigewiza Have Health Insurance?Jerome L. Kroll (bio)Keywordsholistic healing, presentism, Hildegard of Bingen, medieval medicineSuzanne Phillips and Monique Boivin have published an article examining Hildegard of Bingen’s (1098–179) treatment and cure of Sigewiza, a possessed woman. The purpose of their article is to demonstrate Hildegard’s holistic, or biopsychosocial, approach to healing as a model that we in the twenty-first century have lost but (...) would do well to recover. Several questions come to mind:What is Hildegard’s model?Have we lost it?Is it something we wish to emulate?The basics of the case history is that a noblewoman, Sigewiza, is ill or possessed of an evil spirit. Attempts by her local abbot and community to send her on pilgrimages or otherwise to cure or exorcise her, even with Hildegard’s recommendation, have only short-lived success, after which Sigewiza’s illness or demon returns. Finally, the abbot asks Hildegard to take the noblewoman into her Benedictine monastery, and after a suitable time and various interventions, Sigewiza is permanently (presumably) cured. The arduous process of effecting this cure has left Hildegard weak and ill herself, a pattern of poor physical health from which Hildegard suffered all her life.Phillips and Boivin claim that this is an early example of conceptualizing and utilizing a bio-psychosocial model to treat a complex illness. Hildegard, well known for her medical and pharmaceutical knowledge, applies the proper dietary changes to correct Sigewiza’s humoral (biological) imbalance. She treats the psyche and its partner, the soul, by long hours of discussion with Sigewiza and verbal duels with her demon, as well as by exorcising the demon, and she includes the social aspects of treatment by bringing Sigewiza into the Benedictine community of sisters as a participating member. Which of these three modalities may be sufficient for a cure depends upon the medieval literary genre in which the case appears. If in a medical text, then the proper dietary treatment and application of compounds to neutralize and correct the offending humoral imbalances would be the therapeutic agents. In medieval hagiography, [End Page 369] the biological modality is never sufficient and often ridiculed, because the entire thrust of the text is to demonstrate the futility of medical (secular) ministrations and the effectiveness of saintly intervention in producing a cure, whether or not exorcism is technically part of the process. In Sigewiza’s case, perhaps because of the stubbornness of the possessing demon or because of other factors attached to Sigewiza’s condition, the three (biopsychosocial) modalities are utilized. It seems that Sigewiza has a treatment-resistant illness.The narrative follows a familiar topos in saint’s lives (Kroll and Bachrach 2005). Attempts to cure a demoniac by prayers, pilgrimages, intercessions of other local saints or reputedly holy persons, and sometimes by physicians (when available) are to no avail. The sufferer is brought, amidst great fanfare and public attention (a media event), to the holy woman who is the central figure of the particular Vita, and the sufferer is promptly, or protractedly, cured. In such an account, the holiness of the holy woman is further demonstrated and her reputation, shrine, and influence are duly extended and enhanced. The holy person, with humility, attributes the intercession and cure to the power of God, or Jesus or Mary or a particular patron saint, but the crowd of onlookers and the audience of the Vita understand that God (or Jesus or Mary) has in fact granted the miracle cure as a way of demonstrating the holiness of this holy person in contrast to those who previously tried to cure the ill person. The abbot who ‘referred’ Sigewiza to Hildegard, and the previous saints’ shrine to whom Sigewiza was brought, although generally acknowledged as being of fine character or respectability, had to suffer the ignominy of their petitions being rejected to dramatize the special regard in which Hildegard is held.Although we can say that the “purposes” for which Hildegard’s hagiographer includes such anecdotes is to demonstrate her holiness and her importance in God’s eyes, this does not stop us, nine centuries later, from using such... (shrink)

La formación profesional tiene un carácter contextualizado que responde a las exigencias que la época, la sociedad y el país reclaman a las universidades. La Estomatología en Cuba no se encuentra al margen de estos preceptos por lo que desarrolla un plan de estudio que acentúa la flexibilidad para realizar modificaciones necesarias y pertinentes. El estudiante al culminar la carrera debe brindar una atención estomatológica integral donde las anomalías dentomaxilofaciales constituyen la tercera línea de trabajo. Estas ocasionan afectaciones estéticas que (...) repercuten en la autoestima y adaptación social de niños y adolescentes por lo que se necesita de una orientación sicoeducativa, acción para la cual el profesional deberá estar preparado. A partir de las insuficiencias detectadas en el proceso formativo del estomatólogo, el objetivo del presente trabajo es proponer un curso propio sobre la temática para favorecer la graduación de un profesional capaz de resolver los problemas que afectan el complejo estomatognático con un enfoque biosicosocial. Los métodos empleados fueron el histórico-lógico y análisis-síntesis. Professional training has a contextualized nature which reflects the demands that the time, society and the country require from universities. In Cuba, Stomatology is not out of these precepts and therefore it carries out a syllabus that emphasizes flexibility to make necessary and appropriate changes. When students graduate, they must provide a complete stomatological care where dental maxillofacial anomalies are the third line of work. They cause aesthetic harm that affects children and teenagers' self-esteem and social adaptation which makes psych educational guidance necessary; a situation professional must be prepared for. Starting from the weak points discovered in the training process of stomatologists, a crash course in the subject is suggested in order to favor the graduation of professionals who are able to solve problems that affect the stomatognatic complex with a biopsychosocial approach, through the use of required methods, techniques and procedures. (shrink)

The concept, benefits and recommendations for the cultivation of compassion have been recognized in the contemplative traditions for thousands of years. In the last 30 years or so, the study of compassion has revealed it to have major physiological and psychological effects influencing well-being, addressing mental health difficulties, and promoting prosocial behavior. This paper outlines an evolution informed biopsychosocial, multicomponent model to caring behavior and its derivative “compassion” that underpins newer approaches to psychotherapy. The paper explores the origins of caring (...) motives and the nature and biopsychosocial functions of caring-attachment behavior. These include providing a secure base (sources of protection, validation, encouragement and guidance) and safe haven (source of soothing and comfort) for offspring along with physiological regulating functions, which are also central for compassion focused therapy. Second, it suggests that it is the way recent human cognitive competencies give rise to different types of “mind awareness” and “knowing intentionality” that transform basic caring motives into potentials for compassion. While we can care for our gardens and treasured objects, the concept of compassion is only used for sentient beings who can “suffer.” As psychotherapy addresses mental suffering, cultivating the motives and competencies of compassion to self and others can be a central focus for psychotherapy. (shrink)

Neurotheological approaches provide an important bridge between scientific and religious perspectives. These approaches have, however, generally neglected the implications of a primordial form of spiritual healing—shamanism. Cross‐cultural studies establish the universality of shamanic practices in hunter‐gatherer societies around the world and across time. These universal principles of shamanism reflect underlying neurological processes and provide a basis for an evolutionary theology. The shamanic paradigm involves basic brain processes, neurognostic structures, and innate brain modules. This approach reveals that universals of shamanism (...) such as animism, totemism, soul flight, animal spirits, and death‐and‐rebirth experiences reflect fundamental brain operations and structures of consciousness. The shamanic paradigm can contribute to a reconciliation of scientific and religious perspectives by providing a universalistic biopsychosocial framework that explicates the biological underpinnings of spiritual experiences and practices and provides a basis for neurotheology and evolutionary theology approaches. (shrink)

Revisiting the history of postwar LSD (lysergic acid diethylamide) research illuminates how the work of a chemist at the Rockefeller Institute contributed to the development of a biochemical paradigm for mental functioning. Dilworth Wayne Woolley proposed one of the first theories of the biochemistry of mental illness based on empirical evidence. His research with LSD and serotonin had wide-ranging repercussions for pharmacology and fit neatly into the emerging medicalization of mental illness. Reevaluating Woolley’s ideas and the fruits of psychopharmacology leads (...) to possible new approaches toward mental health and illness when considered alongside lessons learned from past research with psychedelic substances, and exemplifies a broader paradigm shift in cultural studies toward a biopsychosocial model that acknowledges the intersections between biology and culture. (shrink)

While loneliness has been linked to various mental and physical health problems, the sense in which loneliness is a cause of these conditions has so far attracted little philosophical attention. This paper aims to fill this gap by analyzing research on health effects of loneliness and therapeutic interventions through current approaches to causality. To deal with the problem of causality between psychological, social, and biological variables, the paper endorses a biopsychosocial model of health and disease. I will investigate how three (...) main approaches to causality used in psychiatry and public health apply to loneliness: interventionism, mechanisms, and dispositional theories. Interventionism can specify whether loneliness causes specific effects, or whether a treatment works, incorporating results from randomized controlled trials. Mechanisms help explain how loneliness brings about negative health effects, spelling out psychological processes involved in lonely social cognition. Dispositional approaches help stress particular features of loneliness connected to negative social interactions, such as defensiveness. I will conclude by showing that previous research alongside emerging approaches to health effects of loneliness lend themselves to analysis in terms of the causal models under discussion. (shrink)