A note on an article in The Lancet Psychiatry

The latest edition of The Lancet Psychiatry features an intriguing, if odd, article. Entitled ‘Rethinking the biopsychosocial formulation‘, its main premise is that, “to split the psychological and social from the biological is no longer scientifically tenable.” This is something I vigorously agree with and have discussed in criticism of the trendy political term, ‘parity of esteem’. As the authors imply, over-attachment to mind-body dualism is a major threat to improving healthcare. And yet, the conclusion that they appear to draw out of this premise is quite baffling.

As a precursor, I should say that my institution only allows me to access the first page of the article, but, assuming the authors don’t make a significant u-turn later on, the claim can speak for itself:

Screen Shot 2015-07-06 at 16.40.06

 

The authors seem to be concluding that problems with ‘splitting’ approaches to mental illness into three perspectives require us to discard of two of these perspectives – no surprises for which of the two the authors and psychiatrists wish to discard. It’s unclear how they expect to be able to favour a biological perspective without first ‘splitting’ it from the other two, an action they claim to oppose, or how this can possibly encourage the “integrative-approach” they apparently support.

Putting aside the contradictions, in suggesting a shift towards a more biological viewpoint they seem to be dismissing decades of scientific research and cultural progress that has moved us towards an integrated interpretation of mental illness that acknowledges the influence of social factors, environmental circumstances, and cognition. If nothing else, this is insulting to other mental health practitioners.

Thankfully another psychiatrist was quick to jump in and gently object to the point. After bringing the article to task for being “a little unfair” in its interpretation of the biopsychosocial model, Duncan Double, a ‘consultant psychiatrist and honorary senior lecturer’, discusses intellectual progress in psychiatry and the need for an integrated approach.

Dr. Double suggests that psychiatrists don’t need to be philosophers, but if they’re going to try and address the issue of dualism, they may do well to read up (here’s Stanford’s introduction). In contrast to their less labouring eastern counterparts, western philosophers have struggled with the mind-body problem since the time of Plato nearly 2500 years ago. Even in 400BC it was acknowledged that thoughts and feelings have a basis in the brain. But no sensible philosopher would go so far as to suggest that one should only view such things biologically – at least not until we can figure out consciousness and map out and biologically intervene in every thought and feeling. (That may take some time.)

Perhaps I’m being uncharitable towards the authors and the rest of the article is more nuanced; or perhaps they didn’t express themselves quite as intended? A quick search online and I see that the lead author of the article appears to have written a book on psychotherapy – which only adds to my puzzlement over the article. If those of us working towards joined-up approaches to mental health and healthcare can be a little sensitive about perceived threats to collaborative working, it’s only because we want to see the varying perspectives (biological, psychological and social) moving forward together.