Saturday, July 04, 2015

Biopsychosocial formulation

There is an article in Lancet Psychiatry about rethinking biosychosocial formulation. I think the article is a little unfair on George Engel but I do understand what it means about the eclectic way in which the biopsychosocial model is implemented. It wasn't how Engel meant it to work to encourage "students to think about the patient from three different perspectives, rather than beginning with the premise that everything that happens to the patient is biological". This comment also reminds me of the emphasis of Susan Lamb in her book on Adolf Meyer (see previous post). What's needed is to integrate mental and brain activities.

The describe/review/link model may well help us to move on from the eclecticism of modern psychiatry for which this mistaken implementation of the biopsychosocial model may be blamed (see my review of Nassir Ghaemi's book and his response). I agree with the authors of the article about the importance of formulation (eg. see previous post).

1 comment:

Chrys Muirhead said...

"We propose a new model for formulation rooted in the idea that everything is biological, designed to guide the formation of hypotheses about cause."

Although the Lancet article is useful I don't think it goes far enough in terms of understanding the reasons for, or causes of, schizophrenia. Not everything is biological, from my perspective of 62 years in living on this earth in my body. Not everything can be explained by science or by the sum total of our body parts. That "otherness" of human beings whether we call it spiritual or existential has played a large part in my living. It's what has kept me alive and enjoying life, bouncing back from adversity and psychiatric drug treatment.

The problem with the biopsychosocial model is that the bio bit dominates the discourse. As far as I can see, from what I've read and been subject to. Plus the money for research is coming mostly from pharmaceutical companies. For example, I recently attended a seminar on the results from a schizophrenia survey in Scotland. At which Prof Lawrie, Scottish Mental Health Research Network, mentioned in his bio that he had got £1million from Pfizer to do genetic imaging studies and around £50K from Roche to study a new drug for schizophrenia. I saw no mention of monies to fund research of talking therapies or spiritual happenings.

He who pays the piper calls the tune. So how on earth are we going to divert the drug money into more therapeutic channels? It costs one million to develop a drug to the point of it being prescribed, so I hear from the Scottish Medicines Consortium. Drug companies will want to both recoup the development costs and make a profit. It's all about big business. The hard sell. And many psychiatrists are linked with the drug companies as consultants and KOLs. I might compare it to the cattle market (I used to sell hogs with lambs at foot, Lanark Market) where farmers selling beasts gave a "luck's penny" to those who bought their beast and in so doing bumped up the price.