Abstract
N. McLaren, Darwin, Australia:
In a succinctly argued paper on the role of empiricism in modern science (including medicine), Harari stated: ‘The history of science demonstrates that observation is problematical and not the simple, unbiased registering of sense-data’ [1], p.727]. Simply put, preconception, bias and prejudice may determine what we see. In turn, what we see often serves to reinforce what we believe. By this means, science can slip into mere selfjustification. How ironic, then, that his own paper should show a glaring example of how an individual's need to believe something determines what he sees.
He continued: ‘The fear of conceptual anarchy… dissolves once… a more sophisticated formulation of medicine is proposed, such as (Engel's) biopsychosocial model, which enables psychiatry to study clinically relevant phenomena at various levels of conceptual integration from the synaptic to the social order’ (p.729).
Four years ago, I showed that the biopsychosocial model, so beloved by Antipodean psychiatrists, was a mirage [2]. All Engel did was argue that we need a model integrating the biological, psychological and sociological aspects of human life, a laudable plea, but he did not write that theory.
Edwin Harari is not the only one to be gulled by this neat piece of legerdemain. In an impassioned case against biologism (I think), Lachter [3] repeatedly invoked Engel's ‘model’, accepting without demur (or references) that it is a reality which needs to be assailed. Nothing could be further from the truth: he was attacking a conjuror's illusion.
Why do these intelligent people, their reviewers, their editors and, above all, their readers, continue to pay homage to something that doesn't exist? How, for example, can Harari say that this sort of self-deception ‘greatly enriches psychiatry’? Simply because he needs to believe it. Like all good psychiatrists, he would have trouble practicing if he did not believe he had a holistic model which could explain the diverse and slippery phenomena of mental disorder. Clearly aware that biological psychiatry doesn't provide such a model [4], that psychodynamic models are prescientific [5], that behaviourism failed its overblown promise [6] and sociology isn't even a starter, he embraced the putative biopsychosocial model, but without bothering to check the details inside its box. Had he done so, he would have found that it doesn't actually have any details. It consists of just three words: ‘The Biopsychosocial Model’, and nothing more.
Since everybody so desperately wants to believe in the shibboleth of ‘biopsychosocialism’, it is difficult to understand why they resolutely ignore the world's only bio-psycho-social model [7]. On second thoughts, I do know: the new model is very long, very difficult to read, highly unorthodox, isn't supportive of drug companies and doesn't lend itself to slick catchphrases. It could never be reduced to three words, and it isn't American which, in this country, is the kiss of death for any idea.
More pertinently, any field which aspires to scientific status is compelled to follow certain rules of conduct. One of them is that new ideas should be received, if not with open arms, then at least with some sense that scientific progress depends on new ways of looking at old problems; that, without criticism of the status quo, there is no progress. In exposing the myth of the biopsychosocial model, I criticised the status quo, fairly trenchantly, I believe, but the establishment seems intent on pretending that my criticism was never made. That is not science as I understand the term.