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Psychiatry uncomfortably spans biological, psychological, and social perspectives on mental illness. As a branch of medicine, psychiatry is under pressure to conform to a biomedical model, according to which diseases are characterized primarily in biological terms (e.g. genetic influence, molecular changes in the body's organs, abnormalities detectable via blood tests, MRI scans, etc.). But psychiatry also draws on the psychotherapeutic tradition, which explains mental distress in terms of life experience and social influences.
These approaches ought to complement each other, but historically this has not happened. With no theory creating global, systematic links between the two approaches, psychiatry is divided between clinicians who take a psychotherapeutic approach, those who take a biomedical approach, and those who subscribe to the uneasy eclecticism of the biopsychosocial approach (BPS). The latter generally involves little more than an acknowledgement that biological, psychological, and social factors are all relevant to understanding mental illness. It has been criticized for failing to specify how mental illnesses may be diagnosed and characterized in BPS terms and for failing to provide directions for treatment (Ghaemi, 2009; McLaren, 2006).
I argue that BPS's failure to provide robust guidance for understanding and treating mental illness is partly due to a lack of clear thinking about the relationship between biological, psychological, and social aspects of mental illness. I then describe how understanding different sorts of reductionism in psychiatry might help advance a BPS understanding of the mind.
I begin, in the first section, by sketching BPS and the relevance to it of reductionism. The second section outlines some key distinctions between types of reductionism. In the third section, I survey psychiatrists' views on reductionism and argue that these views are confused in various ways, and that they impede understanding of mental illness as a result. The fourth section summarizes some ways in which discussion of reduction in psychiatry has resulted in attention being diverted from the most important issues. I then suggest some directions for further thought on this topic to help improve BPS as a useful model for research and treatment in psychiatry.
The Biopsychosocial Approach
The term 'biopsychosocial' was coined by Roy Grinker in a 1954 lecture (published 40 years later: Grinker, 1994) but popularized by George Engel, building on the work of Adolf Meyer....