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ABSTRACT: George Engel's biopsychosocial model was associated with the critique of biomedical dogmatism and acknowledged the historical precedence of the work of Adolf Meyer. However, the importance of Meyer's psychobiology is not always recognized. One of the reasons may be because of his tendency to compromise with biomedical attitudes. This paper restates the Meyerian perspective, explicitly acknowledging the split between biomedical and biopsychological approaches in the origin of modern psychiatry. Our present-day understanding of this conflict is confounded by reactions to 'anti-psychiatry.' Neo-Meyerian principles can only be reestablished by a challenge to biomedicine that accepts, as did Meyer, the inherent uncertainty of medicine and psychiatry.
KEYWORDS: Adolf Meyer, biopsychosocial model, reaction to anti-psychiatry, conceptual basis of psychiatry
THIS PAPER STARTS from two observations about the biopsychosocial model of George Engel (1977). Although attempts to integrate biological, psychological, and social factors in medicine and psychiatry predated Engel, the term "biopsychosocial model" is particularly associated with his paper in Science in 1977 (Shorter 2005).
My first observation is that Engel's model became influential in the context of the modern critique of medicine and the recognition of medicine's limitations. As pointed out by Davey Smith (2005), Engel's paper had an impact at the same time as popular critics of medicine such as Thomas McKeown (1979) and Ivan Illich (1995). The biopsychosocial model was not only a challenge for psychiatry, but also for medicine in general.
The second observation is that Engel acknowledged the historical significance for his model of the work of Adolf Meyer. There are two relevant references in his Science paper. First, he noted that:
[T]he fact is that the major formulations of more integrated and holistic concepts of health and disease proposed in the last 30 years have come not from within the biomedical establishment but from physicians who have drawn upon concepts and methods which originated within psychiatry, notably . . . the reaction-tolife- stress approach of Adolf Meyer and psychobiology. (Engel 1977, 134)
Second, he commented that:
[T]he first efforts to introduce a more holistic approach into the medical curriculum actually date back to Adolph Meyer's program at Johns Hopkins, which was initiated before 1920. (Engel 1977, 135)
Engel, therefore, recognized that his attempt to create a scientific basis for medicine...