Nassir Ghaemi

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The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry

This book is the first historical critique of psychiatry’s mainstream ideology, the biopsychosocial model.

Unique features include:
1. Analysis of the original works by the founders of the BPS model in psychiatry, George Engel and Roy Grinker. This is the first description of Grinker’s unique role in founding the BPS view in psychiatry
2. First book length history or critique of the BPS model
3. Engages larger conceptual and philosophical questions about the psychiatry
4. Examines the nature of medical practice in general
5. Provides a discussion of the ideas of William Osler, a leading founder of modern medicine, and relates his ideas to psychiatry
6. Provides the philosophical analysis of the concept of mental illness
7. Critiques evidence based medicine as applied to psychiatry
8. Shows how the core of the BPS model conceptually is eclecticism

The BPS model, contrasted with the “medical model”, is the mainstream ideology of modern psychiatry. Today, the BPS is seen as an antidote to an overly biological psychiatry; yet it might equally be a cause, failing to provide convincing conceptual or empirical grounds to resist the biologization of psychiatry. The problem exists, perhaps, in a failure of the model itself, not failure to implement it, as many presume.

He shows that the ultimate raison d’etre for the BPS model is eclecticism, the ability to “individualize treatment to the patient,” which, in practice translates into being allowed to do whatever one wants to do. This eclectic freedom borders on anarchy and produces the ultimate paradox: free to do whatever one chooses, one enacts one’s own dogmas (conscious or unconscious). Like a Hegelian tragedy, eclecticism produces dogmatism; anarchy leads to tyranny.

Developed in the 20th century as an outgrowth of psychosomatic medicine, the BPS has served as a ceasefire between the extremes of biological and psychoanalytic approaches to psychiatry. Like any cease fire, however, it has outlived its purpose, and psychiatry needs a new constitution. As a model for medicine, there is a better third alternative to the biomedical and BPS models: medical humanism, with its basis in literature and the humanities as a central feature of medical practice, a seriousness about the humanistic aspect of the “art” of medicine. As a model for psychiatry, there is another better alternative, a method-based psychiatry, that is consistent with modern science and incorporates humanities-based knowledge. This book explores the ideas of important medical and psychiatric thinkers like George Engel, Roy Grinker, William Osler, and Karl Jaspers, among others. It also addresses the claims of evidence-based medicine as well, and shows how these alternatives are better.

Although the BPS model had value as a reaction to biomedical reductionism, its historical role has played out. Mental illness is complex; biology is not enough; but the BPS model does not thereby follow. Other less eclectic, less generic, less vague perspectives exist. This book shows how psychiatry would do well to look to them, rather than revisit an outworn label.

Selected Works

Clinical Psychiatry
A new textbook on the diagnosis and treatment of psychiatric conditions. Oxford University Press, 2019.
Psychiatry, psychology
Depression is complex, and we need guides to help us understand it, guides who comprehend it existentially as part of normal human experience and clinically as sometimes needing the right kind of treatment, including medications. Johns Hopkins University Press, 2013.
An investigation into the surprisingly deep correlation between mental illness and successful leadership, as seen through some of history’s greatest politicians, generals, and businesspeople. Penguin Press, 2011.
Ideas in psychiatry
A sequel and successor to The Concepts, the first book length critique of the BPS model. Johns Hopkins University Press, 2008.
A comprehensive survey of psychiatric thinking. Johns Hopkins University Press, 2003.
Clinical psychiatry
Accessible and clinically relevant, this book describes statistical concepts in plain English with minimal mathematical content. Cambridge University Press, 2008.
A clinical handbook about the diagnosis and treatment of depression and bipolar disorder. Wolters Kluwer, First edition 2003, Second edition 2008.

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