…not promiscuously “eclectic.”…

Ronald W. Pies, MD wrote in the Psychiatric Times of January 22, 2020:

“…Simply stated, the biopsychosocial (BPS) paradigm, as I conceive it, asserts that most (but not necessarily all) serious mental disorders are best understood as having a variety of causes and risk factors–including but not necessarily limited to biological, psychological and social components. (Dr Michael McGee has also emphasized the importance of the spiritual dimension in the origin and treatment of addictions and other psychiatric conditions, arguing for a “bio-psychosocialspiritual” approach)

As I conceive it, the BPS paradigm does not assert that all psychiatric disorders are, like ancient Gaul, divided into three parts: a biological, a psychological, and a social component. Nor does the paradigm assert “tripartite causation” for all or most diseases, though Engel’s 1977 paper briefly alludes to “the role of psychosocial variables in disease causation.” However, the BPS paradigm does encourage the clinician, heuristically, to investigate whether a particular disorder may arise from some combination of these factors; and, if so, whether the condition merits treatment in all three spheres-which will likely not be the case for all psychiatric illnesses.

The BPS paradigm imposes no need to solve the ancient “mind-body” conundrum that has bedeviled philosophy for millennia (eg, “What is the mind? Is it distinct from brain? How does mind interact with the brain?). Those issues, though philosophically important, are at a different epistemic level than that of the BPS paradigm.

To be sure, problems can arise if the BPS paradigm is untethered to the best available evidence. The actual treatment of the patient must always be evidence-based, and not promiscuously “eclectic.” It would indeed be a misuse of the paradigm to “throw a little of this, and a little of that” at the patient, hoping that some combination of biological, psychological, and social therapies will stick. That some practitioners may proceed in this helter-skelter fashion is regrettable but is not an indictment of the BPS paradigm itself, as I have delimited it.

Indeed, the BPS paradigm does have substantial limits. It does not readily lend itself to highly specific, quantitative predictions, along the lines of the Bohr model of the atom. But it does permit some broad, qualitative predictions, and can serve as a heuristic guide to diagnosis, treatment, and medical education…”

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