Monday, October 18, 2021

Comments by GPM

Showing 2 of 2 comments.

  • Neither Engel nor the many people he inspired had such a technical definition of “model” in mind. It was more like the notion of “framework”. Reminds me of what the statistician George Box said, “All models are wrong, but some are useful.” In this case, all definitions of “model” may be wrong, but some may be more useful, or at least more commonly used, than others.

  • I applaud McLaren’s critique of Insel’s new monster, RDoC, except I am puzzled by his comments that George Engel never wrote about the biopsychosocial model and it “doesn’t exist” (“Alerted by the way everybody used the term but nobody ever provided proper references, I trolled through practically everything Engel had ever written, plus dozens of papers that cited him, to find that he had never written the model at all”). Well, it might not exist any more, having been snuffed out by the pseudobiological juggernaut, but for a while it was an inspiration to many young bloods entering the field. Engel wrote at least 3 influential papers between 1977 and 1980, two of which have the term in the title and the other which discusses it in the text, and all of which were decisive in my eventual decision to leave the profession:

    1977 The need for a new medical model: A challenge for biomedicine. Science 196:129-136

    1979 The biopsychosocial model and the education of health professionals. Annals NY Acad Sci 310: 169-181

    1980 The clinical application of the biopsychosocial model. Am. J. Psychiatry 137:535-544

    The first of these (in Science) is the most cited (nearly 2000 times). Years later, after I discovered the BPSM in my training, I corresponded with Engel near the end of his life and his words of encouragement had a lot to do with my eventual abandonment of the practice of psychiatry entirely. In some respects I am even more severe in my disdain for the industry of psychiatry than McLaren, whose outspoken stance I admire, so I just want to dispel the impression (perhaps unintended) that maybe Engel was in the same league as Insel or Gottesmann and others that dominate the industry of pseudobiological psychiatry now. Engel, by the way, was at the University of Rochester NY just down the road from his more famous contrarian contemporary, Thomas Szasz, at the NY State University branch in Syracuse. I was unable to find the full text of McLaren’s 1998 article (“A critical review of the biopsychosocial model” Australasian Psychiatry 32(1):86-92) on line so I don’t know what he actually says about Engel and the BPSM. Despite its limitations, the BPSM did restore some humanity and sanity to the profession for a while.