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

14 Between Science and the Humanities

chapter fourteen Between Science and the Humanities The debate between science and the humanities gets at the core of the philosophical problem underlying the biopsychosocial (BPS) model: Is science, valuable as it is, the main road to knowledge? If not, how is the method of the humanities different ? This philosophical problem lands us in the real world of the practicing psychiatrist and psychologist. Should we be dualists, with two approaches to the mind and body, or monists, or pluralists, or eclectics? We need to answer this question if we are to have a coherent conception of what we are doing.The BPS model sought to reply differently from either biological psychiatry or traditional psychoanalysis. Or perhaps it is simply a way of avoiding a reply. But answer we must, and, because medicine can harm as well as help, we must answer correctly. Ways of Knowing A complex and lengthy literature on science and the humanities, dating back over a century, awaits us. We might begin to approach it by noting two basic views: the idea that there is only one way of knowing versus the view that there are two or more. One view holds that all knowledge is of one kind; in the hands of positivists, the belief is that all knowledge is, or will become, scientific. This might be called the “consilience” model, the idea that all fields of knowledge ultimately lead to a unified science (Wilson 1999).Sociology will become sociobiology,psychology will become cognitive science, and so on. The other view holds that there is a fundamental difference between natural and human sciences—the“two cultures”model —that the two approaches at a basic level cannot be equalized. Thus, we have H2 O —three atoms connected chemically—and we have water—a liquid substance that runs over my hand a certain way. They are two different ways of knowing; one cannot replace the other. If this second view is correct, then we need to understand humanistic knowledge , how it differs from science, and how we can apply, teach, and practice it in psychiatry.In chapter 15,I trace this debate in more philosophical detail.Here I will summarize my conclusions as related to the BPS model. Psychiatric Pluralism: The Rejection of Dogmatism and Eclecticism Many of us go through life assuming that there is only one kind of knowledge and many kinds of error. You can be right only one way; everything else is wrong. This would seem to be common sense, and ever since Sunday school, we are imbued in our bones with this assumption. Some of us have been infected with the theories of Michel Foucault, though we might never have read him; one finds this infection in the adolescent who says that what is good is what feels good; that every person is the judge of his or her own morality; and that everything is relative.1 Either there is only one knowledge or there is no knowledge: This is where most of us are in our own personal philosophies. Among believers in only one kind of knowledge, we find two subsets, roughly equal in number. The first believe that all knowledge is scientific; for them, the touchstone of everything is experience and experiment. If you can put a number on it, they are happy; if you can add a statistical p-value, they are ecstatic. The second believe that all knowledge is metaphysical ; usually religious, sometimes secular. Here one finds the mass of humankind in their deepest beliefs: a faith in another world, a God or gods, books of revelation , Ten Commandments, reincarnation, a chosen people. These two groups are less in conflict than they imagine. It could be that all this back and forth between atheists and believers, scientists and philosophers is nothing more than category 160 What Next? errors in both camps. Perhaps the ways of science are irrelevant to the world of faith and vice versa. In other words, many people are dogmatists: they believe in religion and nothing else; or they believe in science and nothing else. I am not claiming that most people are this way, nor am I proving that this is the case. But the history of humankind should provide sufficient evidence that many dogmatists have existed, and continue to exist, in human societies. Beyond dogmatism, there is another possibility: perhaps there are two kinds of...