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

2 So Many Theories, So Little Time: The Rise of Eclecticism

chapter two So Many Theories, So Little Time The Rise of Eclecticism In 1954, as new president of the Canadian Psychological Association, D. C. Williams gave an incoming address titled“The New Eclecticism”(Williams 1954). In it he identified the key dilemma in psychology as the wars between behaviorism and psychoanalysis—two incompatible theoretical systems. Eclecticism was “a simpleminded , though anything but simplifying, way out of the dilemma.”He noted how previously the term eclectic had a connotation of contempt, that in the 1950s it was beginning to be rehabilitated, and defined the “new eclecticism” as follows: We have, it seems to me, drastically and advantageously shifted our ground. Whereas one previously adopted a theoretical position and argued it from within that frame of reference, now we realize the advantages which may accrue if any number of given positions are found to be approachable from without the particular frame of reference each espouses. It has occurred to many of our number that merely to criticize Theory A from the vantage point of Theory B is unlikely to produce any other effect than a rejoinder in kind and so ad infinitum . . . . It is this current concern to find an alternative, unbiased vantage point from which to view dispassionately the whole field of theory which I term the new eclecticism. (D. C. Williams 1954) He also noted that the new eclecticism would not necessarily lead to a general overarching theory:“These methodological considerations produce general agreement on the rules of the game rather than general acceptance of a specific theoretical position . They produce, as it were, a modus vivendi without cordiality” (D. C. Williams 1954).1 Similarly, some psychiatrists (G. M. Abroms 1969) described the “old eclecticism ” as being “against orthodoxy but not for anything.” In the case of psychology as a discipline, the big conflict at the time was between behaviorism, based on the work of Pavlov and Skinner, and psychoanalysis. Psychologists had to choose between accepting one or the other of those mutually exclusive theories, or becoming eclectic, using both. The old eclecticism was one of theory; the problem was that the theories were incompatible. By the 1950s and 1960s, the “new eclecticism” was sometimes seen as an eclecticism of method rather than one of theory. Yet even then some critics identified risks, one being the danger that this new eclecticism would“disintegrate into shotgun application of too many techniques for poorly rationalized and inconsistent purposes” (G. M. Abroms 1969). To avoid this outcome, the new eclectics insisted on a “unified field theory,” often identified with general systems theory (GST; see chapter 5). In essence, the new eclectics argued that the old orthodoxies could be (and should be) replaced by the new eclecticism if the GST succeeded as a viable overall theoretical framework. Translated into psychiatric language, the biopsychosocial (BPS) model (as the psychiatric equivalent of the GST) was the theoretical basis for the contemporary eclecticism of psychiatry. As an approach, eclecticism stands or falls with the BPS model,which in turn is based on the GST.If either theory fails, then we are faced with the dangers so clearly elucidated by some early critics:“dilettantism,superficiality,dehumanization,and lack of theoretical framework ” (G. M. Abroms 1969).2 Psychological Studies of Eclecticism Most psychotherapists view their practice as eclectic (Dimond, Havens, and Jones 1978). In limited empirical research on the topic (Garfield and Kurtz 1977), it appears that eclectic psychotherapists have a similar general philosophy but differ widely in practice. Eclecticism appears to reflect concern for individualization of treatment:“An effort to integrate the ideas, concepts, and techniques of many psychotherapists into a broad framework that permits and facilitates the development of patient-specific treatment strategies. Basic to this approach is an emphasis on So Many Theories, So Little Time 13 the appreciation of each patient as a unique individual who functions in a particular environment” (Dimond, Havens, and Jones 1978). Of the few empirical studies about the nature of eclecticism in psychology, two used similar methods to study this topic in three different decades (Garfield and Kurtz 1977; Dimond, Havens, and Jones 1978; Norcross, Karpiak, and Lister 2005). In all three decades, the largest single self-identification by psychotherapists was as eclectic or “integrative,” the latter defined as seeking to put together many methods in a single whole. In 1977...