RESTORING WHOLENESS TO PSYCHIATRY:
MODELS OF UNDERSTANDING
Gregory Brown, M.D.1, Lisa Durette, M.D.2, Timothy Ebright, D.O.3, Katie Cho, D.O.4
1 Director of Psychiatry Residency Training, Associate Professor of Psychiatry at the Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas
2 Director of Child and Adolescent Fellowship, Associate Professor of Psychiatry at the Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas
3 Year Four Resident in Psychiatry at the Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas
4 Year Two Resident in Psychiatry at the Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas
Abstract
Psychiatric practice is at a critical juncture in its evolution. Its identified model for understanding the complexity of individuals and their conditions has been the bio-psycho-social-spiritual model since it was first proposed nearly half a century ago. In practice, this construct is being challenged by a biomedical model which asserts all psychiatric conditions can be reduced to either neurotransmitter or gene-based causation. We explore how models are used in science to approximate larger reality, with a focus on Systems Theory, which is the philosophical foundation for the bio-psycho-social-spiritual model to describe why this model is necessarily more complete than the biomedical model. Several examples are presented to illustrate the practical limitations of the reductionist biomedical model and illuminate the impact of its narrow lens upon the assessment and treatment of patients. We argue that the biomedical model is inadequate as it prevents empowerment of the individual and it fails to recognize top-down causation, which are two identifiable strengths of the bio-psycho-social-spiritual model.
Key Words: biopsychosocial, biomedical, psychopharmacology, psychiatry