biopsychosocial model

Psychology is the study of the mind. In modern academia, it prides itself in its scientific progress and growing ability to objectively study human behavior and cognition. With the help of genetics, and the emergence of neuroscience, we now have great insight into the biological underpinnings of the human mind, and some of the biological causes of mental illnesses like autism, schizophrenia, and chronic depression. These advancements have provided tremendous improvements to psychology since Freud’s psychoanalysis in the late 19th century, but not without some caveats.

The biological-basis of psychology is widely prevalent in our mainstream culture. We often see news articles on the “Altruism Gene” or “Gay Gene” or “Hunger Gene.” To some it may seem as though our whole existence can be reduced to the genes we have inherited. Thus we either have these genes or we don’t, and we tend to view ourselves as more fixed in place than we really are. This is emphasized whenever we say things like “this is just how I was made.” Don’t get me wrong, I definitely believe that genes play a big role in who we become, but I want to emphasize that not everything about ourselves is strictly dependent on genes.

One effect of this emerging scientific viewpoint is that many are under the impression that the more we can reduce the mind to a biological level, the better our understanding of mental health. This is the viewpoint modern psychotherapy has adopted over the past half century, which has led to a tremendous growth in psycho-pharmaceuticals.

This biological bias in modern psychology has already seeped into our collective unconscious. We often find everyday people describing the mentally ill as having “chemical imbalances,” and rarely questioning how past history, culture, and habits of living affect our mental well-being and sanity.

The problem with studying the mind on a biological level is not that it is wrong, but that it only takes into account a fraction of the picture. A strictly biological viewpoint ignores how our environment and culture affect the expression of those genes. A recent post at Mind Hacks gives a wonderful example of how this phenomena can come into play:

    “Neuron Culture has a fantastic piece on how a long touted ‘depression gene’ turned out to reduce the risk of mood problems in people in East Asia and why we can’t always understand genetic effects on behaviour without understanding culture.

    The piece riffs on the long-established finding that the short variant of the serotonin transporter or 5-HTTLPR gene is more common in people with depression, until psychologist Joan Chiao found that East Asians are more than twice as likely to have the gene but only have half the rate of mood problems.”

While biology and neuroscience are great fields of study, we cannot mistaken them for a “more scientific” or “more accurate” view of the human mind. They will always be but one piece of the puzzle.

Psychology (and psychotherapy especially) should instead take heed to the biopsychosocial model of mental health. This is the view that mental health encompasses not just biological factors, but also psychological factors (thoughts, emotions, and behaviors) and social factors (family, traditions, culture).

The biopsychosocial model isn’t anything new. It has been talked about since the late 70s and has also been criticized several times for being overly broad and vague. The problem seems to be that we have many different subfields of psychology: Cognitive, Behavioral, Social, and Biological, but science has yet to integrate them all into a coherent whole.

American psychiatrist Steven Sharfstein pointed out in 2005 that “We have let the biopsychosocial model become the bio-bio-bio model.” He warned about modern psychology’s over-emphasis on pharmaceuticals as solutions, and our lack of focus on other factors that influence mental health.

However, other forms of psychotherapy have been developed over the past few decades that aren’t pharmaceutical-based. One such system is Cognitive-Behavioral Therapy (CBT) which focuses on building new skills in patients, like “cognitive-restructing” (changing your thoughts and perspective about a situation) and mindfulness (improving daily awareness), to help patients become more aware of their thoughts and emotions and how they influence their actions. CBT has shown to be effective for a wide-range of different mental disorders, including post-traumatic stress disorder, OCD, and clinical depression. It has also shown to be a worthy complementary medicine for disorders like schizophrenia.

CBT has since been adopted into other forms of psychotherapy including Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT), which have shown moderate success with a wide range of mental disorders.

Often times these kinds of psychotherapies are more effective in combination with pharmaceuticals. This at least shows one step in the right direction when trying to form a more comprehensive view of mental health. One that is not only biology-based but also takes into account cognitive factors.

On the other hand, the social aspect of the biopsychosocial model is a more difficult aspect to turn into a treatment. Most psychologists today only use social factors to assess the risk in certain mental disorders. For example, those who are raised in the city are more inclined toward schizophrenia. In what other ways may our environment and culture contribute to the risk of different mental disorders?

Post-traumatic stress disorder (PTSD) is an illness specifically caused by a person’s experiences and environment. It could be caused by experiences of war, rape, a terrorist attack, or the experience of a natural disaster. These all fit under the “social” or environmental aspect of mental health. Other common factors to look at in social psychology include relationships, socio-economic status, culture, tradition, religion, and geography.

One example related to geography affecting mental health is that many people who live where there are polar nights (24 hours of darkness) are prone to depression. To a lesser extent, this can be seen in those who experience seasonal affective disorder (SAD), otherwise known as winter depression. These are disorders triggered by changes in light, and they can sometimes be treated using light therapy. If you have ever seen the movie Insomnia with Al Pacino than you are familiar with some of the psychological effects darkness can have.

The takeaway message here is that humans are variables of multi-variables. They are never static, and always changing over time depending on new conditions, new relationships, and new habits. Everything seems to have some effect on our mental well-being, and a comprehensive science of the mind must look at the whole picture.

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