On bullshit

Someone asked me if I believe in the biopsychosocial model of illness and recovery.

This is the wrong direction to take regarding the previous post. It’s not important what I believe. I don’t need you to believe what I do. What’s important is what policy makers and mental health providers believe. I personally work to rid myself of beliefs, unfortunately people who exercise power over the lives of others do that out of a belief system. Knowing what they believe is pragmatic, information that helps me navigate the system. Consumers need this information to make a correct assessment of their treatment providers, in knowing who to look for, what to avoid, why treatment is or isn’t working, and what you want to see made available in the marketplace of mental help.

Finding these answers can be depressing, the way finding out how stupid educated people can be is always depressing, but it’s also empowering, which is why consumers are regularly discouraged from asking these questions and why doing so raises eyebrows by breaking form as mindless sheep. They literally don’t believe we have minds, in the philosophical sense, this is what the brain model of mental illness is all about, and why identifying underlying beliefs is imperative.

Can I prove I have a mind? No, what I will do is acknowledge my beliefs for what they are, and since the biopsychosocial model works for me, as a consumer I’ll take my business to treaters consistent with my orientation. And if they’re going to disappear I see no reason to let them go quietly.

I’m pissy about seeing the biopsychosocial model abandoned in mental health discourse. It’s the latest model in a long line of theoretical frameworks sacrificed on the alter of biopsychiatry. I do feel hopeless. The BPS theory has been gaining ground for decades, and professionals felt obligated to at least pay lip service to it. Is it the one true model? That’s not the question, the point is it was a model of the mind, and like all belief in the mind it’s been scrapped for the hysterical pseudo-science of the broken brain model. But yes, I think it’s a better model than let’s-play-eugenics, and is still the gold standard in forensic psychiatry. Or was. I don’t know, it’s hard to keep up with the dogma. It’s still out there in forensic psych television, just last week if I remember correctly Mandy on Criminal Minds described biopsychosocial as biology being the gun, social the bullet, and psychology the trigger. Something for everyone! I prefer the layer cake metaphor, myself, but that’s just me being sweet.

But seriously, every psychiatrist I’ve seen who used BPS to explain my troubles was able to report a good outcome in my treatment, because his ideas weren’t insane, and that gave me grounds to trust and in general comply, including the neuropsychiatrist who put me on medication.

I can console myself somewhat by seeing the BPS model still in the Wikipedia, which links to an exellent essay at the British Medical Journal:

Human beings exist in a meaningful world. When we use terms such as “mind” and “mental” we are referring to some aspect of this world. But this is not something internal, locked away inside a physical body. Think of a painting by Picasso: the famous “Guernica,” perhaps. How do we understand and appreciate this? The type of pigment is important, as are the brushstrokes used. So too are the colours and the shapes of the figures. But to understand what the painting means and the genius of its creator we reach beyond the canvas itself to the context in which it was created. This entails historical, political, cultural, and personal dimensions. Without engaging with its context, we could never appreciate “Guernica” as a work of genius. Its meaning does not reside in the pigment or the canvas but in the relation between these and the world in which it was created and now exists.

Similarly, we will never be able to understand the various elements of our mental life such as thoughts, beliefs, feelings, and values if we think of them as located inside the brain. Trying to grasp the meaningful reality of sadness, alienation, obsession, fear, and madness by looking at scans or analysing biochemistry is like trying to understand a painting by looking at the canvas without reference to its wider world. The philosopher Wittgenstein and his modern followers argue that “mind” is not inside but “out there” in the middle of a social world. We agree.

Me too. Funny that it should even need to be said, unless you know that your days are numbered.