NYTimes Opinion: "Mental Illness isn't All in Your Head" - L. Pryor 2019

https://www.nytimes.com/2019/03/15/opinion/preventing-mental-illness.html

This is an opinion piece that endorses the Biopsychosocial model for understanding mental/psychiatric illness.

We are primed to react negatively to "BPS" because it is used as an assertion to frame CFS and other 'MUS' as psychogenic/psychosomatic. I think this article is referring more to BPS as truism - people are affected by lots of different things and different frames of analysis can be helpful in understanding suffering.

You can read the quotes below to get a good idea of what the author has in mind.

Ultimately, I feel this article is well-meaning, but it seeks to address things that are beyond the scope of psychiatric/medical practice, and more into the realm of public health and social services - or just, you know, left up to a person living there own life as an individual with some level of agency. The implied paternalism is worrying. There is also the strong undertone of Freudian drivel.

Useful analyses of how the the medical system and social services can best interact to produce the best outcomes are surely welcome - but you probably want some reliable data for that, not just a nice truism.

 

Very simple really. A diagnosis is a label. A formulation is bullshit.

The author seems to miss the point that you need evidence to discover which psychosocial factors, if any, are relevant in an individual case, and by and large that evidence is not available.

 

Yep

 

Why the incessant professional ($$ ?) need to rehash and reclassify all sorts of nonsense in the psychiatric field if not because psychiatry has limited efficacy. They are psychopharmacologists.

Oh what luxury to have debates with colleagues about this tripe when patients suffer from mistrust and neglect.

 

The problem is with how it's used, which can't be detached from its underlying model. That basically seems to be the excuse used by people pushing the various PPS, MUS, CSS, functional models, etc. who say that it makes no such claims about psychological causes (then often say the opposite but whatever). In reality, plenty of people do just that and they can't wash their hands off it.

Same as Cochrane, basically saying they mean nothing by putting the ME review in the common mental disorders and that they are not responsible if people use it as a proxy for a purely psychological model. People do just that and they are responsible for its misuse when they make no effort whatsoever to correct this misuse, something that is evidently deliberate.

It's simply way too vague and open to interpretation, even more so than ME actually is so as a "better" explanation it just fails massively. BPS has no shape or form, you can use it to mean anything you want it to mean and even peers won't see the difference. We're seeing that very clearly with CBT as a treatment, where in the psychosocial model of ME it's not at all typical CBT but rather used as a tool to gaslight and convince patients to think themselves healthy.

I have no issues with pursuing this model. But do wait several decades until you have something objective and validated before attempting to put it into practice everywhere at once. All this will do is discredit the whole thing entirely.

 

I would agree that this is the necessary mindset for doctors during clinical practice.

However, I think the idea of 'formulation' deserves more analysis outside of just that context. Particularly in our 'Information Age'. To me a 'formulation' is so vague it's basically an information vector of arbitrary dimension pertaining to a person. This already exists in some form - accumulated by companies that mine our data to ultimately feed algorithms that seek to modify our behavior in some way that they value.

If this approach can be used successfully to get us to buy more junk or spend more time on a platform, etc., it's not surprising that there would be interest in using it to modify health outcomes. That's not to say it would or even can be successful in terms of benefit to the patient or the greater good. But well-meaning people will be tempted to try because we can all see (with questionable accuracy) in ourselves or the people we know 'psychosocial factors' that influence health or well-being, and that we might like to think could be standardized and processed in some way to show the way to better outcomes. And, of course, insurers, employers, and governments will all be very interested in any sort of data they can (ab)use in order to achieve their ends.