A trained psychologist myself, I took great interest in today’s call of the British Psychological Society for a departure of the biomedical model of mental illness. And, to my delight, so did other colleagues – read a great blog post from Social Brain’s Emma Lindley here, where she writes that we might be right now witnessing a bona fide revolution that may change mental health services so radically, ‘they will be unrecognisable to the children of my generation.’ As Emma points out, the debate is as much driven by differing concepts of human nature as it is by politics, and the struggle for professional relevance and power. It is the latter aspect that I want to focus on in this blog post.
The RSA has long taken an interest in professions and their future (including this project in the early 2000s), and is currently managing an independent review of the Police Federation. Further international projects with other professions may follow soon.
Interestingly, even though Psychiatry is the younger term, it is the arguably the older science, and literally means ‘the medical treatment of the soul’, whereas Psychology means ‘study of the soul’. Psychology and, specifically, its subdomain Clinical Psychology, have always had a hard time standing up to their medical cousin. Part of the reason for that one can find in the etymology; isn’t medical treatment is just so much more tangible than mere study? Thus, in more than one hospital of the world (including one I interned in a long, long time ago), Psychologists have not been much more than overeducated sidekicks to doctors. This may change soon.
The main reason for this is that over the last decade, and particularly since 2008, Psychology has arrived in the scientific establishment. It did so by using a strategy applied by underdogs since the advent of mankind: collaboration. (And, of course, the emergence of discipline rockstars like Steven Pinker has helped.)
Not having enough leverage itself, Psychology entered functional marriages with up and coming disciplines like neuroscience and traditional ones like economics, a process that led to the creation of new interdisciplinary fields like behavioural science. A prominent victim of this process was homo economicus – the notion that humans are wholly rational and narrowly self-interested. Homo biomedicus (not an official term, my inadequate creation), the similarly reductionist paradigm underlying present day psychiatry that acknowledges only the physical side of human existence, but leaves aside the social and psychological aspects, may very well be next.
There are two reasons to be concerned about the potential revolution of mental health services given that professional battle lines are drawn:
Firstly, while for Psychology there was the possibility of a non-threatening complementary relationship in the mutual interest with economics or neuroscience, with Psychiatry it is different. Here the question is ‘who runs the show?’, or, if you will, one of professional hegemony. Still, one hopes that the critical voices on both sides steer the process away from the zero-sum-game it is in danger to become, which certainly would leave everyone worse off.
Secondly, the homo biomedicus model is not entirely wrong, just as the homo economicus model is not completely off the mark. The concept has its merit and adequate areas of application, and it will need to be taken into account when designing future services based on a richer, more complex understanding of man as Homo biopsychosocialis that is embedded in a capabilities-based approach. Throwing out the baby with the bath water would be just as wrong.
Josef Lentsch is Director of RSA International – follow him at @joseflentsch