This open access book is a systematic update of the philosophical and scientific foundations of the biopsychosocial model of health, disease and healthcare. First proposed by George Engel 40 years ago, the Biopsychosocial Model is much cited in healthcare settings worldwide, but has been increasingly criticised for being vague, lacking in content, and in need of reworking in the light of recent developments. The book confronts the rapid changes to psychological science, neuroscience, healthcare, and philosophy that have occurred since the (...) model was first proposed and addresses key issues such as the model’s scientific basis, clinical utility, and philosophical coherence. The authors conceptualise biology and the psychosocial as in the same ontological space, interlinked by systems of communication-based regulatory control which constitute a new kind of causation. These are distinguished from physical and chemical laws, most clearly because they can break down, thus providing the basis for difference between health and disease. This work offers an urgent update to the model’s scientific and philosophical foundations, providing a new and coherent account of causal interactions between the biological, the psychological and social. (shrink)

The effects of mental disorder are apparent and pervasive, in suffering, loss of freedom and life opportunities, negative impacts on education, work satisfaction and productivity, complications in law, institutions of healthcare, and more. With a new edition of the 'bible' of psychiatric diagnosis - the DSM - under developmental, it is timely to take a step back and re-evalutate exactly how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the definition and (...) boundaries of mental disorder. It addresses two main questions regarding mental illness. Firstly, what is the basis of the standards or norms by which we judge that a person has a mental disorder - that the person's mind is not working as it should, that their mental functioning is abnormal? Controversies about these questions have been dominated by the contrast between norms that are medical, scientific or natural, on the one hand, and social norms on the other. The norms that define mental disorder seem to belong to psychiatry, to be medical and scientific, but are they really social norms, hijacked and disguised by the medical profession? Secondly, what is the validity of the distinction between mental disorder and order, between abnormal and normal mental functioning? To what extent, notwithstanding appearances, does mental disorder involve meaningful reactions and problem-solving? These responses may be to normal problems of living, or to not so normal problems - to severe psycho-social challenges. Is there after all order in mental disorder? With the closing of asylums and the appearance of care in the community, mental disorder is now in our midst. While attempts have been made to define clearly a concept of mental disorder that is truly medical as opposed to social, there is increasing evidence that such a distinction is unviable - there is no clear line between what is normal in the population and what is abnormal. 'What is Mental Disorder?' reviews these various crucial developments and their profound impact for the concept and its boundaries in a provocative and timely book. (shrink)

This new edition of Mind, Meaning, and Mental Disorder addresses key issues in the philosophy of psychiatry, drawing on both philosophical and scientific theory. The main idea of the book is that causal models of mental disorders have to include meaningful processes as well as any possible lower-level physical causes, and this propsoal is illustrated with detailed discussion of current models of common mental health problems. First published in 1996, this volume played an important role in bridging the gap between (...) philosophy and psychiatry, and introducing those in psychiatry to philosophical ideas somewhat neglected in their field. Completely updated, the new edition of this acclaimed volume draws on the strengths of the first edition, and will be a central text in the burgeoning field of philosophy of psychiatry. (shrink)

The question "What is mental illness?" raises many issues in many contexts, personal, social, legal, and scientific. This chapter reviews mental health problems as they appear to the person with the problems, and to family and friends-before the person attends the clinic and is given a diagnosis-a time in which whether there really is a problem, as opposed to life's normal troubles and variations, is undecided, as also the nature of the problem, if such it be, and the related matter (...) what kind of expert advice should be sought. Once at the clinic, a diagnosis may be given-using criteria well-worked-out in the diagnostic manuals. The chapter discusses the conceptualizations of mental disorder in the diagnostic manuals, their rationale, and what can and cannot be reasonably expected of them. There are more position statements than definitions, and while they signal many dilemmas, they do not resolve them. Attempts to do so in the surrounding literature on the concept of mental illness are reviewed in the chapter, with conclusions favoring the features emphasized in the diagnostic manuals: distress and impairment. Finally the chapter considers how far the science may help draw boundaries around mental illness. (shrink)

I respond to the 4 commentaries by Awais Aftab & Kristopher Nielsen, Hane Htut Maung, Diane O’Leary and Kathryn Tabb under 3 main headings: “What is the BPSM really?” & Why update it?; “Is our approach foundationally compromised?”, and finally, “Antagonists or fellow travellers?”.

This book offers a broad, systematic philosophical approach to mental disorder. The authors spend the first half of the book presenting their basic philosophical allegiances, and they go on to apply their philosophical approach to mental disorder. As the authors note, psychiatry has been largely neglected by contemporary philosophy of mind, and this book is a laudable attempt to rectify the situation by producing a sustained and clinically well-informed philosophical treatment of mental disorder.

In this paper I shall suggest that philosophy which bases itself firmly inlife is incompatible with idealism. The example of such a philosophy to be discussed is the later work of Wittgenstein, and I shall define in what sense this is ‘based in life’, with particular reference to his concept of ‘Lebensform’, or ‘life-form’. I shall understand idealism to be, in general terms, the doctrine that idea is the primary, or the only, category of being. Various kinds of idealism may (...) then be distinguished according to the precise definition each gives of ‘idea’, and of the category, if any, which is held to be less fundamental. Thus, in brief, in Platonic idealism, absolute immaterial being is ontologically prior to the changing world given to sense-experience; in the idealistic systems of more modern thought, mind is more fundamental than matter; or again, subject, or spirit, is more fundamental than object. While the various systems of idealism are properly classed together so far as they assign priority to the concept idea , it is clear that they differ in their interpretations of the concept. When one has in mind these differences, it is of course misconceived to speak of idealism as a single doctrine; nevertheless, it is plausible to suppose that philosophers have been led to apply the term ‘idealism’ to various systems despite their differences, because there is indeed a common tendency of thought to be found in them. The present paper takes this supposition as a working hypothesis, with the particular aim of establishing that philosophy based in life is incompatible with philosophy based in idea, whatever be reasonably meant by ‘idea’. In brief my argument will be this: that life is no idea. (shrink)

Debates about the concept of mental disorder involve social values, the medical model, and the sciences. It is generally agreed that the concept involves values, though how it does this continues to be disputed, and it is also recognized that the label of mental disorder or illness is stigmatizing. Wakefield's proposed definition of mental disorder in terms of harmful dysfunction locates the concept in an evolutionary theoretic framework. However, recent commentaries on Wakefield's analysis have suggested that research programs in evolutionary (...) biology and psychology envisage a broader class of "treatable conditions" that may involve no dysfunction, and hence no disorder in this sense. (shrink)

In this paper I shall suggest that philosophy which bases itself firmly inlife is incompatible with idealism. The example of such a philosophy to be discussed is the later work of Wittgenstein, and I shall define in what sense this is ‘based in life’, with particular reference to his concept of ‘Lebensform’, or ‘life-form’. I shall understand idealism to be, in general terms, the doctrine that idea is the primary, or the only, category of being. Various kinds of idealism may (...) then be distinguished according to the precise definition each gives of ‘idea’, and of the category, if any, which is held to be less fundamental. Thus, in brief, in Platonic idealism, absolute immaterial being is ontologically prior to the changing world given to sense-experience; in the idealistic systems of more modern thought, mind is more fundamental than matter; or again, subject, or spirit, is more fundamental than object. While the various systems of idealism are properly classed together so far as they assign priority to the concept idea, it is clear that they differ in their interpretations of the concept. When one has in mind these differences, it is of course misconceived to speak of idealism as a single doctrine; nevertheless, it is plausible to suppose that philosophers have been led to apply the term ‘idealism’ to various systems despite their differences, because there is indeed a common tendency of thought to be found in them. The present paper takes this supposition as a working hypothesis, with the particular aim of establishing that philosophy based in life is incompatible with philosophy based in idea, whatever be reasonably meant by ‘idea’. In brief my argument will be this: that life is no idea. (shrink)

The concept of regulation pervades biology, for example in models of genetic regulatory networks and the endocrine system. Regulation has a normative opposite, dysregulation, which figures prominently in biomedical models of disease. The use of normative concepts in biology, however, has been thought to present some challenges for the physicalist view of the world, and various resolutions have been proposed. Up to now the problem of biological normativity has been debated largely in connection with the concept of biological information. In (...) this paper we shift focus to the concept of biological regulation, proposing that it provides a promising new approach to these issues. Models of regulatory systems have several features: they are causal, but they do not deal with the energy exchanges and transformations covered by physics and chemistry; further, and entirely connected, regulatory systems can break down, and this is because they and their causal-regulatory properties are dependent on fragile molecular structures. Biological regulatory systems exhibit normativity, because they are not determined by physical and chemical laws, but their close relationship with physical laws and physicalist ontology is transparent. (shrink)

The epistemological principles underlying randomized, controlled trials and evidence-based medicine generally have not received the attention they require. Broadly speaking, they are the application of work done over several centuries in philosophy and scientific method. The epistemological base is sound, but it also implies internal limitations, having to do with decreasing generality, which particularly affect application to psychological problems. The principles also have nothing to say about values. The question of the 'objective validity' of scientific method is briefly discussed.