Twenty years ago, the biopsychosocial model was proposed by George Engel to be the new paradigm for medicine and psychiatry. The model assumed a hierarchical structure of the biological, psychological and social system and simple interactions between the participating systems. This article holds the thesis that the original biopsychosocial model cannot depict psychiatry's reality and problems. The clinical validity of the biopsychosocial model has to be questioned. It is argued that psychiatric interventions can only stimulate but not determine their target (...) systems, because intervention and outcome are only loosely coupled. Thus, psychiatric interventions have in principle limited ranges which differ according to the type of intervention and according to the system to be stimulated. Psychosocial interventions face far more obstacles to be overcome than psychopharmacogical therapy. (shrink)

Since existentialism lost its influence in philosophy in the 1960s, postmodern theory has taken over criticizing basic concepts of western thought. From a postmodern point of view, the main shortcomings of existentialism is that it criticizes traditional unitarian concepts, while re-inventing new unitarian models. Against these unitarian approaches postmodernism holds that the world can only be described in terms of difference. In this article the postmodern program and its differences from existentialism are explained in reference to three concepts of western (...) philosophy: subject, truth, and ethics. Applying these concepts, the relevance of postmodernism for medical theory is illustrated. (shrink)