Causation and Causal Selection in the Biopsychosocial Model of Health and Disease

Abstract

In The Biopsychosocial Model of Health and Disease, Derek Bolton and Grant Gillett argue that a defensible updated version of the biopsychosocial model requires a metaphysically adequate account of disease causation that can accommodate biological, psychological, and social factors. This present paper offers a philosophical critique of their account of biopsychosocial causation. I argue that their account relies on claims about the normativity and the semantic content of biological information that are metaphysically contentious. Moreover, I suggest that these claims are unnecessary for a defence of biopsychosocial causation, as the roles of multiple and diverse factors in disease causation can be readily accommodated by a more widely accepted and less metaphysically contentious account of causation. I then raise the more general concern that they are misdiagnosing the problem with the traditional version of the biopsychosocial model. The challenge when developing an explanatorily valuable version of the biopsychosocial model, I argue, is not so much providing an adequate account of biopsychosocial causation, but providing an adequate account of causal selection. Finally, I consider how this problem may be solved to arrive at a more explanatorily valuable and clinically useful version of the biopsychosocial model.

Integration and Causality in Enactive Approaches to Psychiatry

“…If the integration problem is not solved in Gerrans' (narrow) or Sass's (wide) hierarchical level model, and if we have reasons to doubt that de Haan's fusion model will work in this context, then the idea of a dynamical gestalt offers an alternative way of addressing the integration problem. For purposes of characterizing a gestalt, it is not enough to simply list the relevant factors or processes; rather, we need to say specifically how all of the factors relate (20)(21)(22). To be clear, the idea that there are dynamical connections among the various factors and processes of the gestalt is part of its definition.…”

Philosophy of psychiatry: theoretical advances and clinical implications

“…However, the biopsychosocial model has also received stinging criticism for being overly eclectic and non‐specific 141 , and for offering no particular framework to conceptualize multi‐level causal interactions 142 or allow optimal selection of causal mechanisms 143 . Further, its practical use in psychiatric formulation has led to an inadvertent reification of “biological”, “psychological” and “social” as distinct ontological domains 144 .…”

Loneliness as Cause

“…Again, this is important in psychiatry given the complexity of mental disorders and their determinants. Connecting this to the biopsychosocial model, Maung ( 2021 ) has pointed out that interventionism can overcome shortcomings within the metaphysical background underlying the account by Bolton and Gillett ( 2019 ). Its neutrality with regard to contentious metaphysical issues, such as whether there is normativity in nature, appears to be another benefit of interventionism.…”