The need for a New Medical Model A Challenge for Biomedicine

  • Type:#article
  • Subject: (in brackets, can also bracket keywords in text)
  • Bibtex: @engel1977
  • Bibliography: Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196(4286), 129–136.

Why and when I was reading this

I was doing a deep-dive into the nature of psychiatric disorders.

Key takeaways

  • He argues that psychiatry struggles to find it’s place within medicine because psychiatric disorders do not easily fit the biomedical model.
  • The reductionism seen in the biomedical model is partly to blame, because we are not able to reduce psychiatric disorders to molecular biology just yet.

I contend that all medicine is in crisis and, further, that medicine’s crisis derives from the same basic fault as psychiatry’s, namely, adherence to a model of disease no longer adequate for the scientific tasks and social responsibilities of either medicine or psychiatry.

In sum, psychiatry struggles to clarify its status within the mainstream of medicine, if indeed it belongs in medicine at all. The criterion by which this question is supposed to be resolved rests on the degree to which the field of activity of psychiatry is deemed congruent with the existing medical model of disease. But crucial to this problem is another, that of whether the contemporary model is, in fact, any longer adequate for medicine, much less for psychiatry. For it is not, then perhaps the crisis of psychiatry is part and parcel of a larger crisis that has its roots in the model itself. Should that be the case, then it would be imprudent for psychiatry prematurely to abandon its models in favor of one that may also be flawed.

The Biomedical Model

  • Reductionism: Complex phenomena are ultimately derived from a single primary principle (molecular biology). Physics → Chemistry → Biology → Psychiatry
  • Mind-body dualism: mental and somatic are different things

The biomedical model is dogma, we force everything to fit within the model and struggle with things that do not fit. All behavioral phenomena of disease must be reduced to physics, and if we fail to do so we exclude them from the category of disease.

Limitations of the biomedical model