The Biomedical Model in Psychopathology. A Critical Historical Outline, Contemporary Context and Ethical Problems

Main Article Content

Radosław Stupak
https://orcid.org/0000-0002-7318-546X

Abstract

The article presents a critical historical outline and description of the biomedical model of psychopathology, focusing on the second half of the 20th century. It also identifies and discusses the key problems connected with its dominance in the contemporary clinical and research practice. These problems concern, among other things, the validity and reliability of psychiatric diagnoses, research methodology, treatment effectiveness, or the influence of pharmaceutical companies on research and therapeutic activity. The serious conceptual problems of the whole model call into question the foundations and knowledge base of contemporary psychiatry. There are also justified doubts regarding antipsychotic and antidepressant medications nowadays – despite their increasingly wide use, the number of chronically ill people keeps rising. This situation leads to serious ethical problems and warrants questions regarding the over-medicalisation of issues commonly associated with mental health. A reform of research and clinical practice is urgent.

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Stupak, Radosław. 2020. “The Biomedical Model in Psychopathology. A Critical Historical Outline, Contemporary Context and Ethical Problems”. Diametros 17 (66), 34-51. https://doi.org/10.33392/diam.1260.
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Articles
Author Biography

Radosław Stupak, Institute of Philosophy, Jagiellonian University in Kraków

Institute of Philosophy

Grodzka 52
31-044 Kraków

e-mail: radek.stupak@doctoral.uj.edu.pl

 

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References

Abbasi J. (2017), Ketamine Minus the Trip: New Hope for Treatment-Resistant Depression, „JAMA” 318 (20): 1964–1966.


DOI
View in Google Scholar

Ahn R., Woodbridge A., Abraham A. et al. (2017), Financial Ties of Principal Investigators and Randomized Controlled Trial Outcomes: Cross Sectional Study, „BMJ” 356: i6770.


DOI
View in Google Scholar

American Diabetes Association (2004), Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes, „Diabetes Care” 27 (2): 596–601.


DOI
View in Google Scholar


View in Google Scholar

American Psychiatric Association (1994), Diagnostic and Statistical Manual of Mental Disorders. 4th ed., „APA”, Washington, DC.
View in Google Scholar

Amsterdam J.D., McHenry L.B., Jureidini J.N. (2017), Zjawisko korupcji w badaniach psychia- trycznych, „Psychiatria Polska” 51 (6): 993–1008.


DOI
View in Google Scholar

Bentall R.P. (2003), Madness Explained: Psychosis and Human Nature, Penguin, London. Bernstein F. (1970), A Ten-Year History of the Early Clinical Drug Evaluation Unit (ECDEU) Program, „Psychopharmacol Bulletin” 6: 1–21.
View in Google Scholar

Bielefeldt A.Ø., Danborg P.B., Gøtzsche P.C. (2016), Precursors to Suicidality and Violence on Antidepressants: Systematic Review of Trials in Adult Healthy Volunteers, „JRSM” 109 (10): 381–392.


DOI
View in Google Scholar

Blashfield R.K., Keeley J.W., Flanagan E.H. et al. (2014), The Cycle of Classification: DSM-I Through DSM-5, „Annual Review of Clinical Psychology” 10 (1): 25–51.


DOI
View in Google Scholar

Bond C.H. (1914), The Position of Psychiatry and the Role of the General Hospitals in Its Improvement, „The Lancet” 184 (4755): 935–940.


DOI
View in Google Scholar

Bracken P., Thomas P. (2001), Postpsychiatry: A New Direction for Mental Health, „BMJ” 322 (7288): 724–727.


DOI
View in Google Scholar

Calton T., Ferriter M., Huband N. et al. (2008), A Systematic Review of the Soteria Paradigm for the Treatment of People Diagnosed with Schizophrenia, „Schizophrenia Bulletin” 34 (1): 181–192.


DOI
View in Google Scholar

Cosgrove L., Karter J.M. (2018), The Poison in the Cure: Neoliberalism and Contemporary Movements in Mental Health, „Theory & Psychology” 28 (5): 669–683.


DOI
View in Google Scholar

Cowen P.J., Browning M. (2015), What Has Serotonin to Do with Depression?, „World Psychiatry” 14 (2): 158–160.


DOI
View in Google Scholar

Davies J. (2017), How Voting and Consensus Created the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), „Anthropology & Medicine” 24 (1): 32–46.


DOI
View in Google Scholar

Davies J., Read J. (2018), A Systematic Review into the Incidence, Severity and Duration of Anti- depressant Withdrawal Effects: Are Guidelines Evidence-Based?, „Addictive Behaviors” 97 (Oct 2019): 111–121.


DOI
View in Google Scholar

de Barbaro B. (2014), Dylemat psychiatrii: „zły czy szalony”, „Psychiatra” 5 (7): 14–15.
View in Google Scholar

Deacon B.J. (2013), The Biomedical Model of Mental Disorder: A Critical Analysis of Its Validity, Utility, and Effects on Psychotherapy Research, „Clinical Psychology Review” 33: 846–861.


DOI
View in Google Scholar

Dell’Osso L., Pini S. (2012), What Did We Learn from Research on Comorbidity in Psychiatry? Advantages and Limitations in the Forthcoming DSM-V Era, „Clinical Practice and Epidemiology in Mental Health” 8: 180–184.


DOI
View in Google Scholar

Dub L.A., Lurie L.A. (1939), Use of Benzedrine in the Depressed Phase of the Psychotic State, „Ohio State Medical Journal” 35: 39–45.
View in Google Scholar

Dyga K., Stupak R. (2014), Obraz rehabilitacji psychiatrycznej w Polsce. Opis, porównania i ocena, [w:] Przepis na rehabilitację. Metodologie oraz metody w badaniach i transdyscyplinarnej praktyce rehabilitacyjnej, W. Otrębski, G. Wiącek (red.), Wydawnictwo KUL, Lublin.
View in Google Scholar

Eichenwald K., Kolata G. (1999), A Doctor’s Drug Studies Turn into Fraud, URL = https://partners.nytimes.com/library/national/science/health/051799drug-trials-industry.html [dostęp 1.08.2016].
View in Google Scholar

Ellenberger H.F. (1970), The Discovery of the Unconscious: The History and Evolution of Dynamic Psychiatry, Basic Books, New York, NY.
View in Google Scholar

Fava G.A., Offidani E. (2011), The Mechanisms of Tolerance in Antidepressant Action, „Progress in Neuro-Psychopharmacology & Biological Psychiatry” 35 (7): 1593–1602.


DOI
View in Google Scholar

U.S. Food and Drug Administration (2019), FDA Approves New Nasal Spray Medication for Treatment-Resistant Depression; Available Only at a Certified Doctor’s Office or Clinic, URL = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ ucm632761.htm [dostęp 23.03.2019].
View in Google Scholar

Frances A.J. (2012), DSM-5 Field Trials Discredit APA, URL = https://www.psychologyto-day.com/blog/dsm5-in-distress/201210/dsm-5-field-trials-discredit-apa [dostęp
View in Google Scholar

02.2017].
View in Google Scholar

Freemantle N., Anderson I.M., Young P. (2000), Predictive Value of Pharmacological Activity for the Relative Efficacy of Antidepressant Drugs: Meta-Regression Analysis, „The British Journal of Psychiatry” 177: 292–302.


DOI
View in Google Scholar

Gøtzsche P. (2015), Deadly Psychiatry and Organised Denial, People’s Press, Copenhagen.
View in Google Scholar

Harrow M., Jobe T.H., Faull R.N. (2012), Do All Schizophrenia Patients Need Antipsychotic Treatment Continuously Throughout Their Life Time? A 20-Year Longitudinal Study, „Psychological Medicine” 42 (10): 2145–2155.


DOI
View in Google Scholar

Harrow M., Jobe T.H., Faull R.N. et al. (2017), A 20-Year Multi-Followup Longitudinal Study Assessing Whether Antipsychotic Medications Contribute to Work Functioning in Schizophrenia, „Psychiatry Research” 256: 267–274.


DOI
View in Google Scholar

Healy D. (2002), The Creation of Psychopharmacology, Harvard University Press, Cambridge, MA.


DOI
View in Google Scholar

Hoffer A., Osmond H., Smythies J. (1954), Schizophrenia: A New Approach. II. Results of a Year’s Research, „Journal of Mental Science” 100 (418): 29–45.
View in Google Scholar

Ho B.-C., Andreasen N.C., Ziebell S. et al. (2011), Long-Term Antipsychotic Treatment and Brain Volumes: A Longitudinal Study of First-Episode Schizophrenia, „Archives of General Psychiatry” 68 (2): 128–137.


DOI
View in Google Scholar

Hollister L. (1998), From Hypertension to Psychopharmacology: A Serendipitous Career, [w:] The
View in Google Scholar

Psychopharmacologists, t. 2, D. Healy (red.), Chapman & Hall, London: 215–236.
View in Google Scholar

Huston P., Moher D. (1996), Redundancy, Disaggregation, and the Integrity of Medical Research, „Lancet” 347: 1024–1026.


DOI
View in Google Scholar

Insel T.R. (2006), Mental Illness and Brain Disease: Dispelling Myths and Promoting Recovery Through Awareness and Treatment. Subcommittee on Health of the Committee on Energy and Commerce, United States House of Representatives, URL = https://www.gpo.gov/fd-sys/pkg/CHRG-109hhrg30414/html/CHRG-109hhrg30414.htm [dostęp 10.06.2018].
View in Google Scholar

Insel T.R. (2006b), NIMH’s Dr. Thomas Insel: Group Advocacy, More Data, Will Improve Eating
View in Google Scholar

Disorders Research Funding, „Eating Disorders Review” 18: 5–6. Insel T.R. (2010), Faulty circuits, „Scientific American” 302: 44–51.
View in Google Scholar

Insel T.R. (2013), Transforming Diagnosis, URL = https://www.nimh.nih.gov/about/directors/thomasinsel/blog/2013/transforming-diagnosis.shtml [dostęp 26.01.2017].
View in Google Scholar

Jääskeläinen E., Juola P., Hirvonen N. et al. (2013), A Systematic Review and Meta-Analysis of Recovery in Schizophrenia, „Schizophrenia Bulletin” 39 (6): 1296–1306.


DOI
View in Google Scholar

Jansen K.L.R. (2004), Ketamine: Dreams and Realities, Multidisciplinary Association for Psychedelic Studies, Sarasota, FL.
View in Google Scholar

Kaczmarek E. (2018), How to Distinguish Medicalization from Over-Medicalization?, „Medicine, Health Care and Philosophy” 22 (1): 119–128


DOI
View in Google Scholar

Kamenov K., Twomey C., Cabello M. et al. (2017), The Efficacy of Psychotherapy, Pharmacotherapy and Their Combination on Functioning and Quality of Life in Depression: A Meta-Analysis, „Psychological Medicine” 47 (3): 414–425.


DOI
View in Google Scholar

Kamens S.R., Robbins B.D., Flanagan E.H. (2017), Introduction to the Special Issues on Diagnostic Alternatives, „Journal of Humanistic Psychology” 57 (6): 567–572.


DOI
View in Google Scholar

Kinderman P. (2014), A Prescription for Psychiatry, Palgrave Macmillan, Basingstoke, Hampshire. Kirkpatrick B., Buchanan R.W., Ross D.E. et al. (2001), A Separate Disease Within the Syndrome of Schizophrenia, „Archives of General Psychiatry” 58 (2): 165–171.
View in Google Scholar

Kirsch I., Deacon B.J., Huedo-Medina T.B. et al. (2008), Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration, „PLoS Med” 5 (2): e45.


DOI
View in Google Scholar

Kirsch I., Huedo-Medina T.B., Pigott H.E. et al. (2018), Do Outcomes of Clinical Trials Resemble Those “Real World” Patients? A Reanalysis of the STAR*D Antidepressant Data Set, „Psychology of Consciousness: Theory, Research, and Practice” 5 (4): 339–345.


DOI
View in Google Scholar

Krupitsky E.M., Grinenko A.Y. (1997), Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research, „Journal of Psychoactive Drugs” 29 (2): 165–183.


DOI
View in Google Scholar

Leo J. (2018), Memo to the Newest Generation of Gene Hunters: Read Jay Joseph, „Psychosis” 10 (1): 58–61.


DOI
View in Google Scholar

Longden E. (2013), The Voices in My Head. TED Talk, URL = https://www.ted.com/talks/eleanor_longden_the_voices_in_my_head?language=en [dostęp 11.08.2016].
View in Google Scholar

Ludwig A.M. (1975), The Psychiatrist as Physician, „JAMA” 234 (6): 603–604.


DOI
View in Google Scholar

Mithoefer M.C., Wagner M.T., Mithoefer A.T. et al. (2011), The Safety and Efficacy of {+/-}3,4-Methylenedioxymethamphetamine-Assisted Psychotherapy in Subjects with Chronic, Treatment-Resistant Posttraumatic Stress Disorder: The First Randomized Controlled Pilot Study, „Journal of Psychopharmacology” 25 (4): 439–452.


DOI
View in Google Scholar

Mithoefer M.C., Mithoefer A.T., Feduccia A.A. et al. (2018), 3,4-Methylenedioxymethamphetamine (MDMA)-Assisted Psychotherapy for Post-Traumatic Stress Disorder in Military Veterans, Firefighters, and Police Officers: A Randomised, Double-Blind, Dose-Response, Phase 2 Clinical Trial, „Lancet Psychiatry” 5 (6): 486–497.


DOI
View in Google Scholar

Moncrieff J. (2008), The Myth of the Chemical Cure, Palgrave Macmillan, Basingstoke, Hampshire.


DOI
View in Google Scholar

Moncrieff J. (2008b), Neoliberalism and Biopsychiatry: A Marriage of Convenience, [w:] Liberatory Psychiatry: Philosophy, Politics, and Mental Health, C.I. Cohen, S. Timimi (red.), Cambridge University Press, New York, NY.
View in Google Scholar

Moncrieff J., Kirsch I. (2015), Empirically Derived Criteria Cast Doubt on the Clinical Significance of Antidepressant-Placebo Differences, „Contemporary Clinical Trials” 43: 60–62.


DOI
View in Google Scholar

Moncrieff J. (2016), Misrepresenting Harms in Antidepressant Trials, „BMJ” 352: i217. Moncrieff J. (2016b), New Research into Antipsychotic Discontinuation and Reduction: The RADAR programme, URL = https://joannamoncrieff.com/2016/03/02/new-research-into-antipsychotic-discontinuation-and-reduction-the-radar-programme/ [dostęp 10.06.2018].


DOI
View in Google Scholar

Mulder R.T., Frampton C.M. (2013), Outcome of Mood Disorders Before Psychopharmacology: A Systematic Review, „Australian and New Zealand Journal of Psychiatry” 48 (3): 224–236.


DOI
View in Google Scholar

Oronowicz-Jaśkowiak W., Bąbel P. (2019), Twenty Years After ‘Listening to Prozac but Hearing Placebo’. Do We Hear Placebo Even Louder?, „Health Psychology Report” 7 (1): 1–8. Pużyński S. (2014), Czy kryzys, „Psychiatra” 5 (7): 6–8.
View in Google Scholar

Read J., Bentall R.P., Fosse R. (2009), Time to Abandon the Bio-Bio-Bio Model of Psychosis: Exploring the Epigenetic and Psychological Mechanisms by Which Adverse Life Events Lead to Psychotic Symptoms, „Epidemiology and Psychiatric Sciences” 18 (4): 299–310.


DOI
View in Google Scholar

Rees W.L., King G.N. (1952), Cortisone in the Treatment of Schizophrenia, „The Journal of Mental Science” 98: 408–413.


DOI
View in Google Scholar

Richardson T., Elliott P., Roberts R. et al. (2017), A Longitudinal Study of Financial Difficulties and Mental Health in a National Sample of British Undergraduate Students, „Community Mental Health Journal” 53 (3): 344–352.


DOI
View in Google Scholar

Rogers A., Pilgrim D. (2001), Mental Health Policy in Britain, Palgrave Macmillan, Basingstoke, Hampshire.


DOI
View in Google Scholar

Rogers D. (2017), Star Neuroscientist Tom Insel Leaves the Google-Spawned Verily for... A Startup?, URL = https://www.wired.com/2017/05/star-neuroscientist-tom-insel-leaves-google-spawned-verily-startup/ [dostęp 10.06.2018].
View in Google Scholar

Rzewuska M. (2007), Zaburzenia metaboliczne związane ze stosowaniem leków przeciwpsychotycznych u chorych na schizofrenię, „Psychiatria Polska” 41 (4): 457–472.
View in Google Scholar

Sarchet P. (2011), Harvard Scientists Disciplined for Not Declaring Ties to Drug Companies, URL = http://blogs.nature.com/news/2011/07/harvard_scientists_disciplined.html [dostęp 30.10.2018].
View in Google Scholar

Schizophrenia Working Group of the Psychiatric Genomics Consortium (2014), Biological Insights from 108 Schizophrenia-Associated Genetic Loci, „Nature” 511 (7510): 421–427.


DOI
View in Google Scholar

Scull A. (1994), Somatic Treatments and the Historiography of Psychiatry, „Historiography of Psychiatry” 5: 1–12.


DOI
View in Google Scholar

Seikkula J., Alakare B., Aaltonen J. et al. (2006), 5 Years Experiences of First-Episode Non-Affective Psychosis in Open Dialogue Approach: Treatment Principles, Follow-Up Outcomes and Two Case Analyses, „Psychotherapy Research” 16: 214–228.


DOI
View in Google Scholar

Sharma T., Guski L.S., Freund N. et al. (2016), Suicidality and Aggression During Antidepressant Treatment: Systematic Review and Meta-Analyses Based on Clinical Study Reports, „BMJ” 352: i65.


DOI
View in Google Scholar

Shorter E. (2005), Historia psychiatrii. Od zakładu dla obłąkanych po erę Prozacu, tłum. P. Turski, Wydawnictwa Szkolne i Pedagogiczne, Warszawa.
View in Google Scholar

Smith R. (2005), Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies, „PLoS Med” 2 (5): e138.


DOI
View in Google Scholar

Spielmans G.I., Parry P.I. (2010), From Evidence-Based Medicine to Marketing-Based Medicine: Evidence from Internal Industry Documents, „Journal of Bioethical Inquiry” 7 (1): 13–29.


DOI
View in Google Scholar

Stupak R., Dobroczyński B. (2019), Projekt Soteria: zwiastun „trzeciej drogi” w psychiatrii?, „Psychiatria Polska” 53 (6): 1351–1364.


DOI
View in Google Scholar

Stupak R., Dyga K. (2018), Postpsychiatry and Postmodern Psychotherapy: Theoretical and Ethical Issues in Mental Health Care in a Polish Context, „Theory & Psychology” 28 (6): 780–799.


DOI
View in Google Scholar

Thacker P.D. (2018), Time to Act on Industry Influence Over Medicine and Lay Zombie Arguments to Rest, URL = https://blogs.bmj.com/bmj/2018/10/05/paul-d-thacker-time-to-act-on-industry-influence-over-medicine-and-lay-zombie-arguments-to-rest/ [dostęp 30.10.2018].
View in Google Scholar

The Brainstorm Consortium (2018), Analysis of Shared Heritability in Common Disorders of the Brain, „Science” 360 (6395): eaap8757.
View in Google Scholar

Varese F., Smeets F., Drukker M. et al. (2012), Childhood Adversities Increase the Risk of Psychosis: A Meta-Analysis of Patient-Control, Prospective and Cross-Sectional Cohort Studies, „Schizophrenia Bulletin” 38 (4): 661–671.


DOI
View in Google Scholar

Veling W., Susser E., van Os J. et al. (2008), Ethnic Density of Neighborhoods and Incidence of Psychotic Disorders Among Immigrants, „The American Journal of Psychiatry” 165 (1): 66–73.


DOI
View in Google Scholar

Waszkiewicz A.A., Nizio A.M. (2014), Rola psychologa klinicznego w szpitalu psychiatrycznym, „Psychiatria i Psychoterapia” 10 (1): 3–10.
View in Google Scholar

Whitaker R. (2002), Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill, Perseus Publishing, Cambridge, MA.
View in Google Scholar

Whitaker R. (2016), The Case Against Antipsychotics: A Review of Their Long-Term Effects, URL = http://www.madinamerica.com/wp-content/uploads/2016/07/The-CaseA-gainst-Antipsychotics.pdf [dostęp 10.08.2016].
View in Google Scholar

Whiteford H.A., Harris M.G., McKeon G. et al. (2013), Estimating Remission from Untreated Major Depression: A Systematic Review and Meta-Analysis, „ Psychological Medicine” 43 (8): 1569–1585.


DOI
View in Google Scholar

Wicks S., Hjern A., Dalman C. (2010), Social Risk or Genetic Liability for Psychosis? A Study of Children Born in Sweden and Reared by Adoptive Parents, „The American Journal of Psychiatry” 167 (10): 1240–1246.


DOI
View in Google Scholar

Williams J.B., Gibbon M., First M.B. et al. (1992), The Structured Clinical Interview for DSM- III-R (SCID): II. Multisite Test–Retest Reliability, „Archives of General Psychiatry” 49 (8): 630–636.


DOI
View in Google Scholar

Wolfers T., Doan N.T., Kaufmann T. et al. (2018), Mapping the Heterogeneous Phenotype of Schizophrenia and Bipolar Disorder Using Normative Models, „JAMA Psychiatry” 75 (11): 1146–1155.


DOI
View in Google Scholar

Wunderink L., Nieboer R.M., Wiersma D. et al. (2013), Recovery in Remitted First-Episode Psychosis at 7 Years of Follow-Up of an Early Dose Reduction/Discontinuation or Maintenance Treatment Strategy: Long-Term Follow-Up of a 2-Year Randomized Clinical Trial, „JAMA Psychiatry” 70 (9): 913–920.


DOI
View in Google Scholar

Yesavage J.A., Fairchild J.K., Mi Z. et al. (2018), Effect of Repetitive Transcranial Magnetic Stimulation on Treatment-Resistant Major Depression in US Veterans: A Randomized Clinical Trial, „JAMA Psychiatry” 75 (9): 884–893.


DOI
View in Google Scholar