Limitations and clinical relevance of the biopsychosocial model
The biopsychosocial model is therefore an arguably more ‘integrative, non-reductionist clinical and theoretical’ model that ‘honors the importance of all relevant domains of knowledge, not just the "biological"’ (Benning, 2015). While it is considered as a more inclusive model relevant to medicine and psychiatry, and an improvement on the more reductionist biomedical model (Deacon, 2013), it is still not entirely free of criticism. Those levied against the model include (i) the dominance or under-representation of each of the three domains (bio-, psycho- or social) when applied to research and clinical practice, and (ii) the insensitivity of the model to individuals’ subjective experiences and ‘personal meaning’, particularly within cross-cultural settings.
There are still those who perceive psychiatry as ‘biased’ towards biomedical paradigms (at the expense of the ‘psychological’ and ‘social’ domains), and conversely that psychologically and socially-oriented thinking and approaches are equally ‘biased’ (at the expense of the ‘biological’ domain), making the model difficult to implement (i.e. to translate or replicate in research, or to apply within clinical practice in current healthcare systems and services). Application of the model is also reliant on the practitioner’s (i.e. clinician’s or researcher’s) own understanding and working knowledge of the three domains, affecting treatment selection, clinical judgement and decision-making (Alvarez, Pagani and Meucci, 2012). And consequently, the model does not always translate as ‘combined’ or ‘personalised treatment’ for the individual (although the combination of psychotherapy with pharmacotherapy is gaining wider recognition globally), and practitioners have found the model difficult to incorporate into treatment plans (Alvarez, Pagani and Meucci, 2012).
In terms of an ‘integrative’ model that could improve on Engel’s biopsychosocial model, key issues that remain to be tackled (Kendler, 2010, cited in Benning, 2015, p. 349) are 'how to integrate the diverse etiological factors that contribute to psychiatric illness and how to conceptualize rigorously multidimensional approaches to treatment'. Nevertheless, the ability to draw together these three aspects − bio-, psycho- and social − to critically evaluate evidence and explanations and in this manner gain a broader, more holistic picture, remains key to understanding mental health science. Understanding mental illness also requires viewing mental distress from the standpoint of those who have experienced it, as well as an appreciation of societal and cultural views, and how mental illness and mental health research are portrayed in the media.