Richter D
Westf. Klinik für Psychiatrie und Psychotherapie, Münster, Germany.
Med Health Care Philos. 1999;2(1):21-30. doi: 10.1023/a:1009968106317.
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 psychopharmacological therapy.
二十年前，乔治·恩格尔提出生物心理社会模型，作为医学和精神病学的新范式。该模型假定生物、心理和社会系统具有层次结构，且参与系统之间存在简单的相互作用。本文认为，最初的生物心理社会模型无法描绘精神病学的现实情况和问题。生物心理社会模型的临床有效性值得质疑。有人认为，精神科干预只能刺激而不能决定其目标系统，因为干预与结果之间只是松散地耦合。因此，精神科干预原则上范围有限，其范围因干预类型和要刺激的系统而异。心理社会干预面临的障碍远比心理药物治疗要克服的障碍多。
