We Have Happy Pills, Anxiety Drugs, and Therapists Galore: So Why Are We More Stressed and Depressed Than Ever?
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Models are belief systems—sets of assumptions and explanations we construct to make sense of our experience. In Engel’s words, “The more socially disruptive or individually upsetting the phenomenon, the more pressing the need of humans to devise explanatory systems.” Disease is a very upsetting phenomenon, and humans throughout history have come up with a variety of belief systems to explain it, from the wrath of the gods to possession by spirits to disharmony with the forces of nature. The dominant model of disease in our time is biomedical, built on a foundation of molecular biology. As Engel explains, “It assumes disease to be fully accounted for by deviations from the norm of measurable biological (somatic) variables. It leaves no room within its framework for the social, psychological, and behavioral dimensions of illness. The biomedical model not only requires that disease be dealt with as an entity independent of social behavior, it also demands that behavioral aberrations be explained on the basis of disordered somatic (biochemical or neurophysiological) processes. Thus the biomedical model embraces both reductionism, the philosophic view that complex phenomena are ultimately derived from a single primary principle, and mind-body dualism.”
Engel goes on to say, “The biomedical model has . . . become a cultural imperative, its limitations easily overlooked. In brief, it has now acquired the status of a dogma. . . . Biological dogma requires that all disease, including ‘mental’ disease, be conceptualized in terms of derangement of underlying physical mechanisms.” He proposed an alternative: a biopsychosocial model of health and illness.
There is no question that over the past century, biomedicine has advanced our knowledge of human biology, but the real test of a scientific model—the measure of its superiority to an alternative belief system—is whether or not it increases our ability to describe, predict, and control natural phenomena. In my books about health and healing, I have written a great deal about how strict application of the biomedical model has actually made it harder for us to understand and manage common diseases. For instance, I have pointed out that it fails to account for the fact that many people infected with H. pylori never develop peptic ulcers or have any symptoms at all. They coexist with it in a balanced way. Clearly, factors other than the simple presence of that germ play a role in peptic ulcer disease, including the strength or weakness of host defenses, of an individual’s resistance. One of those defenses is stomach acid, whose production is influenced by the autonomic (involuntary) nervous system and through it by emotions. In the fight-or-flight response, the sympathetic division of the autonomic nervous system shuts down gastrointestinal function, which is unnecessary in an emergency, in order to divert energy and blood flow to muscles. That includes turning off the production of acid in the stomach. In chronic anxiety and stress, the sympathetic nerves are constantly overactive, and therefore there is constantly less acid in the stomach to keep potentially invasive germs from causing tissue damage. To say that H. pylori infection is strongly correlated with peptic ulcer disease is accurate. To say that it is the sole cause of ulcers ignores the complexity of causation and the possible influence of emotions.
In 1980, the American Psychiatric Association radically revised the Diagnostic and Statistical Manual–III (DSM-III) to be in accord with the biomedical model. As a consequence, the role of psychiatrists went from being facilitators of insight in patients to being dispensers of drugs to modify brain chemistry. Although some psychiatrists still rely on talk therapy, of all medical specialties, the profession as a whole is the most dominated and, to my mind, hobbled by blind faith in biomedicine. Psychiatrists were easily seduced because of a collective inferiority complex with regard to their place in the medical hierarchy. Still referred to as witch doctors and shrinks (from headshrinkers), they themselves have a history of questioning whether they are real doctors and whether they need the same basic medical training as cardiologists and surgeons. With the spectacular rise of biomedicine, their discomfort increased, and, not wanting to be left behind, they looked for ways to be even more biologically correct than their colleagues in other specialties. They saw their ticket to acceptance in the new and rapidly developing field of psychopharmacology—the study of the effect of drugs on mental and emotional disorders.