I was first introduced to Professor Bolton's work as a young psychiatrist whiling away some time in the hospital library with Huxley's The Doors of Perception. In pops a psychologist who said if I was interested in that sort of thing, I should read Mind, Meaning and Mental Disorder (MMMD), co-authored by Derek Bolton and Jonathan Hill. It was, he said, a very learned book. What he did not say is that it is a very sophisticated attempt to ground the meaning of mental symptoms in neurobiology without reducing and explaining them away, hence not an easy read. Some years later a French professor of philosophy described it as the greatest book on the philosophy of psychiatry since Jaspers' General Psychopathology. He included Foucault's History of Madness in this. Bolton trained first as a philosopher, then switched to psychology and ultimately gained a chair in philosophy and psychopathology at London's Institute of Psychiatry, Psychology and Neuroscience.
I say all this to foreground my expectations on starting Bolton's latest book, co-authored with Professor Grant Gillett, a neurosurgeon turned philosopher. The Biopsychosocial Model of Health and Disease is a far slimmer and speedier read than MMMD but that is not to say slighter. Its focus is the biopsychosocial model as applied throughout healthcare, and the majority of the examples and evidence presented concerns common physical disorders. The intention is to defend the biopsychosocial model from criticism that it is vague and incoherent; nothing but a repository for any and all hypotheses, however mutually excluding. The key insight, following Erwin Schrödinger and continuous with MMMD, is that biology already contains key elements of the psychological and social. Genes and energy production are constrained by the laws of physics but also involve organisation and regulatory control. This brings the concepts of goals, information and error – replete throughout psychology and sociology – into the most foundational branches of biology. The bio, psycho and social become different ways of describing the same events, undercutting the drive to reduce everything to biology. They argue that the vagueness is not a weakness of the model but rather that the relative contribution each domain makes varies according to the specific medical condition.
The book is well-written and its main thesis clearly argued and structured, with repeated summaries and signposting to guide the reader. Happily, it is available online as an open access book or can be bought as a hard copy. The relative brevity of the book means that some of the details are sketched rather than sharply drawn, however. For instance, as per the continuity thesis, on p. 87 they argue that Wittgenstein's philosophy of language is closely connected to notions of regulation in the biological and behavioural sciences. It is an interesting point but as presented it rests on assertion rather than analysis. There were also a few annoying typos in my review copy. At one point we are promised a quote from Anthony Giddens that never materialises. Nothing, however, to distract from the main thesis. The Biopsychosocial Model of Health and Disease provides a new theoretical and philosophical defence of a central tenet in medicine. It outlines a programme that others will illustrate in time.
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