Advocating for a Biopsychosocial Approach to Care
What is a biopsychosocial approach to mental health and why is it important?
The term “biopsychosocial” has its origins in the 1970s, when psychiatrist George Engel urged the adoption of a framework that included aspects of biology, psychology, and social context as a way to understand individuals, mental illness, and its treatment.
While the field of psychiatry drifted toward more of a biological orientation in the 1990s (“the decade of the brain”) and afterward, the Austen Riggs Center remained committed to the biopsychosocial model, and to the importance of meaning, relationships that continue over time, and respect for the authority and voice of the patient. The fervent hope was that decoding the human genome would reveal the genes for mental disorders, but what we have learned is that there are no simple genetic underpinnings for mental disorders like depression or schizophrenia, and that environmental factors play a much larger role than we imagined. The focus on genetics has shifted to a focus on gene-by-environment interactions.
“The irony is that this is a back to the future moment. It turns out that 'gene-by-environment' is just another way of saying 'biopsychosocial,” says Riggs’ newly appointed Director of Biopsychosocial Advocacy Eric M. Plakun, MD. “In addition to biological factors, it’s the environment we need to pay more attention to; what happens matters, people’s experiences matter, and, in particular, early adversity matters. Environmental experience and relationships determine what our genes will express.” Current research shows that early adverse experiences can be powerful predictors of medical illness, psychiatric, and substance use disorders. “We’ve been searching for biomarkers, but we’ve already got an ‘enviro-marker’ – early adversity,” says Plakun. "Further, Plakun argues that psychotherapy is a form of gene-by-environment interaction."
Plakun’s new appointment is part of the Austen Riggs Center’s effort to bring greater attention to pressing issues in mental health and mental health treatment. Riggs Medical Director/CEO Andrew J. Gerber, MD, PhD, remarked “This new position reflects Eric's growing impact and reputation in the larger mental health field as a voice speaking with clarity and passion about the importance of psychotherapy, psychosocial treatment, residential treatment, as well as ethical and parity issues.”
In his new role, Plakun, who is also the associate medical director and was previously the director of admissions at Riggs for 35 years, will be focusing in two areas of biopsychosocial advocacy: policy and practice.
In terms of policy, Plakun intends to focus on:
- A full implementation of mental health parity, including access to psychotherapy and residential treatment
- An end to stigma
- Ethical managed-care practices
- Patient-centered care and integrated care teams
As for the area of practice, major areas of advocacy include:
- Psychotherapy as a first-line, evidence-based treatment option
- Wider practice of psychodynamic psychopharmacology
- Engaging the increasingly recognized problem of treatment resistance by looking beyond biology to the adverse impact of early adversity and comorbidity, and to the benefit of healing relationships
Plakun is already involved in a number of projects related to his new advocacy role, including authoring recurring columns on psychodynamic therapy in Psychiatric Times and on psychotherapy for the Journal of Psychiatric Practice, and moderating the “Biopsychosocial Matters” forum on Meaning Matters, an online discussion forum for psychoanalytic thinkers across disciplines.
Beyond writing, Plakun is an international presenter on biopsychosocial approaches to care and hopes to use his positions within the American Psychiatric Association (APA) – he is founding chair of the APA Psychotherapy Caucus, serves in the APA Assembly (where he is chair of the Assembly Committee of Representatives of Subspecialties and Sections), and is a member of the Assembly Executive Committee – to further his advocacy work.
“There are issues of advocacy in both the practice domain and in the implementation of parity and they relate to stigma,” says Plakun, who believes we have an opportunity now to more formally take what we know and what we are learning to help reduce that stigma. “I have been advocating for a biopsychosocial approach for a long time,” says Plakun, “and this new role will allow me to dedicate even more time to what I believe is very important and necessary work.”
Engel, George L. (1977). "The need for a new medical model: A challenge for biomedicine". Science 196:129–136.