Biopsychosocial or Bio-bio-bio?
Last month, clinicians and researchers gathered at the Austen Riggs Center for an exciting, stimulating two-day exchange of learning and collaboration at the third annual Riggs-Yale conference. Throughout the conference, which focused on Early Adversity and Developmental Psychopathology, there was a robust discussion about the growing evidence for the value of working with individuals who struggle with mental illness from a biopsychosocial perspective rather than a reductionist biomedical model, also known as the “bio-bio-bio” approach (as coined by Steve Sharfstein, MD in his American Psychiatric Association presidential address) that is currently more prevalent in the mental health care system.
When using a biopsychosocial model, an individual’s psychiatric struggles are viewed as multi-determined and complex. Intersecting biological vulnerabilities, physical health, internal psychological and family dynamics, socioeconomic status, race, religion, ethnicity, age, gender, and sexual orientation are all considered as potentially meaningful and relevant to understanding the individual’s struggles. This perspective demands clinicians pay attention to “the person in environment” and organize treatment plans to address these multiple factors. In contrast, a “bio-bio-bio” perspective of psychiatric disorder locates psychopathology within the individual’s biological constitution, with psychotropic medication aimed at altering brain chemistry considered the primary psychiatric intervention.
The Austen Riggs Center has a long history and tradition of treating patients from a biopsychosocial perspective. Erik Erikson, who was a staff psychologist at Riggs during the 1950s, continued to develop his seminal theories about identity and psychosocial development across the lifespan while at Riggs. Erikson’s “psychosocial” perspective continues to inform our clinical thinking at Riggs.
Within the first few years of the tenure of Edward Shapiro, M.D. as Medical Director/CEO in the 1990s, he recognized the need to further deepen our psychosocial engagement of patients through work with families of Riggs patients. Shapiro did this by expanding the social work department – hiring master’s level clinical social workers trained and educated in systems thinking and the biopsychosocial tradition to evaluate patients’ external contexts and to engage families in the therapeutic process of patients’ recovery.
In addition to the core individual psychotherapy with a doctor on the staff of Riggs, patients work with master’s level clinical social workers who are members of the interdisciplinary treatment teams. Social workers perform psychosocial assessments and interventions with patients and their families to develop a comprehensive understanding of patients in the context of their family system, the treatment system, and the larger social system. In this way, social workers engage and integrate patients’ external context into their treatment experience at Riggs.
I once heard a patient poignantly talk about his struggle to join the therapeutic community at Riggs because he had to disconnect from his home community when he made a decision to enter treatment at Riggs. Our patients, who are dislocated from their communities, deserve our best efforts at engaging and honoring their previous communities and connections. At Riggs, families and community matter. We provide patients with an opportunity to join and belong to our therapeutic community and we diligently work at preserving and strengthening patients’ connections to their families while they engage in the potentially transformative treatment offered at Riggs.