The biopsychosocial model was never developed fully theoretically. Yet, I, and many researchers, think it shows promise. In this essay, I want to think about how a brain condition can have multiple causes. In doing this, I will make analogies with broken bones and physics, and posit social causes.
The cause of a broken bone may be many things. It could be one is vulnerable to breaking bones; there is something about one’s bones that make them prone to breaking. If this is the case, a minor bump, simply standing up, or fall could cause a broken bone.
One could get a broken bone by accident, in playing a sport.
One can get a broken bone by being assaulted by another person.
We have no problem thinking about different causes of broken bones.
Yet, many people have trouble understanding how there could be different causes for brain disorders. This seems to me not an especially difficult problem when we look at non-brain pathologies.
Causes, especially social or psychological causes, may seem strange because we cannot directly perceive them. We cannot see stress or trauma. Yet we seem to have no problem talking about these things, and, in the literature, we see a body of data that strongly suggests causation between stress, trauma, and brain disorders.
Let’s look at stress, for a moment. There’s a whole body of research on how stress can cause a variety of physical problems. Most people, and most professionals, do not have a problem assigning stress as a cause to things like acne, sleep problems, weight loss, overeating, and so forth.
Yet, many people, especially those who hold firm to the biomedical model, would have a problem assigning invisible causes to physical illness, such as brain illness.
This need not be that case.
To see why, let’s turn to introductory physics.
Although the aim in physics as a science is probably to find testable hypotheses, much of physics is theoretical, and deals with both visible and non-visible things. We cannot see gravity, for example. Yet, the average person understands the basics of how gravity works in everyday life, and physicists have a good understanding of how gravity works in the universe. We posit a name for such a thing—calling it gravity—because we can, or rather Newton could, see that things must be pulled to the Earth.
In the same way, I want to posit social causes. A social cause is not a force acting directly upon one’s body, that we know of. It may very well be, I would need more data in order to posit a social force in that way. What we can probably say is that, whatever we make of the psychological, be it material or immaterial, the social can act upon the mind*, and affect it in both positive and negative ways.
This is easy to see, when we look at the literature, but it’s difficult to find a theory and proper understanding of it.
I do not want to imagine the mental or psychological as something mystical and beyond comprehension. I do not think many things in the universe are mystical or beyond comprehension. I may not currently understand such things, but that does not mean human beings cannot understand them.
I also do not want to posit too many things; I want my theory to be as simple as I can make it. This is just keeping with Occam.
Likewise, in keeping in the tradition of many empiricists and philosophers, I take it that the universe makes sense. It is not disordered. It may be surprising, or counterintuitive, at times, but it is not disordered. For me, what’s disordered is my mind*, when I am psychotic. But even then, there’s some sense to it. I do not magically know how to speak Arabic—which I don’t know when I’m sane—when I’m psychotic. My mind* can only scramble, order, disorder and reassemble things I know, and it can create just so long as I am, at any rate, creative, when I am psychotic.
So I want to posit social causes, which are causes just like any direct, physical cause. This is what I mean by cause.
Much has been made of making psychology, sociology, and other social science into hard sciences. Many think this is not possible.
I think, when we are dealing with the social sciences, we are dealing, in a way, with the same kinds of things as theoretical physicists are dealing with. What I mean by that is that we are dealing with many things interacting, we are dealing with complex causes, and we are dealing with forces acting upon things which are not, necessarily, directly touching. I do not have the understanding of physics that I’d like to have in order to make this comparison even more compelling, but I’m not trying to make the social sciences into hard sciences in order to make them more credible in whatever way. I’m making this analogy because I think it’s true, and, after looking at data, think there’s some merit to it. We do not have a problem, normally, thinking that the Sun affects the Earth, even thought these two objects do not touch. In a similar way, I want us to think about social causes as one social event affecting a person, even though they may not be touching.
In this way, I believe in the armchair, but I also believe in experimenting. Because there’s only so much we can directly observe. Our personal observations may lead us astray, which is why I refer to the data, which I am keen to look at.
So, social causes, I want to think are just as real and forceful as physical causes.