Exploring biopsychosocial hegemony through a critical lens
Many of the forthcoming blogs will explore different aspects of biopsychosocial discourse and biopsychosocial hegemony. By hegemony, I mean the persistence and increasing reach of biopsychosocial discourse in the clinical and social arenas - despite lack of evidential support for theories and interventions in the field of ‘medically unexplained symptoms’, and particularly in the field of myalgic encephalomyelitis / chronic fatigue syndrome (ME/CFS).
Most people who are familiar with biopsychosocial narratives within this context will argue that psychiatry has much to do with the ascendency of a particular variant of the biopsychosocial model that now seems dominate health and social policy in the UK and beyond. After all, psychiatry – especially from a critical standpoint - is well recognised and written about as a social force in its own right, constructing the knowledge that it claims to merely reflect.
Further, psychiatry – like all disciplines that consider themselves scientific – lays claim to an apolitical neutrality that lends authority and credence to the narratives it constructs. Within the ME/CFS patient community, the blatent bias of certain psychiatrists who have played a significant role in the psychosocial construction of ME/CFS is a very common topic for discussion. (Bias that seems to be recognised by everybody other than said psychiatrists and devotees). Such discussions have a solid foundation in extant literature: critical theorists, notably feminist scholars, have long critiqued the pretensions of science and the psy disciplines to objectivity, alongside highlighting a thorough lack of reflexivity when it comes to personal and institutional agendas. Biopsychosocial discourse may be one of the best (or worst) examples of such lack of reflexivity.
Whilst the role of psychiatry (or at least, certain psychiatrists) in the social construction of medically unexplained symptoms and in the psychosocial framing of ME/CFS is very important, I think it is far from the whole picture. There is a more complicated picture, that rarely if ever finds its way into peer-reviewed literature, involving a network of academics (some but not all of whom are psychiatrists), government officials, and the health insurance industry whose interests revolve around welfare reform and retrenchment of the healthcare and welfare sectors.
One of the key figures in the network, who has been involved in all three spheres of the academia-government-health insurance complex, is Professor Sir Mansel Aylward, who is not a psychiatrist but a physician who trained in specialities such as rheumatology, public health and rehabilitation. Aylward has also held a number of positions within the UK Department and Work and Pensions (DWP), alongside cultivating associations with the health insurance industry. Aylward was also on the trial steering committee of the now infamous PACE trial and helped secure funding for the trial from the DWP - go figure.
In shining the spotlight of scrutiny on this network of associations and enabling socio-structural context that has given rise to biopsychosocial hegemony, I think that mainstream approaches (such as mainstream health and/or social psychology) are helpful but not sufficient. I think we also need to turn to disability activists’ work, alongside that of scholars within the field of disability studies, combined with other critical disciplines such as critical psychology. I hope to contribute to this in some small way in forthcoming blogs.