Oxford Loebel Lectures and Research Programme
The Oxford Loebel Lectures and Research Programme (OLLRP) form an interdisciplinary scientific and philosophical project dedicated to exploring and explicating the causal and conceptual links between the biological, psychological, and social factors that contribute to mental processes, mental health, and in particular mental illness. Its aim is to lay the ground work for a unified theory that can form the basis for clinical work in psychiatry. The first two of the three Annual Lectures planned were presented by Professors Kenneth Kendler and Stephen Hyman respectively.
The field of psychiatry uncomfortably spans biological and psycho-social views of mind and behaviour. As a branch of medicine, psychiatry has long been under pressure to conform to the sort of reductive, biological model that has traditionally defined medicine. According to this biomedical model, diseases are characterized primarily in biological terms (e.g. genetic influence, molecular changes in the body’s organs, abnormalities detectable via blood tests, MRI scans, etc.) As well as being a branch of medicine, however, psychiatry draws heavily on the psychodynamic tradition. This makes no reference to the biological underpinnings of mental life, concerning itself instead with psycho-social elements. Patients’ mental distress, on this approach, is explained with reference to life experience and treated by reflecting on past experience and current feelings in psychotherapeutic treatment.
The biomedical approach and the psychodynamic approach ought to inform and complement each other—after all, both aim at understanding the mind, and each contributes something unique and important to this understanding. However, historically, this has not happened. With no theory creating global, systematic links between the two approaches, psychiatry is divided between those clinicians who adopt a psychodynamic view of the mind, those who take a biomedical approach, and those who subscribe to an uneasy eclecticism under the rubric of the biopsychosocial model. Generally, however, the latter view involves little more than an acknowledgement that biological, psychological, and social factors are relevant to understanding mental illness. It has been criticised both for failing to specify how mental illnesses may be diagnosed and characterized in biopsychosocial terms, and for failing to provide directions for treatment (McLaren 2006, 2007; Ghaemi 2009).
The term ‘biopsychosocial’ was first introduced by the psychiatrist George Engel, building on the work of Adolf Meyer (1917). Engel (1977) drew upon general systems theory—according to which the various ways of conceptualizing the mind (biological, psychological, social) form a hierarchy, with some laws and principles applying only within a level and others applying to the system as a whole—to envisage a holistic way of understanding and scientifically studying the mind. In recent years, evidence for interactions between these levels has begun to emerge. For example, progress has been made in understanding how the brain changes at the cellular molecular level when we learn and retain information (Kandel 2001); the relationship between genetic factors, life events, and psychiatric disorders (Nemeroff and Vale 2005); the neural basis of mental illnesses (Andreasen 1997); the effects of psychotherapy on the brain (Gabbard 2000); the neuroscience of free will (Haggard 2008); and how to characterize mental illnesses in biopsychosocial terms (Kendler 2012).
The Oxford Loebel Lectures and Research Programme will present the best evidence of interaction between the biological, psychological, and social factors that contribute to mental illness, and philosophically analyse the conceptual relationships between these. Its aim is to strengthen the biopsychosocial approach to psychiatry such that it is able to provide a coherent basis for further research and clinical decision-making. The project is motivated by the aphorism ascribed to Hippocrates translated as ‘it is more important to know what sort of person has a disease than to know what sort of disease a person has’. Thus, while the reductive, biomedical approach will always continue to be useful, we anticipate that it will come to be seen as one component of a biopsychosocial view and methodology.
The Oxford Loebel Lectures and Research Programme were established in 2013 through the generosity of Dr Pierre and Mrs Felice Loebel. Dr Loebel’s concerns about the theoretical basis of psychiatry have been formed during a career of over forty years as a psychiatrist.
The Oxford Loebel Lectures and Research Programme (OLLRP) seeks to address the shortcomings of a unilinear approach to mental illness that comes from focussing uniquely on the biological, psychological or social contributions, functioning independently. Instead, the Programme will work towards delineating the nature and magnitude of biopsychosocial interactions in the causation, evaluation and management of mental states, normal and abnormal (e.g. how the gene interacts with the environment), going beyond a simple checklist of contributing factors to arrive at an understanding of how the interactions between factors affect one other, and indeed configure the whole.
Research Focus and Question
We will initially identify key areas and examples of existing work where BPS factors have been assessed and are beginning to be understood e.g. MAO-A status, abuse and criminal behaviour, early deprivation of maternal bonding behaviour and the effects of this on brain development, early life stress, genotype expression of neurotransmitters and the propensity for development of depression in later years, and relapse in schizophrenia as a function of the psycho-social setting. We will use these individual cases to develop a broader conceptual understanding of the BPS approach. Philosophical analyses needed to clarify these considerations will entail a move beyond mental illness into an understanding of BPS contributions to areas such as consciousness and free will.
To build an educational and research agenda with the interplay of at least two of the BPS factors considered together, to be built on further in the future, leading to an understanding of how the 3 factors acting together affect the causes and treatments of mental illness. For this purpose the method will be to:
- Present the most recent and fundamental advances in integration between biology, psychology and sociology
- In addition, to facilitate the interchange of ideas between each of these disciplines and germane others by providing social opportunities for exchanges, as well as blogs and other internet based media
- Provide concomitant critical philosophical examination of related concepts
- Delineate the nature of the final product and how it might be put into practice and taught
- Valid Clinical Outcome: a theoretical foundation of practice
- Predictive value and Prophylaxis
Once these advances are recognized and widely employed, 21st Century medicine should be able to provide care-giving with better understanding of the mechanisms at work, treat with greater efficacy, enhance individual function and provide more effective prevention. We look to an outcome of improved patient care, satisfaction and, not least, concomitant financial savings.
For centuries there has been discussion around whether mental events are of physiogenetic (soma, brain) or psychogenetic (psyche, mind) origin, how those comes about, and what the nature is of the relation between those domains. These questions are of critical practical importance in medicine, and especially in psychiatry.
The Oxford Loebel Lectures and Research Programme (OLLRP) seeks to address the shortcomings of a unilinear approach to mental illness that comes from focussing uniquely on the biological, psychological or social contributions, functioning independently.
Instead, the Programme will work towards delineating the nature and magnitude of biopsychosocial interactions in the causation, evaluation and management of mental states, normal and abnormal (e.g. how the gene interacts with the environment), going beyond a simple checklist of contributing factors to arrive at an understanding of how the interactions between factors affect one other, and indeed configure the whole. An approximation to the concept is the image presented by a finely woven tapestry in which the design emerges clearly from a weave whose threads are too fine to be seen unaided.
We will bring the best philosophy to bear on this analysis to clarify concepts and generate hypotheses. Ethics will evaluate potential interventions and management strategies, and beyond to consider the possibilities of functional enhancement.
The end result of this manner of conceptualizing mental illness and indeed illness in general is potentially transformative. The appeal to understand the patient “as a whole” has been heard at least since Hippocrates who aphoristically enjoined us “to understand not the illness the patient has, but the patient the disease has”. This entails the diagnosis and treatment not solely of symptoms but also of propensity and vulnerability, of risk factors, resistance and resilience, and the potential for the attainment not only of recovery from an ailment but the attainment of wellness. Thus, while the reductive or atomistic approach will always continue to be useful it will come to be seen as complementary to the approach proposed by George Engel with the title “Biopsychosocial” (BPS).
OLLRP will examine the BPS approach with a view to incorporating modern findings and hence further develop the concept for the 21st Century.
The project will aim to emulate the manner in which the development of Evidence Based Medicine - a relatively new concept in 90s - has become now a foundation for practice, for research and for policy.