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.