Since George HW Bush declared the 1990’s as the Decade of the Brain, research on the brain has revealed how its internal bio-chemistry interacts and what roles its constituent parts play in healthy brain functioning. The research guided the development of different drugs and different therapies intended to restore to health a brain whose malfunctioning led to mental illness. These advancements also meant that Psychiatry and Psychology’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), needed to be revised, and currently is in its fifth edition. By following the common medical model of assessing a patient through observation and patient feedback, then checking the DSM for the closest possible diagnostic description, psychiatrists and psychologists strived to place patients into the appropriate treatment plan.
However, the Decade of the Brainalso invited the Medicine to begin thinking beyond the predominate medical model of a disease being a bio-chemical malfunction occurring in a disconnected human and recognize disease more properly as the result of a confluence of factors negatively impacting the body’s bio-chemistry. An early proponent of this new approach was George L. Engel, an internist and psychiatrist who published in 1977 in the journal Sciencewhat many now recognize as a landmark article. In his essay, Engel advocated for a medical model that sees disease in terms of the biopsychosocial factors the patient presents. Today, his model is called a psychiatric formulation.
If a diagnosis is a label, a formulation is more like a story. In a few sentences, a formulation gathers up all the biological, psychological and social factors that have led to a person becoming unwell and considers how these factors interconnect. In doing so, it provides clues to the pathway out of suffering.
This story might take into account the individual’s genetic predisposition for mental illness, attachment to a primary caregiver as a child, developmental trauma, intellectual functioning, economic circumstances, illicit drug use or complications created by physical illness, such as thyroid disease or chronic pain.