Biological and Psychological: An Integrated Perspective Beyond False Psychotherapeutic Dichotomies

Since the early consolidation of psychology as an academic discipline, scholars have sought to identify and integrate the diverse dimensions that constitute human experience. The biopsychosocial model, brought to prominence by Engel’s seminal work [1], is grounded in the premise that health and illness cannot be fully understood through any single explanatory level - biological, psychological, or social - in isolation. Rather, it proposes a necessary integration of these domains, not their mutual exclusion.

Yet in practice-particularly within psychological communities and discussion forumsthere often emerges a marked discomfort when the conversation turns to the neurobiological underpinnings of behavior. This reaction, at times vehement, reveals a lingering hesitation to fully incorporate biological perspectives into both psychological discourse and clinical practice. The implicit fear appears to be that such integration risks dehumanizing the patient, reducing their lived experience to mere molecular events, or diminishing the value of traditional, subjectivity-centered approaches-whether humanistic, behavioral, or existential.

Consider, for instance, the assertion that psychotherapy constitutes a biological intervention insofar as it reshapes synaptic connections. Such statements frequently provoke strong resistance. They are swiftly labeled as instances of “neuroscientism” or “reductionism,” accused of disregarding the subjective and sociocultural dimensions of psychological suffering.

This critique, however, rests on a misunderstanding. Acknowledging the biological dimension of therapeutic change does not entail reducing the phenomenon to biology alone. Recognizing that psychotherapy modulates neural circuits-as does any form of learning or emotional regulation-does not in any way negate the importance of the therapeutic alliance, the clinical setting, or the nuanced handling of patients’ narratives and sociocultural contexts. On the contrary, growing evidence from neuroimaging studies and research on therapeutic efficacy underscores the deeply intertwined nature of psychological and biological processes [2].

Why, then, does resistance to biological explanations of psychological phenomena persist? Much of it appears to stem from a misinterpretation of what it means to “biologize” psychological experience [3]. For some, the invocation of neural mechanisms seems to strip experience of its essence-as though explaining thoughts and behaviors in terms of circuits and chemicals negates the uniqueness or freedom of the human subject. Yet, paradoxically, the very literature that affirms the central role of the brain in mediating subjective experience also emphasizes that such explanations do not diminish human complexity. On the contrary, they enhance our understanding of how relational, cultural, and historical dynamics can quite literally shape neural structures and functions [4].

Why, then, does resistance to biological explanations of psychological phenomena persist? Much of it appears to stem from a misinterpretation of what it means to “biologize” psychological experience. For some, the invocation of neural mechanisms seems to strip experience of its essence-as though explaining thoughts and behaviors in terms of circuits and chemicals negates the uniqueness or freedom of the human subject. Yet, paradoxically, the very literature that affirms the central role of the brain in mediating subjective experience also emphasizes that such explanations do not diminish human complexity. On the contrary, they enhance our understanding of how relational, cultural, and historical dynamics can quite literally shape neural structures and functions [5].

To characterize any reference to synaptic plasticity as a “reduction” or “dehumanization” of psychic suffering is to risk committing another form of reductionism: the neglect of the material basis upon which all psychological phenomena depend. Even the most empathetic and client-centered therapeutic encounter is, at its core, mediated by neuropsychological processes [6]. This does not imply, as some critics caricature, that psychologists must become neuroscientists or directly “manipulate synapses.” Rather, it underscores that psychology and neuroscience share a common territory the brain as the substrate of lived experience, of emotion, perception, and behavior.

The persistent “fear of biology” within some corners of psychology may have broader consequences than is often acknowledged. Most notably, it risks undermining the quality of interdisciplinary dialogue. Psychiatrists, neurologists, and other healthcare professionals frequently rely on biomedical frameworks to generate hypotheses and guide clinical decisions. If psychologists reflexively reject any reference to neurobiological foundations, these disciplines may come to speak mutually unintelligible languages.

Secondly, the denial or minimization of the biological component may give rise to an epistemological bias that leans toward unilaterally “culturalist” or exclusively “symbolic” interpretations of psychological suffering. While it is undeniable that socioeconomic contexts and interpersonal relationships profoundly shape mental health, one must not overlook the existence of biological conditions that can predispose individuals to, or exacerbate, psychiatric disorders-such as genetic predispositions or alterations in neurotransmitter systems [7].

In this regard, an excessive detachment from the organic dimension may hinder certain patients’ engagement with psychotherapy. Many individuals afflicted by severe psychiatric conditions yearn to comprehend “what is happening in my brain” and find reassurance when their therapist demonstrates a capacity to engage, at least minimally, with neurobiological concepts while still acknowledging the subjective and psychosocial dimensions of their experience. Put differently, an uncompromising rejection of brain-related knowledge risks alienating a public that seeks clear, evidence-based explanations for their struggles.

The reluctance to acknowledge the biological component in clinical psychology can, in certain instances, be interpreted as part of an identity struggle within the profession. Psychologists have historically fought-and continue to strive-to establish their autonomy vis-à-vis medicine and psychiatry. In this context, there may be an apprehension that recognizing the cerebral underpinnings of behavior equates to “surrendering” to biomedical hegemony. While this fear is historically understandable, it risks obstructing significant progress in our understanding of mental disorders and the therapeutic process itself.

Examples of successful integration between psychology and neuroscience abound. Studies on cognitive-behavioral therapy for depression, for instance, reveal that psychological interventions can induce measurable changes in brain regions associated with mood regulation, such as the prefrontal cortex and hippocampus [8,9]. Far from diminishing the value of dialogue, the therapeutic alliance, or the psychological techniques employed, these findings underscore their capacity to facilitate tangible neural reorganization. This convergence enriches, rather than undermines, the practice of psychology.

Thus, advocating for an integrated perspective is not tantamount to endorsing a strictly biomedical model. The traditional biomedical framework often reduces the origins of illness to isolated organic dysfunctions, thereby underestimating the role of social, psychological, and cultural determinants [1]. In contrast, psychology, in its pursuit of autonomy, prioritizes the subjectivities and meanings that permeate psychological suffering. When taken to extremes, both stances remain incomplete. The path forward lies not in rejecting one in favor of the other, but in embracing the multifaceted complexity of human behavior.

This convergence of diverse analytical layers is eloquently synthesized by Fuster [10], who conceptualizes “cognition” as a function emerging from neural systems in perpetual interaction with both the environment and an individual’s life history. When psychology professionals categorically dismiss references to the “brain” or “synapses” in elucidating therapeutic processes, they risk overlooking a fundamental reality: even speech and language— cornerstones of virtually all psychotherapeutic approaches-rely on intricate neural circuitry [11] If a deeper understanding of these mechanisms can enhance our capacity for intervention, why should we choose to disregard them?

Acknowledging the bidirectional interplay between mind and brain fosters a more open and less dogmatic stance. Rather than adhering to interpretations that sharply delineate the “organic” from the “symbolic,” we might cultivate psychologists adept at navigating multiple levels of analysis. Such an approach not only enriches clinical practice but also propels scientific advancement by posing research questions that transcend disciplinary boundaries.

It is pertinent to emphasize that the pathways through which psychotherapy manifests in cerebral alterations are manifold [8,12]: A. Cognitive attributions: Cognitive restructuring, for instance, entails challenging distorted beliefs, which may mitigate chronic stress responses. This process influences the hypothalamic-pituitary-adrenal (HPA) axis and modulates neurotransmitter regulation, including serotonin and norepinephrine. B. Emotional regulation: Techniques such as anxiety management, mindfulness, relaxation training, and related practices can modulate amygdala activity while enhancing functional connectivity between prefrontal regions and limbic structures [13]. C. Therapeutic alliance and social support: The empathy, attunement, and sense of safety fostered within the clinical setting can engender a feeling of security, reducing cortisol release and other fight-or-flight-related substances, thereby indirectly contributing to a more balanced neurophysiological state.

These findings elucidate why psychotherapy yields substantial outcomes, not only in symptom alleviation but also in fostering overall well-being. From a practical standpoint, they underscore the value of incorporating tools that bolster patients’ self-regulatory capacities, as such strategies may ultimately promote organic changes linked to emotional equilibrium.

Recognizing the biological dimensions of therapeutic processes neither diminishes human subjectivity nor reduces the richness of psychological experiences. On the contrary, it broadens our comprehension of how cultural, relational, and historical factors intertwine with cerebral foundations that underpin learning and emotional regulation.

Overcoming the longstanding dichotomy between the “bio” and the “psycho” demands from psychology professionals an openness to interdisciplinary dialogue and a self-reflective stance toward their own professional identity. In this light, collaboration with fields such as neuroscience and psychiatry should not be perceived as a relinquishment of autonomy, but rather as an opportunity to deepen our understanding of the genesis and persistence of pathological processes. Moreover, integrating neurobiological insights into therapeutic planning does not negate the relational, historical, and cultural facets of suffering; instead, it situates them within a more expansive framework, one capable of encompassing the full complexity of the human being across its biological, emotional, and social dimensions.