Biopsychosocial model

The biopsychosocial model posits that biological, psychological and social factors (abbreviated "BPS") all play a significant role in human functioning, including in mental processes. The concept is used in fields such as medicine, psychology and sociology, and particularly in more specialist fields such as psychiatry and clinical psychology. In medicine, it is a way of looking at the mind and body of a patient as two important systems that are interlinked. The biopsychosocial paradigm is also a technical term for the popular concept of the mind-body connection. This is in contrast to the traditional biomedical model of medicine.

The "model" was theorised by psychiatrist George Engel at the University of Rochester, and putatively discussed in a 1977 article in Science, where he posited "the need for a new medical model"; however no single definitive, irreducable model has been published.

General medicine

In general medicine, the biopsychosocial model implies treating biological, psychological and social issues as interlinked systems of the body, similar to organ systems such as for instance the respiratory or the cardiovascular system.

The biopsychosocial model draws a distinction between the actual pathological processes that cause disease, and the patient's perception of their health and the effects on it, called the illness.^{[citation needed]}

Illness and disease do not necessarily run together. A patient may be reasonably well (no sickness), but if they feel unwell that's an illness. Similarly, patients with something physically wrong with them are diseased, but they may feel completely all right; they are not ill.

The biopsychosocial model presumes that it is important to handle the two together as they are both important. Proponents say that much money is wasted on healthy patients^{[citation needed]} because the doctor is not treating the illness. From this perspective, a patient has not recovered from a disease until they feel better and their illness is over, assuming that illness is neccessarily finite.

The biopsychosocial model gives great importance to the illness^{[citation needed]}; therefore much more information needs to be gathered during a consultation. As well as the biological signs and symptoms, a clinician must find out about the patient's psychological state, their feelings and beliefs about the illness, and social factors such as their relationship with families and the larger community.

For this reason, the interview process should encourage the patient to give as much information about not only the physical symptoms, but how the illness affects the patient. This is a patient-centred approach, and generally involves open-ended questions designed for the patient to do much of the talking. The patient is also better involved in the treatment, and it includes steps to get over any illness as well as the disease^{[citation needed]}, unless the disease is lifelong or progressive.

As well as a separate existence of disease and illness, the biopsychosocial model states that the workings of the body can affect the mind, and the workings of the mind can affect the body. This means both a direct interaction between mind and body as well as indirect effects through intermediate factors.

There are also theories that the state of mind directly affects the immune system, and there are many carefully-planned studies that show this to be the case (psychoneuroimmunology). Psychosocial factors can cause a biological effect by predisposing the patient to risk factors. An example is that depression by itself may not cause liver problems, but a depressed person may be more likely to have alcohol problems, thus liver damage. It is this increased risk-taking that can also lead to an increased likelihood of disease. Most of the diseases referred to in BPS discussion tend to be such behaviourally-moderated illnesses which have known high risk factors, or so-called "biopsychosocial illnesses/disorders"

Of course, it is apparent to most people that a pathological disease can have an effect on a person's mind. It is not surprising that some people who have been diagnosed with cancer develop depression. This should not automatically be taken to mean that the depression is perpetuating the cancer or that cancer treatment is less important.

It is often discussed how to break up the biopsychosocial model, especially in terms of separating the psychological from the social, as these factors are often tightly interwoven.

Criticism of the Biopsychosocial model

Critics point out this question of distinction and of determination of the roles of illness and disease runs against the growing concept of the patient-doctor partnership or patient empowerment, as "biopsychosocial" becomes one more disengenous euphemism for psychosomatic illness. This may be exploitated by medical insurance companies or government welfare departments eager to limit or deny access to medical and social care.

Some psychiatrists see the BPS model as flawed, in either formulation or application. Epstein et al describes six conflicting interpretations of what the model might be, and proposes that "...habits of mind may be the missing link between a biopsychosocial intent and clinical reality." Rather than the result of the BPS model, David Pilgrim suggests that neccessitous pragmatism and a form of "mutual tolerance" (Goldie, 1977) has forced a co-existence and not "genuine evidence of theoretical integration as a shared BPS orthodoxy." Pilgrim goes on to state, "Despite these scientific and ethical virtues," the BPS model "...has not been properly realised. It seems to have been pushed into the shadows by a return to medicine and the re-ascendancy of a biomedical model."

Perhaps the most vocal critic of the BPS model, Niall McLaren writes:

"Since the collapse of the 19th century models (psychoanalysis, biologism and behaviourism), psychiatrists have been in search of a model which integrates the psyche and the soma. So keen has been their search that they embraced the so-called ‘biopsychosocial model’ without ever bothering to check its details. If, at any time over the last three decades, they had done so, they would have found it had none. This would have forced them into the embarrassing position of having to acknowledge that modern psychiatry is operating in a theoretical vacuum

See also

• Psychoneuroimmunology
• Activities of daily living
• Psychosomatic illness
• Health psychology
• Tension myositis syndrome
• Body-mind

Eternal Links

• Sarno, John E. MD The Divided Mind: The Epidemic of Mindbody Disorders, 2006 [3]
• Bracken, Patrick, Thomas, Philip, "Time to move beyond the mind-body split", editorial, British Medical Journal 2002;325:1433-1434 (21 December)