The
biopsychosocial model (abbreviated "BPS") is a general model or approach that posits that
biologicalBiology is the natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy...
,
psychologicalPsychology is an academic and applied discipline involving the systematic, and sometimes scientific, study of human or animal mental functions and behavior...
(which entails thoughts, emotions, and behaviors), and
socialThe term Social refers to a characteristic of living organisms...
factors, all play a significant role in human functioning in the context of
diseaseA disease or medical condition isan abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and signs...
or illness. Indeed, health is best understood in terms of a combination of biological, psychological, and social factors rather than purely in biological terms . This is in contrast to the traditional,
reductionistReductionism can either mean an approach to understand the nature of complex things by reducing them to the interactions of their parts, or to simpler or more fundamental things or a philosophical position that a complex system is nothing but the sum of its parts, and that an account of it can be...
biomedical modelThe biomedical model of medicine, has been around since the mid-nineteenth century as the predominant model used by physicians in diagnosing diseases....
of medicine that suggests every disease process can be explained in terms of an underlying deviation from normal function such as a pathogen, genetic or
developmental abnormality, or injury. The concept is used in fields such as
medicineMedicine is the art and science of healing. It encompasses a range of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
,
nursingNursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from birth to the end of life....
,
health psychologyHealth psychology is concerned with understanding how biology, behavior, and social context influence health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behaviour change in public health promotion, teach at universities, and conduct...
and
sociologySociology is the scientific or systematic study of human societies. It is a branch of social science that uses various methods of empirical investigation and critical analysis to develop and refine a body of knowledge about human social structure and activity, often with the goal of applying such...
, and particularly in more specialist fields such as
psychiatryPsychiatry is a medical specialty officially devoted to the treatment and study of mental disorders. The term was first coined by the German physician Johann Christian Reil in 1808....
,
health psychologyHealth psychology is concerned with understanding how biology, behavior, and social context influence health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behaviour change in public health promotion, teach at universities, and conduct...
,
chiropracticChiropractic is a health care discipline and profession that emphasizes diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially the spine, under the hypothesis that these disorders affect general health via the nervous system...
, clinical social work, and
clinical psychologyClinical psychology includes the scientific study and application of psychology for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
. The biopsychosocial paradigm is also a technical term for the popular concept of the mind–body connection, which addresses more philosophical arguments between the biopsychosocial and biomedical models, rather than their empirical exploration and clinical application.
The model was theorized by
psychiatristA psychiatrist is a physician who specializes in psychiatry and is certified in treating mental disorders. All psychiatrists are trained in diagnostic evaluation and in psychotherapy...
George L. EngelGeorge Libman Engel was an American psychiatrist. He spent most of his career at the University of Rochester Medical Center in Rochester, New York. He is best known his formulation of the biopsychosocial model, a general theory of illness and healing.-Early life:Engel was born in New York City in...
at the
University of RochesterThe University of Rochester is a private, nonsectarian, research university located in Rochester, New York. The University grants undergraduate, graduate, doctoral, and professional degrees through six schools and various interdisciplinary programs...
, and putatively discussed in a 1977 article in
ScienceScience is the academic journal of the American Association for the Advancement of Science and is considered one of the world's most prestigious scientific journals. The peer-reviewed journal, first published in 1880 is circulated weekly and has a print subscriber base of around 130,000...
, where he posited "the need for a new medical model"; however no single definitive, irreducible model has been published. However, the general BPS model has guided formulation and testing of models within each professional field. Interestingly, evidence for the application of the biopsychosocial model was found in ancient Asian (2600 B.C.) and Greek (500 B.C.) civilizations prior to Engel's introduction of the theory in 1977. The novelty, acceptance, and prevalence of the biopsychosocial model varies across cultures.
Model description and application in medicine
The biological component of the biopsychosocial model seeks to understand how the cause of the illness stems from the functioning of the individual's body. The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such lack of self-control, emotional turmoil, and negative thinking. The social part of the biopsychosocial model investigates how different social factors such as socioeconomic status, culture, poverty, technology, and religion can influence health.
The biopsychosocial model of health is based in part on
social cognitive theorySocial Cognitive Theory, used in psychology, education, and communication, posits that portions of an individual's knowledge acquisition can be directly related to observing others within the context of social interactions, experiences, and outside media influences.-History:Social Cognitive Theory...
. The biopsychosocial model implies that treatment of disease processes, for example type two diabetes and
cancerCancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
, requires that the health care team address
biologicalBiology is the natural science concerned with the study of life and living organisms, including their structure, function, growth, origin, evolution, distribution, and taxonomy...
,
psychologicalPsychology is an academic and applied discipline involving the systematic, and sometimes scientific, study of human or animal mental functions and behavior...
and
socialSociety or human society is the manner or condition in which the members of a community live together for their mutual benefit. By extension, society denotes the people of a region or country, sometimes even the world, taken as a whole....
influences upon a patient's functioning. In a philosophical sense, 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.
The biopsychosocial model presumes that it is important to handle the three together as a growing body of empirical literature suggests that patient perceptions of health and threat of disease, as well as barriers in a patient's social or cultural environment, appear to influence the likelihood that a patient will engage in health-promoting or treatment behaviors, such as medication taking, proper diet, and engaging in physical activity.
While operating from a BPS framework requires that more information be gathered during a consultation, a growing trend in US healthcare (and already well-established in Europe such as in the U.K. & Germany) includes the integration of professional services through integrated disciplinary teams, to provide better care and address the patient's needs at all three levels. As seen, for example in integrated primary care clinics, such as used in the U.K., Germany, U.S. Veteran's Administration, U.S. military, Kaiser Permanente, integrated teams may comprise of physicians, nurses, health psychologists, social workers, and other specialties to address all three aspects of the BPS framework, allowing the physician to focus on predominantly biological mechanisms of the patient's complaints See also
There are also theories that the state of mind directly affects the
immune systemAn immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumour cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
, and there are many carefully-planned studies that show this to be the case; see
psychoneuroimmunologyPsychoneuroimmunology is the study of the interaction between psychological processes and the nervous and immune systems of the human body...
. Psychosocial factors can cause a biological effect by predisposing the patient to risk factors. An example is that
depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities...
by itself may not cause
liverThe liver is a vital organ present in vertebrates and some other animals; it has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion...
problems, but a depressed person may be more likely to have
alcoholEthanol, also called ethyl alcohol, pure alcohol, grain alcohol, or drinking alcohol, is a volatile, flammable, colorless liquid. It is a psychoactive drug, best known as the type of alcohol found in alcoholic beverages and in modern thermometers. Ethanol is one of the oldest recreational drugs...
problems, and therefore liver damage. Perhaps it is this increased risk-taking that leads 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". An example of this is type 2 diabetes, which with the growing prevalence of obesity and physical inactivity, is on course to become a worldwide pandemic. For example, approximately 20 million Americans are estimated to have diabetes, with 90% to 95% considered type 2.
It is important to note that the biopsychosocial model does not provide a straightforward, testable model to explain the interactions or causal influences (that is, amount of variance accounted for) by each of the components (biological, psychological, or social). Rather, the model has been a general framework to guide theoretical and empirical exploration, which has amassed a great deal of research since Engel's 1977 article. One of the areas that has been greatly influenced is the formulation and testing of social-cognitive models of health behavior over the past 30 years. While no single model has taken precedence, a large body of empirical literature has identified social-cognitive (the psyho-social aspect of Engel's model) variables that appear to influence engagement in healthy behaviors and adhere to prescribed medical regimens, such as self-efficacy, in chronic diseases such as type 2 diabetes, cardiovascular disease, etc. These models include the
Health Belief ModelThe Health Belief was a psychological model developed by Rosenstock in the 1966 for studying and promoting the uptake of services offered by social psychologists. The model was furthered by Becker and colleagues in the 1970s and 1980s...
,
Theory of Reasoned ActionThe theory of reasoned action , developed by Martin Fishbein and , derived from previous research that started out as the theory of attitude, which led to the study of attitude and behavior...
and
Theory of Planned BehaviorIn psychology, the theory of planned behavior is a theory about the link between attitudes and behavior. It was proposed by Icek Ajzen as an extension of the theory of reasoned action. It is one of the most predictive persuasion theories...
,
Transtheoretical ModelThe transtheoretical model in health psychology is intended to explain or predict a person's success or failure in achieving a proposed behavior change, such as developing different habits. It attempts to answer why the change "stuck" or alternatively why the change was not made.The...
, the Relapse Prevention Model, Gollwitzer's
implementation-intentionsThe psychologist Peter Gollwitzer has developed the implementation hypothesis for better goal attainment. The idea is that planning in advance when, where and how one will complete a self assigned goal will lead to greater success. An implementation intention is the name of the plan that one...
, the Precaution–Adoption Model, the
Health Action Process ApproachModels of health behavior change are designed to examine a set of psychological constructs that jointly aim at explaining what people motivates to change and how they take preventive action ....
, etc.
Criticism
Some 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 empowermentThe patient empowerment concept, a recent outgrowth of the natural health movement, asserts that to be truly healthy, people must bring about changes in their social situations and in the environment that influences their lives, not only in their personal behavior.According to advocates of the...
, as "biopsychosocial" becomes one more disingenuous
euphemismA euphemism is a substitution of an agreeable or less offensive expression in place of one that may offend or suggest something unpleasant to the listener, or in the case of Doublespeak, to make it less troublesome for the speaker...
for psychosomatic illness. This may be exploited 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 and colleagues describe 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 necessary 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 philosophical 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."
McLaren claims that his model of emergent dualist interaction, based in the work of
Alan TuringAlan Mathison Turing, OBE, FRS , was an English mathematician, logician, cryptanalyst, and computer scientist. He was influential in the development of computer science and provided an influential formalisation of the concept of the algorithm and computation with the Turing machine...
and
David ChalmersDavid John Chalmers is an Australian philosopher specializing in the area of philosophy of mind. He is Professor of Philosophy and Director of the Centre for Consciousness at the Australian National University.-Background:...
, more than satisfies the expectations institutional psychiatry has placed upon Engel's model.
See also
- Activities of daily living
Activities of daily living is a term used in medicine and nursing, especially in the care of the elderly. are "the things we normally do in daily living, including any daily activity we perform for self-care , work, homemaking, and leisure." A number of national surveys collect data on the ADL...
- Bodymind
- Brain Blogger
Brain Blogger is a biomedical blog sponsored by the Global Neuroscience Initiative Foundation and edited by Dr. Shaheen Lakhan. Its byline is "topics from multidimensional biopsychosocial perspectives." It reviews the latest news and stories related to neuroscience, psychiatry, and neurology...
- Diathesis–stress model
- Health psychology
Health psychology is concerned with understanding how biology, behavior, and social context influence health and illness. Health psychologists work alongside other medical professionals in clinical settings, work on behaviour change in public health promotion, teach at universities, and conduct...
- Psychoneuroimmunology
Psychoneuroimmunology is the study of the interaction between psychological processes and the nervous and immune systems of the human body...
- Psychosomatic medicine
External links