The Biopsychosocial Model
The Biopsychosocial Model is a perspective in clinical medicine which includes psychological and social components of patient identity, as well as biology, in the determination of causes and treatments of disease. It contrasts with the Biomedical Model, the predominant and reductive reductive approach in Western medicine, which focuses exclusively on biological factors.
History
The Biomedical Model
The emergence of many technological advancements in the Industrial Revolution lead to great reductions in adult and infant mortality rates, and an ensuing population explosion. [1] The prevalence of empirical science motivated a purely physiological conception of human health. For example, the philosopher Rene Descartes proposed that if the mind and body are separate entities, then the human mind/soul must outlive the body when it dies. [2] This, among others, offset a Christian reluctance against dissection and lead to reductionist models of human health. [3] Healthcare became more or less universally standardized based on the belief that we all have the same parts and same normal functioning. This strictly empirical model lead to the attribution of most human suffering, including psychological and emotional problems, to physical causes in a process called medicalization.
Engel's Hypothesis
Because of increasing governmental costs of healthcare for Canadians [4], as well as the emergence of Psychology and Sociology as formal fields of study in the mid-20th century, the individual context of each patient's health has become a point of clinical interest. The Biopsychosocial model places the ill person (as well as the doctor) at the centre of a network of factors including social behaviour and psychological well-being, as well as physiological health, all interacting with each other to influence overall health. As such, it has created opportunities to reduce costs through preventive health methods, such as diet, lifestyle, and mental health. [5] For instance, the deep correlation between depression/anxiety/anger and cardiac illness may be causal; if so, the costs of heart illness to society can be reduced by more affordably addressing these psychological issues with preventive emotional therapy, rather than by costly and potentially harmful surgery and medicines. [6]
Impact
The Biopsychosocial Model
Biology
Consistent with the Biomedical model, the Biopsychosocial model includes genetics, immune function, and countless other biochemical processes in evaluating personal health. Everything which the Biomedical model examines, the Biopsychosocial model includes, with the addition of personal Psychological and Social factors as well [3].
Psychology
Emotion, cognition, and motivation all play a role in our personal relationship with health. Research has shown that people predisposed to anxiety, depression, and pessimism are more likely to have a shorter lifespan and suffer from heart disease [6]. People are prone to cognitive shortcuts that may cause them to frequently under- or overestimate the effectiveness of treatments or medication, disrupting the recovery process. And any number of competing factors may interfere with an ill person's motivation to pursue and maintain treatment, especially in the case of chronic illness, where symptoms may fluctuate over time.
Sociology
Society, community, and family units all influence our relationship to health. For instance, in societies which have normalized the frequent recreational consumption of alcohol, people are likely to drink more alcohol, and thereby are more vulnerable to the negative health outcomes associated with drinking. On a community scale, individuals may be compelled to maintain their social status, such as through demonstrations of wealth, at the expense of health maintenance. On a family scale, transgression of values, such as premarital sex, may guilt individuals out of pursuing treatment for associated illness, such as a sexually transmitted infection.
Research Outcomes
The inclusion of psychological and social factors in clinical research has advanced the range of preventive and corrective methods available to clinical practice, counteracting the widespread medicalization of suffering to some degree. A recent review of Biopsychosocial practice calls for an emphasis of self-awareness, emotional education, and the use of clinical evidence to foster dialogue, a perspective clearly at odds with the current prevalence of pharmacological treatment. [7] Perhaps most crucially, there is recurring evidence that intense and/or chronic stress weakens the cellular and humoral immune systems. [8] This counteracts medicalization because it suggests that non-medical treatments, such as stress-management techniques, can prevent suffering. On the whole, the Biopsychosocial model works to de-medicalize health by including subjective factors of individual health, such as psychology and sociology, and emphasizing health as a function of lifestyle, rather than a set of problems to be solved as they arise.
References
- ↑ Kumar, Krushan (2009). "Modernization." Encyclopedia Britannica. Retrieved 5 December 2016.
- ↑ Skirry, Justin. "Rene Descartes: The Mind-Body Distinction." The Internet Encyclopedia of Philosophy. Retrieved 7 December 2016.
- ↑ 3.0 3.1 Engel, George L (1977). The need for a new medical model: A challenge for medicine. Science. 196(4286). Retrieved 3 December 2016.
- ↑ World Health Organization (2014). "Health expenditure ratios, by country, 1995-2014, Canada." World Health Statistics 2014. Retrieved 7 December 2016.
- ↑ Belloc, N B, & Breslow, L (1972). Relationship of physical health status and health practices. Preventive Medicine. 1(3). Retrieved 7 December 2016.
- ↑ 6.0 6.1 Boehm, J K, & Kubzansky, L D (2012). The heart's content: the association between positive psychological well-being and cardiovascular health. Psychological Bulletin. 138(4). Retrieved 7 December 2016.
- ↑ Borrell-Carrio, F B, Suchman, A L, & Epstein, R L (2004). "The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry." Annals of Family Medicine. 2(6). Retrieved 5 December 2016
- ↑ Segerstrom, S & Miller, G E (2004). Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychology Bulletin. 130(4). Retrieved 9 December 2016.