Review the remaining articles on the biopsychosocial model
Review the remaining articles on the biopsychosocial model. Think about how biological, psychological, and social factors affect the health and wellness issues addressed in the articles.
Select one health issue from the following list:
Migraine headaches
Postpartum depression
Obesity
Substance abuse/addiction
Eating Disorder (anorexia, bulimia)
Identify biological, psychological, and social factors that contribute to the health issue you selected.
Describe the health issue you selected and identify key contributors or factors, based on the biopsychosocial model, that could contribute to the development of the issue (be sure to include all three aspects of the model). Then describe the role of subjective experience and how it could influence the mitigation/severity of the issue.
Review Bronfenbrenner’s Ecological Model, located in this week’s learning resources. Focus on the meaning and interrelationships among the microsystem, exosystem, and macrosystem from a child’s perspective. Consider how these systems would be generalized to apply to an adult.
Using Bronfenbrenner’s model, identify two out of three systems (microsystem, exosystem, macrosystem) and their settings (school, work, family gatherings, neighborhood, country, etc.). Think about how demands and expectations in one setting might impact your ability to meet demands and expectations in another setting.
Identify the two systems you chose and describe settings within each system that influence your life and behavior/activity. Then explain how demands and expectations in one setting could impact the ability to meet demands and expectations in another setting. Be specific.
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The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientifi c Inquiry
ABSTRACT The biopsychosocial model is both a philosophy of clinical care and a practical clinical guide. Philosophically, it is a way of understanding how suffering, disease, and illness are affected by multiple levels of organization, from the societal to the molecular. At the practical level, it is a way of understanding the patient’s subjec- tive experience as an essential contributor to accurate diagnosis, health outcomes, and humane care. In this article, we defend the biopsychosocial model as a nec- essary contribution to the scientifi c clinical method, while suggesting 3 clarifi ca- tions: (1) the relationship between mental and physical aspects of health is com- plex—subjective experience depends on but is not reducible to laws of physiology; (2) models of circular causality must be tempered by linear approximations when considering treatment options; and (3) promoting a more participatory clinician- patient relationship is in keeping with current Western cultural tendencies, but may not be universally accepted. We propose a biopsychosocial-oriented clinical prac- tice whose pillars include (1) self-awareness; (2) active cultivation of trust; (3) an emotional style characterized by empathic curiosity; (4) self-calibration as a way to reduce bias; (5) educating the emotions to assist with diagnosis and forming thera- peutic relationships; (6) using informed intuition; and (7) communicating clinical evidence to foster dialogue, not just the mechanical application of protocol. In con- clusion, the value of the biopsychosocial model has not been in the discovery of new scientifi c laws, as the term “new paradigm” would suggest, but rather in guid- ing parsimonious application of medical knowledge to the needs of each patient.
Ann Fam Med 2004;2:576-582. DOI: 10.1370/afm.245.
GEORGE ENGEL’S LEGACY
The late George Engel believed that to understand and respond adequately to patients’ suffering—and to give them a sense of being understood—clinicians must attend simultaneously to the biologi- cal, psychological, and social dimensions of illness. He offered a holistic alternative to the prevailing biomedical model that had dominated indus- trialized societies since the mid-20th century.1 His new model came to be known as the biopsychosocial model. He formulated his model at a time when science itself was evolving from an exclusively analytic, reductionis- tic, and specialized endeavor to become more contextual and cross-disci- plinary.2-4 Engel did not deny that the mainstream of biomedical research had fostered important advances in medicine, but he criticized its exces- sively narrow (biomedical) focus for leading clinicians to regard patients as objects and for ignoring the possibility that the subjective experience of the patient was amenable to scientifi c study. Engel championed his ideas not only as a scientifi c proposal, but also as a fundamental ideology that tried to reverse the dehumanization of medicine and disempowerment of patients (Table 1). His model struck a resonant chord with those sectors of the medical profession that wished to bring more empathy and compassion into medical practice.
In this article we critically examine and update 3 areas in which the biopsychosocial model was offered as a “new medical paradigm”5,6: (1) a
Francesc Borrell-Carrió, MD1
Anthony L. Suchman MD2,3
Ronald M. Epstein MD4 1Department of Medicine, University of Barcelona, CAP Cornellà, Catalonian Institute of Health (ICS), Cornellà de Llobregat, Spain
2Relationship Centered Health Care, Rochester, NY
3Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
4Department of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
CORRESPONDING AUTHOR
Francesc Borrell-Carrió, MD Department of Medicine University of Barcelona CAP Cornellà, Catalonian Institute of Health (ICS) C/Bellaterra 39 08940 Cornellà de Llobregat, Spain 12902fbc@comb.es
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BIOPSYCHOSOCIAL MODEL 25 YEARS LATER
world view that would include the patient’s subjective experience alongside objective biomedical data, (2) a model of causation that would be more comprehensive and naturalistic than simple linear reductionist models, and (3) a perspective on the patient-clinician relation- ship that would accord more power to the patient in the clinical process and transform the patient’s role from passive object of investigation to the subject and protagonist of the clinical act. We will also explore the interface between the biopsychosocial model and evi- dence-based medicine.
DUALISM, REDUCTIONISM, AND THE DETACHED OBSERVER In advancing the biopsychosocial model, Engel was responding to 3 main strands in medical thinking that he believed were responsible for dehumanizing care. First, he criticized the dualistic nature of the biomedi- cal model, with its separation of body and mind (which is popularly, but perhaps inaccurately, traced to Des- cartes).7,8 This conceptualization (further discussed in the supplemental appendix, available online at http://
www.annfammed.org/cgi/content/full/2/6/576/ DC1) included an implicit privileging of the
former as more “real” and therefore more worthy of a scientifi c clinician’s attention. Engel rejected this view for encouraging physicians to maintain a strict separation between the body-as-machine and the nar- rative biography and emotions of the person—to focus on the disease to the exclusion of the person who was suffering—without building bridges between the two realms. His research in psychosomatics pointed toward a more integrative view, showing that fear, rage, neglect, and attachment had physiologic and develop- mental effects on the whole organism.
Second, Engel criticized the excessively materialis-
tic and reductionistic orientation of medical thinking. According to these principles, anything that could not be objectively verifi ed and explained at the level of cel- lular and molecular processes was ignored or devalued. The main focus of this criticism—a cold, impersonal, technical, biomedi- cally-oriented style of clinical practice—may not have been so much a matter of underlying philosophy, but discomfort with practice that neglected the human dimension of suffering. His semi- nal 1980 article on the clinical application of the biopsychoso-
cial model5 examines the case of a man with chest pain whose arrhythmia was precipitated by a lack of caring on the part of his treating physician.
The third element was the infl uence of the observer on the observed. Engel understood that one cannot understand a system from the inside without disturbing the system in some way; in other words, in the human dimension, as in the world of particle physics, one can- not assume a stance of pure objectivity. In that way, Engel provided a rationale for including the human dimension of the physician and the patient as a legiti- mate focus for scientifi c study.
Engel’s perspective is contrasted with a so-called monistic or reductionistic view, in which all phenom- ena could be reduced to smaller parts and understood as molecular interactions. Nor did he endorse a holis- tic-energetic view, many of whose adherents espouse a biopsychosocial philosophy; these views hold that all physical phenomena are ephemeral and control- lable by the manipulation of healing energies. Rather, in embracing Systems Theory,2 Engel recognized that mental and social phenomena depended upon but could not necessarily be reduced to (ie, explained in terms of) more basic physical phenomena given our current state of knowledge. He endorsed what would now be considered a complexity view,9 in which differ- ent levels of the biopsychosocial hierarchy could inter- act, but the rules of…
