An overview of the Biopsychosocial model of health and disease, highlighting it's useful application today in treating patients.
The traditional approach towards health and disease was, until recent decades, the medical or biological model where a patient’s illness was treated solely by medical means. However, research has challenged this approach and developed a more extensive model of health that incorporates psychological and social factors. This allows for better treatment, management and understanding of health and disease.
The Biopsychosocial Model was proposed by Engel in 1977. It implies that biological, psychological and social factors all play a significant role in health and disease and may influence a physical state. Engel advocated that no single illness, patient or condition can be reduced to any one aspect – they are all relevant and each patient should be viewed as an individual. This is in contrast to the previously held biomedical model, the reductionist approach of which was seen as cold and impersonal. The biopsychosocial model is a more realistic model in light of the role lifestyles play in modern society, as it incorporates the importance of cultural factors, patient behaviours/emotions and socioeconomic status.
Many common illnesses today, such as heart disease and cancer, have been found to have psychological and social components to their aetiology. For example, it has been estimated that 30% of cancers are associated with tobacco use and that diet accounts for some incidence of digestive tract cancers (Doll and Peto, 1981). The interconnection of psychological and gastrointestinal functioning is evident in many GI disorders, with each able to influence the other, which supports the usefulness of a biopsychosocial model. Furthermore, the biopsychosocial model has led to the development of therapeutic and cost-effective interdisciplinary chronic pain management programmes, which are more successful than those achieved through the biomedical model alone. The biopsychosocial model of disease requires a multidisciplinary approach combining various forms of treatment and input from different specialists, such as in psychiatry where the team will consist of a consultant psychiatrist, doctor and social worker. This has a very effective result as the team is aware of the wider needs of the patient.
However, although the biopsychosocial model is the mainstream view of contemporary medicine and psychiatry today, there have been recent proponents of alternative approaches. One is a method-based psychiatry, as advocated by Karl Jaspers, whilst another is a medical humanist model, as developed by William Osler. Both of these approaches can be seen to fall somewhere in the middle of the biomedical and biopsychosocial models.
Through paying attention to the biological, psychological and social aspects of an illness via the biopsychosocial model, health and disease can be better understood and ultimately more of the patient’s needs can be satisfied.
1. McInerney, S. ‘Rapid Response to: Introducing the Biopsychosocial Model for good medicine and good doctors’. BMJ. 2002 [online] Available at: https://www.bmj.com/rapid-response/2011/10/29/introducing-biopsychosocial-model-good-medicine-and-good-doctors
2. Vogele, C. ‘Behavioral Medicine.’ International Encyclopedia of the Social & Behavioral Sciences (Second Edition). 2015 [online] Available at: https://www.sciencedirect.com/topics/social-sciences/biopsychosocial-model
3. Ghaemi, S. ‘The rise and fall of the biopsychosocial model,’ British Journal of Psychiatry, 2009; 195(1):3–4. [online] Available at: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/rise-and-fall-of-the-biopsychosocial-model/A31DAA3BED6569F6080A1DF2C1D15A64
4. Doll, R., Peto, R. ‘The causes of cancer: quantitative estimates of avoidable risks of cancer in the United States today’. J Natl Cancer Inst. 1981; 66(6):1191-308.
5. Mikocka-Walus, A. ‘Gastrointestinal Diseases: Psycho-social Aspects’. International Encyclopedia of the Social & Behavioral Sciences (Second Edition). 2015 [online] Available at: https://www.sciencedirect.com/topics/social-sciences/biopsychosocial-model
6. Gatchel, R. ‘The Biopsychosocial Approach’. Practical Pain Management, 2021; 8(4). [online] Available at: https://www.practicalpainmanagement.com/treatments/psychological/biopsychosocial-approach