The Biopsychosocial approach to health is thirty years old this month. The what? Yeah, I bet it doesn’t mean much to you, does it? And that’s pretty amazing really. It shows how tenaciously orthodoxy clings to its old models. The dominant model in Western Medicine is the “biomedical” one, which seeks a biomolecular explanation for all illness. This is a materialistic and a reductionist understanding of illness. In fact, proponents deny the very reality of any illness which cannot be explained by molecular, physical changes in a body.
Thirty years ago, George Engel proposed the term “biopsychosocial” as an alternative mode of understanding. Essentially this approach considered that “the study of every disease must include the individual, his/her body and his/her surrounding environment as essential components of the total system.” It situated the individual in the inextricable contexts of his or her life. It proposed that the way to understand illness required a holistic understanding of a person, with every single person being different and unique. It was an argument against reductionism and for insights gained from understandings of the links and influences which exist within our living networks. More than that, it opened the door for psychosomatic medicine – the joining back together of the body and the mind, for so long considered as separate, almost vaguely related entities. There’s an awful lot of illness which is not explainable from a disease focussed approach. We can’t really reduce individual illness experience to a set of physical entities or lesions. And the other side of the coin is that Engel’s approach demanded a holistic understanding of health. From this perspective health is so much more than the mere absence of disease.
So why hasn’t it become the dominant model? And why do we still consider most illnesses as physical entities which we call diseases which can be treated with surgery to remove the lesions and drugs to fight the disorder?
Well, Engel himself gave us the explanation in advance. He said
… nothing will change unless or until those who control resources have the wisdom to venture off the beaten path of exclusive reliance on biomedicine as the only approach to health care
Those who control the resources still like to consider the world as made up of physical, separate objects; still think of disease as an entity to be fought and expelled. We have a better scientific explanation now but it’s still a long way from being the dominant model.
Heroes Not Zombies 
Just catching up on some of your thoughts which resonate. I sent you a paper Bob on models of pain which follows this line of thought and uses the Biological thoughts of Maturana to think in a systems way.
Most people and that includes most Dr’s have not really grasped the BPS model. I sometimes think that aspects of CAM pay ‘lipservice’ too.
In my experience it is common for Homeopathy and Acupuncture to be used in just the same way as a pharmacy remedy.Courses of acupuncture are offered at pain clinics for example in just the same way as a spinal nerve block, often with no real dialogue or understanding of the patient.
Perhaps the BPS model is just too complex and people prefer the naive assurance of physical treatments for ‘physical’ problems? This is certainly the case regarding the many treatments offered for poorly understood chronic pain problems.However, I see the problem at a deeper level. In General practice it is ‘suffering’,lack of coping skills and ‘meaning’ which seem to be the dominant issues for many patients. http://www.medscape.com/viewarticle/512438_6
I think the whole enterprise needs an injection of lateral thinking and creativity!
ian
[…] the whole of a person’s life, and by that I mean the whole of their present time life (a biopsychosocial approach), and the whole of their life from start to finish. This has at least two consequences. Firstly, it […]