Synopsis: The BioPsychoSocial model (BPS) is an integrative approach to medicine and healthcare and is of much importance to social science subjects like Psychology, Sociology, and Anthropology. This article delves into the topic of the BPS model by describing what the approach is and stating a brief historical background to understand how the model came into being. It further covers the criticisms faced by the popular Biomedical model, the application and uses of the Biopsychosocial model, how it is used in clinical settings, and the criticisms it has faced.
Introduction to Biopsychosocial Perspective:
Within the discipline of psychology, and among its many branches and sub-divisions, one of the most common and the most important method used is the Levels of Analysis, or LOA model (Passer & Smith, 2009). Within this framework, one particular aspect of human behavior (for example, aggression) is assessed from three different angles: biological, cognitive or psychological, and social or cultural. This corresponds to the Biopsychosocial Model. This approach brings together the three domains of biological, socio-cultural, and psychological analysis together in a comprehensive form of scientific examination.
The Biopsychosocial model explores any topic, not from a single perspective, but using all three. This helps to understand the matter much more thoroughly which also allows for an enhanced level of clarity. The significance of the approach lies in the diversity of viewpoints that it imparts to a single theme, the acknowledgment it contains regarding the multifaceted roots and nature of particular concepts, and in the manner, it favors a deeper, more elaborate analysis rather than being satisfied with surface-level answers which might often be deceiving (Passer & Smith, 2009).
The biological side is involved with the physical aspects of human beings. This includes the eugenics or hereditary factors, the internal workings of the body, and the ongoing chemical processes within the body (Cardoso, 2013). Diseases and damages, immunogenic responses, and how the body’s operations react to and change with alterations in biological cycles and processes, such as movement, rest, etc., are all explored under the biological level to understand a particular behavior.
The cognitive or psychological angle takes on the mental processes. This includes emotions, perception, sensations, learning, cognition, memory, linguistic abilities, thinking and processing abilities, motivation, etc. (Cardoso, 2013). These are the processes that take place within the mental sphere and affect individuals and those around them. How these mental operations change in response to variations in situations is inspected under the cognitive assessment.
The social, or cultural, or socio-cultural perspective is the one that focuses on the impact of a person’s environment and social settings on the behavior that they display (Cardoso, 2013). This includes both the influence of the immediate surroundings with which people interact directly, as well as the overarching social blanket. Because people cannot exist outside society, it has a significant effect on how different aspects of a person’s life. Socialization, the process of integrating a person into the society which requires them to adhere to the social norms, beliefs, and practices, begins at the very conception of a child and continues till their death. Therefore, it has a huge impact on how a person develops – an individual’s thoughts, behavior, practices, and beliefs all depend upon their design of interaction with the others around them.
Besides being used in the case of evaluating a situation, the biopsychosocial model can be used also in administering treatment. Therefore, it is of great importance to understand this approach better. Not only does this approach examine how each of the three factors acts on individuals, but also studies how they are interconnected and how they affect each other as well.
A Brief Historical Background:
The proposition and inclusion of the Biopsychosocial model did not happen a long time back. The entire model is very recent. In the 1970s, American psychiatrist George Libman Engel, along with his colleague John Romano, proposed the idea of using the biopsychosocial approach in direct opposition to the existing biomedical model (Cohen & Clark, 2010). Both were from the University of Rochester, and have worked on several other projects together. According to Engel, the biomedical model was lacking key factors which were, to him, important in diagnosis and treatment (McLaren, 1998).
In 1977, Engel published a paper, titled The need for a new medical model: A challenge for biomedicine, in which he put forward the need for a more extensive approach to addressing health and illness (Engel, 1977). This was the foundation of the biopsychosocial model, to the further development of which Engel contributed greatly. Any study under the biopsychosocial model does not focus on the problem (i.e., the diseases, etc.), but is instead concerned about the affected individual and their situations (Havelka et al., 2009).
The World Health Organization (WHO) adopted the biopsychosocial model as the ICF, or International Classification of Function’s basis in 2002 (Hopwood & Donnellan, 2010).
Criticisms of the Biomedical Model:
Engel advocated the biopsychosocial model by criticizing the biomedical model which was already in use when he put forward his approach. Here is a look at the several criticisms Engel brings forward to describe how the biomedical model fell short of the requirements of a proper tool of theoretical analysis.
Engel’s first problem with the biomedical model was that it left “no room within its framework for the social, psychological, and behavioral dimensions of illness” (Engel, 1977). According to Engel (1977), the biomedical model of analysis blatantly ignored the effect that social settings might have on individuals. He asserted that the approach adopted a “reductionist” conception, which demanded that the root of every complex situation is a simple one, and, in the case of health-related issues, which put chemical and physical changes as the primary causes of the biological ones. At the same time, it also promoted a “mind-body dualism” which considered the physical and the mental processes to have no connection to each other (Engel, 1977).
To Engel (1977), the biomedical model had been given a status so high that it had deeply entrenched itself not only in the scientific field but also in culture. How a disease was to be perceived culturally was determined by the biomedical model itself. Engel went so far as to declare the biomedical model as ‘unscientific’. He claimed that it had ceased to remain a scientific method of examination, and had instead been transformed into a “dogma” which “requires that discrepant data be forced to fit the model or be excluded” (Engel, 1977).
Engel provided a strong basis for his proposal for a new model of analysis in medicine and health (Havelka et al., 2009). For a start, different individuals belonging from different social conditions and having dissimilar pre-existing psychological backgrounds display different characteristics of the progress of disease even when the technique of assessment is the same. How and to what degree patients and their medical practitioners are emotionally connected might have an impact on their recovery rates (Havelka et al., 2009). Many times it might also happen that due to some psychological factors, people may consider themselves ill and in need of treatment when in reality they are not. To take into account these factors, along with several others, does not correspond to a decrease in the usefulness of the biomedical factors; instead, it adds to the existing framework to support a much more comprehensive form of inspection (Havelka et al., 2009).
Clinical Applications of the BioPsychoSocial Approach:
Engel himself released one of the first papers on the clinical use of the Biopsychosocial model. He explained the ‘steps’ followed in clinical settings using the biopsychosocial model by taking the example of a case study (Engel, 1980).
Engel (1980) explains that the process starts with the “two-person system” of the patient-doctor relationship. The doctor or the practitioner is directly involved in the process. Then, the information that is collected by the doctor consists of two parts: one, the “inner experience” as expressed by the patient, and two, the “reported and observable behavior” of the patient (Engel, 1980). Next, Engel (1980) states the application of the “systems hierarchy” as in the biopsychosocial model, which the medical practitioner uses to examine all the data that has been gathered, and considers which ones are relevant to the patient’s condition. Data on the patient, even the most minor details such as “age, gender, place of residence, marital and family status, occupation, and employment” might be “useful for future judgments and decisions” (Engel, 1980).
Engel gives a detailed “Sequence of Events” to further explain how the biopsychosocial model has crucial applications in clinical practices.
Borrell-Carrio et al. (2004) highlight seven “principles of biopsychosocial-oriented clinical practice”. First, the physician must be “calibrated” regularly, i.e., the knowledge, skills, and practices of the health practitioner must be constantly increased, adjusted, and audited by the practitioner to be effective in different situations. In other words, the physician must practice “mindfulness” to keep a proper watch on themselves and the situation at hand, and to react appropriately, with understanding. Next, the clinician must acknowledge any behavior of the patient, favorable or otherwise, with a uniform state of composure and congenial attitude, to set a definitive boundary between the personal and the professional (Borrell-Carrio et al., 2004). Third, the article mentions that the physician must have an open-minded and curious nature to every case, and not indulge in personal bias in particular cases (such as, considering the cases of some patients more interesting than the others, thereby paying more attention to those). In the same context, the next important aspect for the practitioner is to identify personal prejudices, understand how they might affect a diagnosis or treatment, and work actively to remove them. Borrell-Carrio et al. (2004) then mention that it is important for physicians to educate or train their emotions. The paper then highlights the last two principles: basing intuitive ideas on corroborative scientific observations instead of dismissing them as trivial feelings, and conveying important clinical information in lucid, bite-sized, gradual amounts instead of using clinical jargon and flood them on the patient (Borrell-Carrio et al., 2004).
As we can gather from the above, using the Biopsychosocial model means that the clinician is actively engaged with the problem of the patient, and also plays an important role during and after diagnosis and treatment. The disease is also no longer simply endowed with an internal cause–the external factors and their importance in the illness are effectively brought under scrutiny.
The Biopsychosocial perspective is now used as a tool of analysis in several medical, psychological, and other social science fields. Kusnanto et al. (2018) show how the biopsychosocial model has major implications and importance in detection, evaluation, interpretation, management, and results in cases of primary care doctors dealing with chronic illnesses. The approach is also applied in psychiatry (Tripathi et al., 2019), in understanding and management of chronic pain (Turk & Monarch, 2002), etc. Publications have also examined behaviors such as swearing (Vingerhoets et al., 2013), and even hook-ups (Garcia & Reiber, 2008).
Criticisms of the Biopsychosocial Model:
Although the idea has been revolutionary, has found application, and is being used in numerous studies, the biopsychosocial model has faced a variety of criticisms as well.
Ghaemi (2009) has declared several adjectives, such as “eclectic”, “vague”, and “generic”, to highlight the limitations of the biopsychosocial approach. The article also cites possible replacements for the model which is considered outdated. (McLaren, 1998) declares the model “seriously flawed”, and identifies a need to develop different models in psychiatry.
Babalola et al., (2017) call attention to the cumbersomeness and long-drawn-out nature of the model. Clinical settings with fewer resources might also find the process not only time-inefficient but also expensive to afford. Lack of proper training and facilities in medical centers, and certain inherent problems of the BPS model, such as obscurity, lack of evidence, etc., render the approach even more questionable (Babalola et al., 2017).
Although a seminal concept, the Biopsychosocial (or BPS) model comes with its own set of shortcomings. With a gradually increasing number of publications offering a critical review of the Biopsychosocial Model, the approach must be reviewed, analyzed, and modified where necessary to fit the dynamic nature of health and medical research.
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Borrell-Carrio, F., Suchman, A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. The Annals of Family Medicine, 2(6), 576–582. https://doi.org/10.1370/afm.245
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