In 1977 George Engel published his seminal piece on biopsychosocial theory in Nature. In the article he argued that biomedical theories failed to account for the human experience of being ill and only noted the biochemical derangement of the disease. Furthermore, in order to fully elucidate clinical illness it was necessary to correlate the laboratory data with behavioral and psychosocial information (131). Engel opined that the “biomedical model ignores both the rigor required to achieve reliability in the interview process and the necessity to analyze the meaning of the patient's report in psychological, social, and cultural as well as in anatomical, physiological, or biochemical terms” (132)
The laboratory data does not actually provide a sufficient basis for clinical diagnosis. The individual’s life, life experiences, and the social expectations he lives in all have a bearing on when the patient will begin to understand himself as ill. It will also determine when he will begin to view himself as healthy after the laboratory data suggests he has recovered. Following this, the patient’s relationship with the clinician is also of utmost importance in regards to regulation of disease and full recovery – that is, the physician must be able to modify the patients behavior. Thus, the three prongs of the biopsychosocial model are: the patient, the patient’s social context, and the systems in society that deal with the deleterious effects of illness. In the current biomedical model, Engel opined that those who feel well but whose lab data is abnormal will get treatment, whereas those who feel ill but whose lab data is normal will not get treatment – this is a great failure.
It is well known that psychological stress can lead to death (Adler 608). The psychosocial is neither a necessary nor sufficient condition of disease, however, when there is a basis for disease it’s compounding effects are astounding. Organisms do not react uniformly to stimulus; that is to say, one persons fear is another’s fetish. Individual reality is key to understanding human illness and countless examples exist of individuals having completely opposite effects to what was medically expected (Adler 609). To overlook the patient’s total history and the environment that he developed in will inevitably lead to medical errors and diagnosis, and, what may amount to torturing the patient through mismanagement and poor treatment. So, in order to be a good and effective physician it is required to pay close attention to the patient’s words and be sensitive to the cultural context in which he was raised. Pain and disease is as much a cultural experience as an individual experience. Similarly, substance abuse may be a coping measure for an underlying anxiety of the patient, or a patient may be looing for positive effects of substances, whereas others may use substances to avoid social situations – if a patient presents with a substance abuse problem, the treatment must take into account the totality of the patient and what is the background of his problem (Buckmner, Heimberg, Ecker, and Vinci 281)
It is common when taking a patient history to ask questions concerning the onset of symptoms, their frequency, any antecedent illness, and the intensity and duration of the complained about symptom. The biopsychosocial model informs our understanding of each of those steps of proper history taking. Biopsychosocial obstacles will either make a patient not “feel” an existent problem, or otherwise not follow proper advice (Sanders, Foster, Bishop, and Ong 4). Physical symptoms may only arise and abet when one is culturally comfortable with their expression.
In sum, it is important for the practitioner to have a complete understanding of the patient and his history as opposed to just the laboratory data. It is impossible to treat a patient if the practitioner is unaware of the cultural influences that may or may not lead him to feel ill or seek treatment. Similarly, it is impossible to treat a patient if one is unaware of the reasons they are seeking treatment or the reasons they actually feel ill. Ultimately, a person may have many laboratory derangements and still be healthy, however, a person who feels unhealthy but has normal laboratory findings must be treated for his illness too.
Works Cited:
Engel, George L. “The Need for a New Medical Model: A Challenge for Biomedicine.”
Science. 8 April 1977: 129-136. Jstor. Web. 10th April.
Buckner, Julia D., Heimberg, Richard G., Ecker, Anthony H., Vinci, Christine. “A
Biopsychosocial Model of Social Anxiety and Substance Use.” Depression and Anxiety. (13 December 2012): 276-284. Wiley Online. Web. 10th April.
< DOI 10.1002/da.22032>.
Sanders, Tom., Foster, Nadine E., Bishop, Annette., Ong, Bie Nio. “Biopsychosocial care
and the physiotherapy encounter: physiotherapists’ accounts of back pain consultations.” BMC Musculoskeletal Disorders. (2013). Biomed Central. Web. 10th April
Adler, Rolf H. “Engel’s biopsychosocial model is still relevant today.” Journal of
Psychosomatic Research. (2009):607-611. ScienceDirect. Web. 10th April.
< doi:10.1016/j.jpsychores.2009.08.008>
