DIAGNOSIS,TREATMENT, AND CURE OF ILLNESS-The Biopsychosocial Model Versus the Biomedical Model Choosing Wisely

"The biopsychosocial model has led to the development of the most therapeutic and cost-effective interdisciplinary pain management programs and makes it far more likely for the chronic pain patient to regain function and experience vast improvements in quality of life"- Robert J. Gatchel, PhD, ABPP, Krista J. Howard, PhD and Nancy D. Kishino

Dr. George,an American Psychiatrist in 1977 introduced the Biopsychosocial model as a response to the cold and clinical mechanistic medical model.-a diagnosis and treatment based entirely on clinical tests ignores the person and how they are coping. Engel conceptualize symptoms of illness or disease as arising from  a dynamic interaction between psychological, social and biomedical factors.

Illustration of a woman examining the contents
of a man's head.Credits; Lorelyn Medina

Illustration of medical doctor examining
of  a patient.Credits;DiverDR.jpg  

The biomedical model is most characteristics of medicine is based on molecular biology and great advances are made using this model, it is most successful against infectious agents, but less successful against lifestyle-related diseases such as heart disease and some cancer. 

The best way to understand the biopsychosocial model is to contrast it with the biomedical model of medicine which governed the thinking of most health practitioners for the past 300 years and assumes that psychological and social processes are largely irrelevant to the disease process.

The Biomedical model of medicine can be understood in terms of its answers to the following questions 

• What causes illness? According to the biomedical model of medicine, diseases either come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition. 

• Who is responsible for illness? Individuals are not seen as responsible for their illness because illness is seen as arising from biological changes beyond their control. They are regarded as victims of some external force causing internal changes. 

• How should illness be treated? Treatment in terms of vaccination, surgery, chemotherapy and radiotherapy, all of which aim to change the physical state of the body. 

• Who is responsible for treatment? The responsibility for treatment rests with the medical profession.

• What is the relationship between health and illness? Within the biomedical model, health and illness are seen as qualitatively different – you are either healthy or ill, there is no continuum between the two. 

• What is the relationship between the mind and the body? The mind and body function independently of each other as separate entities incapable of influencing physical matter.The mind is seen as abstract and relating to feelings and thoughts, and the body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in state of mind. 

• What is the role of psychology in health and illness? illness may have psychological consequences, but not psychological causes. For example, cancer may cause unhappiness but mood is not seen as related to either the onset or progression of the cancer. 

The Shortcomings of the Biomedical Model

•  It ignores psychological and sociocultural factors that are important in diagnoses, treatment, and recovery because health is clearly related to attitudes, emotions, and personality traits as well as exposure to viruses and bacteria 

• It has difficulty accounting for why a particular set of somatic conditions need not inevitably lead to illness. Why, for example, if six people are exposed to measles, do only three develop the disease?

•  Such a narrow scope on health limited the understanding of wellbeing, thwarted treatment efforts and more importantly suppressed treatment measures (Saheed Lakhan, 2006). Hence the need for medical practitioners to incorporate a holistic view of health in sound medical application gave birth to the Biopsychosocial model of health and illness

An Image of a Man at a Psychologist and his Patient at
Therapy Session..Credits;John Takai

illutration;Psychology Today

The Biopsychosocial Model can be understood in terms of the same questions that were asked of the biomedical model

• What causes illness? illness is caused by a multitude of factors and not by a single causal factor.This is an attempt to move away from a simple linear model of health which claims that illness can be caused by a combination of biological (e.g. a virus), psychological (e.g. behaviours, beliefs) and social (e.g. employment) factors. 

• Who is responsible for illness? The individual is no longer simply seen as a passive victim because illness is regarded as a result of a combination of factors,. For example, the recognition of a role for behaviour in the cause of illness means that the individual may be held responsible for their health and illness. 

• How should illness be treated? The whole person should be treated, not just the physical changes that have taken place. This can take the form of behaviour change, encouraging changes in beliefs and coping strategies and compliance with medical recommendations. 

• Who is responsible for treatment? The patient is in part responsible for their treatment because the whole person is treated, not just their physical illness, This may take the form of responsibility to take medication, responsibility to change beliefs and behaviour. They are not seen as a victim. 

• What is the relationship between health and illness? Health and illness are not qualitatively different, but exist on a continuum. Rather than being either healthy or ill, individuals progress along this continuum from healthiness to illness and back again. 

• What is the relationship between the mind and body? The mind and body interact and are seen as influencing each other. 

• What is the role of psychology in health and illness? Psychological factors are not only a possible consequences of illness but as contributing to its aetiology considering both a direct and indirect association between psychology and health. The direct pathway is reflected in the research exploring the impact of stress on illnesses such as coronary heart disease and cancer.

How, Then, Does the Biopsychosocial Model of Health and illness Overcome the Disadvantages of the Biomedical model? 

•  The biopsychosocial model maintains that health and illness are caused by multiple factors(biological, psychological,social)of health and illness and produce multiple effects. 

• As such, both macrolevel processes (such as the existence of social support or the presence of depression) and microlevel processes (such as cellular disorders or chemical imbalances) interact to produce a state of health or illness. 

Health and illness;How Biological, Social, and Psychological Variables interact

If biological factors are microlevel processes and psychological and social factors are macrolevel processes how they interact? To address this question, researchers have adopted a systems theory approach to health and illness;

• Systems theory maintains that all levels of organization in any entity are linked to each other hierarchically and that change in any one level will effect change in all the other levels. This means that the microlevel processes (such as cellular changes) are nested within the macrolevel processes (such as societal values) and that changes on the microlevel can have macrolevel effects (and vice versa).

• Consequently, health, illness, and medical care are interrelated processes involving interacting changes both within the individual and on these various levels.

•  To address these issues impels researchers toward interdisciplinary thinking and collaboration. It also requires researchers to apply sophisticated, multivariate approaches to testing problems and to the often complex statistics needed to analyze them (Suls & Rothman, 2004).

From this viewpoint, health becomes something that one achieves through attention to biological, psychological, and social needs rather than something that is taken for granted.