Disadvantages of a biopsychosocial approach Essay Example

Glover who has a second heart attack six months after his first. Engel elegantly indicates that Mr Glover's personality helps to interpret his chest pain, that he is in some degree of denial and that it is only the intervention of his employer that gives him permission to seek help.

Whereas reductionistically his heart attack can be understood as a clot in a coronary artery, the wider personal perspective helps to understand that different outcomes may be possible depending on how the person responds to his condition. Subsequently Mr Glover in the emergency room develops a cardiac arrest as a result of an incompetent arterial puncture. Once again systems theory can analyse this event in wider terms than just a cardiac arrhythmia. It sees the event as due to inadequate training and supervision of junior staff in an emergency room.

Thus while there may be "no single definitive, irreducible model has been published," [4] Engel's elegant exposition of his model in this paper gives plenty of scope for this broader understanding of clinical practice. The novelty, acceptance, and prevalence of the biopsychosocial model varies across cultures. [1] Model description and application in medicine[edit] Some thinkers see the biopsychosocial model in terms of causation. On this understanding the biological component of the biopsychosocial model seeks to understand how the cause of the illness stems from the functioning of the individual's body.

The psychological component of the biopsychosocial model looks for potential psychological causes for a health problem such as lack of self-control, emotional turmoil, and negative thinking. The social part of the biopsychosocial model investigates how different social factors such as socioeconomic status,

culture, poverty, technology, and religion can influence health. [1] However a closer reading of Engel's seminal paper in the American Journal of Psychiatry (1980) embeds the biopsychosocial model far more closely into patient care.

It is not just about causation but about how any clinical condition (medical, surgical or psychiatric) can either be seen narrowly as just biological or more widely as a condition with psychological and social components, which will impinge on a patient's understanding of her condition and will affect the clinical course of that condition. Drawing on the systems theory of Weiss and von Bertalanffy, Engel describes the commonsense observation that nature is a "hierarchically arranged continuum with its more complex, larger units superordinate on the less complex smaller units."

He represents them schematically either as a vertical stack or as a nest of squares, with the simplest at the centre and the most complex on the outside. He subdivided the vertical stack into two stacks. The first starts with sub-atomic particles and ends with the individual person. The second starts with the person and finishes with the biosphere. The first is an organismic hierarchy, the second a social hierarchy. He then delineates some principles: 1. Each level in the system is relatively autonomous. Thus a cell can be studies just as a cell. 2. Each level depends on the level below.

Thus a cell is composed of nuclei, mitochondria and all sorts of other organelles. 3. Each level is a component of a higher system. Thus cells organise together to become tissues, and organs etc. Thus, "in the continuity of natural systems every unit is at the very

same time both a whole and a part. " To these principles Engel developed we can add further that higher level properties emerge from lower level systems and cannot be predicted from studying the lower level, We can also add the principle of top-down causation namely that higher levels can influence lower levels.

The biopsychosocial model of health is based in part on social cognitive theory. The biopsychosocial model implies that treatment of disease processes, for example type two diabetes and cancer, requires that the health care team address biological, psychological and social influences upon a patient's functioning. In a philosophical sense, the biopsychosocial model states that the workings of the body can affect the mind, and the workings of the mind can affect the body.

This means both a direct interaction between mind and body as well as indirect effects through intermediate factors. The biopsychosocial model presumes that it is important to handle the three together as a growing body of empirical literature suggests that patient perceptions of health and threat of disease, as well as barriers in a patient's social or cultural environment, appear to influence the likelihood that a patient will engage in health-promoting or treatment behaviors, such as medication taking, proper diet or nutrition, and engaging in physical activity.

While operating from a BPS framework requires that more information be gathered during a consultation, a growing trend in US healthcare (and already well-established in Europe such as in the U. K. & Germany) includes the integration of professional services through integrated disciplinary teams, to provide better care and address the patient's needs at all three levels. [7]