Health Psychology Challenges the Assumptions underlying the Biomedical Model

 A critical Review of Literature on the Development of the Biopsychosocial Model

 

Health Psychology Challenges the Assumptions underlying the Biomedical Model

 

Liverpool John Moores University

(LJMU)

Faculty of Health

Department of Psychology 

Joseph Akech Deng Alol

MSc Psychology

This work is an assignment that has been submitted to the University for academic purposes

A Summative Assessment Point

May 20, 2021

The Biopsychosocial model was initially theorized by George Engel in 1977 proposing that, in order to know an individual's medical problem, it is not all about the biological issues to deliberate on but to also pay attention to his/her psychological and social issues. This paper discusses two models; Biopsychosocial Model (BPS) and Biomedical Model (BM). The Biopsychosocial Model mainly focuses on social impacts, environmental and psychological factors of an individual regarding the sickness, while Biomedical Model purely focuses on Biological factors regarding the sickness (Alonso, 2004). Health Medical intervention is caught on as an established set of practices (like paying attention to the patient, inquiring questions, diagnosing, or prescribing medications) attempted by specialists to assist those who look for restorative consideration. During such therapeutic responsibilities, is the description of ‘ailment’ and ‘sickness’, there are two important terms established completely unlike considerations of human’s ‘sick body’. Whereas the word ‘ailment’ will regularly possess an entirely physiologically founded meaning, the word ‘sickness’ is regularly characterized by forms of a person's encounter of ‘sick body’, including all impartial together with individual genuineness to its meaning (Lidler, 1979).  

Biomedical Model (BM)

This model had been existing since the midst of the 19^th century and was mainly practiced by doctors in diagnosing the disease. This model has four main fundamentals. It claims that health is founded on the absence of pain, illness, and/ or defect that justifies the normalcy of human health. Biomedical Model focuses on the physical courses like physiology, pathology, and biochemistry of an illness that cannot recognize the impact caused by personal problems or social issues (Bolton, 2019). In contrast to the biopsychosocial model, the biomedical model drops to recognize discussion between a patient and the doctor in finding the diagnosis. So, the model purely concentrates on biological factors. It does not include social impacts, environmental besides psychological issues. Americas and European nations have approved this model as the principal modern technique that health personnel manages and identify health issues. Irrespective of the limits this model shows, this has been perilous regarding advancing the projects that may prevent the contagion of ailments. Additionally, this provides vast evidence towards the biopsychosocial technique (White, 2009).

Biopsychosocial Model (BPS)

Biopsychosocial Model is a technique that says that social, biological, and psychological factors play important role in a person’s daily functioning regarding disease and sickness. This model highlights that, health is by focusing on social, biological, and psychological factors instead of paying attention to only biological issues. It is quite different from Biomedical Model (Engel, 1977). The biomedical model assumes that the cause of the disease remains as a result of changes in usual functions like birth defects, developmental abnormality, the presents of viruses or bacteria in the blood, and injury (White, 2009).

This approach is mainly applied in the specialties of health psychology and sociology, medicine, and nursing. The acceptability, prevalence, and uniqueness of the biopsychosocial model show disparities transversely over the cultures. This model has been existing for a long and it will grow faster with health psychology research and designs (Farre & Rapley, 2017).

The state of the future of Healthcare

The biopsychosocial model is at the rim of becoming the core of the healthcare future. Many specialties in healthcare have shifted for a holistic approach to include clinical psychology, chiropractic, psychiatry, health psychology, clinical social work, and family therapy. Most doctors/clinicians will include rudiments of biomedical and biopsychosocial models in their clinical practices. Nevertheless, this is something debatable that any disease whether organic or functional, the best way to manage it is via a biopsychosocial approach instead of biomedical practices (Engel, 1977a). These models have one thing in common, both aim at improving patients’ wellbeing. Their major difference is the basis of how a doctor deliberates on illness, its causes, and probable treatments. Furthermore, the biopsychosocial approach extends the meaning of this objective by applying it in clinical practices. Sickness is handled as suffering to the patient. The overall objective of appropriately handling the illness is by identifying the exposures of the client such as psychological, biological, and social factors (Borrell-Carrió et al., 2004)

Key weaknesses of Biomedical Model

This model is likely to lose its credibility soon in healthcare intervention because of its assumptions that psychological and social factors are unconnected to the disease. The key weaknesses it reveals are so many. The biomedical model largely possesses three obligations. The first is that this model is reductionist in its nature because it reduces disease to a lower approach (Ghaemi, 2009). It focuses on imbalances of biochemicals in blood and cells disorders. The model fails to consider the overall function of social and psychological factors. The second point is that this biomedical model is a one-factor model. It describes disease on impairment of biological issues rather to recognize the various factors where biological ones are just a few among the causative ag of a disease (Herman, 2005). Point number three is that this model shoulders a body-mind dualism. The biomedical model upholds mind and body as two separate things. Last but not least is that the biomedical model places strong consideration on disease over health. Its main attention is abnormalities that could cause disease rather than situations and issues that can promote health (McLaren, 1998).

The Clinical insinuations and advantages of the Biopsychosocial Model

Both Medical intervention, disease, and illness are interconnected courses. Both include communication of deviations in an individual besides other stages.  Many authors are much motivated by this approach for multidisciplinary intervention, thinking, and collaboration.  This model upholds that, the process of diagnosis must recognize the interactions and functions of biological, psychosocial, and social factors. It demands a multidisciplinary approach when formulating the diagnosis of a disease (Foss, 1997).

With this regard, Health psychology must implement the biopsychosocial model by involving these three factors. Treatment is tailored to an individual bearing in mind his/her health status by confirming therapeutic endorsements which can better deal with several other issues systematically. Furthermore, a multidisciplinary approach is considered the best intervention (Kontos, 2011).

The connection between a practitioner and the doctor remains highlighted by the biopsychosocial model. Effectiveness of therapy, the speed of addressing the sickness, and the client/patient’s service provision could be enhanced using the efficient relationship of a patient and practitioner. This biopsychosocial model produces the insinuations of which the doctor should have a precise consideration of social and psychological issues which could contribute to the sickness so that to formulate an effective treatment approach (Kim,2014). For anyone who is not sick, the biopsychosocial model stands with a suggestion that his/her health status should be ensured in psychosocial and social circumstances.  If someone is sick, regaining back normalcy is propelled by biological, social, and psychological factors. Such factors might uphold meager health behaviors unless there are appropriate changes, these can influence those who are healthy (Oudenhove & Cuypers, 2014).

Biopsychosocial Viewpoints: Behavior, Health, and Psychosomatics

Chronic stress, social isolation, depression, and conscientiousness can all be acknowledged by medical professionals besides health psychologists like how it impacts on protection and vulnerability of various illnesses. There reliable connection of pathogenesis with clinical depression in addition to the manifestation of heart disorders. According to a research conducted in 2009 by Salomon, he inspected the prevailing variances in the reaction of vascular disease to, besides improvement from the two laboratory stressors amid control samples of healthy ones with no self-reported past history of cardiovascular disease and natural samples of clinical depression (Nezu, 2013).

Furthermore; the studies conducted earlier demonstrate substantial psychosomatic associated behaviors amid disease, health, and illness, the Biopsychosocial model must emphasize clarifying the complex issues facing individuals (Searight, 2016).

The Rise of the Biopsychosocial Model in Medicine

A review of the previous studies by Engel will help in harmonizing unusual prejudice for health psychology, delivery of classy and satisfactory consideration of the social and cultural delineations that cause disease and health, hence nurturing bigger incorporation amongst bio-psycho-social fields (Smith et al., 2013).

Throughout many research paperwork distributed between 1960 and 1980 (Engel, 1977a, p. 135,1977b, p. 384), Engel enunciated a persuasive argument of the generally prevailing Medical Model, the Biomedical Model by laying out its weaknesses and requested aiming at an inquiry of a modern therapeutic model by which he himself, Engel named that modern therapeutic model as the ‘biopsychosocial model (Engel, 1977b, p. 384). Taking after his evaluation, a conventional biomedical model, that ‘undertakes illness in the direction of completely nonconformities as of the standard quantifiable organic (physical) elements take off not any space inside the system regarding social, mental, and behavioral measurements for the ailment (Engel, 1977b, p. 384). He contended about driven towards an essential contradiction by saying “some people with positive laboratory findings are told that they need treatment when in fact they are feeling quite well, while others feeling sick are assured that they are well” (Engel, 1977b, p. 384). He further continued and set up by saying:

THE EXISTING BIOMEDICAL MODEL DOES NOT SUFFICE. TO PROVIDE A BASIS FOR UNDERSTANDING THE DETERMINANTS OF DISEASE AND ARRIVING AT RATIONAL TREATMENTS AND PATTERNS OF HEALTH CARE, A MEDICAL MODEL MUST ALSO CONSIDER THE PATIENT, THE SOCIAL CONTEXT IN WHICH HE LIVES, AND THE COMPLEMENTARY SYSTEM DEVISED BY SOCIETY TO DEAL WITH THE DISRUPTIVE EFFECTS OF ILLNESS, THAT IS, THE PHYSICIAN ROLE AND THE HEALTH CARE SYSTEM. THIS REQUIRES A BIOPSYCHOSOCIAL MODEL. (ENGEL, 1977B, P. 132).

In separate statements, he suggested widening the biomedical model aiming to incorporate psychosocial short of relinquishing preferences of the biomedical approach (Engel, 1980, p. 538) in such a way that sick people can proceed to be taken care of against an illness angle including, mental and personal data would be given a break-even by standup with the attention procedure (Smith et al., 2013, p. 269). In this way, health professionals would remain bright toward the assessment of any variable that is causing an ailment, while recognizing a few components by way of extra imperative. Some few indeed for the fundamental disorder (contradicted for a source too) sickness, as an alternative of paving supremacy of natural variables itself (Engel, 1980, p. 536). Through such intellect, the biopsychosocial model became famous for essential proficient information and abilities ought to length the social, mental, and organics assumed the medical choices and activities for a sick person’s sake including both 3 spaces (Engel, 1977b, p. 387).

Employing such thinking towards medical practice, the biopsychosocial model was characterized as an encircling data as of points/levels underneath or over the people as practiced by everyone, for instance, professional health personnel looks for and coordinate information of a psychological stage by collecting information as of the natural stage (underneath) and information from the social level (over) to develop the biopsychosocial portrayal of each patient (Figure 1).

Figure 1: Schematic representation of the pecking order and continuum of characteristic frameworks as applicable to Engel’s definition of the biopsychosocial model, adapted from ‘The clinical application of the biopsychosocial model (Engel, 1980, p. 536).

In lieu of this model, it is evident that each level within the chain of command works concurring to a one of a kind framework (for example, matters plus structures on organic stage; recognizing the encounter of the mental stage; acknowledging the connotation of the social stage); in any case, this is through the incorporation of all those contexts for the basic in relations to consideration of the sick person’s biopsychosocial landing. In this way, health personnel-patient interaction gets to the crucial venturing stage to joining different stages and considering ailment and supportive behavior (Engel, 1980, p. 539, 1997, p. 524).

Biopsychosocial further elaborates on the impact of social support. Within many studies, more satisfying social relationships or confidants result in an individual recovering more quickly from illnesses and diseases as compared to those with minimal social support.

Biopsychosocial Model and the Culture

Cultural values develop with time. This carry-along with ambiguity besides argument. Society and Culture are informative. Culture impacts each establishing lump of the biopsychosocial model. Any weakness to show up enough the important functions of the cultural trend to health psychology linked to medical practice will lead to the consequence of discernment in the health provision. To have a better complete approach in health psychology, it is good to seriously consider the culture when trying to fit in the biopsychosocial model (Searight, 2016).

Health Psychology: Biopsychosocial Model Revolutions and the Future

The emerging behavioral medicine and health psychology around primary healthcare setups and overall training of doctors on several other health, models had given rise to alertness where patients can nowadays realize that medical professionals see them as a human instead of just a disease (Bolton, 2019).

In some years back, the study on behavioral interventions and health psychology had developed highly with several critiques. The quality of a patient’s life together with healthiness have been observed by Psychologists with great improvement from humanity perspective. In the direction of completely tightening the importance of a combined therapy besides psychologists, it is very important to carry out long-term experimental research. Medical doctors are questioning the reason why changes in medicine include behavioural interventions which give a lot of work to already trained clinicians. Studies with massive information about behaviour teaching services administered by Psychologists must be included when promoting hospital-based medical care (Herman, 2005).

Societal and health care changes prevent psychology to transform. The field of Psychology wants to expand specific skills of Clinical and Health Psychology to medical professionals. Psychopharmacology is the newest in the establishment of an independent practitioner psychologist. Therefore, Psychologists should seek for and keep inter-professional teamwork with medical doctors to safeguard medical responsibility besides psychology. This is to allow psychosocial issues of medical difficulties to be solved. The quality of medical service can be challenged due to meager rapport between psychologists and physicians (Kim, 2014).

Partnerships and collaborations for managing and diagnosing all health issues shall be adopted soon. Teaching programmes regarding health psychology shall rise in quantity. Interested students in research, education, and clinical settings shall be having specialties where they will specialize.  Teachers and professionals who involve in policy-making must be trained and educated on the biopsychosocial model. The effects of biopsychosocial teaching on healthcare will be an increase in loyalty to plans of treatment, promotion of self-empowerment, provocational of behavioural change, improved occupational control, and reduction of health costs. Unified healthcare can ultimately solve the whole range of the human body and mind as same one (Kim, 2014).

Health Psychology Future and Application of Holistic Approach of Biopsychosocial model

In the existing medical practices, the biomedical model of illness and health is dominant. This model is only active in the prevention of infections and sickness. A biopsychosocial approach is required when dealing with chronic non-infectious diseases. This model considers other determinants of health. Therefore, the biopsychosocial model is advancing to be a better strategy rather than the biomedical model (Ghaemi, 2009).

Furthermore, integrating culture into the focus of biological, psychological, and social aspects is one of the much better holistic approaches. Consideration of culture shall yield a better holistic approach in the future. The upcoming research in health fields and strategic interventions should bear and focus on all aspects that are holistic ones. The biopsychosocial model will develop over time. With this consideration thereof, an evaluation of the efficacy of culture, biological, psychological, and social rights should be done (Bolton, 2019).

Conclusion

The Biopsychosocial model is where most of the future of healthcare rests compare to the biomedical model. Nevertheless, as shown in the progress of the BPS model in the field of Health Psychology and in the future, there are some parts of the biopsychosocial model that ought to be included. An example of this is to increase participation and collaboration among physicians and psychologists. These professionals must work in partnership towards safeguarding the attainment of the well-being of an individual through the efficient model application. The cultural aspects must too be considered in the context so that to make sure acceptability of health service is guaranteed in different societies. Implications of clinical practice are sole aspects of the development of the biopsychosocial model. Biomedical research and Health psychology will serve as the main structural lumps in the future of BPS.

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