Biopsychosocial vs. Biomedical Model

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DEFINING HEALTH PSYCHOLOGY and: BIO-MEDICAL MODEL and: PSYCHOSOMATIC MEDICINE and: BIOPSYCHOSOCIAL MODEL

in DEFINING HEALTH PSYCHOLOGY

from Key Concepts in Health Psychology

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MEANING The development of ideas about the origins and meaning of the terms 'health' and 'illness' has resulted in the emergence of a number of approaches designed to encapsulate the primary details of the concept and also provide parameters to its study. These approaches in many ways provide the conceptual pathway that has resulted in the discipline of health psychology. Think of these models as being formative in the historical development of health psychology as an independent level of enquiry. It is the parameters detailed in models and approaches developed to conceptualize health and illness that need to be considered, if the distinctiveness of a psychological approach to health is to be established.

ORIGINS The study of health, illness and well being has a long history, dating back to the philosophical debates about the relationship between physical (bodily systems) and psychological systems found in the writings of the Greek philosophers Hippocrates (circa 460–circa 377 BC) and Galen (AD 129–circa 199). In so-called 'humoral' theory, these early writers argued that disease or illness arose when the four fluids argued to circulate the physical system (i.e. blood, black bile, yellow bile and phlegm) were out of balance. Importantly, however, these writers also proposed that there was a relationship between a preponderance of one of the bodily fluids and bodily temperaments or personality types. In other words, disease was associated with physical factors but these physical factors also affected the mind. The Middle Ages saw an obsession with demonology and mysticism and reinforced the view that illness was associated only with mental states. With the rise of modern medicine, however, dualism – the argument that the mind and body are independent and not causally related – became the favoured position, and as such physicians treated bodily ailments without the need to recognize the role of the mind in illness aetiology.

CURRENT USAGE The bio-medical model adheres to this formulation. It considers that the mind cannot influence physical systems and vice versa and as such that the mind and body are completely separate entities. Illness is caused by external agents such as viruses or germs which create physical changes in the bodily system. Psychological processes are completely independent from any illness or disease process. The biomedical model has provided the mainstay of descriptive parameters for the study of health and illness for over 300 years. During the last century, however, a number of perspectives have been developed which challenge the bio-medical perspective. These propose a greater role for psychological and social processes in the aetiology and treatment of illness. Psychosomatic medicine grew as a branch of psychoanalysis and the study of hysteria developed by Freud and Breuer (Sulloway, 1980). It was observed that some people showed all the classic indications of neurological damage, such as paralysis of the legs or arms, when there was no underlying physical cause. Freud called this observation 'hysterical paralysis' and argued, on the basis of his famous work studying the patient Anna O, that the ailment was caused by mentalisms i.e. thoughts about experiences and feelings. While the arguments are intriguing, psychosomatic medicine suffers from its inability to provide sound empirical evidence to link causally mind matters and physical health (Holroyd and Coyne, 1987).

The biopsychosocial model of health and illness (after Engel, 1980)

Probably the most influential contemporary model of health and illness is the biopsychosocial model which considers that biological, social and psychological factors interact as dynamic processes in determining the onset, progression and recovery from illness (see Engel, 1977, 1980; Anagnostopoulou, 2005; and also Figure 1.1).

As you can see in Figure 1.1, the biopsychosocial model proposes that factors ranging from the changing status of molecular structures (i.e. the biological), the presence of social support (i.e. the social factor) and thoughts and feelings (i.e. the psychological factors) co-vary with each other to produce illness or health. It therefore rejects the dualist philosophy of the bio-medical model. Donovan (1988) has proposed a biopsychosocial model of addiction which focuses on the interaction between the biological (e.g. neuroadaptation after the ingestion of an addictive substance), the social (e.g. submitting to peer pressure to use addictive substances or behaviours, socio-economic class, and so on) and the psychological (e.g. expectancies associated with undertaking a behaviour) to explain the multifaceted experience of 'addiction' (see also Marlatt et al., 1988). The biopsychosocial model also implies a more 'holist' approach for the study of health and illness, as well as interventions designed to prevent people from becoming unhealthy and making ill people well again. While, as a model, the biopsychosocial is inherently appealing by emphasizing the interplay between various forces and factors in the experience of health and illness, the complexity of these relationships means that the 'true' causal structure of the system may not be derived in a complete state (Armstrong, 1987).

SIGNIFICANCE TO HEALTH PSYCHOLOGY The bio-medical model, psychosomatic medicine and, in particular, the biopsychosocial model provide the history and parameters within which to view the development of the discipline called 'health psychology' (see health psychology concept – this chapter). These approaches have argued about the relationship between the mind and body either taking a dualist stance (biomedicine) or monist (biopsychosocial) stance, the later being adopted for the study of psychology and health.