The Biopsychosocial Model Has it turned medicine into

The Biopsychosocial Model Has it turned medicine into holistic feel-goodery? Prof Craig Jackson Head of Psychology Birmingham City University

George Engel Spring 1977 Groundbreaking The need for a new medical model: a challenge for biomedicine Challenged reductionist linear approach to psychiatric disease

George Engel "The dominant model of disease today is biomedical, with molecular science it's basic scientific discipline. It assumes disease to be fully accounted for by deviations from the norm of measurable biological (somatic) variables. It leaves no room within its framework for the social, psychological, and behavioural dimensions of illness" Against patients as "cases"

Medical Model Pathogen Modifiers Lifestyle Individual susceptibility

Acceptance Commonly accepted in managing ill health Integrates. . . psychological factors & sociological conditions

Hippocrates 2 Millennia onwards Man is more than his disease Ramazzini

Hermann Nothnagel Physician 1882 Medicine is treating sick people NOT disease

Early Adopters of BPS William Osler Russell Reynolds 1869 Francis Peabody 1927 George Robinson 1939 Franz Alexander Roy Grinker 1954 challenged psychoanalytic orthodoxy

William Osler "The good physician treats the disease, the great physician treats the person"

Rene Descartes Cartesian Dualism Allows for placebo Therapeutic symbol Response determined subjectively by Dr and Patient von Bertanlaffy's General Systems Theory

General Systems Theory von Bertanlaffy All levels of organisation in entities are hierarchically linked Changes in one level influence change at other levels Micro level processes are nested within macro level process Changes on micro level have macro level effects and vice versa

Complexity Theory BPS strong in analysing complexity Smoking Education Working Gambling Risk Communication

Biopsychosocial Application 45 yr old female checkout worker Off sick with GAD

Emphasis on Wellbeing Biomed model focused on "cures" an repairing altered biology BPS looks at maintaining wellbeing possibly in absence of the above Complete wellbeing PHYSICAL, MENTAL & Health is not merely absence of disease SOCIAL

Empowers Physicians Empowers doctor to explore other causes of ill health other than biomedical Provide information Discuss treatment options Allows for the Artistry of Medicine

Failing of BPS Strength of BPS also it's weakness Incorporating all other possible causes of disease it lends itself to more complex and circumnavigatory models of complexity No universal theory of everything We would have found it by now

Linear Simplicity Is "more possible explanations" better? More perspectives gets closer to a "highly complex reality"? Linear simplicity of cause and effect is good too

Helicobacter Pylori Discovered 1982 Implicated in peptic ulcers Once seen as classic psychosomatic illness However. . Mesothelioma - not "just" biomed exposure

Blame and Stigma Implying some illness has psychological origins Holds patients responsible for their diseases Blaming leads to Labelling leads to Stigma Revival of psychosomatic concept of illness or "hysterias" All in the Mind

Blaming the patient not the disease! Economy in terrible state Unemployed with 3 children Female in a prejudiced community Becomes depressed Eventually suicidal BPS still places locus of problem with patient

"Physician-Endorsed Malingering" Stress epidemic 1995 - Present day

Biopsychosocial Model Hazard Psychoscial Factors Attitudes Behaviour Qo. L Illness (wellbeing) Rise of the patient as a “psychological entity”

Psychosocial Triparte of Ill-Health Individual vulnerability Personality type Experience Learned behaviours

Biopsychosocial Effects of Stress

Weakness of Eclecticism Hypertensive Patient Excessive salt Stressful job Reduce dietary salt Stress reduction course Poor social support Over-responsible personality Medication Psychotherapy

Irritable Bowel Syndrome Common digestive disorder Functional syndrome Traumatic life events, Personality disorders, Stress, Anxiety, Depression Somatization Not a psychological disorder Night-workers Loners Psychology important : how symptoms are perceived and reacted to

Irritable Bowel Syndrome

Chronic Fatigue Syndrome Non-specific subjective symptom Overlap with psychiatric diagnoses (66%) Chronic long-term inability and tiredness Both Physical and Psychological fatigue Most prevalent in white, middle class 30 s females Fatigue dominates activities and life

Chronic Fatigue Syndrome

Chronic Fatigue Syndrome

Iatrogenic Harm Professional Meddling

The Cope not Cure Industry

Spurious Practices

Legacy of the Biopsychosocial Model Displaced traditional medicine from dominant role Made "consultations" a thing of the past Empowered patients - not always a good thing Made space for quackery, frauds and crystals Has it been best for the patient? Will trad-med make a comeback?

References Engel, GL. (1977) The need for a new medical model: a challenge for biomedicine. Science. 196(4286): 129 -36. Jackson CA. (2005). Review of "Biopsychosocial Medicine: An Integrated Approach to Understanding Illness" by Peter White. Occup Medicine; 55(7): 582. Jackson CA. (2007). Psychosocial Hazards. In Smedley, J et al. (eds) Oxford Handbook of Occupational Health. Oxford University Press; 167 -179. Karasek R. (1979). Jobs demands, job decision latitude and mental strain : implication for job redesign, Administrative Science Quarterly, 285 -308.

References Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, and Kirjonen J. (2002). Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ; 325: 857 Lees, R. , and Laundry, B. R. (1989). Comparison of reported workplace morbidity in 8 -hour and 12 -hour shifts in one plant. Journal of the Society of Occupational Medicine 39. Premchand P, Paraskeva K. , Jackson CA, Isaacs P. Fibre, Bran and Irritable Bowel Syndrome: role in primary care setting. British Society of Gastroenterology Annual Meeting, March 21 -23 2000, Birmingham, UK White, P. (2005) Biopsychosocial Medicine: An Integrated Approach to Understanding Illness. Oxford University Press, Oxford.