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What does actually mean biopsychosocial?
07 March 2012
Journal of Psychotherapy and Psychosomatics
The term “biopsychosocial model” is frequently used in the medical literature. But what does really mean? A group of investigators of the University of Bologna with a Hopkins researcher provides a renewed interpretation of what George Engel wrote in a widely cited article in Science.
The paper that George Engel published in Science in 1977 on the need for a new medical model certainly attracted a lot of attention over the years. It is generally seen as being concerned with the biopsychosocial model, which allows illness to be viewed as a result of interacting mechanisms at the cellular, tissue, organismic, interpersonal, and environmental levels. Accordingly, the study of every disease must include the individual, his/her body, and his/her surrounding environment as
essential components of the total system. Another part of Engel’s paper was concerned with the clinical inadequacy of the concept of disease, which has only become manifest in recent years.
It has been argued that the time has come to abandon disease as the focus of medical care. Clinical decision making for all patients should be addressed to attainment of individual goals and identification and treatment of all modifiable and non-biological factors, rather than solely on the diagnosis and treatment of individual diseases. Clinimetrics, the science of clinical measurements, offers unprecedented opportunities for identifying such factors. In psychiatry, exclusive reliance on diagnostic criteria has impoverished the clinical process and does not reflect the complex thinking that underlies decisions in psychiatric practice.
The use of transfer stations with repeated assessments instead of diagnostic endpoints, the building of global formulations of clinical integration, staging methods, and a better organization of clinical information (encompassing subclinical distress, illness behavior, psychological well-being, and macro- and micro-analy-sis) may be an antidote to oversimplified models that derive from biological reductionism, neglect individual responses to treatment, and clash with clinical reality. A final remark of the paper was on the progressive decline of clinical observation as the primary source of scientific challenges and on the key characteristic of clinical science in its explicit attention to humanness. As Engel later wrote, ‘observation (outer viewing), introspection (inner viewing), and dialogue (interviewing) are the basic methodologic triad for clinical study and for rendering patient data scientific’.
In Psychotherapy and Psychosomatics, a paper recently referred to the ‘clinical factor’ (CF) as ‘the degree and extent to which a journal provides information to the clinician that may improve his/her practice’ and started reviewing the psychiatric literature based on the CF and the financial independence of the sources of information. The Authors of this paper thus believe that the ‘biopsychosocial factor’ (and not the static concept of ‘model’) may provide a stimulus for a psychosomatic renewal of health care.