1.7 Models of health care delivery: the biopsychosocial model
Activity 4: The biopsychosocial model
Read the following description of the biopsychosocial model and make notes on the positive and negative implications for lay users.
While disease dominates biomedical thinking, the biopsychosocial model incorporates social, psychological and emotional factors in diagnosis and treatment. It recognises that illness cannot be studied or treated in isolation from the social and cultural environment. Whereas the biomedical model prioritises professional knowledge, the biopsychosocial model expects health carers and doctors to acknowledge and take into account users' circumstances. This change in focus is reflected in research priorities, in that government departments increasingly respect qualitative research (previously dismissed by the medical research community as ‘soft’). (See, for example, ESRC, 2003.)
Medicine practised within a biopsychosocial framework acknowledges the links between socioeconomic deprivation and adverse health. It also considers issues such as improving access to health services and reducing health inequalities as a legitimate and appropriate function of health service provision (Engels, 1980).
The biopsychosocial model recognises the connection between health and the experience of illness and the physical and social environment. Heart disease and obesity are linked epidemiologically to ethnicity and poverty, and therefore cannot be explained simply in terms of individual self-responsibility and willpower. Rather, definitions of health within a biopsychosocial model consider the way in which people negotiate their way through environmental, social and informational influences (Fulder, 1998). Health is a process concerned with norms of functioning and wellbeing, which are determined by society and professionals, and vary from time to time and group to group. In this sense, health is relative rather than absolute: a process rather than a fixed, defined condition. Fulder describes this process as ‘one of dynamic balance where the capacity of the organism to self-repair, self-support, and renewal is not overwhelmed by the interactions with the world within and outside the organism’ (1998, p. 152). Within this model, ‘the organism’ means the community as well as the individual.
The dominance of the biopsychosocial model in western health care is exemplified by the inclusion in medical training of subjects such as medical sociology, medical anthropology and community medicine. None the less, this model is still grounded in scientific method, thus building on the major elements of biomedicine.
The implications of the biopsychosocial model for users and therapeutic relationships include the accommodation of emotional and spiritual aspects of health. Consultations with health professionals who use this model should acknowledge the wider environment, users' social support networks, family support and stress levels. In theory, the biopsychosocial model can generate hypotheses about individual illness which tally with people's broader understandings about why they are ill, in the context of their whole life story. This moves away from professionals deciding what is wrong to a more balanced therapeutic relationship in which users are encouraged to be active partners in health decisions. There may also be scope for more ‘caring’ therapeutic relationships: some people will value the opportunity to talk about their emotions and broader concerns and may find this therapeutic in itself.