41 terms

Biopsychosocial model model

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Who was the influential key figure of the biopsychosocial model?
George Engel
Was a physician, psychiatrist, educator
Controversial figure at the time
What was Engel's seminal piece of work and when was it?
The need for a new medical model: a challenge for biomedicine
1977
How was the biopsychosocial model developed?
- reaction against the mind-body dualism with need for something more holistic
- reaction against reductionism and specific aetiology of biomedicine and said there were multiple causes of illness
- response to changing pattern of conditions (infectious ➡️ chronic)
- response to escalating cost of health care - shift responsibility from expert to person.
- promoted attention to the interface between medicine and psychosomatic medicine (psychiatry and psychoanalysis)
- argued that all doctors should attend systematically to the patient's culture, psychological being, behaviours and inner life
What is holism?
- health and illness = state of being that result from multiple factors and have multiple effects - bio, physiological, pathogens, chemical imbalances, psychosocial, personality and behaviour.
Break down the interplay of the biopsychosocial model. Provide an example.
Bio - genetic material, inheritance from parents, physiological functioning, body defects, body's effectiveness in protecting itself.
Psych - personality, health behaviours, mental processes. Involves: Cognition (learning, remembering, thinking, interpreting, believing , problem-solving), emotion (subjective feeling affecting/affected by thoughts, behaviour and physiology, important part of decision making re treatment), motivation (exploring why people behave the way they do).
Social - each affect levels of social relationships community: individuals who live near one another influence and are influenced by each other . society: promoting certain values through mass media etc. family: strong influence as children grow up -> learn health behaviours (one member can influence entire unit e.g. if one child doesn't like a certain food).
*** example: Mandy's athletic figure = bio contribution of inherited genes, social contribution of family dietary practice, health values and psychological contribution of learning correct eating and exercise behaviours, maintenance through positive reinforcement. Social influence of friends while she's away perpetuates drinking behaviours.
What are some similarities between diabetes and schizophrenia?
- symptoms clusters
- multiple aetiologies -range of intensity from fever and deliberating to latent or borderline
-genetic and environmental influences
What are the key assumptions of biopsychosocial model?
- Health = wellbeing of the organism, rather than just the absence of disease or pathology in the body.
- wellness = optimum health
- mind and body mutually influence health
- multiple causes
- human organism influences and is influenced by its environment (social and physical)
- human behaviour, feelings, transactions & relationships can be specifically investigated
- distinguishes between disease and illness
- explains why some individuals experience phenomena as illness and others as problems of living - addresses help seeking behaviour
- individualistic - focus on individual (like biomed)
- person-in-environment perspective
What is the biopsychosocial view of Health?
Health and wellbeing of the individual/person, not just the absence of disease.
How is the focus 'person in a local context'?
- person - body and mind mutually influence health
- local context - human organism influences and is influenced by its environment (social and physical)
- multiple causes
What is systems theory and what is its relationship to the biomedical model?
- attempts to understand behaviour of dynamic interrelated elements.
- overall system is a dynamic whole entity within which parts and components are layered and continuously interrelating, smaller simpler systems nest within larger, more complex ones.
- interconnected systems, functioning at different levels, such as the body, mind and social relationships
- compatible with but not developed from systems theory
What is homoeostasis?
- balance among various elements of a system, maintained by feedback of info. Negative feedback = system or one of its elements to decrease activity in order to achieve homoeostasis. Positive feedback = system increases activity in order to achieve homoeostasis.
What is conversation hysteria?
Freud believed mental conflicts were being converted into physical symptoms which required the talking cure aka psychoanalysis.
What is behaviourism?
- how behaviour is learned through conditioning.
What is behaviour medicine?
- interdisciplinary field
- developing integration of behavioural and biomedical science knowledge and technologies relevant to health and illness. These techniques are used for prevention, diagnosis, treatment and rehabilitation.
Who developed systems theory?
Ludwig von Bertalanffy.
How can a person be viewed in terms of systems?
- Body - cells, organs. However not to the degree biomed would, might do the surgery, but refer you for surgery e.g GP may use BPS and surgeon may use Biomed.
- mind - beliefs, values, perspective etc.
- social - real relationships with others (not social structures and institutions)
- family and community systems
What is the life span perspective?
- characteristics of a person are considered with respect to their prior development, current and likely future development.
- types of illnesses change as we age: younger people and children = short term diseases e.g. flu, late adulthood = heart disease, stroke, older people = chronic disease
- psychological - change via cognitive process - limited as a child and then develops
social - children become parents in adulthood --> grandparents. Growing responsibility in own health. In teenager years = peer pressure/risky behaviour.
What is the difference between disease and ill health?
How would these be viewed differently with the biomedical and biopsychosocial models in a hospital setting?
Disease - located in the body
Illness - experience of ill health.
Biomedicine just looks at body and fixing it where as BPS considers whether you have children that need picking up from school etc. wanting to think about what's possible in the persons circumstance, rather than just fixing the immediate medical problem without considering the situation and what the best options are for the person.
What are some problems with the biomedical model being the ultimate criteria for defining disease?
- people with positive laboratory findings are told that they are in need of treatment when in fact they are in need of treatment when in fact they are feeling quite well
- others who are feeling sick are assured that they are well and that they have no disease.
What makes others seek help in regard to health and illness?
- experiences of other people that you know e.g if you friend finds a lump in her breast and it ends up being breast cancer, if you find a lump in your breast you might go to a doctor straight away.
- some people may experience phenomena as illness or as problems of living and perspective will influence this E.g. Someone cuts their finger - a farmer might not get it looked at but a typist might.
What is the phenomenology of illness and when did this develop?
Focus on the experience of illness
- 1980s
What are medical anthropologists?
Cultural manifestations &a cultural concepts of illness
Is it rare for people to take a biomedical approach?
- yes, BPS usually creeps in to consider you as a whole person
What is the importance of risk in BPS?
- focus on lifestyle diseases
- focus on risk and protective factors
What are some risk and protection factories?
- exercising, diet, smoking, alcohol/drug abuse, stress management, seatbelt.
Can a factor be a risk for some and protective for others?
Yes - protective family can be a support for some or a risk to others because they're intrusive and don't respect privacy.
What is the usual approach to risk factors and whose responsibly is it?
Behaviour change which is an individual responsibility and therefore about agency
Why might some people not follow recommendations?
- medication too expensive
- lack of education
- BPS looks at why individuals don't comply with treatment and aim to help them achieve means of complying
What is the effect or non-compliance?
- can be expensive due to missed appointments
- physicians over estimate compliance levels.
How many people do not fill curative prescriptions?
20-30%
How many people do not fill preventative prescriptions?
30-40%
How many people do not fill life time medication prescriptions?
50%
What is health psychology?
Aims to increase likelihood that someone will follow treatment recommendations through behaviour change theory and help people to cope with their conditions that often cannot be cured
Explain why education does not necessarily lead to doing using the stages of behaviour change?
- pre-contemplation - no intent to change e.g not wanting to quit smoking
- contemplation - aware of problem and thinking about changing behaviour - maybe I should quit smoking
- preparation - intent to change and minor behavioural changes - saying they will quit smoking and then not having the next cigarette
- action - people modify their environment and behaviour - implementing diet plan and cooking style
- maintenance - prevent relapse and consolidate gains - thinking what you will do if you have a lapse and how you can maintain healthy behaviour
What are some sociological critiques of the BPS framework?
- focus on individuals rather than broader systems in which they live
- assessment and treatment remains individual focus
- health and illness remain defined within a biomedical framework e.g pathology and deficits of individuals
- broader social, political and cultural determinants of health and illness not considered
- doesn't consider culturally different ways of knowing about illness and health
- doesn't seek patterns in society
- doesn't see effects of class and gender and culture
- doesn't use potential of community and interrelatedness of the larger group to effect change and provide social support,
What are some medical critiques of the biopsychosocial model?
- little evidence for efficacy of approach
- too broad and non-specific
- medical healthcare system is a barrier to good application of the model
- influences from individual's environment not sufficiently attended to - it's broadening out biomed but doesn't extend to cultural context
What dimension should be included in holistic health?
Spirituality
Which model is most health expenditure spent on and which is most practiced by health professionals?
Most - 74% - money spent on biomed but BPS practiced most
What are some comparisons between the Biomed and BPS models?
- absence of disease vs wellbeing and optimal health
- direct cause and effect vs multiple causes and risk factors
- cure by addressing cause/manage if you can't cure vs reduce number/severity of risk factors go reduce likelihood of occurrence
- concerned with body/cells/systems vs concerned with person, feelings and behaviour
- victim blaming - the body failed to be normal vs victim blaming - person failed to control risk factors
- the expert is responsible vs the person is responsible to control risk factors
What don't the biomed and biopsychosocial models look at?
- patterns in society - still focused on individual
- effects of class, ses, gender, culture, (social determinants)
- own role in medical surveillance
- potential of the community and interrelatedness of larger groups in attitudinal change and provision of support
How has the BPS model influenced approaches to health care in Australia?
- emphasis on mind-body connection in health
- underpins professional education of many health care disciplines e.g. nursing
- contributed to evidence-based knowledge such as human development,health beliefs, decision-making, behaviour, stress, coping and adaptation
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