Better Healthcare: The Biopsychosocial Model

With all the complexity surrounding the way the world works, I’ve grown accustom to viewing it through mental models. Sometimes zooming into specific scenarios and judging outcomes based up on all the possible if-then conditions. Other times taking a global view and working backwards, applying the same if-then conditions in an attempt to understand how said scenario came to be.

The ability humans have to build hypothetical mental models and apply them to the environment around us has been instrumental in the scientific world. After-all, models are how scientist do their research and communicate their ideas to each other. But models aren’t always accurate or clear cut, for all the pros we do get some cons.

Take the biopsychosocial model for example, it exists in the space where psychology, sociology and biology overlap, essentially, it takes a broad view of health and specifically disease causation. It does this by looking at biological factors such as genetics and the biochemistry of the human body, psychological factors like personality & behaviour as well as the social influences around you culture, socio-economic status, etc…

This is opposed to what the extremely popular biomedical model does, looking solely at the biological implications of medicine, treating the social or psychological factors as noise with no real value. Leading to long lists of medicines which induce depressive, sometimes suicidal thoughts.

Engel’s paper in the American Journal of Psychiatry (1980) embeds the biopsychosocial model more into the realm of patient care. It is not just about causation but about how any clinical condition (medical, surgical or psychiatric) can be seen narrowly as just biological or more widely as a condition with psychological and social components, both of which can have an impact on a patient’s understanding of their condition and affect the clinical course.

The main idea is to not only medicate the problem, but look at what causes the problem in the first place.

Depression itself may not cause liver problems, but a depressed person may be more likely to have alcohol problems, and therefore liver damage.

While this requires more information be extracted from patients, a growing trend in US healthcare (well-established in Europe) includes the integration of professional services through varied disciplinary teams, to provide better care and address the patient’s needs at all three levels. Teams comprised of physicians, nurses, occupational therapists, health psychologists, social workers make this a whole lot easier.

While this may all make sense to you, the underlying scientific principle (and majority of the community) doesn’t entirely agree. Models are designed to be testable and no model of mental disorder can validly exist without establishing a theory of mind.

On top of that, looking at the track record of psychological studies doesn’t inspire confidence either, seeing as over half of psychology studies fail reproducibility test.

So I guess we simply aren’t as far along as we think we are, we really don’t understand ourselves… do we?

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