Transcript Prof Craig Jackson

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
QoL
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 30s 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. 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.