HEALTHY LIVING
The Need for a Biopsychosocial Model of Health By Venkat Srinivasan, MD
Introduction The World Health Organization defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 This definition, which was adopted in 1948, created a seat for social and psychological well-being at the table of health care. One could state that being happy, having a family and having a comfortable job were conceived to be as relevant to health as having healthy cholesterol levels. Translating this definition into an actionable plan has, however, proven elusive. Limitations of the Biomedical Model Health care is dominated by a biomedical model, where diseases are primarily defined by underlying biochemical abnormalities; interventions are directed at reversing them. One of the critics of this biomedical model was George L. Engel (1913-1999), who was a major figure in the field of psychosomatic medicine in the United States. He felt that medicine was bound by a seventeenth-century worldview of a body-mind divide that was erroneous.2 This artificial dichotomy had resulted in a hierarchical organization in the treating physician’s estimate that continues to this day. Physical processes that can be measured and easily manipulated alone are “real” and considered as worth treating, while the more subtle psychological processes are relegated as much less relevant.
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SAN ANTONIO MEDICINE • January 2022
He stated that: 1. A biochemical alteration does not translate directly into an illness. The appearance of illness results from the interaction of diverse causal factors, including those at the molecular, individual and social levels. And the converse, psychological alterations may, under certain circumstances, manifest as illnesses or forms of suffering that constitute health problems, including, at times, biochemical correlates. 2. The presence of a biological derangement does not shed light on the meaning of the symptoms to the patient, nor does it necessarily infer the attitudes and skills that the clinician must have to gather information and process it well. 3. Psychosocial variables are more important determinants of susceptibility, severity and course of illness than had been previously appreciated by those who maintain a biomedical view of illness. 4. Adopting a sick role is not necessarily associated with the presence of a biological derangement. 5. The success of the most biological of treatments is influenced by psychosocial factors, for example, the so-called placebo effect. 6. The patient-clinician relationship influences medical outcomes, even if only because of its influence on adherence to a chosen treatment. 7. Unlike inanimate subjects of scientific scrutiny, patients are profoundly influenced by the way in which they are studied, and the scientists engaged in the study are influenced by their subjects.2
