Is the Biopsychosocial Model all it’s cracked up to be?

It’s quite common these days to see advocates of a more ‘holistic’ healthcare practice championing the Biopsychosocial (BPS) Model.  In areas where healthcare has become increasingly complex – where people’s individual values and beliefs can’t be avoided, and where people’s social context affects their lives so palpably that a biomechanical approach to assessment and treatment is simply inadequate – the BPS model is promoted as a way forward.  But is it as sound as people seem to think?

The BPS model was initially proposed by George Engel as a ‘unified concept of health and disability’ (Engel 1960) and was based on a very particular form of positivist psychology called General Systems Theory (Braziller, & Grinker 1967).  General Systems Theory was an approach that placed a lot of value in the kinds of industrial, machine-like social processes that Hannah Arendt disparagingly called ‘fabrication’.  These are the kinds of social systems and structures that strip people of their humanity and reduced them to units within a machinery of production.  (Arendt argued that this was one of the necessary conditions – alongside the creation of ethical rules and norms – that actually made the abuse of people possible).

In S. Nassir Ghaemi’s 2010 book The Rise and Fall of the Biopsychosocial Model, the author explores the history of the model and its basis in a systematic, reductive, psychologically-informed, scientific view of people’s behaviour and social relations, and defines its ‘fall’ on the basis that it was never meant to embrace subjective, qualitative, or socially constructed understandings of health and illness.  Nassir Ghaemi argues that these aspects of modern life have become more and more important to people and, consequently, technologies that assert old social hierarchies (like the BPS model) are in slow decline.

So it is interesting to see it emerging now in pain science, as clinicians explore more holistic approaches to treatment.  What is perhaps most interesting, is how the model has saturated people’s thinking at the exclusion of other ways of being ‘holistic’.  Why, for instance, is it necessary to have one, all-encompassing approach to what are clearly immeasurably complex issues?  And why have we so readily accepted a model that has its origins in the very same systematising, reductive thinking that it would be reasonable to assume we are trying to escape?

If the BPS model is merely shorthand for a desire to see greater inclusiveness and diversity in our thinking about patient assessment and treatment, fair enough.  But we should be mindful of its limitations when we consider advocating for it.  It may well be that the BPS model denies as much, if not more, than it enables.

Reference

Braziller, G., & Grinker, R. R. (1967). Toward a unified theory of human behavior: An introduction to general systems theory. New York: Basic Books.

Engel, G. L. (1960). A unified concept of health and disease. Perspectives in Biological Medicine, 3, 459-85.

Ghaemi, S. N. (2010). The rise and fall of the biopsychosocial model : Reconciling art and science in psychiatry. Baltimore: Johns Hopkins University Press.