Since there are many different definitions and applications available, I will here clarify what biopsychosocial medicine refers to for us.
With biopsychosocial medicine we represents biological, psychological and social-cultural processes that have effects on human health and development of illness and disease where medicine refers to art of healing/behaviors, i.e. biopsychosocial processes/behaviors/factors that causes conditions like hypertension, cardiac – and autoimmune diseases and metal problems. With biopsychosocial stress medicine, we specifically (a) refer to the processes above that influence stress physiological dynamic systems which we can measure with acceptable reliability and range of validity criteria, eg. autonomic nervous system, parts of the cell metabolism and cardiovascular processes but we also (b) focus on R&D of all that is not empirically investigated. We use here causally clinical experience while also using single case design measurements (IBED, individual biopsychosocial evidenced based documentation) with a priori prediction based on hypothesis diagnosis in tern based on as careful as possible examination criteria.
As we try to focus on complex systems functions out of a common determinator for most human functioning/behaviors direct or indirectly, we measure and identify dysfunctions if any, and the predict a priori effects of patients learning and individual application/use of our biopsychosocial toolbox validated using integrated biofeedback to followed the process as well as accomplish outcome prestests using single cade design when this is possible. The treatment manual is “patient as an educated, resource and coworker in her/his own rehabilitation” (based on von Scheele 1986).
Below George Engels critics on the biochemical model (see more below)
- Engel critics:
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
- 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
- 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
- Adopting a sick role is not necessarily associated with the presence of a biological derangement
- The success of the most biological of treatments is influenced by psychosocial factors, for example, the so-called placebo effect
- The patient-clinician relationship influences medical outcomes, even if only because of its influence on adherence to a chosen treatment
- 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
Engel’s perspective is contrasted with a so-called monistic or reductionistic view, in which all phenomena could be reduced to smaller parts and understood as molecular interactions. Nor did he endorse a holistic-energetic view, many of whose adherents espouse a biopsychosocial philosophy; these views hold that all physical phenomena are ephemeral and controllable by the manipulation of healing energies. Rather, in embracing Systems Theory, (von Bertanlaffy L. Perspectives on General System Theory. New York, NY: George Braziller, Inc; 1975).
Engel recognized that mental and social phenomena depended upon but could not necessarily be reduced to (ie, explained in terms of) more basic physical phenomena given our current state of knowledge. He endorsed what would now be considered a complexity view,9 in which different levels of the biopsychosocial hierarchy could interact, but the rules of interaction might not be directly derived from the rules of the higher and lower rungs of the biopsychosocial ladder. Rather, they would be considered emergent properties that would be highly dependent on the persons involved and the initial conditions with which they were presented, much as large weather patterns can depend on initial conditions and small influences.9 This perspective has guided decades of research seeking to elucidate the nature of these interactions (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1466742/).
Engel G. The need for a new medical model: a challenge for biomedicine. Science. 1977;196:129–136.
von Scheele, B.H:C. Assessment of a Multifaceted Treatment of Negative stress: A Cognitive and Cardiovascular Approach. Acta Universitatis Upsaliensis. Comprehensiv Summaries of Uppsala Dissertations from the Faculty of Social Sciences 4. 1986.