The Biopsychosocial Model and Its Limitations

The Biopsychosocial Model and Its Limitations | Psychology Today |  Oct 30, 2015 | Gregg Henriques Ph.D

The Biopsychosocial Model is the currently accepted model for chronic pain used by all medical practitioners. I’ve only recently come to question it since a particularly cruel pain experiment with mice purported to find that “opioids prolong pain” in general.

If our pain is a biopsychosocial disorder, then such animal torture is not an appropriate model.

In 1977, George Engel famously argued that medicine in general and psychiatry in particular ought to shift from a bio-medical perspective of disease to a biopsychosocial (BPS) perspective on health. 

He argued that the bio-medical perspective was too reductionistic and that a holistic perspective grounded in general systems theory was necessary to address health related issues.

The World Health Organization seems to agree with Engel’s view in that it defines its central mission as improving well-being which is defined as an overall state of health and happiness at the biological, psychological and social levels.  

Engel argued this was a big mistake and that to appreciate health in general we must consider the psychological, behavioral, and social dimensions that contribute to illness related events.

The BPS model additionally allows for the consideration of such issues like the belief factors associated with healing (i.e., what bio-medicine refers to—or dismisses—as ‘placebo’ effects) and general the social conceptions of disease and the socially constructed elements that justify policies and the behaviors of healers and patients.

The advantages of the BPS model are found in its holism, awareness of levels in nature, and inclusiveness of diverse perspectives.

Within the field of psychiatry in particular, the BPS model provided a broader home that allowed for at least some basic reconciliation between the two dominant conceptions psychiatrists have of mental illness, which are:

1) the biological psychiatry view that mental disorders arises from faulty biology and

2) the psychodynamic view that emphasizes the psychological dimensions of maladaptive patterns of thinking, feeling and acting and relating

But not everyone agrees the BPS model represents an advance in medicine, and there are a number of different criticisms that can be effectively leveled against it

One of the most generally cited problem with the BPS model is that its inclusiveness results in an unscientific, “fluffy”, pluralistic approach

The goal of science is analytic understanding and that understanding requires intelligible frames that break the world into its component parts. In contrast to this, the BPS model potentially justifies a morass of “anything goes” in medicine and health

This has certainly come to pass now that the CDC is suggesting the pain patients use the very “alternative” treatments that they ridiculed in the past

Nassir Ghaemi has offered one of the most systematic critiques of the BPS model.

From the critics’ perspective, the potentially confusing and convoluted aspect of the BPS model becomes particularly clear when we try to define these terms and their boundaries and interrelationships

Consider, for example, the following questions:

  • What is the relationship between biology and the physical and chemical processes that take place within the cell?
  • Is biology just complicated chemistry?
  • Or consider the question of, what, exactly, is the relationship between biology and psychology?
  • That is, where does biology end and psychology begin?
  • What about the relationship between psychology and behavior—are they the same thing or different?
  • Moving up a level, where does psychology meet the social?
  • Is a family of bonobos a psychological or a social level entity?
  • What about a human family living in Canada?
  • Moving further up the scale, what is the relationship between culture and society?
  • Does the biosphere include the cultural or are they separate?
  • Is the whole of the earth a singular organism-like creature or not?

Does this position pass for science or is it mush?

Another related criticism exists on the pragmatic side of things. By being all inclusive, Ghaemi argues that the physician who adopts the BPS model is in real danger of losing clear boundaries regarding their knowledge and expertise. In short, must a physician now understand everything?

If knowledge expectations and training become too diffuse, then expertise will inevitably suffer. It is worth noting here that the general trend in medicine has been toward specialization, not in broadening one’s perspective.

Here is a summary list of critiques of the BPS model from Ghaemi (2011).

Limitations of the Biopsychosocial Model (from Ghaemi)

I believe these critiques of the biopsychosocial model have relevance, especially the following:

1) whether the BPS frame is appropriate for medicine; and

2) the critique that the boundaries between the domains are not at all clear  

Here is the definition of the biopsychosocial model from Wikipedia:

The biopsychosocial model (“BPS“) is a broad view that attributes disease causation or disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors(mood, personality, behavior, etc), and social factors(cultural, familial, socioeconomic, medical, etc).[1]

The biopsychosocial model counters the biomedical model, which attributes disease to roughly only biological factors, such as viruses, genes, or somatic abnormalities.[2]

The biopsychosocial model applies to disciplines ranging from medicine to psychology to sociology; its novelty, acceptance, and prevalence vary across disciplines[3] and across cultures.[1]

Other thoughts?

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