The bio-psycho-social model (BPS) was proposed by Engel (1977) in response to the crisis that, according to the author plagued the medical society as a result of “adherence to a model of disease no longer adequate for the scientific tasks and social responsibilities” (p. 129). This outdated biomedical model was reductionist and dualistic: it “reduced” complex phenomena to a single cause and principle and separated the body and the mind leaving “no room within its framework for the social, psychological, and behavioral dimensions of illness” (Engel, 1977, p. 130). Dissatisfied with this limitation, Engel (1977) offered the BPS model that incorporated all the mentioned aspects to ensure the evaluation of “all the factors contributing to both illness and patienthood” (p. 133). In other words, as pointed out by Trilling (2000), Engel (1977) proposed taking into account the context of a disease that used to be neglected in the biomedical model. As a result, the biological, psychological, and social factors of disease are considered to be a system of interacting and equally significant elements. An example of such interaction that was provided by Engel (1977) illustrates the way the susceptibility to diabetes or schizophrenia can be affected by the psychological and physiological reactions to changing circumstances. Similarly, psychological and social factors determine the self-perception of an ill person, which affects the disease in multiple ways. For instance, if the patients do not believe that they are not healthy, they are more likely to start receiving treatment too late or refuse to do so. All these aspects have their impact on healthcare.
The model has been adopted and developed from various perspectives of medical research and practice. For instance, Trilling (2000) demonstrates the importance of psychosocial stimuli for the behavior of the immune system, signaling the necessity of incorporating BPS in immunology. Day, Thorn, and Burns, (2012) discuss the practical application of the model in the field of pain intervention and point out the modern tendency towards “looking beyond the biological, which they are proud of” (p. 115). Oral health researchers have also been considering the issue. Brondani and MacEntee (2013) describe the model of oral health proposed by Locker and Gibson in 2005 as a “more biopsychological view” (p. 1091). In general, Brondani and MacEntee (2013) claim that the theoretical models of oral health tend to gravitate towards the biomedical, less comprehensive view of the disease, and the more BPS model is still to be developed. They believe that the efforts towards the development of such a model are visible. The examples include the existential model suggested by MacEntee in 2006, which the authors also attempt to refine by including not only social but also cultural aspects of the patients’ life as well as their health values and beliefs.
According to U.S. Department of Health and Human Services, NIH, National Cancer Institute (2005), “effective practice depends on using theories and strategies that are appropriate to a situation” (p. 6). However, BPS is a fundamental model. It has set in motion the shift of paradigm that is significant to medical practice on every level, including the individual and community levels. Therefore, it is important to a clinician or public health planner. They are both required to evaluate and take into account the mentioned aspects of illness and patienthood discovering the needs of patients or groups of patients, and their strategies must be accommodated to these needs. Naturally, the actual practice and the usage of a particular approach depend on the unit and the problem, but BPS is the basis of the new healthcare culture.
Indeed, as Engel (1977) pointed out, the biomedical model comprised the culture of the medical society of this time. It fulfilled a purpose by promoting technological advancement (Trilling, 2000). At the same time, according to Trilling (2000), even then physicians gave credit to the context of a disease, but they did so unconsciously. Since the introduction of BPS, it is the job of medical practitioners to do so consciously and be guided by relevant research in their practice.
References
Brondani, M., & MacEntee, M. (2013). Thirty Years of Portraying Oral Health through Models: What Have We Accomplished in Oral Health-Related Quality of Life Research? Quality Of Life Research, 23(4), 1087-1096. Web.
Day, M. A., Thorn, B. E, & Burns, J. W. (2012). The Continuing Evolution of Biopsychosocial Interventions for Chronic Pain. Journal of Cognitive Psychotherapy, 26(2), 114-129. Web.
Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science,196(4286), 129-136.
Trilling, J. S. (2000). Psychoneuroimmunology: Validation of a biopsychosocial model. Family Practice, 17(1), 90-93.
U.S. Department of Health and Human Services, NIH, National Cancer Institute. (2005). Theory at a glance: A guide for health promotion practice. Web.