The Biopsychosocial Model

As previously noted, the biopsychosocial model was proposed as a scientific paradigm by Engel (1977), who encouraged the clinician to observe biochemical and morphologic changes in relation to a patient's emotional patterns, life goals, attitudes toward illness, and social environment. Engel proposed that the brain and peripheral organs were linked in complex, mutually adjusting relationships, affected by changes in social as well as physical stimuli. Within this model, environmental and psychological stress is seen as potentially pathogenic for the individual. Emotions may serve as the organism's bridge between the meaning (or significance) of stressful events and the changes in physiologic function (Zegans, 1983). Engel urged physicians to evaluate the patient on biologic, psychological, and social factors in order to understand and manage clinical problems effectively (Wise, 1997). For example, a workplace accident could be seen as resulting from poorly designed equipment (social) and inattentiveness (psychological) brought about by low blood sugar (biologic). Similarly, the accident could result in damage to internal organs (biologic), distress (psychological), and lost income (social), any or all of which may become the focus of physician intervention.

Comprehensive evaluation of biopsychosocial dimensions would assess the following:

• Biologic factors, including genetics, medical history, and environmental factors that affect physiologic functioning (e.g., those causing cancer).

• Psychological factors, including affective, cognitive, and behavioral components, such as feelings, beliefs, expectations, personality, coping style, and health behaviors (e.g., exercise, diet, smoking), which are contributors to patients' experience of health and illness.

• Social factors, including access to health care, quality of available health care, social systems (e.g., family, school, work, church, government), social values, customs, and social support.

Further discussion of biologic influences on health is beyond the scope of this chapter. Psychological and social factors known to affect health are discussed next.

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