The Biopsychosocial Approach. Raivon Speed. A short summary of this paper. The Biopsychosocial Approach The biopsychosocial approach was developed at Rochester decades ago by Drs. George Engel and John Romano. While traditional biomedical models of clinical medicine focus on pathophysiology and other biological approaches to disease, the biopsychosocial approach in our training programs emphasize the importance of understanding human health and illness in their fullest contexts.
Background Citations. Methods Citations. Results Citations. Citation Type. Has PDF. Publication Type. More Filters. Rehabilitation Contexts: A Holistic Approach. Psychosocial rehabilitation involves a gamut of activities that need to be personalized to suit an individual's needs. The context in which rehabilitation occurs greatly influences the range and … Expand. Shop for Books on Google Play Browse the world's largest eBookstore and start reading today on the web, tablet, phone, or ereader. Go to Google Play Now ».
Richard M. Frankel , Timothy E. Quill , Susan H. University Rochester Press , - Psychology - pages. For thousands of years, Western culture has dichotomized science and art, empiricism and subjective experience, and biology and psychology. The activating or silencing of genes and their regulation are majorly via environmental contributions, and thus, the role of psychosocial determinants is overwhelming.
The etiological complexity of psychiatric disorders has made it impossible to explain their causation through a single explanation. Simple Mendelian disorders or infectious diseases can be explained easily through the biomedical model; but for psychiatric disorders, there is a need to incorporate several factors.
Thus, both biological and psychosocial models are unable to explain psychiatric disorders adequately. For example, if we take one of the most prevalent psychiatric disorders, depression, on one side, improvement through pharmacological mechanisms targeting the neurotransmitter imbalance can be observed, and on the other side, despite adequate and rational treatments, there might not be noticeable improvement with them in individuals experiencing ongoing psychosocial stressors.
Psychiatric disorders cannot be fully explained with only behavioral or psychodynamic perspective. It is also accepted that psychological experiences are also dependent on the functioning of the brain.
Thus, the causal bridge about how biological factors can result in psychological manifestations are to be studied in detail. However, there is still scarcity in the identification of any psychological manifestation which can be adequately explained through biology only. Various facets such as neurochemistry, cognition, personality, environment, and so on should be analyzed while formulating a psychiatric disorder.
Substance use disorder can be explained well with this formulation. It is known that there are cognitive predispositions in this group of individuals, which act vulnerable to them. The presence of environmental cues in the form of peer pressure also forms an important part. Family history also has a social and a biological component. The personality of the patient also acts as an important predisposing and perpetuating factor.
Thus, the biopsychosocial approach provides us with the most integrative causality for such a complex interplay of factors. In psychiatry, each patient is different.
Other psychosocial aspects such as social support, family, and the role of culture in psychiatric disorders also point to the fact that the individual differences are not solely due to neurobiological dysfunctions or any biological models. The other part is supra-personal, which comprises of the psychosocial context of the individual, which is made of the family, culture, community, and the society of the individual.
It has been seen that stressful events indeed precipitate or cause fluctuations in the disease. The role of social support is also well established for such disorders. Interventions, however, can be based on a factor that has the maximum impact with the least harm or is the most responsive to interventions within the least possible time and the least amount of resources, etc.
Psychotherapy research in depression, anxiety disorders, obsessive-compulsive disorders, and personality disorders have proven that effective therapy normalizes basal brain metabolism and basal cerebral blood flow, and they resemble neurobiological changes after successful psychopharmacological treatments.
Psychiatry cannot afford to ignore social determinants of health such as poverty, illiteracy, migration, unplanned urbanization, and inequitable distribution of resources as well as personal attributes such as lifestyle choices, personality, motivation, desires, and fantasies in the understanding of illnesses.
These social factors indeed powerfully influence the course and outcome of psychiatric disorders. Inequitable social availability of resources in childhood can pave the pathway for future psychiatric disorders.
The social facet, which also involves culture, has shown that there are specific ramifications of psychiatric disorders due to cultural context. The biopsychosocial model will continue to remain valid in medicine and more so in psychiatry. Mutual disrespect or contempt of biological or psychosocial schools of psychiatry are not based on science.
The reality that mental disorders are caused by multi-level mechanisms makes the biopsychosocial approach valid. What remains is to stitch the different factors to make a reliable network of factors that can provide a reliable framework to explain psychiatric disorders. Persistent evolution of biological science and its integration with psychology for understanding complex diseases is necessary for holistic understanding and management of disorders. The medical curriculum should be regularly upgraded to incorporate the latest biological framework, and an understanding of psychosocial theories in light of the latest knowledge and discoveries should be done.
The need of the hour is about resetting relative positions of biological and psychosocial models in context with each other, for better development and progress of the psychiatry.
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