Biomedical models

The biomedical and biopsychosocial models have been two significant approaches as ways of attempting to decipher the pathways of health, disease, and well-being. The traditional biomedical model considers disease to be primarily a failure within the body, resulting from infections, accidents and inheritance and does not regard any social and psychological aspects of illness within the model. The biopsychosocial model is the predominant model of understanding illness today by incorporating the social and psychological factors into the prevailing biomedical model. It is a better way of understanding how health and illness are affected by many levels of systems, from molecular to the societal, and how these can affect the overall well-being of the patient. There are many differences between the two models and so these two models will be compared and contrasted with each other to show how each understands illness and how it maintains health and well-being for individuals and society.

History and the Biomedical Model

Back in the nineteenth and up to the early twentieth century, most of the diseases present at that time were infectious diseases that spread and killed many rapidly, for example, measles, lupus and small pox. Therefore at that time, physicians assumed that diagnosis was a relatively objective process and that reducing the pain that the patient was feeling simply meant removing the cause of the illness (Reeves, 2005). Consultation between patient and physician were seen as unnecessary as the illnesses were self-evident.

The medical model that developed from this view was the predominant model for understanding and treating illnesses for over a century in Western societies. It only focused on the root causes of disease and illness by focusing on the aetiology and the pathologic processes involved in disease and did not take into account any social, psychological and behavioural dimensions of illness. Research that was undertaken was primarily focused on faulty genes, bacteria and viruses, assuming that these could be identified, classified and then be removed by treating with the appropriate medical disciplines.

The Biopsychosocial Model

The idea of a biopsychosocial model was proposed in the 1970's by George Engel, a professor of psychiatry and medicine at the University of Rochester, who suggested that there was a need for a new medical model for explaining health and illness. Health needs were decided that they were not being met, with many complaining that physicians were lacking understanding and interest and in addition, biomedical research was not having sufficient impact in human terms. Thus the new model that arose from this idea is the biopsychosocial model. It is now the predominant model of understanding disease and illness in today's society. It combines a holistic understanding of disease-illness processes which gives a better understanding of the determinants of disease by integrating psychosocial, environmental and biological factors which take into account the patient, social context of the patient, physician and the health care organisation (Lindau, 2003). These factors play a major role in the aetiology and progression of health problems like lung cancer, arthritis and many chronic illnesses.

Similarities

Although the biomedical and biopsychosocial model are different in the way that they approach and understand illness, biomedical and biopsychosocial models are both similar in that they both aim to prevent, reduce and treat the amount of pain that a patient may be feeling due to disease activity or injury, in order for recovery. In this way, using one model over the other is not necessarily unsuitable as both models overlap each other; the biopsychosocial model includes the medical model plus integration of social and psychological factors. Thus, the biopsychosocial model is seen as a more comprehensive approach to investigating and treating conditions such as rheumatic arthritis (Walker et al, 2004).

Differences

The first difference is that within the medical model, ill health is seen to be caused by biological calamities. That is, it is due to things like germs and viruses, mutation of genes, trauma and accidents. In conditions such as rheumatic arthritis, pathophysiology is clearly present causing inflammation resulting in synovitis and leading to the erosion of cartilage and the ultimately the destruction of bone (Larson, cited in Walker et al, 2004). In order to treat, medical knowledge is exclusionary to establish appropriate interventions and course of treatments as such. On the other hand, disorders such as problems of living, depressions and character disorders within the social model are caused by social factors such concerned within environment to a broader context. As a lot of mental illnesses are not capable of being explained under the biomedical model, they are eliminated from the category of disease.

Another difference between the two models is the way the causes are identified. In the medical model, causes are identified through signs and symptoms such as changes in physical appearance, alterations in functioning, in performance, or in feelings (Alonso, 2003). Through these signs and symptoms, physicians are then able to classify their illness and deduce the kind of treatment that the patient requires. For example, a person who has a severe sore throat is most likely to have bacterial infection. Visiting the physician means that once he has identified what pathogen is causing the soreness, he is able to treat the patient with the right medication which in this case would be antibiotics.

With the biopsychosocial model, causes of disease are not only identified through signs and symptoms, but also through beliefs and interpretation. The physician has to account for dysfunction and disphoria and how it leads to the patient to seek medical help, take on the sick role and accept treatment (Engel, 1977). This is especially useful for explaining why conditions such as diabetes and schizophrenia do not have a specific time in which the person falls ill or accept the status of a patient. Engel (1977) makes the point that psychological responses to changes in life may be directly involved with other body processes within the body to alter the susceptibility of the illness, therefore affecting the time it takes for the disease to be recognised, the severity and the route of the illness.

A third difference is that the medical model is reductionism. The organism is reduced to its basic components in order to treat. The body is viewed as a machine, completely isolated from the mind and the body giving little importance to the organism as a whole (Thompson, 2002). For example, a person who has an X-ray of disease activity for knee pain from osteoarthritis found that it only explained a small proportion of the pain that the patient felt. The attempt of eradication of the tissue problem did not reduce much pain and so it can be seen that sometimes medical interventions designed to remove the tissue damage are not always successful in removing the disease activity (Walker et al, 2004). The medical model entirely focuses on specific aspects of the patient with no consideration of the other dimensions and the relationships between them.

In contrast to that, the social model is holistic, whereby when individuals are treated they are viewed as a whole person with the mind, body and spirit of humankind as a whole component (Thompson, 2002). Narayanasamy (2002) makes the important point that "holism is diametrically opposed to the Cartesian mechanistic and analytical approach to medicine where the mind and body are capable of being broken down into parts." When viewing a patient, spiritual aspects of health are included in addition to the social, psychological and biological factors considered. A patient who is seen to have a holistic understanding experiences a harmonious balance between body, mind and spirit (Thompson, 2002). Hence, if a patient with a malignant tumour had just got the removal of the tumour to eliminate the pain, the physician would take account of the role psychological factors play in the aftermath, unlike the biomedical model.

Conclusion

After the comparing the biomedical and biopsychosocial models together, it can be seen that the biopsychosocial model is a more effective way of approaching treatment for patients and to obtain a better understanding of the disease processes and their causes. The biopsychosocial model incorporates all levels of organisation, from the molecular to the societal and has been highly productive in the advancement of our understanding of aetiology. It does not believe in mind-body dualism but rather the organism as a whole and this is effective for improving the well-being of the individual. By integrating the social and psychological aspects along with the biological, it widens the framework for the clinical approach to illness and allows many illnesses to be explainable. The biomedical approach is too narrow for the range of diseases and under this model; it would not prove adequate for the social responsibilities.