In 1977, a psychiatrist named George Engel asked a critical question: does biomedicine adequately address all the factors that influence health and disease?
If someone is living in a cold, damp, and moldy apartment, does the biomedical model address and treat their pneumonia? Are an individual’s social, economic, and relational situations not equally as important to consider when treating a person’s health? Furthermore, how could a person’s psychological well-being and behavioral decisions be isolated from their molecular, biological health?
Engel contended that a strictly biomedical approach “leaves no room within its framework for the social, psychological, and behavioral dimensions of illness.” (Engel 1977:130) To efficiently and holistically treat disease, the strict biomedical model is inadequate — the social and psychological conditions of a patient are too critical to brush aside. To focus on disease solely at the microscopic level of bacteria and viruses and to ignore the rest of a person’s life is to work blindly. It is, ultimately, irresponsible medicine.
Engel suggested a new approach for healthcare: he coined it the Biopsychosocial Model, “which includes the patient as well as the illness” (131). At the heart of the model was a simple assumption: you cannot think about a person’s mind, social conditions, and physical health in separate, unrelated compartments. Each factor is interconnected and influences the others. These three factors are referred to as the biological, cognitive, and socioemotional. (Santrock 2007:13)
Think about how stress affects your mind, which affects your choices, which affects your eating, which affects your health, which affects your mood, which affects your mind…
Think about how the conditions in which a child is raised affects their learning, which affects their schooling, which affects their income, which affects their living conditions, which affects their health, which affects their choices, which affects their learning…
The biopsychosocial model is a reminder that everything about your life is systemic: you, your body, your choices, and your environment are constantly influencing each other. In fact, to think of these as separate ‘entities’ is a little bit of make-believe. This proposition means that every choice you make today has consequences. Do not think of today’s diet, housecleaning, reading list, work, and exercise in separate silos — each activity, in some way, impacts all the rest.
(An earlier version of this article appeared in Caesura Letters: Volume II — All That We Are)