Shiven Patel
English 137H
Paradigm Shift Essay
Traditional U.S. Health Care has long focused on the physical well being of
patients, because it has greater value, greater resources available, and easier access to
physical problems. However, this traditional view had to be adjusted due to its inability
to deal with chronic disease. Seven out of ten deaths among Americans each year are
from chronic diseases–heart disease, cancer and stroke–which account for more than
50% of all deaths each year. The state of mental healthcare in the United States was
(and still is) perplexing, to say the least. This perplexity spawned the Biopsychosocial
(BPS) revolution, marking a major paradigm shift in the field of medicine.
Since Louis Pasteur’s laboratory research of the germ theory in the 1860s,
Western medicine has been primarily fixated on biological factors when dealing with
patients. The known existence of germs actually preceded the theory by more than two
centuries. The first documented moment when germs were acknowledged dates back
to 1677, when Antonie van Leeuwenhoek used the first simple microscope to see tiny
“animalcules.” These “animalcules” were tiny organisms in the droplets of water he
was examining. Leeuwenhoek never made a proper correlation between these
“animalcules” and disease, saying germs were an effect of disease, rather than the
cause. Since the popular theory at the time was spontaneous generation,
Leeuwenhoek’s assertion seemed to make sense.
Antonie van Leeuwenhoek provided a solid foundation of data for future
scientists to conduct more research on. Louis Pasteur used experiments and
microscopes to find that liquids such as beer and milk went off because of the rapid
multiplication of very small organisms–germs–in that liquid. Pasteur’s research led to
the widespread acceptance of his germ theory, which stated, “that many diseases are
caused by the presence and actions of specific micro-organisms within the body.”
Pasteur’s theory provided a guideline for Western medical practitioners, leading to the
formulation of the Biomedical Model.
Brett J. Deacon states, “The biomedical model posits that mental disorders are
brain diseases and emphasizes pharmacological treatment to target presumed
biological abnormalities.” In other words, the model states that mental disorders such
as ADHD, schizophrenia and depression are biologically based brain diseases. The core
principles of this model include: “there is no meaningful distinction between mental
diseases and physical diseases” and “mental disorders are caused by biological
abnormalities principally located in the brain.” The ascendancy of this model yielded
notable progress in neuroscience and molecular biology. However, Deacon recognizes
that what was often overlooked in the context of widespread enthusiasm for the
Biomedical Model was “the fact that mental health outcomes in the United States are
disconcertingly poor.”
George L. Engel directly challenged the concept of “mind-body dualism” in his
renowned 1977 article in Science journal. Titled “The Need for a New Medical Model,”
Engel criticized both the fields of medicine and psychiatry for, “adhering to a model of
disease no longer adequate for the scientific tasks and social responsibilities of either
medicine or psychiatry.” Engel relates the Biomedical Model to a dogma, since a dogma
requires that data be forced to adhere to a model or be excluded. This point, echoed by
Deacon, stresses there are issues at hand with the current model, which are being
overlooked. In this article, Engel proposes a new model–one that does not have the
limitations of the Biomedical Model.
The Biomedical Model fails in introducing a psychiatric perspective to diseases.
For example, Engel states that if we were to think of patients with diabetes and
schizophrenia in exactly the same terms, we would see how focusing only on biological
factors while ignoring psychosocial perspectives would greatly interfere with proper
patient care. Engel’s new model is called the Biopsychosocial Model, which
incorporates biological, psychological, and social factors when diagnosing and treating
diseases. Engel argues that the “Biopsychosocial Model which includes the patient as
well as the illness would encompass [all] circumstances.” When all circumstances are
accounted for, rather than giving primacy biological factors (which the Biomedical
Model does), there is a higher possibility of explaining why some individuals
experience “illness” conditions while others regard those conditions merely as
problems of living.
The Biopsychosocial Model presents a more effective alternative to the
preceding model, and rationale that better links medicine to science. The main
difference between the models is that the newer model incorporates psychological and
social factors, meaning there is a greater emphasis on provider-patient relationships.
Robert C. Smith argues that by incorporating biological aspects in addition to
psychosocial aspects, “we become more humanistic.” By following this new approach,
the patients’ needs are put ahead of the disease issues, which enhances communication
and provider-patient relationships. This integrated model provides practical means for
a more scientific understanding of each patient.
2012 President of the American Psychological Association Suzanne Bennett
Johnson argues that “patient-centered care” is the future of U.S. Health Care. Johnson
also acknowledges these issues come from the notion of “mind-body dualism.” This is
the theory that the mind and body are distinct kinds of entities, and do not relate to
one another. Johnson condemns traditional U.S. medical approaches for having
prioritized physical health (the body) while paying no attention to the mental health
(the mind). Furthermore, mental health and physical health providers were trained
separately, with physical health providers having “greater resources and prestige.” The
separation of physical and mental health was the underlying issue in the Biomedical
Model, and this problem was addressed by the proposition of the Biopsychosocial
Model.
In patient-centered care, the patient is treated as one whole person (without
mind-body dualism) and both the mental and physical needs of the patient are
addressed. Also in patient-centered care, the patient is treated by inter-professional
health teams, which includes physical and mental health expertise, and is situated “in a
non-stigmatizing environment that considers the patient’s preferences and culture.”
Looking at recent history, the Biopsychosocial Model has been accepted in the United
States.
Treatment utilization trends, grant funding priorities, the language used to
describe psychiatric diagnoses, and psychotherapy research methodology have
progressively adopted the Biopsychosocial Model in recent decades. Medicine is now
embracing the Biopsychosocial Model, emphasizing patient-centered care delivered by
interdisciplinary provider teams that include mental health expertise. The Affordable
Care Act requires that essential health benefits include mental health, preventive and
wellness services. The MCAT (Medical College Admission Test) now includes the same
number of items on psychological, social and biological foundations of behavior as it
has on biology or biochemistry. Lastly, medical schools are now required to teach
patient-provider communication skills, the medical impact of common societal
problems, and the impact of patient culture and beliefs. The paradigm shift from
biological factors to the integration of psychology into medicine is evident in the shift
from the Biomedical Model to the Biopsychosocial Model.
SOURCES:
Deacon, B. J. (2013). The Biomedical Model of Mental Disorder: A Critical Analysis Of Its
Validity, Utility, And Effects On Psychotherapy Research. Clinical Psychology Review,
33(7), 846-861.
Engel, G. (1977). The Need For A New Medical Model: A Challenge For Biomedicine.
Science, 196(4286), 129-136.
Johnson, S. B. (2012). Psychology's Paradigm Shift: From A Mental Health To A Health
Profession?. Monitor on Psychology, 43(6), 5.
Smith, R. C. (2002). The Biopsychosocial Revolution. Interviewing And Providerpatient Relationships Becoming Key Issues For Primary Care. Journal of General
Internal Medicine, 17(4), 309-310.
Wade, D. T. (2004). Do Biomedical Models Of Illness Make For Good Healthcare
Systems?. BMJ, 329(7479), 1398-1401.