Psychology: Critically Evaluate the Future of Healthcare (Essay Sample)

Critically Evaluate the Future of Healthcare: The Biomedical or the Biopsychosocial Model?
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Critically Evaluate the Future of Healthcare: The Biomedical or the Biopsychosocial Model?
Decisions on care of individual patients and delivery of care are mostly based on models of health. The model of health that is embraced determines whether an individual or their health care professional interprets observed changes in their state as showing a disease (Engel, 1977; Wade & Halligan, 2004). The model also determines how and when an individual should be described and viewed as sick as well as the kind of health care that should be provided to them. Further, the model chosen shapes the attitude of the health care professionals toward patients as well as their behavior with their patients (Engel, 1977). Therefore, a model of health that a society chooses might be associated with crucial consequences. Society’s determination that a certain behavior or observed symptom is a sign of illness places certain privileges on individuals and formal responsibilities on the society. Many models of health suggest there could be a causal association between disease and illness. They help in determining the weight attached to symptoms and consequent commitment of medical resources (Wade & Halligan, 2004). This paper provides a critical evaluation the future of health care, with close reference to biomedical and biopsychosocial models. It is demonstrated that the biopsychosocial model (BPSM) holds the future of health care, provided that a full integration of biological, psychological, and social dimensions is realized.
Grounded in the molecular biology, the biomedical model (BM) stemmed from Virchow’s observation that all disease is a consequent of cellular abnormalities (Engel, 1977; Wade & Halligan, 2004). BM of illness is highly relevant to many illnesses based on disease. The model has an intuitive appeal, in addition to having gained a huge support from biological findings. The model assumes that deviations from the norm of measurable biological variables fully accounts for a disease. In particular, the model holds that all illnesses, signs and symptoms arise from a disease. A disease may be viewed as an underlying abnormality within an individual’s body, in relation to the function or structure of specific body organs. It holds that all diseases result in symptoms, either in their early or late stages of disease progression. Although other factors might affect the results of the disease, such factors do not influence the development and manifestation of the disease (Wade & Halligan, 2004).
Biomedical model holds that health is sufficiently defined by the absence or lack of disease. The model propagates the belief that mental phenomena have no connection with other disturbances linked to body functioning (Engel, 1977). This assumption means that emotional disturbances or delusions are not related, or are separate from, abnormalities within the functioning or structure of the other body organs and systems (Engen, 1977). Further, BM suggests that the patient has little or no responsibility for cause of the illness. This assumption advances the idea that the patient is normally a victim of circumstances in the cause of the illnesses. When an individual is ill and allowed to assume the sick role, they may experience some social and personal benefits, such as absorption from social responsibilities, not being held responsible for their situation, and eligibility for healthcare benefits. Further, BM sees the patient as playing a passive role in the treatment process, other than the expected cooperation (Wade & Halligan, 2004).
A number of problems associated with BM have been identified. BM of illness is unable to provide a full accountability of a great range of illnesses (Turner, 2001), which has been linked to the model’s belief that all illnesses have a single underlying cause. Engel (1977, p. 129) argued that medicine and psychiatry were in crisis for adhering to “a model of disease no longer adequate for the scientific tasks and social responsibilities of either medicine or psychiatry.” The reason is that the model assumes the single underlying cause is always the disease or pathology. This assumption is considered as responsible for the medicalisation of anomalous sensations that individuals might often experience, and suspicious considerations for patients who might present with illness but lack observable disease process. According to the model, removing or attenuating the single underlying cause (the disease) leads to cure or improvement in health. Viewed this way, the medical model suggests that mental illness is a myth because it does not have an underlying single disease. As a consequent, the medical model “is not relevant to the behavioral and psychological problems classically deemed the domain of psychiatry” (Engel, 1977, p. 77). Previous research provides evidence to suggest that this assumption is wrong (Atkins, Brownell, Kornelsen, Woolard, & Whitley, 2013; Wade & Halligan, 2004; Stone et al., 2011).
It has been demonstrated that many individuals present with symptoms that might have no causal relationships with any underlying disease or pathology (Atkins et al., 2013; Carson et al., 2000; Stone et al., 2011). Termed as functional somatic syndromes, psychological and social factors have an important role to play in their presentation (Atkins et al., 2013; Stone et al., 2011). BM sought to exclude mental illness with no known biological brain dysfunction from the category of mental illnesses. The disorders in this category were identified as “problems of living, social adjustment reactions, character disorders, dependency syndromes, existential depressions, and various social deviance conditions” (Engel, 1977, p. 129). Some of those who proposed that psychiatry be closely aligned with medicine under the medical model argued that disorders that do not have known biological brain dysfunction should be excluded from mental illnesses category (Engel, 1977).
The reason is that it was believed individuals with such conditions had their neurophysiological functional in place, and, therefore, the disorders were as a result of psychosocial variables (Engel, 1977). The proposed exclusion of such disorders meant that they would be handled by professionals outside the medical field. Despite this, patients with no underlying pathology are assigned diagnostic labels, implying the existence of an underlying functional or structural cause. Such medical diagnosis has serious implications not only for the patient, but also for the society and the reputation of medicine. Patients might find the suggestion that they do not have a disease to explain their illness upsetting (Turner, 2001). The healthcare bureaucracy may find it difficult to deal with such patients because it heavily relies on disease labels (Atkins et al., 2013; Stone et al., 2011; Turner, 2001).
The insufficiency of BM in explaining disorders with social and psychological origin led Engen (1977) to propose a new model. Engen (1977) argued that a new approach to disease that did not sacrifice the important benefits of BM was needed. The new model, therefore, was required to account for psychological and social aspects of illness. In this light, Engen (1977) proposed BPSM. BPSM holds that biological, psychological, and social levels should be considered in health care delivery. Engel (1977) argued that the three levels are more or less equally important to all illnesses, patients, or condition. BPSM differs from its biomedical counterpart in that it recognizes the role of psychological and social factors in illness. Considered as the status quo of psychiatry (Ghaemi, 2011), the biospychosocial model holds that psychological and social factors significantly affect the perceptions and actions of a patient. This in turn influences the patient’s experiences of illness (Wade & Halligan, 2004). It has also been considered as more scientific and more pragmatic or humanistic (Ghaemi, 2011). Therefore, there is no situation that can be reduced to any one of the three levels.
BM provides an organ-based viewpoint, focusing on disease mechanism with the assumption that psychological and social aspects are not necessary in understanding illnesses and treating patients (Lane, 2014). Contrary to this perspective, BPSM provides several perspectives to illnesses. This forms the basis of a conceptual defense used in advancing the model. BPSM might solve some of the limitations of BM. Particularly, BPSM might be used to understand those illnesses with no underlying pathology. Patients whose illnesses are unexplained by underlying disease may have more psychological symptoms than the patients whose illnesses can be explained by underlying pathology (Stone et al., 2011). However, some (e.g. Ghaemi, 2011) do not seem to agree that the future of specialties such as psychiatry lies in BPSM. BPSM has been faulted for showing no commitment to prevent biologisation or medicalisation of psychiatry. The model provides neither a reliable conceptual framework nor sufficient empirical grounds to defend psychiatry against possible biologisation (Ghaemi, 2011). Moreover, it is difficult to determine which aspect of illness (biological, psychological, and social) to prioritize. This leaves room for each person to rely on their own preferences in determining what to prioritise.
Biological, psychological, and social factors may be integrated. The challenges associated with the two models in explaining illness may be addressed by bridging these three dimensions. In fact, it has been argued that challenges involved in integrating the three dimensions of BPSM are responsible for the challenges experienced in health care, such resource-related challenges ...