The biopsychosocial model thirty years later

Medically unexplained symptoms appear to be the rule in primary care and disturbances such as depression, anxiety, hostility and illness behaviour may affect the course, therapeutic response and outcome of a given illness episode. The use of psychotherapeutic strategies has yielded a substantial improvement in quality of life, coping and the course of several medical disorders.

The need to include consideration of function in daily life, productivity, performance of social roles, intellectual capacity, emotional stability and well-being, has emerged as a crucial part of clinical investigation and patient care.

Thirty years ago George L. Engel, the father of North American psychosomatic medicine, highlighted the inadequacies and limitations of the traditional biomedical model and advocated the endorsement of a psychosomatic (biopsychosocial) approach. The article, published in Science, attracted nearly 2000 citations. According to Giovanni A. Fava (University of Bologna) and Nicoletta Sonino (University of Padova) the challenge to biomedicine is more timely today than it was thirty years ago.

In an editorial published in the January issue of Psychotherapy and Psychosomatics, the Authors report that, in line with Engel’s biopsychosocial approach, the study of every disease must include the individual, his/her body and his/her surrounding environment as essential components of the total system. Psychosocial factors may operate to facilitate, sustain or modify the course of illness, even though their relative weight may vary from illness to illness, from one individual to another and even between 2 different episodes of the same illness in the same individual. However, the dominant model of disease today is, as 30 years ago, still biomedical, with molecular biology being the basic scientific discipline.

A large body of research documents the role of stressful life events and repeated or chronic environmental challenge in modulating individual vulnerability to illness. Medically unexplained symptoms appear to be the rule in primary care and affective disturbances (such as depression, anxiety, hostility) and illness behaviour, the ways in which individuals experience, perceive, evaluate and respond to their own health status, may affect the course, therapeutic response and outcome of a given illness episode. The need to include consideration of function in daily life, productivity, performance of social roles, intellectual capacity, emotional stability and psychological well-being, has emerged as a crucial part of clinical investigation and patient care. Moreover, in controlled investigations for a number of medical disorders, the use of psychotherapeutic strategies has yielded a substantial improvement in quality of life, coping and the course of disease.

As George Engel stated 30 years ago ‘… nothing will change unless or until those who control resources have the wisdom to venture off the beaten path of exclusive reliance on biomedicine as the only approach to health care’ (p. 135).