A New Medical Model

The need for a new medical model: a challenge for biomedicine

The biological model of disease now in use provides little place for the social, psychological, and behavioral aspects of sickness to be considered within this framework. Specifically, a biopsychosocial model is offered, which serves as a framework for study, a model for teaching, and a model for action in the real world of health care.

Similar articles

  • New medical models are required, and this will be a challenge for biomedicine to meet. The Journal of Psychiatry and Neuroscience (Psychodyn Psychiatry) published an article by Engel GL in September 2012, titled Psychodyn Psychiatry, Volume 40, Issue 3, page 377. PMID: 23002701. There is no abstract available. Perspective: Is biomedicine a threat or a figment of our imagination? The biopsychosocial argument is being reexamined. The Journal of Academic Medicine (JAMA) published a paper by N. Kontos, MD, PhD, in April 2011: 86(4):509-15. doi: 10.1097/ACM.0b013e31820e0d16.JAMA 2011.PMID: 21346496. For forty years, the “Biopsychosocial Model” has been used in the field of psychiatry. 2017 Apr-Jun
  • 28(2):107-110. doi: 10.22365/jpsych.2017.282.107.Psychiatriki. 2017.PMID:28686557 Papadimitriou G.Papadimitriou G.Psychiatriki. 2017.PMID:28686557 Papadimitriou G.Psychiatriki. 2017.PMID:28686557 The biopsychosocial paradigm and the future of psychiatry are discussed in English, Greek, and modern times. The Journal of Comparative Psychiatry, Volume 36, Number 6, December 1995, pages 397-406. doi: 10.1016/s0010-440x(95)90246-5.Compr Psychiatry, Volume 36, Number 6, December 1995, pages 397-406. PMID: 8565443. ,

Cited by 1,288articles

  • For cancer and serious diseases, a prospective observational study was conducted to determine the prevalence of gut feelings in general practitioners as well as their diagnostic value. Among others who contributed to this work were B. Oliva-Fanlo, S. March, C. Gadea-Ruiz, E. Stolper, and M. Esteva of the CORap group. B. Oliva-Fanlo and colleagues J Gen Intern Med. 2022 Jan 27:1-9. doi: 10.1007/s11606-021-07352-w. J Gen Intern Med. 2022 Jan 27:1-9. Online before the print version is available. The Journal of General Internal Medicine published a paper in 2022 with the PMID 35088202. An open-access PMC paper, Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors experiencing discomfort during sexual intercourse: Results from a one-year follow-up mixed-method research, is available for download. Cyr MP, Dostie R, Camden C, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. Cyr MP, Dostie R, Camden C, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. Cyr MP, et PLoS One. 2022 Jan 25
  • 17(1):e0262844. doi: 10.1371/journal.pone.0262844. eCollection 2022.PMID:35077479 PLoS One. 2022 Jan 25
  • 17(1):e0262844. doi: 10.1371/journal.pone.0262844. Patient-centered medical center article
  • Experiences and perceptions of social eating for patients living with and beyond head and neck cancer: a qualitative research (available for free on PMC). Dornan M, Semple C, Moorhead A.Dornan M, et al.Dornan M, et al.Dornan M, et al. Support Care Cancer. 2022 Jan 24:1-9. doi: 10.1007/s00520-022-06853-6. This article was published online ahead of print on January 24, 2012. Supportive Care for Cancer Patients in 2022.PMID:35072791 The Influence of Quarantine on Pain Sensation Among the General Population in China During the COVID-19 Pandemic is a free PMC paper available online. Zheng YB, Liu L, Li SQ, Zhao YM, Zhu XM, Que JY, Li MZ, Liu WJ, Yuan KW, Yan W, Liu XG, Chang SH, Chen X, Gao N, Shi J, Bao YP, Lu L. Sun J, et al. Zheng YB, Liu L, Li SQ, Zhao YM, Zhu XM, Que Brain Sci. 2022 Jan 5
  • 12(1):79. doi: 10.3390/brainsci12010079.Brain Sci. 2022.PMID:35053822.Brain Sci. 2022.PMID:35053822.Brain Sci. 2022.PMID:35053822 Multiple Chemical Sensitivity is a free PMC article available online. Zumco GM, Doty RLZucco GM, and colleaguesZucco GM, and colleagues Science, 2021 Dec 29
  • 12(1):46. doi: 10.3390/science12010046.Brain Sci. 2021.PMID:35053790 Science, 2021.PMID:35053790 PMC article that is completely free. Review

The new medical model: a renewed challenge for biomedicine

There have been numerous new “medicines” that have appeared on the health-care scene in the last 25 years. These include narrative medicine, personalization of health care, precision medicine, and person-centered medicine, among others. The philosopher Miriam Solomon distinguishes between the first three of these movements as various “means of knowing” or “techniques,” and she believes that they are each a response to the faults of methods that came before them in the past. The reactions to the present dominant model of medicine should also be interpreted as a whole.

Dr.

As stated in the language of the fundamental biomedical sciences, such as anatomy, physiology, and molecular biology, this approach regarded illness as a departure from normal biological functioning caused by biological determinants.

What do you mean?

A number of incisive criticisms have been leveled at the biomedical model over the years, many of which have come from scholars in the humanities and social sciences such as philosophers, who have pointed out perceived “reductionism” and neglect of the psychological and social aspects of the model’s components.

  1. It is possible to identify at least three fundamental components of the traditional medical paradigm as defined by Engel: a disease notion, an ethical framework, and a logical framework.
  2. Its etiquette or ethical obligation is to heal the ailment or correct the malfunction in question.
  3. Finally, the type of medicine modeled by the traditional medical paradigm is one in which physicians cure biological disease by the application of biomedical mechanistic thinking.
  4. For example, for a bacterial infection, treat with an antibiotic to prevent the germ from growing or surviving and thus clearing the infection.
  5. Due to the fact that chronic diseases are often incurable and that many individuals with chronic disease have not just one disease but numerous separate diseases, chronic diseases contradict the traditional medical model (multimorbidity).

meanwhile, evidence-based medicine contradicts the traditional model by giving precedence to reasoning based on the findings of clinical epidemiologic research rather than mechanical reasoning. meanwhile,

Footnotes

This article has been subjected to peer review. Jonathan Fuller was awarded a scholarship from the Canadian Institutes of Health Research, which helped him further his education.

References

There has been peer review for this paper. Jonathan Fuller was supported by the Canadian Institutes of Health Research through a scholarship award.

The new medical model: a renewed challenge for biomedicine

There have been numerous new “medicines” that have appeared on the health-care scene in the last 25 years. These include narrative medicine, personalization of health care, precision medicine, and person-centered medicine, among others. The philosopher Miriam Solomon distinguishes between the first three of these movements as various “means of knowing” or “techniques,” and she believes that they are each a response to the faults of methods that came before them in the past. The reactions to the present dominant model of medicine should also be interpreted as a whole.

Dr.

As stated in the language of the fundamental biomedical sciences, such as anatomy, physiology, and molecular biology, this approach regarded illness as a departure from normal biological functioning caused by biological determinants.

What do you mean?

A number of incisive criticisms have been leveled at the biomedical model over the years, many of which have come from scholars in the humanities and social sciences such as philosophers, who have pointed out perceived “reductionism” and neglect of the psychological and social aspects of the model’s components.

  • It is possible to identify at least three fundamental components of the traditional medical paradigm as defined by Engel: a disease notion, an ethical framework, and a logical framework.
  • Its etiquette or ethical obligation is to heal the ailment or correct the malfunction in question.
  • Finally, the type of medicine modeled by the traditional medical paradigm is one in which physicians cure biological disease by the application of biomedical mechanistic thinking.
  • For example, for a bacterial infection, treat with an antibiotic to prevent the germ from growing or surviving and thus clearing the infection.
  • Due to the fact that chronic diseases are often incurable and that many individuals with chronic disease have not just one disease but numerous separate diseases, chronic diseases contradict the traditional medical model (multimorbidity).
  • meanwhile, A photograph of James T.
  • The University of Toronto Scientific Instruments Collection, located in Toronto, Ontario, has a copy of this document.

Following these new clinical realities, the old medical model has given way to what is known as the “new medical model,” which reflects the cure, prevention, and management of biological disease(s) utilizing the rationale and principles of evidence-based medicine as a basis.

6).

As a result of the fact that clinical recommendations are often disease-specific and evidence-based, the new medical paradigm is firmly established in clinical guideline–directed treatment.

Although the new medical model was not exactly what Engel had in mind when he declared the need for a new model in the title of his landmark article, it was a step in the right direction nonetheless.

These issues include reductionistic and fragmented care, as well as the difficulties associated with generalizing and implementing study findings in practice.

Philosophers can be of use in this situation by disentangling the philosophical issues from the practical issues and making contributions to the unraveling of both.

7 In a similar vein, when patient treatment is geared on or structured around bodily parts rather than treating the full patient in their living context, it is sometimes referred to as reductionistic.

Due to the fact that multimorbidity is handled by treating each of its constituent diseases individually, care might become even more fractured or fragmented for patients under the new paradigm — increasing the likelihood of treatment conflicts — when they have many diseases.

6the nature of chronic illness and comorbidity/multimorbidity, 8as well as explanatory techniques in medical practice 7 It is worthwhile to investigate, for example, whether chronic diseases and their pathogenesis are best understood — and even defined — at psychological and social levels in addition to biological levels, given the importance of these factors in the prevention and management of chronic maladies and diseases of aging.

  1. Nevertheless, how can we characterize multilayer chronic illnesses and their etiology in a comprehensive way that allows for efficient prevention and therapy while going beyond just listing socioeconomic determinants?
  2. Meanwhile, because of the evidence-based logic of the new medical paradigm, which requires clinicians to make diagnostic, prognostic, and therapeutic predictions based on clinical epidemiologic information, the obstacles of generalizing and implementing research results arise.
  3. As with other scientific conclusions, it is based on assumptions.
  4. A common concern among medical commenters is that explanatory randomized trials have weak generalizability, and that the average research results translate poorly to specific individuals, if at all, in practice.

9,10 The practical challenges I described (reductionistic/fractured care, generalizing/applying study results) are not insurmountable obstacles for medicine to overcome, because they arise as a result of the concepts, ethics, and logic of a particular model of practice, rather than as a result of the model’s inherent limitations (the new medical model).

The disease-centered ethic of the approach is rejected by narrative medicine and person-centered medicine.

Engel’s own technique was to reject the illness notion of the medical model and suggest a biopsychosocial model 3in which sickness is conceived in terms of the psychological and social, in addition to the biological aspects of the disease.

As a result, both medical and philosophical expertise will be required to meet the new problems that it will provide. 2

Footnotes

  • There have been numerous new “medicines” that have appeared on the health-care scene in the last 25 years. These include narrative medicine, personalization of health care, precision medicine, and person-centered health care. Physicist Miriam Solomon refers to the first three of these trends as “means of knowing” or “techniques,” and she contends that they are each a reaction to the faults of methods that came before them. In addition, they should be viewed as responses to the present dominant model of medicine. 1 Here, I’ll discuss our prevailing model, which I refer to as “the new medical model,” in further detail. The philosophical roots of contemporary medicine, I shall argue, are the source of some monumental issues in modern medicine, and hence require philosophical investigation. “The dominant paradigm of disease today is biological,” stated Dr. George Engel, a psychiatrist, in his paper “The Need for a New Medical Model: A Challenge for Biomedicine,” published forty years ago. Engle asserted that the “biomedical model,” sometimes known as “biomedicine,” was the conventional model of disease, as well as the orthodox paradigm of medical treatment in general. As presented in the language of the fundamental biomedical sciences, such as anatomy, physiology, and molecular biology, this approach regarded illness as a departure from normal biological function caused by biological determinants. To treat sickness and restore normal functioning, the physician was guided by the biological paradigm. Tell me about it. This is accomplished by the application of knowledge from these same fields. A number of incisive criticisms have been leveled at the biomedical model in recent years, many of which have come from scholars in the humanities and social sciences such as philosophers, who have pointed out perceived “reductionism” and neglect of the psychological and social aspects of the model’s components. For reasons that I shall explain later, even though biomedicine is commonly referred to as “the medical model,” I will refer to it as the “old medical model.” We can identify at least three critical components of the traditional medical paradigm, as articulated by Engel: a disease notion, an ethical framework, and a logical framework. In this model, illness is defined as a physical, biochemical, and psychological malfunction. Its etiquette or ethical obligation is to heal the ailment or correct the dysfunction in society. Finally, its logic, or “style of scientific reasoning,” 5 is based on biomedical “mechanistic reasoning,” which is the process of thinking via the biological mechanisms of health and illness that are present. Overall, the type of medicine modeled by the old medical paradigm is one in which physicians cure biological disease by the application of biomedical mechanistic thinking. When it comes to acute infectious diseases, the old model’s paradigmatic diseases are acute infectious diseases that are generally curable and can be understood and treated using biological reasoning: for a bacterial infection, treat with an antibiotic to halt the germ’s growth or survival, and thus clear the infection. Two key developments had already occurred by the time Engel issued his “challenge to biomedicine,” namely the increase of chronic illnesses and the creation of evidence-based medicine. Due to the fact that chronic diseases are often incurable and that many individuals with chronic disease have not just one disease but numerous separate diseases, chronic diseases contradict the conventional medical model (multimorbidity). Meanwhile, evidence-based medicine challenges the traditional approach by prioritizing reasoning based on the findings of clinical epidemiologic research above mechanical reasoning. From James T. White’s Physiological Manikin (often known as a life-size anatomy atlas), taken in around 1895. This collection is housed at The Scientific Instruments Collection at the University of Toronto in Toronto, Ontario. Ari Gross and Erich Weidenhammer provided the image for this piece. Due to these new clinical realities, the old medical model has developed into the “new medical model,” which depicts the cure, prevention, and management of biological disease(s) utilizing the rationale and principles of evidence-based medicine as the basis for decision-making. 2 In comparison to the previous medical model, the new medical model’s illness concept is likely to be unchanged (the “concept of disease” argument in philosophy of medicine is a vigorous and ongoing discussion). 6). The new model’s ethic, on the other hand, has been broadened to include the prevention and management of incurable chronic illness and multimorbidity, and its rationale is consistent with evidence-based medical principles. Because clinical recommendations are often disease-specific and evidence-based, the new medical paradigm is embedded in clinical guideline–directed treatment. When treating a patient with type 2 diabetes and heart failure, for example, the physician would manage these biological disturbances (in glucose homeostasis, in cardiac function) individually while also preventing other diseases or complications through interventions supported by evidence from clinical research, particularly clinical trials, as described above. While the new medical model was not exactly what Engel had in mind when he declared the need for a new model in the title of his landmark article, it was a step in the right direction nonetheless. 3 As a result, the new medical model incorporates elements of both the old and new medical models, inheriting many of the advantages and shortcomings of the old model while also posing new challenges to medical practice. There are other issues to consider, including reductionistic and fragmented care, as well as the difficulties associated with generalizing and implementing study findings in practice. These practical issues are intertwined with philosophical issues, including those pertaining to the metaphysics or nature of chronic disease and multimorbidity, the ethical purposes of medicine, and the epistemology or logic of evidence-based medicine, among other things. In this case, philosophers can be of assistance by disentangling the philosophical issues from the practical challenges and making contributions to the unraveling of both of these problems. When it comes to medical philosophy, reductionism may be defined as an approach in which clinical symptoms or results are explained by reference to specific aspects of the patient (organs, cells, molecules). 7 In a similar vein, when patient treatment is geared toward or structured around bodily parts rather than treating the patient as a whole in their living context, it is frequently referred to as reductionistic. The illness concept and the disease-centered ethic of the new medical model work together to promote reductionism, since diseases are understood in terms of the body’s component components, and the purpose is to cure, prevent, or manage the condition, respectively. Due to the fact that multimorbidity is handled by treating each of its constituent diseases individually, care might become even more fractured or fragmented for patients under the new approach – increasing the possibility of treatment disputes. These issues can be better understood by philosophers of medicine who study the way we think about sickness. 6the nature of chronic illness and comorbidity/multimorbidity, 8as well as explanatory techniques in medical practice. 7 Because of the importance of psychological and social factors in the prevention and management of chronic diseases, it is worthwhile to investigate whether chronic diseases and their pathogenesis are best understood — and even defined — at psychological and social levels in addition to biological levels, as has been done in the past. However, how can we characterize multilayer chronic illnesses and their pathophysiology in a comprehensive way that promotes effective prevention and management and goes beyond just listing socioeconomic determinants and other risk factors? 2 As a result of the difficulties associated with fragmented care, it is worthwhile investigating whether comorbidities are truly distinct/discrete entities, 2,8, and how we might better represent and classify complex morbidity in a more integrative way for patients who are currently receiving multiple chronic disease diagnoses. Meanwhile, because of the evidence-based logic of the new medical paradigm, which requires clinicians to make diagnostic, prognostic, and therapeutic predictions based on clinical epidemiologic information, the obstacles of generalizing and implementing research results are posed. A scientific inference is the process of extrapolating research findings and applying them to specific patients. As with other scientific conclusions, it is based on assumptions. 9 The conclusions and assumptions that are made in medicine, on the other hand, are inadequately stated and hardly recognized. Doctors and medical pundits frequently express concern that explanatory randomized trials have low generalizability, implying that average research outcomes apply poorly or not at all to specific individuals. Such problems are investigated by philosophers of science by logically rebuilding the underlying conclusions, revealing and evaluating their assumptions, and devising alternative ways for making reliable predictions. 9,10 The practical challenges I described (reductionistic/fractured care, generalizing/applying study results) are not insurmountable obstacles for medicine to overcome, because they arise as a result of the concepts, ethics, and logic of a particular model of practice, rather than as a result of the model’s inherent shortcomings (the new medical model). In recent years, a number of medical movements have attempted to address the model’s flaws. The disease-centered ethic of the concept is rejected by narrative medicine and person-centered medicine, among other approaches. Precision medicine and personalized medicine are both concerned with the logic of medicine and the goal of improving personalised prediction in both fields of medicine. As for Engel’s own technique, he rejected the illness notion of the medical model and proposed a biopsychosocial model 3in which sickness is conceived in terms of the psychological and social as well as the biological. In summary, the new medical model symbolizes the progress of biomedicine in response to the increase of chronic illnesses and the adoption of evidence-based medicine, and it incorporates a philosophy of care on a grander scale than previous models. It will take medical and philosophical expertise to meet the new problems that it will impose on society. 2
See also:  CBG 101: Is Cannabigerol Really the Mother of All Cannabinoids?

The “new” medical model, fragmented clinical care and philosophy of medicine

The shift from a “old” biomedical model to a “new” one, as well as the issues that have arisen as a result of the new model, are discussed by Jonathan Fuller in his recentCMAJarticle1. Indeed, he views fragmentation of clinical care as one of the most important concerns facing the medical community. This fragmentation is compounded by the fact that patients frequently adhere to Hickam’s dictum, which is characterized by what may be termed multimorbidity. Certainly, as Fuller argues, philosophers of medicine may make significant contributions to the resolution of issues such as fragmentation of treatment.

  1. Concerning fragmentation of treatment, particularly for patients with many comorbidities, they might highlight the metaphysical assumptions that underpin medicine, as Fuller does with reductionism, and suggest alternative theories of care.
  2. What is required, though, is a firm and compelling conception of the whole.
  3. Indeed, as Francis Peabody 4stressed almost a century ago, in order to give good treatment, the clinician must consider the patient as a “impressionistic picture” that incorporates not just the patient’s biology, but also other characteristics that distinguish the patient as a person.
  4. As the field that seeks knowledge, philosophy of medicine should be at the forefront of this appeal, offering clarity and direction to address the issues that the new medical model is up against.

Footnotes

The significance of how sickness and illness are conceptualized stems from the fact that understanding the boundaries and extent of responsibility connected with medical practice is critical to understanding the nature of the profession. As a result of this study, we want to present a more comprehensive picture of the interplay between these understandings in defining the nature of medical labor both philosophically and practically. We begin by discussing the emergence of the biopsychosocial model, which was developed as a means of both challenging and broadening the traditional biological approach.

Despite repeated critiques and inconsistent adoption, the biopsychosocial model has gone on to affect fundamental elements of medical practice, teaching, and research across a wide range of medical specialties and disciplines.

The authors conclude that a more optimal use of existing bodies of evidence, bringing together evidence-based methodological advancements of the biopsychosocial model and existing evidence on the psychosocial needs associated with specific conditions/populations, can assist in bridging the gap between philosophy and practical application.

Figures are displayed in full-text mode. This is an open access article published under the terms of the Creative Commons Attribution License, which enables free use, distribution, and reproduction in any form, as long as the original work is properly cited in the publication.

From the Lesson of George Engel to Current Knowledge: The Biopsychosocial Model 40 Years Later

“The Need for a New Medical Model: A Challenge for Biomedicine,” written by George L. Engel (1913-1999), a renowned academic in the psychosomatic movement of the twentieth century, was published in the journal Science forty years ago. The study had a significant influence on the scientific community and was cited more than 3,500 times in the Web of Science, demonstrating its importance. A striking feature of this data is that the flow of citations does not appear to diminish with time, and in fact, it has risen in the previous decade.

  • Specifically, he expressed worry about reductionism, which he defined as the inclination to see complex clinical occurrences as ultimately coming from a single underlying cause (for example genetic) rather than adopting a multifactorial frame of reference to explain them.
  • It is anticipated that corporate involvement in medical science will increase awareness of single causative variables and therapeutic substances in the management of disease.
  • The emergence of evidence-based medicine, which is prone to focus on single factors while failing to give appropriate weight to clinical variability and all treatment components, has played a significant role in the development of reductionism.
  • However, there is still more work to be done in terms of practical applications, and the disregard of psychological and social aspects may potentially result in a “depersonalized” approach to health.
  • The following are the results of extensive study conducted over the past four decades: 1.
  • 2.
  • A common clinical phenomenon is the tendency to experience and communicate psychological distress in the form of physical symptoms, and to seek medical attention for these symptoms.
See also:  Out of India

The course, treatment response, and outcome of any particular disease episode may be influenced by affective disturbances such as sadness and anxiety as well as sickness behavior (the ways in which individuals experience, perceive, assess, and respond to their own health condition).

Consequently, it has become clear that examination of everyday functioning, productivity, performance of social duties, intellectual capacity, emotional stability and well-being, as well as emotional stability and well-being, is an essential component of clinical study and patient management.

Engel brought attention to the dilemma of patients who are experiencing symptoms of illness yet are told that they are well due to the absence of aberrant test data.

The identification of all changeable biological and nonbiological elements, as well as the achievement of individual goals, should be the primary objectives of treatment.

Engle believed that the transformation from a restricted biological paradigm to a biopsychosocial one was the most significant problem facing medicine at the start of the twentieth century.

He stressed in particular the physician’s power to influence and alter the patient’s behavior in a positive and healthy manner.

The American Diabetes Association’s latest policy statement on psychosocial treatment for persons with diabetes, which was released in June, is in accordance with this viewpoint.

According to its original concept, evidence-based medicine was concerned with “integrating individual clinical experience with the most recent and best available external data.” The problem is that “external evidence” is twisted and misapplied in order to legitimize financial conflicts of interest in political campaigns.

  • The majority of medical problems do not have a straightforward “average” remedy.
  • Horwitz et al.
  • 1156).
  • The availability of technological instruments for illness management does not negate the need of being scientific in the human arena.

In the future, new scientific models and discoveries will presumably take Engel’s biopsychosocial construct into consideration and completely embrace it. As a result, there would be more effective communication and interaction between psychosomatic evidence and biological advancements.

Disclosure Statement

“The Need for a New Medical Model: A Challenge for Biomedicine,” written by George L. Engel (1913-1999), a renowned academic in the psychosomatic movement of the twentieth century, was published in the journal Science 40 years ago. With more than 3,500 citations in the Web of Science, this paper has made an enormous influence on both the scientific community and the media. A striking feature of this trend is that the flow of citations does not appear to diminish with time, and in fact, it has risen in the previous decade.

  • Specifically, he expressed worry about reductionism, which he defined as the inclination to see complicated clinical events as ultimately resulting from a single underlying cause (for example genetic) rather than from a multifactorial frame of reference.
  • Indeed, corporate involvement in medical science is expected to draw attention to the relevance of individual etiological variables and therapeutic agents in the treatment of disease.
  • He was right.
  • Genomic-based knowledge, often known as personalized/precision medicine, promises to treat each patient as the unique biological individual that he or she is.

One of the most serious criticisms of the traditional medical model was the failure to integrate advances in behavioral and social sciences into clinical medicine, particularly in light of the fact that almost all health-care spending is directed at biomedically oriented interventions in today’s society.

  1. Individual sensitivity to disease is modulated by stressful life events as well as recurring or chronic environmental stresses, among other factors.
  2. A common clinical phenomenon is the tendency to experience and communicate psychological distress in the form of physical symptoms, and to seek medical attention for these symptoms.
  3. The course, treatment response, and outcome of any particular sickness episode can all be influenced by affective disturbances such as sadness and anxiety as well as illness behavior (the ways in which individuals experience, perceive, assess, and respond to their own health condition).
  4. This has resulted in the requirement for clinical study and patient care to take into account factors such as daily life function, productivity, performance of social roles, intellectual capability, emotional stability and well-being, as well as other factors.
  5. In his presentation, Engel brought attention to the dilemma of patients who are experiencing symptoms of illness but who are convinced that they are well since no aberrant laboratory findings have been discovered.
  6. Identifying and addressing all changeable biological and nonbiological elements, as well as achieving individual goals, should be the primary objectives of treatment.
  7. Engel believed that the move from a restricted biological paradigm to a biopsychosocial model was the most significant problem facing medicine at the start of the twentieth century.

A special emphasis was placed on the capacity of a physician to influence and change a patient’s behavior in a positive manner.

It is in keeping with this approach that the American Diabetes Association has released a policy statement on psychosocial treatment for persons with diabetes.

Indeed, evidence-based medicine was defined as “integrating individual clinical experience with the best available external data” in its original definition.

It has the net consequence of causing the prescribing physician to give excessive weight to prospective advantages while paying little attention to the probability of responsiveness and potential vulnerabilities in regard to the detrimental effects of therapy, as shown in Figure 1.

When it comes to most medical conditions, there is no one “average” solution.

According to Horwitz et al., “what is required to complement the potential of genomics is an emphasis on personal traits of patients and their circumstances, and to combine these aspects into an enhanced approach to customized therapy” (p.

Relationships and healing are at the heart of medicine, in the final analysis.

In the future, new scientific models and discoveries will presumably take Engel’s biopsychosocial construct into consideration and incorporate it fully. This would also mean improved communication and interplay between psychosomatic evidence and biological advancements in the future as well.

The Need for a New Medical Model: A Challenge for Biopsychosocial and Ecopsychologica Medicine

Chinese medicine speaks of alignment between humans, heaven and earth. It is a complex view with a focus upon relationship. These are comprehensive ideas with no specific terms in contemporary medical practice.Here, I want to expand upon the attempts to transform conventional biomedicine into a more sensitive and socially responsible “biopsychosocial” model. Given the richness and depth of the early Chinese world view, a more comprehensive and distinct set of possibilities arise.Biological medicine generally falls into the category of medical practices that focus upon isolated biological events. In response to the problems such an isolated view brings to care, psychiatrist George L. Engel, at the University of Rochester, developed the idea of a biopsychosocial model of medicine. He published these thoughts in a 1977 article inScience, where he posited, “The dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioral dimensions of illness. This biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care.”The biopsychosocial view has three obvious components: biological, social and psychosocial. It transcends the reductionist single-cause view which medicine has relied upon since the “enlightenment.” Biological systems theory allows for complex interacting systems. The social aspect works with the problems and self and other. Lastly, the psychological view permits inquiry into the psyche and the rich archetypal inner world that humans bring to the conversation. (See Figure 1)Figure 1This new holism for conventional medicine is inadequate to describe the conditions affecting health that early Chinese medical practitioners articulated. These include, but are not limited to, temporal factors such as diurnal, monthly and seasonal conditions. Weather may also have impact. Thus, the meteorological and cosmological correlates with human health and wellbeing are similarly not included within the concept of biopsychosocial. Here, we might build the idea of a “biometeorological” frame, but this, too, remains inadequate.There is also the notion of “ecopsychology,” a term coined by Theodore Roszak inThe Voice of the Earth(1993). He developed the idea further in the anthology called,Ecopsychologywith his co-editors Mary Gomes and Allen Kanner (1995). Ecopsychology extends beyond the traditional psychology, focusing upon sustainability and the nature of human psyche in the context of damaging the world in which we live. A large part of the focus is upon resolving the isolation from nature that human beings experience in a post-industrial, information and technology centered culture. Given the possibility that many environmentally damaging behaviors are addictive, the idea of non-pejorative psychotherapeutic values enters – one where judgment gives way to healing the guilt and avoidance framework that ensue when one engages in activities that damage the environment which sustains our existence.The main premise of ecopsychology is that while today the human mind is shaped by the modern social world, it is adapted to the natural environment in which it evolved. Biologist E.O. Wilson, suggests that human beings instinctually connect on an emotional level with nature, lending a power of healing at the psychological and emotional levels in the presence of nature (1995). These thoughts align with early Daoist thought and that of the naturopathic doctor who relies upon “nature cure.” The problem with the term ecopsychology is that the social components are not obvious. (See Figure 2)Figure 2We are operating at the intersection of biology, psychology, sociology and nature. The notion of ecology includes internal and external biological, but also meteorological and seasonal phenomena as they impact human beings. Biological medicine, ecopsychology and biopsychosocial views each touch a piece of the discipline in which we are engaged. Thus, while these perspectives appreciate the complexity of causes and consequent clinical phenomena, they do not fully describe the larger field of complex systems which affect and participate in human life. I propose, therefore, the term “ecopsychosocial” as a term which captures the larger framework of considerations in the clinic.Early cultures used signs as part of a larger field of experience which involved a ecopsychosocial worldview that embraced the totality of biological events on the interior and exterior, the seasons, the time of life and the ecosphere. This expanded view allows for the observation of signs that involve the environment as part of the person and the events that compose a life. It is in this interplay between subjective and objective, internal and external environments, individual and collective, process and form, where knowledge about the patient and the clinical relationship emerge. Thus, the word ecopsychosocial denotes a worldview that includes the interior and exterior ecology, with psychological, spiritual and social experiences.This ecopsychosocial construct aligns perfectly with theThe Yellow Emperor’s Inner Classic(Huáng Dì Nèi Jing). Chapter two of the Basic Questions (Sù Wèn) discusses the impact of the seasons upon health and longevity, most importantly, the virtue of living in accord with the seasons. Chapter three explores the impact of cold, wet, heat and wind upon the human condition. This ecopsychosocial view is embedded throughout the entireThe Yellow Emperor’s Inner Classicand the term biopsychocial cannot encompass the breadth and wisdom imparted through the immortal classical lore rooted in the Han Dynasty circa 206 B.C.E. – 220 C.E.Today, the worldviews that we use to create reality are manifold. For conventional medical practices, it becomes necessary to gain a paradigm shift similar to the discussion rendered by Thomas Kuhn in theStructure of Scientific Revolutions(1962).Early cultures enjoyed what I call the ecopsychosocial view. It is one where internal and external ecology blend with the psychological and spiritual well-being of the individual and their social systems. Contemporary terms such as biometerological, ecopsychological and biopsychosocial are each lacking some portion of the comprehensive view presented in the ecopsychosocial view. It is time to use a term which describes what we do as fully developed humanistic practitioners: ecopsychosocial.References:

Acupuncture Today– April, 2015, Vol. 16, Issue 04
  1. G. Bateson’s et al (2000). The First Steps Towards an Ecology of Mind University of Chicago Press
  2. Engel, G. Chicago: University of Chicago Press
  3. (1977). New medical models are required, and this will be a challenge for biomedicine to meet. Science, 196(4286), 129-136. doi:10.1126/science.847460
  4. Kuhn, T. S., Science, 196(4286), 129-136. (1962). The Structure of Scientific Revolutions: University of Chicago Press
  5. Morris, W. The Structure of Scientific Revolutions: University of Chicago Press (2012). Post-paradox: There’s Always Room for a View. Acupuncture Today, 13(8)
  6. Morris, W. R. Acupuncture Today, 13(8) (2009). A doctoral dissertation completed at the California Institute of Integral Studies in San Francisco, California, on Chinese pulse diagnosis: epistemology, practice and tradition. Available from the NCCPL database at the California Institute of Integral Studies
  7. Roszak, T. (1993). The Earth’s voice: An investigation into the field of ecopsychology Touchstone
  8. T. Roszak, M. E. Gomes, and A. D. Kanner (eds.). New York: Touchstone
  9. Roszak, T., Gomes, M. E., and Kanner, A. D. (1995). Ecopsychology is the science of mending the earth and healing the psyche. Sierra Club Books, San Francisco, CA
  10. Wilson, E. O., ed (1995). The Biophilia Hypothesis is published by Island Press.

Previous articles written by William Morris, DAOM, PhD, LAc, may be found here.

The Need for a New Medical Model

After going through cancer treatment, my understanding of the complexity of sickness has increased, something I could not completely realize when practicing medicine as a doctor who tries to pay close attention to his or her patients. Because of my own experiences with managed care, I have come to realize that our current system of healthcare financing fundamentally misunderstands the nature of sickness and the goals that the healthcare system should be attempting to achieve. In my situation as a cancer patient, I was grateful that there was such sophisticated technology as Bone Marrow Transplantation available, but it is a bleak procedure.

The spiritual aspect of caring, not necessarily in a supernatural sense, but certainly in a transcending sense, is something I feel to be important.

In 1977, George Engel highlighted the need for a “new medical model,” which he termed “transformational.” Rather than just expanding on the bio-reductionistic model then in use at the time, he recommended a bio-psycho-social model to replace it.

Up to a certain time, that model was incredibly successful.

Even organs, like the worn-out pieces of an old vehicle, may be replaced in their entirety.

We now understand how the mind (and stress) affects the body-machine and how a large number of illnesses that individuals suffer from have behavioral origins that have physiological correlations to them.

However, it must equally be acknowledged that the topic of spirituality in contemporary Western philosophy is strained and uncomfortable at times.

I am well aware that, if we are to have a discussion about the role of spirituality in health care, we will need to address everything from the wide range of organized faiths to the most distinctive kinds of New Age individuality.

And that is exactly the aim of this article.

Additionally, people may discover their own own road to healing.

My experience with the Bone Marrow Transplant included many spiritual insights, which played an important role in my recovery.

The fact that there was one area of the therapy that I did not think Duke handled especially well was one of my concerns.

There are a lot of people at Duke who are interested in religion and spirituality, as well as the role they play in medicine.

Every now and again, he would wander into the clinic and make his way around, asking questions and attempting to engage in discussion with the staff and patients.

It was never obvious to me whether he was bringing solace, providing psychiatric treatment, or searching for souls to rescue them.

During a visit from a chaplain to his mother when she was in the hospital, Robert Coles, the child psychiatrist who has written extensively about the lives of children, shares a personal anecdote about his mother.

According to my recollection of the story, this interpretation simply made her further furious.

This would undoubtedly be a suitable function for a chaplain to fulfill.

However, I believe that such ambiguity is only an evidence that the function of spirituality in medicine has not been thoroughly thought through.

Their presence and attentive attention repeatedly transcended the commonplace concerns of chemicals and lab values, and they were praised for it.

My own contemplations on spirituality while undergoing cancer treatment prompted me to recall my travels to Nepal, where spirituality seemed to come naturally and unforcedly to me.

The Hopi religion is primarily concerned with the weather.

Both of their religions are concerned with “ultimate issues,” as theologian Paul Tillich predicted religions will do in the future.

Every month, a different costume is worn, and the costumes are the same from town to village.

The cumulus clouds, which deliver rain, are represented as a tall, piled headgear.

The chests of the guys taking part in the dance are painted with clouds in various sizes.

They are wielding curved sticks like bolts of lightning.

The drums generate a rumbling sound that sounds like thunder.

This also has a thunderous tone to it.

I was not permitted to enter the kiva, which is considered to be the most sacred of all sites.

The clouds march over the desert in a configuration akin to that of soldiers.

These are referred to as “cloud streets” by atmospheric scientists.

My scientific colleagues at the museum laughed in my face when I told them about my findings.

I couldn’t figure out what the Bermuda current was doing in the Pacific and in the American Southwest until much later.

Every rain dance I went to got rained out, which I pointed out to my pals, so you can take your own conclusions from that.

Because the ritual is designed in such a way, everything that is done serves as a constant reminder of the reason for which it is being performed, which is to attract the attention of the katchina gods.

As a result, everything in the ceremony is intended to act as a reminder, including weather symbols, imagery of clouds, corn stalks, and thunderous sounds, among others.

If someone is consumed with a marital infidelity, for example, everyone will suffer as a result of that preoccupation.

An analogous explanation for religious ritual may be found in the writings of the Danish philosopher Soren Kierkegaard.

Christian ritual is centered on the ultimate issue of redemption and everlasting life, rather than on anything else.

To have purity of heart means to just want one thing.

This was quite similar to my cancer treatment ritual.

Nurses changed bandages as physicians checked on the patient’s development.

Navajo ceremonies are also concerned with health, specifically with the restoration of health after sickness.

A family may live in a hogan, which is a mud, wood, or even cider brick cabin, but they may spend much of the year in tents because of the harsh climate.

Sand painting is one of the most visually arresting of the Navajo arts and crafts.

These “paintings” are predated and should not be confused with the Four Corners region, which includes Arizona, New Mexico, Colorado, and Utah (where the Navajo Reservation is located at the intersection of Arizona, New Mexico, and Utah).

Eventually, they may measure four or five feet in square footage.

I was quite pleased with my participation.

A sand painting is typically used in a healing ritual to promote healing.

If the sick person is male, the medicine man may enlist the assistance of male relatives in the construction of the elaborate sand painting.

A little wind or a gentle move of the hand can restore the sand to its natural state of a random assortment of grains.

Chaos is the inherent condition of the cosmos, from which we can briefly chisel out a little order, but the second law of thermodynamics inevitably prevails in the long run.

Chaos and confusion have taken over.

No provision in the healing rituals forbids the administration of antibiotics or other pharmaceuticals.

On a Sunday morning on the Navajo reservation, I recall something that happened.

It was a Presbyterian Church, as far as I recall.

The sermon was more akin to an anthropology lecture than a sermon.

However, the Navajos in attendance did not appear to be bothered by his explanations, although I was.

The conversation was purely academic and critical in nature.

In many ways, he reminded us of the chaplain we encountered in the Duke cancer ward.

It was more than just a spiritual experience.

In contrast, I’d like to offer a spiritually uplifting experience that occurred throughout my own therapy.

When the low-dose chemotherapy cycles were over, I found myself dealing with the full brunt of the side effects of the steroids that had been prescribed to me.

They were my own psychiatry resident and medical student, and we were talking about our psychiatric patients on the floor below us, who the resident and medical student will shortly see, but I would not be able to leave my bed until the resident and medical student returned.

It would be necessary for me to enlist the assistance of a colleague.

My personal internist from the University Physicians Practice Group walked into the room with her residents and medical students, as well as the oncology fellow, and we exchanged pleasantries.

They gathered in a circle about me, and as they (we) worked out the details of the medications and treatment plan, it was clear that they were thinking of me and wishing me well.

Scott was someone with whom I enjoyed working out and water skiing on a regular basis.

He was going to pick me up (in more ways than one).

This was a spiritually uplifting experience.

I returned to my room just after the formal rounds were completed by Steve Loyd, who was undergoing an accelerated residency (an internship during the fourth year of medical school).

When I arrived at their house at the end of the day, I noticed this eloquent little four-year-old child, dressed in the flannel Superman pajamas I had previously seen him in, down on his knees by the bed and praying aloud for my health.

In one instance, while watching the President deliver a speech on television—not one of the iconic addresses, but rather one that even a four-year-old could understand—Steve asked his kid whether he recognized the speaker.

Dyer?” Heath inquired.

Some of my friends, even adults, told me that they prayed for me out loud on their knees by their beds at the end of the day.

To have purity of heart means to just want one thing.

Dr.

I have to tell you that I thought this to be especially encouraging to read.

The fact that a physician like Steve Loyd would prepare himself to provide excellent treatment to cancer patients like myself would be undeniable.

You might accept it on the basis of faith.

The serum protein electrophoresis returned to normal after a brief interruption.

The results of the bone marrow aspirates were normal. All of the indicators associated with multiple myeloma were restored to normal. I’m at a loss for words when it comes to expressing what happened, but I’d have to call it a miracle.

Leave a Comment

Your email address will not be published. Required fields are marked *