Biopsychosocial model (1)

The use of the biopsychosocial model of illness is the major, central defining feature of rehabilitation. All other features follow on from its use – the need for a multi-disciplinary team, the need for rehabilitation planning and goal-setting meetings etc. The model is discussed in more detail in another section of the website (here). This page just highlights its main features. It is worth emphasising that the model is easily understood by patients and families who appreciate its simplicity, and its relevance to their situation.

Most people imbibe, from birth, the biomedical model such that few people realised that they even have and use a model of illness. The biomedical model is focused on disease, and takes a reductionist, simplifying approach. The biopsychosocial model of illness, takes a holistic approach and focuses on a person in their context – their family and friends, their past and present and anticipated future, their physical environment, their culture and so on. The biomedical model, or theory, of illness recognises and illustrates how complex an illness is.

The biopsychosocial model of illness is illustrated in this figure. The figure shows that the model has:

  • four levels concerning the person:
    • organs, where dysfunction is usually termed disease or pathology;
    • the whole person, where dysfunction is usually termed symptoms or signs but is better considered a the personal, interpreted experience of the person;
    • the person’s activities, their goal-directed interaction with the physical environment, where dysfunction is usually termed disability
    • the person’s social functioning, their interaction with other people which is always in terms of roles. There is no commonly-accepted or used term for altered function.
  • four levels concerning the person’s context:
    • personal context, what the person “brings to the situation”, often referred to by such terms as their personality or personal characteristics;
    • physical context, the observable objects and physical environment around the person;
    • social context, the not-observable but powerful social determinants and consequences of social interaction;
    • temporal context, the stage the person is in both within the trajectory of their illness, and within the trajectory of their life.
  • Two extremely important additional factors, which are entirely personal to the patient, and that must be considered as being in a third, different dimension. These factors acknowledge that only the patient’s personal judgement can determine and explain two phenomena:
    • choice. The person will always be making choices, influencing their behaviour including specifically what they report to a healthcare professional;
    • quality of life. The person is the only person who can determine their own quality of life. It is determined by many factors, and the importance given to each factor is entirely chosen by the person.

A much more in-depth explanation and exploration is given here, but in the meantime two other links give further information:

  • Two drawings (one explains the other): here and here
  • An article reviewing progress over 40 years and explaining it in more detail, with many references.
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