Current Perspectives on Health and Illness

Once we add the person to the biomedical model, we have a different and broader picture of how health and illness come about. This new perspective, called the Biopsychosocial model, expands the biomedical view by adding to biological factors the influence of psychological and social factors (Engel, 1977. 1980; Schwartz, 1982). This new model proposes that all three factors affect and are affected by the person’s health.

Before we describe in detail the biopsychosocial model, let us first clarify what exactly the biomedical model is.

The Background to Biomedical Model:

During the nineteenth century, modern medicine was established. Man (the nineteenth century term) was studied using dissection, physical investigations and medical examinations. Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution. This revolutionary theory identified a place for Man within Nature and suggested that we were part of nature, that we developed from nature and that we were biological beings.

This was in accord with the biomedical model of medicine, which studied Man in the same way that other members of the natural world had been studied in earlier years. This model described human beings as having a biological identity in common with all other biological beings.

What is the Biomedical Model?

The biomedical model of medicine can be understood in terms of its answers to the following questions:

What Causes Illness?

According to the biomedical model of medicine, diseases either come from outside the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition.

Who is Responsible for Illness?

Because illness is seen as arising from biological changes beyond their control, individuals are not seen as responsible for their illness. They are regarded as victims of some external force causing internal changes.

How should Illness be Treated?

The biomedical model regards treatment in terms of vaccination, surgery, chemotherapy, and radiotherapy, all of which aim to change the physical state of the body.

Who is Responsible for Treatment?

The responsibility for treatment rests with the medical profession. The professionals are considered to be experts whose recommendations must be followed in order for the treatment to be successful.

What is the Relationship between Health and Illness?

Within the biomedical model, health and illness are seen as qualitatively different – you are either healthy or ill, there is no continuum between the two.

What is the Relationship between Mind and Body?

According to the biomedical model of medicine, the mind and body are separate entities; they function independently of each other. This is comparable to a traditional dualistic model of the mind-body split. From this perspective, the mind is incapable of influencing physical matter. The mind is seen as abstract and relating to feelings and thoughts, and the body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in the state of mind.

What is the role of Psychology in Health and Illness?

Within traditional biomedicine, illness may have psychological consequences, but not psychological causes. For example, cancer may cause unhappiness but mood is not seen as related to either the onset or progression of the cancer.

Health psychology and its focus on the Biopsychosocial Model:

Health psychology challenges the mind-body split by suggesting a role for the mind in both the cause and treatment of illness. Health psychology is the only field that completely adheres to the biopsychosocial model.

Health psychology and the biopsychosocial model can be understood in terms of the same questions that were asked of the biomedical model:

What Causes Illness?

Health psychology suggests that human beings should be seen as complex systems and that illness is caused by a multitude of factors and not by a single causal factor.

Health psychology therefore attempts to move away from a simple linear model of health and claims that illness can be caused by a combination of biological (e.g., a virus), psychological (e.g., behaviors, beliefs) and social (e.g., employment) factors.

Who is Responsible for Illness?

Because illness is regarded as a result of a combination of factors, the individual is no longer simply seen as a passive victim. For example, the recognition of a role for behavior in the cause of illness means that the individual may be held responsible for their health and illness.

How should Illness be Treated?

According to health psychology, the whole person should be treated, not just the physical changes that have taken place. This can take the form of behavior change, encouraging changes in beliefs and coping strategies and compliance with medical recommendations.

Who is Responsible for Treatment?

Because the whole person is treated, not just their physical illness, the patient is therefore in part responsible for their treatment. This may take the form of responsibility to take medicine, responsibility to change beliefs and behaviors. Patients are not seen as victims.

What is the relationship between Health and Illness?

From a biopsychosocial perspective, health and illness are not qualitatively different, but exist on a continuum. Rather than being either healthy or ill, individuals progress along this continuum from healthiness to illness and back again.

What is the Relationship between Mind and Body?

The twentieth century has seen a challenge to the traditional separation of mind and body suggested by the dualistic model of health and illness, with an increasing focus on an interaction between the mind and the body. This shift in perspective is reflected in the development of a holistic or a whole-person approach to health. Health psychology therefore maintains that the mind and body interact.

However, although this represents a departure from the traditional medical perspective, in that these two entities are seen as influencing each other, they are still categorized as separate – the existence of two different terms (the mind and the body) suggests a degree of separation and “interaction” can only occur between distinct structures.

What is the role of Psychology in Health and Illness?

Health psychology regards psychological factors not only as possible consequences of illness, but as contributing to its etiology as well.

The Biopsychosocial Perspective

We can see elements of the Biopsychosocial perspective in the story about Sara told in our first lecture. A possible biological contribution to her becoming overweight might be her inheritance, since her mother is overweight and was heavy as a child. Psychological factors are probably important, as shown in Sara’s behavior—she eats too much fattening food and gets little exercise. And, although the story did not describe how social factors play a role in her weight problem, they are probably there—for example, if she imitates her mothers dietary and exercise habits. But we did see social factors relating to Sara’s condition when her schoolmates taunted her and her parents expressed concern and urged her to join a recreation program. Let’s look at the elements of the Biopsychosocial model in more detail.

The Role of Biological Factors

What is included in the term biological factors? This term includes the genetic materials and processes by which we inherit characteristics from our parents. It also includes aspects of the person’s physiological functioning—for example, whether the body

(1) contains structural detects, such as a malformed heart valve or some damage in the brain, that impair the operation of these organs;

(2) responds effectively in protecting itself, such as by fighting infection; and

(3) overreacts sometimes in the protective function, as happens in many allergic reactions to harmless substances, such as pollen or dust.

The body is made up of enormously complex physical systems. For instance, it has organs, bones, and nerves, and these are composed of tissues, which in turn consist of cells, molecules, and atoms. The efficient, effective, and healthful functioning of these systems depends on the way these components operate and interact with each other.

The Role of Psychological Factors

When we discussed the role of lifestyle and personality in health and illness earlier, we were describing behavior and mental processes, in other words, psychological factors. Behavior and mental processes are the focus of psychology, and they involve cognition, emotion, and motivation.

Cognition is a mental activity that encompasses perceiving, learning, remembering, thinking, interpreting, believing, and problem solving. How do these cognitive Factors affect health and illness? Suppose, for instance, you strongly believe, life is not worth living without the things I enjoy.” If you enjoy smoking cigarettes, would you quit reducing your risk of getting cancer or heart disease? Probably not. Or suppose you develop a pain in your abdomen and you remember having had a similar symptom in the past that disappeared in a couple of days. Would you seek treatment? Again, probably not. These examples are just two of the countless ways cognition plays a role in health and illness.

Emotion is a subjective feeling that affects and is affected by our thoughts, behavior, and physiology. Some emotions are positive or pleasant, such as joy and affection, and others are negative, such as anger, fear, and sadness. Emotions relate to health and illness in many ways. For Instance, people whose emotions are relatively positive are less disease-prone and more likely to take good care of their health and to recover quickly from an illness than are people whose emotions are relatively negative. We considered these relationships when we discussed the role of personality in illness. Emotions can also be important in people’s decisions about seeking treatment. People who are frightened of doctors and dentists may avoid getting the health care they need.

Motivation is a term applied to explanations of why people behave the way they do—why they start some activity, choose its direction, and persist in it. A person who is motivated to feel and look better might begin an exercise program, choose the goals to be reached, and stick with it. Many people are motivated to do what important people in their lives want them to do. Parents who quit smoking because their children plead with them to protect their health are an example.

The Role of Social Factors

People live in a social world. We have relationships with individual people—an acquaintance, a friend, or a family member—and with groups. As we interact with people, we affect them and they affect us. But our social world is larger than just the people we know or meet, and it contains levels of social spheres, such as our community and our family, and each level affects the others.

On a fairly broad level, our society affects the health of individuals by promoting certain values of our culture. One of these values is that being fit and healthy is good. Often the mass media—television, newspapers, and so on—reflect these values by setting good examples and urging us to eat well, not to use drugs, and not to drink and drive. The mass media can do much to promote health. But sometimes these media encourage unhealthful behavior, such as when we observe celebrities on television smoking cigarettes or drinking excessively. Can individuals affect society’s values? Yes. As part of the society, we can affect its values by writing our opinions to the mass media, selecting which television shows and movies to watch, and buying healthful products, for example.

Our community consists of individuals who live fairly near one another, such as in the same town or county. These people influence and are influenced by each other. This influence can be seen in the research finding that communities differ in the extent to which their members practice certain health-related behaviors, such as smoking cigarettes or consuming fatty diets. These differences may develop in many ways. For instance, adolescents often start smoking cigarettes and drinking alcohol as a result of peer pressure. Sometimes simply observing other teenagers engaged in these behaviors can encourage adolescents to smoke and drink. They want very much to be popular and to look cool or tough to others in their community. These examples involve clear and powerful motivational elements that are social in nature.

The closest and most continuous social relation ships for most people occur within the family, which can include non-relatives who live together and share a strong emotional bond. As individuals grow and develop in early childhood, the family has an especially strong influence. Children learn many health-related behaviors, attitudes, and beliefs from their parents, brothers, and sisters. For instance, parents can set good examples for healthful behavior by using seat belts, serving and eating nutritious meals, exercising, not smoking, and so on.

Families can also encourage children to perform healthful behaviors and praise them when they do. Moreover, as we have said, an individual can influence the larger social unit. A family may stop eating certain nutritious foods, such as sprouts or fish, because one of the children has a tantrum when these foods are served.

The role of biological, psychological, and social factors in health and illness is not hard to see. What is more difficult to understand is how health is affected by the interplay of these components, as the Biopsychosocial model proposes.

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