The biopsychosocial model of health and illness was proposed in a 1977 article in the journal Science by George L. Engel.1 He was responding to tendencies in psychiatry which he saw as unproductive: either restricting it to an exclusive medical model, or else, removing it from medicine entirely. He proposed a different approach, a model that incorporated aspects of biology, psychology, and social factors into the experiences of illness and health: the biopsychosocial (BPS) model. In the decades since he proposed it, the BPS model has expanded to encompass much more than just psychiatry. It is a useful abstraction for understanding all aspects of being embodied, not just one or two specialist dimensions of the experience.
(By “abstraction,” we mean finding and focusing on the qualities that different individuals share, or that they have in common. For example, two people may look very different from each other, and as humans, they in turn may look very different from cats, dogs, horses, elephants, and bears. Yet humans, cats, dogs, horses, elephants, and bears all share the experience of delivering live young instead of laying eggs, and feeding those young with milk from their mothers, an abstraction captured in the term “mammal.”)
The BPS model can be visualized as a triangle, with each side representing one of the three aspects of the model. The left line represents purely biological aspects of illness or health, depending on what you are applying to the model. It could be a norovirus if you’re looking at policies when a client or massage therapist should cancel a spa appointment due to illness, or for how long surfaces should be disinfected, or it could be genetic markers for genes that are associated with long healthy lives.
The right line represents purely psychological aspects of illness and health—the worry or shame that an individual feels over a particular condition, or the role of mindfulness in promoting health and healthy lifestyles.
The bottom line
represents the purely
social aspects of illness
or health—how societies
decide which diseases or patients they approve of versus the ones that they look down on, or the role of social support in promoting health and quality of life.
As we all know, very few things in life belong to purely one aspect or another. Life is more complex than that, and most aspects of living experience are multifactorial. So in this model, the sides aren’t the most interesting part; it’s the interactions among them that take place inside the triangle where the really interesting analyses exist.
Having just seen the movie Bohemian Rhapsody, I find the example of Freddie Mercury’s final illness comes to mind as illustrative of all three parts of the BPS model. Freddie Mercury, lead singer of the British rock group Queen, died of AIDS in 1991. The anti-retroviral drugs that have extended how long people can live with AIDS and have made symptoms manageable came along later in the 1990s, so they were too late for him. Despite lots of rumors and speculation in the press about his health, he concealed his illness until releasing a press statement about it one day before his death. So biologically, the virus HIV interacted with the social fear and stigma attached to the disease in the early 1990s, and these interactions influenced Mercury’s psychological state, which led to his decision to conceal his illness for as long as possible, even lying
about it and denying that he had the disease.
It’s important not to be mistakenly hyperspecific about what this model means. It’s not a vending machine or a computer program that delivers a specific output in response to exactly the right inputs. Instead, it represents in a very general way factors that interact in clients’ or patients’ experience of illness or health, and that experience—even though the biological, psychological, and social factors may be very similar—can be totally different for two different individuals.
Also, aspects can change over time. For example, anti-retroviral drugs have made it possible to delay the inevitable biological death sentence that AIDS used to be, and communities don’t run children with AIDS out of town, like Kokomo, Indiana, did with Ryan White in 1987. This model does not quantify the exact contributions that each factor brings to the experience, and it doesn’t predict how one individual or another will feel or behave. Instead, it’s useful as a guideline of what to remember as we work with our clients. We’re interested in taking this abstraction, and putting it into real-life practice in a spa environment.
20 massage & fitness magazine