'Outline and asses the biomedical model of health and illness.'

‘Outline and asses the biomedical model of health and illness.’

(60 marks)

The most dominant theory in Modern Western medicine of health and illness, held by many official health practitioners such as doctors, consultants, and surgeons has been labelled the 'biomedical approach' or by some as the 'biomechanical model'. The biomedical model presumes that illness is always due to abnormalities in the body's workings. It is the basis of modern Western medical practice. It works on the theory that if a part of the body goes wrong it should be fixed or replaced, in the same way that a machine would be repaired. It is a reductionist view of illness. This means that it takes the simplest possible cause of the illness and applies the simplest cure. It’s unlike other models such as the social model as that looks to other factors and focuses on them, such as culture, and social aspects.

The biomedical model has an emphasis on an Illness being treated and hopefully cured, for example with the use antibiotics can be use to treat infections. Biomedical treatments often involve the removal of the cause, for example the virus or bacteria. The biomedical model is based on the belief that there is always a cure and the idea that illness is temporary, episodic and a physical condition. Modern biomedicine rests upon two major developments, both of which remain influential to this day. It is first important to consider the Cartesian revolution, after the 17th century French philosophy René Descartes. The Cartesian revolution encouraged the idea that the body and mind are independent or not closely related. In this mechanistic view, the body is perceived to function like a machine, with its individual parts individually treatable, and those that treat them considered engineers. The second conceptual shift that transformed medical thinking was Louis Pasteur's development of 'germ theory' and Robert Koch's further development of it. The Germ theory claimed that in certain (for example infectious) diseases, tiny micro-organisms invisible to the naked eye caused disease, and could be transmitted through coughs, and sneezes and such actions. As Pasteur stated 'these germs that float in the air' are always present. By the 1870s Pasteur was able to demonstrate that germs were the cause rather the product of disease.

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It’s been suggested by Ken Browne that what counts as health and ill health in recent years has been shown to be influenced by society and that some or most illnesses are shown to be socially constructed. This deviates from the biomedical model as it suggest that not just biological factors are the cause of illness. Secondly it’s suggested that just treating the physical factors and symptoms of disease completely ignores the wider social conditions that may have created the symptoms in the first place. As Trowler points out people are now treated as objects to be manipulated by medical technology. Thirdly the biomedical gives doctors and medical practitioners enormous amounts of power as they have a monopoly of control. Also the biomedical has until recently downgraded other alternates treatments, such as acupuncture, herbalism, colour healing and other such treatments; these mainly originate from the eastern medical practices.

Other approaches such as the biopsychosocial model takes a different approach to health and illness. It is not reductionist and attributes ill health to five factors; ecological systems such as the atmosphere, ecosystems and other life forms that we live with, social systems such as our culture and family, psychological systems, like emotion, behaviour, biological systems such as our organs tissues and cells, and lastly physical systems such as molecules and atoms. All of these factors can affect us individually, causing illnesses. These factors can be split into two categories; micro levels, which are physically small factors such as hormones, and macro levels, which are more visible factors such as culture. Taking the example used to illustrate the biomedical model of health, heart disease, may be described by the biopsychosocial model as being caused by; a culture of unhealthy eating or smoking, a family situation where others smoke causing passive smoking, a hereditary disposition to the disease and the patient himself smoking. Ken Browne suggests that putting to much empathises on the social aspects and the expense of the medical model, as medicine has indeed help to contribute to improvements in health, for example childhood inoculation (TB, MNR). Mark Kirby suggests that taken to it limits the biopsychology model suggests that medical science has no objective at all and is totally irrelevant. However realists suggest otherwise. Sheerman argues that the most extreme version of social construction can be criticised on many levels. For example social and economic status, this reflects health care and sanitation, it is socially based though there is biological reasoning for health also. Sheerman is also highly critical of the biomedical model though suggests that as it’s based on scientific procedures it can claim special status; he therefore suggests that we take a new realism approach to health, considering both models, and so illness needs to be treated using science even if socially constructed.

Another explanation is that the biomedical model is based on four core assumptions. The first is that the mind and body can be treated separately. This is better known as mind-body dualism. The second assumption is that the body can be 'repaired like a machine; thus medicine adopts a “mechanical metaphor” presuming that doctors can act like enginners to mend which is dysfunctioning.’ Thirdly Specific aetiology, which refers to the way in which modern medical models assume that a specific cause for a disease, and by targeting the cause the disease can be cured. Finally objective science in which the belief is that there’s a scientific method, which can provide the truth behind the subject under study. Illich’s conflict view also needs to be considered; this suggests that modern medicine can also make people ill. He called this “Iatrogenesis” this means illness caused by medical technology. Examples of this, are harmful clinical items, problems in surgery, side affects such as “thalidomide”; which was given to mothers during pregnancy to stop mourning sickness but cause deformed babies with limbs missing; and, drug addiction.

The functionalist’s perspectives of health and ill health is defined that anyone unable to perform their social role is ill. This, within the functionalist’s perspective, has serious consequences on the functioning of society, for if everyone was sick society would no longer function. It is suggested within this perspective that there is a sub-conscious or conscious desire to be ill. Thus the “sick role” is created, as a functioning role within society. The “sick role” has it’s own rights and responsibilities, which include being exempt from work, and pampering from carers. This model suggests that biological analysis alone is inadequate, and suggests that social factors need to be considered. However this “sick role” is a dangerous creation and could lead to a subculture of “sickness” to which people are drawn to because of the release from responsibilities. However this perspective relies too heavily on the “over-socialised” concept of society. Not everyone accepts and adopts the “sick role”, many would ignore the role and soldier regardless, and for example many disabled people do this.

Overall at this point the evidence presented seems to be inconclusive and unable to support a specific model, within this discussion. Therefore it’s concluded that there needs to be more of a joint model of health and ill health such as the new realists approach, which takes into account both medical and social aspects of health; giving a more well rounded definition of health.

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