George Engel (1977) challenged health care practitioners regarding their use of the then, widely used, biomedical model. He suggested moving towards a new medical approach. That new approach was the bio-psychosocial approach; named because of the importance of biological, psychological and social factors. Applying the bio-psychosocial approach to health care, requires recognition that good relationships are vital, for providing adequate and fulfilling health care. Self-awareness must be used as a diagnostic, and therapeutic tool, and decisions need to be made regarding what aspects of the biological, psychological and social domains are most important to understanding the service users’ needs; and how best to proceed in promoting optimal health. Multidimensional treatment is a must!! (Suchman et al, 2004).
The Bio-psychosocial model has a very good basis for a using the holistic approach.
Brom (cited in The Open University, 2010, p. 45), tells us that the principles underlying holism are, that every person is an integrated system, made up of many parts. He tells us that moving any one of those parts can be detrimental to the person. He also tells us the human system is an open system, and is in contact with outside environment; and inwardly, with spiritual dimensions. Brom concludes with telling us that the human system is not only biochemical; but it is multidimensional, and he says that there are many causes for diseases and no single cause can ever be found and/or singled out.
However, Seedhouse, cited in The Open University (2010) argues this case and tells us “A whole cannot be fully understood, even if all its parts are understood separately”. Therefore, from that perspective, we can see how by not knowing the ‘whole’; just because we know all the ‘parts’, shows that service users, and their intrapersonal boundaries are not solid or static. This is exactly like the boundaries between the dimensions of the holistic model. They are permeable, and they are forever changing. Changes can depend on what is going on within that person’s life that that particular time, and can change at any given moment.
Perspectives that can be used to treat illness are the medical model, the biomedical model, the psychological model, the bio psychological, the social model and the bio-psychosocial model. There are also religious, humanistic and transpersonal models that can be considered.
For example; a service user presents themselves at their local accident & emergency department with a broken arm, or a broken leg. The model that would be used in this instance would be that of the medical model. What this would entail is a doctor would prescribe medication for the pain that they are feeling because of the broken limb, and treatment will be given to ensure the bone will heal correctly, i.e., by means of a plaster cast.
Another example of a different model could be a service user making a routine appointment with their GP. On arrival for that appointment they speak with the GP and find themselves crying uncontrollably and in a highly emotional state. Once the GP has spoken to the patient and having witnessed the patient crying, along with them showing other very clear signs that they are suffering from a great deal of mental distress, the doctor can prescribe medication such as an antidepressant and a short tem tablet to deal with the overwhelming feelings that the service user is having now, and has had for the last few weeks/months. A couple of weeks later the service user feels they are still not at an acceptable level of healing they could go back to the GP and the GP could make a referral to a therapist and/or a psychiatrist, depending on how ill the service user is. With the doctor having had prescribed medication and referring the patient on for therapy, such as Cognitive Behavioural Therapy (CBT), the approach that is used in this case would be the bio psychological approach.
Diagnosis of a mental illness attempts to make sense of a range of human problems from a medical angle. Medical professionals who have experience of mental distress can be an advantage when working with those who may be having the same difficulties. It is much easier for them to be able to empathise with the service user and they will also have a better understanding of what they are going through. However, it has also been noted that sometimes powerful or distressing experiences can prevent people from working with other who have been through similar situations (The Open University, 2010, p 71)
Once diagnosed/labelled with a mental illness, issues surrounding stigma and discrimination can arise. Sayce (cited in The Open University, 2010, p.127) explains how people who have been diagnosed as being mental ill are seen to be dangerous, irresponsible and completely lacking in morals. This is often the case seen in films and through the media in general. Most of the time those suffering from mental distress are portrayed in a bad way, and we hardly ever get to see/hear from the perspective of someone who is actually suffering from mental illness.
Stigma and labelling can take many different forms. (Goffman 1968) speaks of three types of stigmatised identity. These are Abominations of the Body, i.e. Physical deformities, Blemishes of individual character, i.e. Alcoholism or homosexuality, and Tribal, i.e. religion or social class. The first two types are directly related to users of health and social care. Goffman refers to non-stigmatised people as ‘normal’; therefore, having a stigmatised identity can have many implications and leaves the person wide open to labelled insults such as lunatic or madman. This in turn, then leads on to the person being stereotyped, or having generalised assumptions made about their character. (Goffman, cited in K217, Chapter 5, p.10)
Even though the holistic model considers the whole person and believes that all parts are interconnected, some medical professionals still think that physical and mental illness should be treated as individual illnesses. This can be very challenging however, because of the amount of specially trained health care professionals within the health care field. Specialists such as psychologists, biologists and doctors have their own approach to health care and firmly believe that their method, is the correct method, so for them, finding a balance, or trying to move to holism can be extremely difficult.
Another problem that may arise for health care professionals when trying to treat someone who has a mental illness could come from the service user themselves. There could be many scenarios that would not fit in with the normal protocol of treatment with using the holistic approach. Examples would be (a) the user might just want the medication with no therapy, or (b) they could want therapy but no drugs. Or (c) could be that the user doesn’t want their details passed on to anyone else – for whatever reason that may be. I know from personal experience that many people are paranoid (even if they haven’t been diagnosed with a mental illness!!!!) with regards to seeing doctors, etc., and divulging personal information about them. This could be to do with other people knowing their business and talking about them, behind their backs to others, or it could be someone maybe passing on information regarding them. People worry that their details or private medical issues/file could fall into the ‘wrong hands’. However, I know this is not the case, but not everyone trusts the health service’s confidentiality policy.
Mental well-being can be improved and enhanced by using the holistic model. The holistic model supports the idea that body chemistry, spirituality, diet, nutrition, and other factors can impact the brain in diverse ways (Moore, N.D). This can only be a good thing. Using the holistic approach to help a service user heal has many benefits. It means the service user not only feels better physically, and mentally, but also ensures anything else that may come from their illness will also be dealt with at the same time. It can be a lengthy process to ensure full potential of the holistic model has been reached but it is definitely much better in the long run.
Word Count
1899
References
Aggleton (1990:91) ‘The Symbolic Interactionist perspective of health and illness’, Concepts of health and illness: Section 1. The Sociological Perspective [online] (Accessed 1st December 2013)
Ethomed (2003) Mental Distress Information [Online], Available at (Accessed 26th November 2013)
Goffman, E. (1968) ‘Who are you? Identity in health and social care’, [online] Available at
(Accessed 10th December 2013)
Moore, T. (N.D) The Holistic Approach to Mental Illness [Online], Available at (Accessed 28th November 2013)
Oxford Dictionary (2013) Definition of holism in English [Online], Available at (Accessed 8th December 2013)
Suchman, A. L., Epstein, R. M., Borrel-Carrio, F. (2004) The Bio-psychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry, vol. 2, no. 6, pp. 576-582 [Online], Available at (Accessed 07th December 2013)
The Open University (2010) ‘Learning guide 5: Identity, health and wellbeing’, Activity 5.4: Identity and service users [online], Available at (Accessed 9h December 2013)
The Open University (2010) K272 Challenging Ideas in Mental Health, Block 1: Shifting Boundaries, Milton Keynes, The Open University
The Open University (2010) ‘Unit 1: Boundaries of Explanation’, Milton Keynes, The Open University, p. 23
The Open University (2010) ‘Unit 2: A Holistic Approach: Hilary’s Story’, Milton Keynes, The Open University, p. 44
The Open University (2010) ‘Unit 2: A Holistic Approach: Hilary’s Story’, Milton Keynes, The Open University, p. 45
The Open University (2010) ‘Unit 2: A Holistic Approach: Hilary’s Story’, Milton Keynes, The Open University, p. 109-112
The Open University (2010) ‘Unit 3: Relationship Boundaries’, Milton Keynes, The Open University, p.71
The Open University (2010) ‘Unit 6: Boundaries of Exclusion’, Milton Keynes, The Open University, p.127
Wade, D. (2009) Holistic Healthcare [Online], Available at (Accessed 24th November 2013)
Wise Geek (2013) ‘What is the Biomedical Model?’ [Online], Available at (Accessed 03rd December 2013)
Hi Maurice
Thanks again for the extended extension. I really appreciate your help. I am finished at long last – hip hip hooray!!! I am my own worst critic. Things have been put out and changed, then put back in and changed again – I am a complete nightmare!!!! Hoping it is what you are looking for though. To be honest I found the question to be a little confusion – I felt it didn’t really make sense. Not sure if anyone else had difficulty with it but I did seem to struggle. I am so glad it is completed!!!
Thanks again
Kellie Ann
by
kellsomcnal (student)
