The aim of this assignment is to critically evaluate the biopsychosocial perspectives and influences on the health and well being of a patient, a 38 year old gentleman who is dependent on alcohol.

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The aim of this assignment is to critically evaluate the biopsychosocial perspectives and influences on the health and well being of a patient, a 38 year old gentleman who is dependent on alcohol.  This is in order to gain an insight into the pathophysiological effects of alcohol and the psychology and social influences on his drinking.  To comply with the NMC The Code (2008) on confidentiality I have called my patient Jack.


The World Health Organisation (WHO) (1948) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease’,
(World Health Organisation, WHO, 1946, pg 100).  This definition which was believed to be forward for its time is recognised as being an achievement with the ‘absence of disease’ (Taylor 2006), however the definition has also been criticised for being unrealistic as Godlee (2011) states, this definition explains health to be flawless, which would be impossible to achieve for the majority of the population, making us all unhealthy with Huber (2011) agreeing stating that giving the rise of chronic diseases the word ‘complete’ would leave most people unhealthy’.  Canguilhem (1991) believed the definition from the WHO was considered to be an idealistic goal rather than a realistic one as he states that health could not be defined as a state, but seen as a process of continuous adjustment to the changing demands of living and of the changing meanings we give to life.  This definition appears to be more holistic and realistic towards an individual’s lifestyle taking into account their psychological and social aspects of life.  The Department of Health, (DoH, 2007, pg 41) defined health as “a subjective state of being healthy, happy, contended, comfortable and satisfied with one’s quality of life.”  These definitions are more holistic to an individual and appear to support the biopsychosocial model, whereas The WHO, (1946), definition appears to use the biomedical model as a framework as it defined health as the ‘absence of disease’ which has a less holistic approach but this could be because the biopsychosocial model had not been developed until 1977.


In the late eighteenth century knowledge and perception of health and illness had began to expand due to development of science and advancement of technology and that these developments have influenced the perception of health and illness according to the biomedical approach, (Rana and Upton, 2009).
  The biomedical model was developed in the late 19th century and proposed that ‘illnesses are caused by physical entities or attributes, such as viruses and bacteria, injuries or biochemical imbalances (Engel, 1977: Schwartz 1982).  This implies that the biomedical model does not take into account physical and psychological factors and are seen as a ‘process that contributes to ill health by limiting the ability of an individual to function’ (Lundstrom 2008).  Physiology is viewed as the most important cause for illness and injury, a biomedical viewpoint tends to ignore the influence of patients minds or mental states, their social relationships and cultural background (Snooks 2009).  Brannon et al (2000) states that ‘this biomedical model defines health exclusively in terms of the absence of disease and has been the predominant view in medicine’.  In this respect the biomedical model has led to great advances in medicine as it only focused on the biology of illness.  Sanderson (2004) stated ‘ the biomedical model has led to a number of benefits for our society including advancements in immunology, public health, pathology and surgery but increasing evidence is showing that biological factors alone cannot account for health’.  Engel (1977) agreed that the mainstream of biomedical research had fostered important advances (cited in Borrell-Carrio et al, 2004) whilst Snooks (2009) stated ‘advances have been made using this model, it is most successful against infectious agents but less successful against lifestyle related diseases such as heart disease and some cancers’.  Wade and Halligan (2004), ‘declare the biomedical model is inadequate and outdated in today’s society and indicates that the failure of the biomedical model originates from three features within the main principle of the model.  It suggests that all disease has a single cause and that ill health is due to a physiological state and once the disease has been corrected the individual will automatically become healthy’.  This model then presents with a limitation which is having only one cause or contributing factor for any health problem and could overlook other issues (Snooks 2009).  The biomedical model is not personal and individualised and does not provide a holistic approach which is why some issues may have been missed.  Kenworthy et al (2006) stated that ‘this model worked well with routine, traditional physical care but made no allowances for the individuality of the patient’.  Physicians assumed that diagnosis was a relatively objective process and that reducing the pain that the patient was feeling simply meant removing the cause of the illness (Reeves, 2005).  Engel, (1977), believed Individual lifestyles may impact on health such as; psychological, behavioral, cultural and social influences and that illness could not be treated by just considering biological factors alone.  Individual health needs were not being met, due to clinician’s perceptions of illness and lack of interest in patient’s individual health.  Brannon et al (2010) states that when chronic diseases started to replace infectious diseases as a leading cause of death, questions began to arise about the adequacy of the biomedical model.    

In 1977 Engel proposed an expansion of the biomedical model as he believed that other factors could be linked to illness.  Engel (1977) stated that ‘biological, psychological and social factors are all important determinants of health and illness and that a medical diagnosis should always consider the interaction of biological, psychological and social factors to assess health and make recommendations for treatment thus bringing together the biopsychosocial model of health.  The meaning of biopsychosocial can be broken down into three categories, biological, psychological and sociology.  Ogden (2007) states that:

‘The bio contributing factors include genetics, viruses, bacteria and structural defects.  The psycho aspects were described in terms of cognition, emotions and behaviours and the social aspect were described in social norms of behaviour, pressures to change behaviour, social values of health, social class and ethnicity’ (Ogden, 2007; pg 4)

Bringing them together, the biopsychosocial model as a whole is an amalgamation of looking at the body, mind and social aspects which can contribute to health and illness and not just looking at illness but contributory factors which could have influenced a person’s illness (Ogden 2007).  The model subsequently focuses not on disease but on health in general, highlighting psycho-social influences that may impact greatly on the recovery of an individual with an illness, (Lackhan, 2006).  The biopsychosocial model accepts the role of the biological factors but as one of the factors and not as a whole (Allen 1998).  A study conducted by White and Grenyer (1999) using the biopsychosocial approach on end stage renal disease, the experience of dialysis on patients and their partners,  for this study forty four participants (22 patients and their partners) were interviewed by way of open ended questions and multiple themes were identified from verbatim transcripts.  White and Greyner (1999) identified that this study gives an insight on the negative impact dialysis can have on a couples lifestyle but as a couple were more supportive and positive towards each other.  From a biopsychosocial point results indicate that nurses need to recognise and acknowledge the impact a chronic illness and its treatment can have on patients and their families.  The strength of this study would be the in depth interviews and asking open ended questions allowing participants to voice their own views, a weakness of the study would be participants were mainly home dialysis patients, a different perspective may have shown for patients who had to travel to hospital for their dialysis.

Despite widespread interest in and support for the biopsychosocial model, many physicians admit to having difficulty applying it in practice (Smith, 2002), Herman (1989) argued that perhaps the biopsychosocial model is “simply too good for present standards of practice” (Herman, 1989, p. 107) and that the emotional burden of employing the full biopsychosocial framework in caring for each and every patient would be overwhelming.   Weston (2005) states that another key feature of the patient-centered model is the concept of “being realistic.”  The amount of time and energy physicians can give to an individual patient on any single occasion is often severely limited.  Due to high demands clinics are often full with allotted times, over-running on appointments can cause a knock on effect with other appointments, with the biopsychosocial model not being used to its full potential.   Hepworth, and Cushman, (2005), believe that the biopsychosocial model has not fully replaced the biomedical model in practice as it is thought to take too long to apply to a patients’ situation resulting in the model not being applied effectively.  For a patient centred approach and for the model to be used effectively also depends on the patient and their outcome of what they want from an appointment, if a patient does not want to discuss more personal details then physicians will not push patients to discuss issues further.  (Watson 2005).

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The biomedical model and biopsychosocial model of health have some similarities as they both aspire to treat the illness to aid recovery but their approach and understanding of disease and illness differs.  The biomedical model looks at the disease but the biopsychosocial model incorporates social and psychological factors.    Taylor (2006) states ‘that the biomedical model is a reductionist model as it reduces  illness to low level processes rather than recognising the role of social and psychological processes’. Walker et al (2004) states the biopsychosocial model is seen as a more comprehensive approach to investigating and treating conditions such ...

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