Biopsychosocial Conditions of Health and Disease

Abstract

This chapter continues from the previous chapter on themes in biopsychosocial conditions of health and disease, picking up some core questions familiar in the theory and philosophy of medicine. We argue that the concepts and boundaries of health and disease are themselves biopsychosocial. Controversies about whether such-and-such a condition is or is not a medical matter, as opposed to difference or lifestyle choice, the consequences of being which involve benefits such as access to healthcare and/or harms such as stigma, and the terms in which such debates are conducted-are all thoroughly biopsychosocial-political. Core defining features of illness-activity limitations, pain and distresslikewise involve our psychology and social life as well as our biology. On the theme of causation, we endorse scientific method as the route to identifying causal mechanisms, note the major role of chronic stress in models of causal mechanisms linking psychosocial factors with biological damage, and spell out that chronic stress is a quintessential biopsychosocial concept. We consider the Research Domain Criteria (RDoC) proposed recently by the N.I.M.H. as a framework for research in mental health as an illustration of a biopsychosocial research framework, potentially extendable to cover physical health and biomedicine. Physical and mental health conditions are brought together in the new biopsychosocial model rather than being axiomatically separate-as they were in the old context of reductionism and dualism.

How Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Progresses: The Natural History of ME/CFS

“…The degree of reversibility of various physiological abnormalities is likely to decrease with time, and some permanent functional, and even structural, damage may occur consequently. This is likely caused by either the persistence or frequent reactivation of the initial stressor ( 87 , 133 ), an accumulation of insults, a continuing dysfunctional host-response, or the effects of the numerous psychosocial risk factors that influence disease development and progression ( 134 ), or a combination of all of these.…”

“…Although our framework focuses on the underlying biological mechanisms that may be at play in the development and progression of ME/CFS, it is important to acknowledge the impact of psychosocial and behavioral aspects in the progression of chronic diseases. Stressors such as stressful life events, low satisfaction with social and medical support, and excessive use of coping mechanisms, have been shown to contribute to the neuroendocrine and immune responses by acting through complex pathways that ultimately affect health and health outcomes ( 134 – 136 ).…”

Emotional and Behavioral Trajectories of 2 to 9 Years Old Children Born to Opioid-Dependent Mothers

“…Most importantly, almost no studies have examined the complex interplay of prenatal exposures, social background, and postnatal environmental factors that may heighten or mitigate risk for infants exposed to opioids. We propose that a biopsychosocial framework may help incorporate the multimodal and multidisciplinary theoretical aspects mentioned above (Bolton & Gillett, 2019 ). Conradt, Crowell, and Lester ( 2018 ), for instance, have proposed an integrated model of how different factors such as socioeconomic status, maternal psychopathology and nutrition may alter opioid-exposed infants’ development prenatally, and they propose that effects could extend into the postnatal period, for instance via mother-infant interactions (Conradt et al, 2018 ).…”

Contextual risk and psychosocial profiles of opioid-using mothers: A mixed-methods study

“… 33 Biopsychosocial frameworks offer multidisciplinary explanatory mechanisms by integrating theories from the social and medical sciences. 34 Understanding the contributions of different biological and environmental factors such as genetics, in-utero exposures, and postnatal environmental experiences to individuals’ life-course trajectories is critical in informing intervention efforts. For instance, biopsychosocial studies propose that biological compared with environmental adversities may affect development via different pathways, 35 – 37 and effects may be additive or interactive.…”