Perspective: Biomedicine—Menace or Straw Man? Reexamining the Biopsychosocial Argument

Abstract

More than 30 years after its introduction by George Engel, the biopsychosocial model exerts a major influence on the rhetoric and intentions of academic medicine. However, advocates of the model do not feel that it has significantly altered the practice of physicians, whom they portray as tightly clinging to a biomedical approach. Using Engel's original writings, those of his successors, and the work of medical historians, the author asserts that biopsychosocial advocates use clinical biomedicine as a straw man to support their argument. Proceeding from that point, the author attempts to demonstrate that excessive focus on this straw man has inhibited critique of the biopsychosocial model and the argument supporting it. He identifies failures to address clinical medicine's functional specificity and relationship with broader social trends as contributors to the biopsychosocial model's stagnation. The author proposes that it would be more productive to view clinical biomedicine as an epiphenomenon of the human traits of overenthusiasm and the need for security. Recognizing that medicine is made up of heterogeneous tasks, he observes that no one model, including the biopsychosocial model, tends to all of them. The biopsychosocial model would be best served by shedding the biomedical straw man and modifying its ambitions.

Sociomateriality in medical practice and learning: attuning to what matters

“…The argument is not about creating or recreating dichotomies between art and science, biomedicine and patient understanding, or evidence‐based practice and everyday improvisation. As Kontos has shown, to pitch ‘reductionist’ biomedicine against ‘patient‐centred’ empathic biosocial medicine is to create a false war and shut down richer possibilities. The current issues of medical practice and learning outlined here point instead to an interest in examining the interplay among these diverse forces, and the enactments of practice they produce together.…”

Psychiatric Polypharmacy: A Clinical Approach Based on Etiology and Differential Diagnosis

“…A less obvious influence on polypharmacy has its source in today's biopsychosocial, patient-centered education of medical students, who are encouraged to see all suffering as medically relevant and thus subject to treatment. 31 Unfortunately, the presence of a problem does not mean that a psychiatric solution exists. For some physicians, doing nothing is difficult because it runs counter to the myth of the physician as powerful healer.…”

Fighting the Good Fight: Responsibility and Rationale in the Confrontation of Patients

“…12 Clinical medicine's goals can entail secondary attention to just about any aspect of the patient's life. 13 However, such attention is paid in the interest of dealing with disease, and material unconnected to this purpose is "none of the doctor's business." 12 While this patient's behavior may be boorish, it does not stand in the way of his care, and confrontation is not indicated.…”