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Just Talk w/ Karla Carwile, MA, MA, LCPC President

Global Health Initiative

September 23, 2013 | Health Psychology- The Perfect Storm When Biological, Psychological and Social Environments Collide

As most of our Nation swirls with the discussion of healthcare I am hearing a pattern of discussion that makes me smile. Many people simply want to know, "How will my healthcare needs be handled? Will the doctor understand my unique situation?". My excitement for this topic stems from the fact that we are now starting to recognize that the patient should be seen as a whole. Much as the world is a sum of its parts, so too is a patient. I also understand that many simply don't understand the distinction. This week, lets focus on understanding the models of healthcare.

For decades, the biomedical model has predominantly been used by physicians when assessing, diagnosing and treating disease. Rooted in scientific, biological sciences, the biomedical model views disease as a cellular process where the disease is a departure from a normal healthy state. In the Biomedical approach, every disease process can be explained as a pathologic deviation from normal functioning and can be replicated in experimental research. In this model, the mind and body are seen as independent of one another, emphasizing illness over health with respect to the notion that health is the absence of disease. While this model continues to be supported by the medical community, it does not, account for psychological or behavioral aspects of illness. While this model tends to lend itself as more appropriate for experimental or scientific research does not take into account the many variables associated with humanism.

As an individual deeply immersed in the field of health psychology, I spend a lot of my time counseling patients and healthcare professionals alike about the link between the biological, psychological and social aspects of health and wellness. The biopsychosocial approach to healthcare is gaining significant attention these days and rightfully so. Growing trends within the medical field, including, mental and physical health are being combined to create multidisciplinary approaches to address these influences on healthcare. Today, more patients are being seen in their entirety. The environments they live and work, their socioeconomic status, their ethnic and cultural beliefs, sexual orientation, relationship status, their social supports, or lack there of, etc are being deemed as critical pieces of the health and wellness puzzle. These issues and many others are indicators that often spell poor outcomes in patients if not addressed. We have a battle to fight in our own back yard. So for today, do you part. Take into account the importance of your environment. Ask yourself, are you contributing to a productive safe environment for yourself and your family? If so, perfect…lives will be changed because of attitudes like yours. If not…be accountable. Leaving a footprint today will change a life tomorrow…Are you in?

The biomedical approach assumes that all human distress is considered disease. To the contrary, the fundamental assumption of the biopsychosocial model asserts that health and illness are consequences of the interplay of biological, psychological, and social factors where emphasis of the importance of an effective patient-practitioner relationship is critical as patients play an important role in their diagnosis. It is much more difficult to control through experimentation as a direct result of the many variables associated with the psychosocial needs of a patient. Since the biopsychosocial approach asserts that health and illness are caused by multiple factors and produce multiple effects, it is critical to utilize an interdisciplinary team approach in diagnosis which provides focus on all aspects surrounding biological, psychological, and social factors. In doing so, a systems approach allows for evaluation of all facets of a patient’s environment addressing everything from cellular to societal implications of health and wellness.

It is well documented that psychosocial factors such as stress, unemployment, and social isolation, play a significant role in overall health and wellness, especially as it is exacerbated by poverty, which can not account for illness alone. In many cultures, medicine is a highly integrated model where illness is viewed in a holistic sense, despite social standing. Likewise, in cultures where more complimentary medical approaches are utilized, the empathy associated with the doctor patient relationship is utilized as an advocacy tool to support and encourage patient autonomy. Since differences in race, gender, religious belief and even socioeconomic status play a role in the climate of healthcare outcomes, it is difficult to discern how the biomedical approach can account for the differences that exist without taking into account the whole patient; a primary example of this gender.

In society, the number of roles associated with a male are quite limited. While there may be multiple levels associated with responsibility, most male roles revolve around being the provider. Women on the other hand tend to have multiple roles within the family and within society. As the demands of these roles increase women tend to be more susceptible to a number of physical and psychological illnesses including anxiety and depression. As caretakers, many women fail to integrate the importance of self-care rituals into their own lives. As reports of self-care are diminished, women attempt to cope with the daily stressors which can ultimately lead to psychological symptoms manifesting as physical complaints.

Biomedical and biopsychosocial models of treatment have long been noted as competing dogma. As physicians, psychiatrists and psychologists alike search for a better, more effective way to cope with the complexities of today’s patients, it is virtually impossible to ignore the impact that psychosocial factors have on health and wellness. Since health is no longer viewed as a model of disease in need of a cure, but rather as a continuum that accounts for a combination of physiological, psychological, and social factors that impact health and wellness it is only appropriate to practice with a model that addresses each of these independently and in combination. Doing so allows for programs of prevention to be established based on an understanding of the various factors that impact illness. By understanding the patient as a whole, the medical and psychological communities have a chance to come together to establish programs and treatments that act in the best interest of the patient by being proactive rather than reactive.

Karla Carwile

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