Miami Dade College Interactive Biopsychosocial Model Questions Read attached document in order to accurately answer this question.*Future Career: Medicine

Miami Dade College Interactive Biopsychosocial Model Questions Read attached document in order to accurately answer this question.*Future Career: Medicine (Neonatologist)Describe the Interactive Biopsychosocial Model of Health (IBM). What do you see as its strengths and weaknesses? How do you envision integrating it into your future career? In what ways might the model be helpful to you- professionally, in how you view your own experiences, and in how you interact with others? NIH Public Access
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Perspect Biol Med. Author manuscript; available in PMC 2005 September 13.
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Published in final edited form as:
Perspect Biol Med. 2003 ; 46(3 Suppl): S74–S86.
Synthesis of Scientific Disciplines in Pursuit of Health:
the Interactive Biopsychosocial Model
Stacy Tessler Lindau,*, Edward O. Laumann†, Wendy Levinson‡, and Linda J. Waite†
*Department of Obstetrics and Gynecology and Medicine (Geriatrics), Pritzker School of Medicine,
University of Chicago.
†Department of Sociology, University of Chicago.
‡Department of Internal Medicine, University of Toronto.
Abstract
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Twenty-five years ago, George Engel proposed a challenge to the biomedical model and its limited
view of disease as biologically rooted. Building on Engel’s work, we present the Interactive
Biopsychosocial Model (IBM). The IBM argues for a reorientation in biomedicine where research,
education, and clinical practice: (1) address health in addition to illness; (2) aim to decipher
interrelated biophysical, psychocognitive, and social processes in health and disease, rather than seek
a single root cause; and (3) take into account the social networks of the individual to achieve, maintain,
and maximize health and well-being for individuals, their significant others, and society. Based on
an interdisciplinary collaboration of medical and social scientists, this paper demonstrates the
application of the IBM to understanding and generating hypotheses about the longitudinal
relationship between sexuality and health, and sexuality and chronic illness (diabetes mellitus) at
older ages. The model provides a dynamic, dyadic, framework for building scientific hypotheses
about the etiologies and consequences of health, well-being, and disease throughout the life course.
The dominant model of disease today is biomedical, and it leaves no room within its
framework for the social, psychological, and behavioral dimensions of illness. A
biopsychosocial model is proposed that provides a blueprint far research, a framework
for teaching, and a design for action in the real world of health care.
—George Engel (1977)
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The time for this larger synthesis of scientific disciplines in pursuit of human health
has come.
—National Research Council (2001)
IN 1977, GEORGE ENGEL, professor of psychiatry and medicine at the University of Rochester,
proposed integrating psychological and social variables into prevailing models of disease, and
created what he called the “biopsychosocial model.” Now, a quarter of a century later, the
National Research Council and the Institute of Medicine (IOM) are urging scientists to integrate
psychosocial and behavioral processes into attempts to decipher pathways of disease, health,
and well-being, and to include biological measures in population-based social science research
(Finch, Vaupel, and Kinsella 2001: IOM 2001 ; National Research Council 2001). This call
for integrative approaches is driven in large measure by the increasing prominence of
psychosocial issues in clinical practice and education. For example, physicians are often
Correspondence: Stacy Tessler Lindau, Department of Obstetrics and Gynecology, Pritzker School of Medicine. University of Chicago,
5841 South Maryland Ave, MC2050, Chicago, IL 60637. Email: slindau@babies bsd.uchicago.edu..
The research for this paper was funded in part by the Robert Wood Johnson Clinical Scholars Program, the National Institute on Aging
through the Center on Aging at the University of Chicago, and the National Opinion Research Center (NORC).
Lindau et al.
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confronted with patients who cannot afford regular checkups or medicines. Older patients
experiencing cognitive decline may have difficulty adhering to directions on prescriptions, and
patients who have spouses in poor health may be less able to manage their own chronic illness.
To promote the cross-disciplinary collaboration necessary for a new approach to the science
of health, we need a unified vision of health and disease.
In this paper, we examine the theoretical foundations and limitations of disease-oriented
models of biomedicine and propose a new model, the Interactive Biopsychosocial Model of
health (IBM). Based on Engel’s work, the IBM argues for a reorientation in biomedicine where
research, education, and clinical practice: (1) address health in addition to illness; (2) aim to
decipher interrelated biophysical, psychocognitive, and social processes in health and disease,
rather than seek a single root cause; and (3) take into account the social networks of the
individual to achieve, maintain, and maximize health and well-being for individuals, their
significant others, and society. The model provides a dynamic framework for building scientific
hypotheses about the etiologies and consequences of health, well-being, and disease throughout
the life course, and it can be used, in addition, as a teaching tool at the bedside or in the
classroom.
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This work arises from our research in aging and human sexuality, where the greatest scientific
and clinical challenge is as often understanding and maintaining health as it is rectifying
dysfunction or disease. Additionally, research in sexuality demands a shift in focus from the
individual to the dyad or larger social network. The IBM emerged as a framework for scientific
investigation about health and life quality over the life course, when it became apparent that
we would need to incorporate psychocognitive and psychosocial variables into traditional
disease-oriented models. Below we describe this new model and apply it to the relationship
between aging and sexuality.
Historical Context
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In proposing the biopsychosocial model of disease, Engel (1977) issued a “challenge for
biomedicine” to reconsider the prevailing biomedical model of disease. The biomedical model,
still the dominant framework guiding medical research, education, and clinical care today,
focuses on the root cause of disease, where disease is “fully accounted for by deviations from
the norm of measurable biological (somatic) variables.” Engel offered, instead, a model
designed to “provide a basis for understanding determinants of disease and arriving at rational
treatment patterns of health care.” Engel’s groundbreaking work grew out of his clinical
psychiatric practice, where he found himself often frustrated by “adherence to a model no
longer adequate for the scientific tasks and social responsibilities” of medicine. He aimed,
therefore, to change the profession’s approach to the causes of illness and disease, and to widen
the framework for the clinical approach to illness, in general, and mental illness in particular.
General systems theory was emerging in both the biological and social sciences during the
formative years of Engel’s work, and Engel used this theory to lay the groundwork for his
biopsychosocial model (Buckley 1967; Henry and Stephens 1977; Parsons 1951; von
Bertalanffy 1968), Engel claimed that “systems theory holds that all levels of organization are
linked to each other in a hierarchical relationship so that change in one affects change in the
others,” and that this theory treats “sets of related events collectively as systems manifesting
functions and properties on the specific level of the whole.” Engel believed that applying
systems theory to medicine could reconcile two fundamental tensions implicit in the traditional
biomedical model: mind-body dualism, the belief that the mental and the somatic operate
independently; and the reductionist-holistic dichotomy, in which complex phenomena are
derived from a single physical aberration from the norm rather than from an integrated system
where changes interact at various levels.
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While Engel’s work consciously shifted away from the primacy of biological etiology, he
remained focused on the individual as the embodiment of a disease and its consequences. The
treatment of disease was still framed in the clinical setting and conceptualized primarily as an
interaction between physician and patient. Social variables, only superficially described,
became simply additional characteristics of the diseased individual to be considered in the
pursuit of the root cause.
Although Engel’s work is widely cited in the medical literature (a citation search in the Web
of Science Citation Index found 1,419 citations of the Science article as of June 2002), the
model remains largely on the margins of biomedicine, particularly as a framework for scientific
investigation. Engel’s model has failed to replace the biomedical model for two main reasons:
clinicians and scientists continue to emphasize the progression from etiology to disease to the
exclusion of health as an outcome; and professional and research institutions are often
structurally rooted in the biomedical model. These factors motivate us to reconsider the utility
of the biopsychosocial model for defining health. In the following sections, we offer a
framework for integrating the social factors that influence health, wellness, illness, and disease
into the clinic or the science of medicine.
Defining and Measuring Health
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Historically, a negative definition of health has prevailed in biomedicine: i.e., health is the
absence of disease, dysfunction, or injury, Epidemiologic measures assess population health
by rates of morbidity and mortality. Both perspectives rely on normative judgments about the
average health of individuals in a given clinical population, community, or society. The primary
appeal of these definitions lies in ease of measurement (e.g., measurement of blood pressure,
or observation of death certificates), but outcomes in these models are limited to physiological
endpoints. Positive outcomes, such as quality of life, well-being, or resilience, typically lie
outside these definitions (IOM 2001).
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The demographic shift in the age of the U.S. population (Kinsella and Velkoff 2001), combined
with medical advances resulting in increased longevity, provides additional impetus for a new,
more holistic approach to aging, health, and adult human development. Longer, healthier life
in industrialized nations requires a shift in focus from treatment to prevention, from reduction
of mortality caused by acute illness to reduction of morbidity due to chronic illness, and from
the management of external threats (injury, infection) to the modification of internal threats
(negative behaviors such as smoking, poor diet, or sedentary lifestyle). Concepts of successful
and productive aging incorporate a positive behavioral orientation and a perspective that
encompasses the entire life course (Bass and Caro 2001; Rowe and Kahn 1997). Building on
these concepts, the IOM (1998, 2001) proposes “positive health,” defined as “a healthy body;
high-quality personal relationships; a sense of purpose in life; self-regarded mastery of life’s
tasks; and resilience to stress, trauma, and change.”
Health is a “multi-attribute concept” that depends upon a complex network of physical,
biological, environmental, economic, social, cultural, and possibly metaphysical (spiritual and
moral) factors (Cutler and Richardson 1998; Thorsen and Harris 2002). The World Health
Organization (1958) defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” On a population level, the definition
of health evolves with social change: “The rising expectations of the past 150 years have led
to a shift away from viewing health in terms of survival, through a phase of defining it in terms
of freedom from disease, onward to an emphasis on an individual’s ability to perform daily
activities, and more recently to an emphasis on positive themes of happiness, social and
emotional well-being, and quality of life,” as well as equity and justice in the distribution of
health care across societies (Labonte 2000; McDowell and Newell 1996; Morreim 2000; Riley
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1987). For the individual, healthiness changes over the life course and involves not only an
internal assessment of health and well-being against one’s own prior health and personal
expectations, but also an external view of one’s health in reference to others and to societal
expectations.
Recent debate over the concept of health in the United States has also resulted from health care
reform and associated efforts to define coverage and medical necessity or to identify the
purpose of health care (Morreim 2000). The debate involves both ethical and philosophical
issues and cannot be separated from the pressures of technology or the varying political and
economic perspectives of many stakeholders, including, of course, the profession of medicine
itself. Labonte (2000), writing for the Hastings Center on the health promotion/disease
prevention movement, compares three health “explanatory systems”—medical, behavioral,
and socio-environmental—in terms of the compatibility of each with either a libertarian or
social justice theory of the common good. This perspective is directly relevant to disputes
within the profession of medicine over where responsibility for health lies. Engel recognized
this tension 25 years ago in his description of a Rockefeller Foundation seminar on the concept
of health, where participants argued that only the organic elements of disease constituted “real”
disease and that “the physician should not be saddled with problems that have arisen from the
abdication of the theologian and the philosopher” (Engel 1977).
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The Interactive Biopsychosocial Model (IBM)
The IBM is based on the IOM concept of health and the following core principles: (1) an
orientation toward health rather than illness; (2) analytic capacity for outcomes of health or
illness; (3) parity among the three domains of capital (biophysical, psychocognitive, and social)
as factors in an individuals health endowment; (4) bi-directional causality and feedback (i.e..
biopsychosocial capital influences the health endowment and the endowment influences access
to and use of biopsychosocial resources); (5) primacy of the multi-actor frame (i.e., analysis
of individual health or illness embedded in the partner, the family, or other explicitly defined
social networks); (6) interdependency of social and life course dynamics; and (7) the potential
of capital inputs to act as assets or liabilities. (See Figure 1.)
Creating and using a dynamic, health-centered model requires an explicit vocabulary to
describe and explain the relationships between its core components: the biophysical,
psychocognitive, and social dimensions of health. We propose a vocabulary that draws on the
socioeconomic concept of capital to specify biophysical, psychocognitive, and social inputs
to health. This vocabulary makes it possible to view the components of health as potential
assets or liabilities and reinforces the dynamic function of the model, because stocks of capital
change over time (O’Rand 2001).
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The application of economic principles to the construction of health models is not new (see,
for example, Becker 1964; Cutler and Richardson 1998; Grossman 1972), Grossman proposes
that “good health” be viewed as a durable capital stock inherited by individuals. The stock
increases with investment and depreciates with age; other factors—such as education, gender,
or ethnicity (“human capital”)—may positively or negatively affect the rate of health
depreciation and efficiency in acquiring good health over time.
Biophysical, psychocognitive, and social capital comprise an individual’s health
endowment. Biophysical capital includes genetic composition, physiology, physique, sensory
function, nourishment, strength, and appearance. Investments in biophysical capital affect an
individual’s physical and physiological capacity for health. Psychocognitive capital includes
intelligence, emotions, well-being, personality attributes, self-esteem and self-efficacy, coping,
and resilience. Investments of this type determine attitudes, interests, and desires related to
health. Social capital refers to the networks of dynamic relationships with others (kin, friends,
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neighbors, physicians) who encourage or sanction certain kinds of behavior, and the social
connectedness and social constraints that result. Investment in social capital through
monitoring, provision and sharing of information, and solidarity (companionship, love,
advocacy) with another determines how much access an individual has to the health endowment
(Sandefur and Laumann 1998). We distinguish “social capital” from the notion of
“sociocultural context,” a frequently invoked but vague term. In this model, “sociocultural
context” is defined as the broader environment of social locations (ethnic, religious, gender,
political, or economic class) and summarizes the set of social expectations and norms as well
as socially determined conditions, such as differential access to scarce resources, that influence
individuals’ health.
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The health endowment of the individual is inextricably linked to socially relevant others
(partner, kin, friend). This mutual dependency for health involves pooling resources, sharing
capital, and negotiating joint resources. In our model, this interdependency allows two healthy
individuals acting jointly to generate a surplus greater than each would generate alone. The
interdependency occurs through repeated small exchanges and specialization of roles within
the relationship, and serves to maximize efficiency and efficacy and to perpetuate the
interdependency. If individuals have disparate levels of health (one with a large health
endowment, the other with a small endowment) or are both in bad health, they may generate
a net surplus or a deficit, depending on their relative health, the trajectory of health prior to
and within the relationship, and the sociocultural context.
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In our model, the health endowment can grow and contract over rime, but at any given time,
it is finite and quantifiable. Expansion of an individual’s health endowment might occur when
an individual begins an intimate partnership. Contraction of the endowment could occur by
acquisition of a disease. Individuals may also shift capital resources from one area to another,
to stabilize the health endowment and to compensate for specific health challenges. Because
the endowment is finite at any given time, investment in biophysical capital, for example
through exercise (often a solo activity such as running or biking), could draw resources away
from psychocognitive or social capital, although the exchange need not be one-to-one.
Alternatively, where physical capital is lowered, social capital may be used to compensate
(e.g., a woman with a hip fracture calls on her partner to assist her with dressing and bathing).
Alzheimer’s disease may erode psychocognitive capital, but reallocating time or energy to
physical capital or social support may lessen the impact of dementia on overall health,
Reallocation of resources to maximize health depends on an individual’s connections to
significant others and the constraints imposed by these connections. Partnerships characterized
by mutually high social capital are the most e…
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