The Biopsychosocial Model of Health

Abstract This chapter provides an update to the biopsychosocial model of health first described in detail by George Engel in the 1970s. He argued that abnormalities in biological mechanisms are not enough to explain the subjective experience of “illness” or to account for the variation in treatment response, course, and ultimate outcome of many conditions. Instead, psychological and social factors come to the fore, determining when and how people come to view themselves as unwell, influencing whether and when they enter and remain in treatment, as well as many other key aspects of the illness experience. The model has been heavily criticized in the light of advances in the understanding of biological mechanisms; opponents claim that the model is little more than a distraction from the real understanding of disease, or a convenient compromise to resolve ideological conflicts with the champions of psychology and sociology. What is missing, they imply, is any evidence for a truly causal psychosocial mechanism that interacts with biology at a fundamental level. In this light, the recent theoretical work of Derek Bolton and Gillett provides a way forward. This model and supporting evidence are described.