The Status of the “Biopsychosocial” Model in Health Psychology: Towards an Integrated Approach and a Critique of Cultural Conceptions

Abstract

The current status of the “Biopsychosocial” Model in health psychology is contested and arguably exists in a stage of infancy. Despite original goals, medical researchers have developed theoretical and empirical integrations across bio-psycho-social domains only to a limited extent. This review article addresses this issue by making connections across research findings in health psychology and related medical fields in order to strengthen the associations across bio-psycho-social domains. In particular, research in sociosomatics, neuroplasticity and psychosocial genomics are introduced and explored. The role of “culture” as conceived of within the Biopsychosocial Model is also ambiguous and somewhat problematic. Arthur Klienman’s conceptions of culture as what is at stake for individuals in their local social and moral worlds is adopted to offer a critique of previous perspectives of culture and question its role amidst bio-psycho-social domains. Overall, a multilevel integrative or ‘holistic’ perspective is advanced to strengthen the Biopsychosocial Model for use within health psychology and biomedical research. In the end, some clinical implications are discussed.

Share and Cite:

A. Hatala, "The Status of the “Biopsychosocial” Model in Health Psychology: Towards an Integrated Approach and a Critique of Cultural Conceptions," Open Journal of Medical Psychology, Vol. 1 No. 4, 2012, pp. 51-62. doi: 10.4236/ojmp.2012.14009.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] American Psychological Association (APA) Task Force on Health Research, “Contributions of Psychology to Health Research: Patterns, Problems, and Potentials,” American Psychologist, Vol. 31, 1976, pp. 263-274. doi:10.1037/0003-066X.31.4.263
[2] J. D. Matarazzo, “Behavioral Health’s Challenge to Academic, Scientific, and Professional Psychology,” American Psychologist, Vol. 37, 1982, pp. 1-14. doi:10.1037/0003-066X.37.1.1
[3] J. D. Matarazzo, “Behavioral Health and Behavioral Medicine: Frontiers for a New Health Psychology,” American Psychologist, Vol. 35, No. 9, 1980, pp. 807-817. doi:10.1037/0003-066X.35.9.807
[4] S. Taylor, “The Progress and Prospects of Health Psychology: Tasks of a Maturing Discipline,” Health Psychology, Vol. 6, No. 1, 1987, pp. 73-87. doi:10.1037/0278-6133.6.1.73
[5] S. Weiss, “Health Psychology: The Time Is Now,” Health Psychology, Vol. 1, No. 1, 1982, pp. 81-91. doi:10.1037/0278-6133.1.1.81
[6] A. Baum and D. Poslunsny, “Health Psychology: Mapping Biobehavioral Contributions to Health and Illness,” Annual Review of Psychology, Vol. 50, 1999, pp. 137-163. doi:10.1146/annurev.psych.50.1.137
[7] K. Salomon, A. Clift, M. Karlsdottir and J. Rottenberg, “Major Depressive Disorder Is Associated with Attenuated Cardiovascular Reactivity and Impaired Recovery among Those Free of Cardiovascular Disease,” Health Psychology, Vol. 28, No. 2, 2009, pp. 157-165. doi:10.1037/a0013001
[8] P. M. Nicassio, B. E. Meyerowitz and R. D. Kerns, “The Future of Health Psychology Interventions,” Health Psychology, Vol. 23, No. 2, pp. 132-137. doi:10.1037/0278-6133.23.2.132
[9] S. Michie and C. Abraham, “Health Psychology in Practice,” Blackwell, London, 2004. doi:10.1002/9780470694008
[10] M. Brydon-Miller, “Using Participatory Action Research to Address Community Health Issues,” In M. Murray (Eds.), Critical Health Psychology, Palgrave, Macmillian, 2000, pp. 187-202.
[11] E. Estacio, “Going Beyond the Rhetoric: The Movement of Critical Health Psychology towards Social Action,” Journal of Health Psychology, Vol. 11, No. 3, 2006, pp. 347-350. doi:10.1177/1359105306063301
[12] D. F. Marks, M. Murray, B. Evans, C, Willig, C. Woodall and C. Sykes, “Health Psychology: Theory, Research and Practice,” 2nd Edition, Thousand Oaks, California, 2005.
[13] M. Murray and B. Poland, “Health Psychology and Social Action,” Journal of Health Psychology, Vol. 11, No. 3, 2006, pp. 379-384. doi:10.1177/1359105306063308
[14] S. Kazarian and D. Evans, “Health Psychology and Culture: Embracing the 21st Century,” In S. Kazarian and D. Evans, Eds., Handbook of Cultural Health Psychology, Academic Press, Waltham, 2001, pp. 3-43.
[15] L. J. Kirmayer, “The Cultural Diversity of Healing: Meaning, Metaphor and Mechanism,” British Medical Bulletin, Vol. 69, 2004, pp. 33-48. doi:10.1093/bmb/ldh006
[16] K. Chamberlain and M. Murray, “Critical Health Psychology,” In D. Fox, I. Prilleltensky and S. Austins, Eds., 2nd Edition, Critical Psychology: An Introduction, Sage, London, 2009, pp. 144-158.
[17] D. F. Marks, “Freedom, Responsibility and Power: Contrasting Approaches to Health Psychology,” Journal of Health Psychology, Vol. 7, No. 1, 2002, pp. 5-19. doi:10.1177/1359105302007001062
[18] M. Murray, “Conclusion: Towards a Critical Health Psychology,” In M. Murray, Ed., Critical Health Psychology, Palgrave, Macmillian, 2004, pp. 222-229.
[19] I. Prilleltensky and O. Prilleltensky, “Towards a Critical Health Psychology,” Journal of health psychology, Vol. 8, No. 2, 2003, pp. 197-210. doi:10.1177/1359105303008002659
[20] M. Kemeny, “Psychneuroimmunology,” In H. Friedman and R. Cohen, Eds., “Foundations of Health Psychology,” Oxford University Press, Oxford, 2007, pp. 92-116.
[21] O. Ray, “The Revolutionary Health Science of Psychoendoneuroimmunology: A New Paradigm for Understanding Health and Treating Illness,” In R. Yehuda and B. McEwen, Eds., Biobehavioral Stress Response: Protective and Damaging Effects: Annals of the New York Academy of Sciences, Vol. 1032, New York Academy of Sciences, New York, 2004, pp. 35-51.
[22] J. Cacioppo and G. Berntson, “The Brain, Homeostasis, and Health: Balancing the Demands of the Internal and External Milieu,” In H. Friedman and R. Cohen, Eds., Foundations of Health Psychology, Oxford University Press, Oxford, 2007, pp. 73-91.
[23] G. Miller, E. Chen and S. Cole, “Health Psychology: Developing Biologically Plausible Models Linking the Social World and Physical health,” Annual Review of Psychology, Vol. 60, 2009, pp. 501-524. doi:10.1146/annurev.psych.60.110707.163551
[24] E. Sarafino, “Health Psychology: Biopsychosocial Interactions,” 5th Edition, Wiley, Hoboken, 2006.
[25] G. L. Engel, “The Need for a New Medical Model: A Challenge for Biomedicine,” Science, Vol. 96, 1977, pp. 129-136. doi:10.1126/science.847460
[26] N. S. Ghaemi, “The Rise and Fall of the Biopsychosocal Model,” The British Journal of Psychiatry, Vol. 195, 2009, pp. 3-4. doi:10.1192/bjp.bp.109.063859
[27] H. R. Tavakoli, “A Closer Evaluation of Current Methods in Psychiatric Assessments: A Challenge for the Biopsychosocial Model,” Psychiatry, Vol. 6 No. 2, 2009, pp. 25-30.
[28] R. Adler, “Engel’s Biopsychosocial Model Is Still Relevant Today,” Journal of Psychosomatic Research, Vol. 67, 2009, pp. 607-611. doi:10.1016/j.jpsychores.2009.08.008
[29] G. E. Schwartz, “Testing the Biopsychosocial Model: The Ultimate Challenge Facing Behavioral Medicine?” Journal of Consulting and Clinical Psychology, Vol. 50, pp. 1040-1053. doi:10.1037/0022-006X.50.6.1040
[30] S. E. Taylor, “Health Psychology: The Science and the Field,” American Psychologist, Vol. 45, 1990, pp. 40-50. doi:10.1037/0003-066X.45.1.40
[31] R. J. Gatchel, “Comorbidity of Chronic Pain and Mental Health: The Biopsychosocial Perspective,” American Psychologist, Vol. 59, 2004, pp. 792-794. doi:10.1037/0003-066X.59.8.795
[32] R. J. Gatchel, Y. Bo Pang, M. L. Peters, P. Fuchs and D. C. Turk, “The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions,” Psychological Bulletin, Vol. 133, No. 4, 2007, pp. 581-624. doi:10.1037/0033-2909.133.4.581
[33] H. Leventhal, J. Weinman, E. Leventhal and A. Phillips, “Health Psychology: The Search for Pathways between Behavior and Health,” Annual Review of Psychology, Vol. 59, 2008, pp. 477-505. doi:10.1146/annurev.psych.59.103006.093643
[34] N. McLaren, “A Critical Review of the Biopsychosocial Model,” The Australian and New Zealand Journal of Psychiatry, Vol. 32, No. 1, 1998, pp. 86-96. doi:10.3109/00048679809062712
[35] N. McLaren, “Humanizing Psychiatry,” Loving Healing Press, Michigan, 2009.
[36] H. Stam, “A Sounds Mind in a Sound Body: A Critical Historical Analysis of Health Psychology,” In M. Murray, Ed., Critical Health Psychology, Macmillian, Palgrave, 2004, pp. 15-30.
[37] Y. Alonso, “The Biopsychosocial Model in Medical Research: The Evolution of the Health Concept over the Last Two Decades,” Patient Education and Counseling, Vol. 53, 2003, pp. 239-244. doi:10.1016/S0738-3991(03)00146-0
[38] H. Stam, “Theorizing Health and Illness: Functionalism, Subjectivity and Reflexivity,” Journal of Health Psychology, Vol. 5, 2000, 273-284. doi:10.1177/135910530000500309
[39] N. McLaren, “The Myth of the Biopsychosocial Model,” Australian and New Zealand Journal of Psychiatry, Vol. 36, No. 5, 2002, pp. 701-703. doi:10.1046/j.1440-1614.2002.01076.x
[40] D. Pilgrim, “The Biopsychosocial Model in Anglo-American Psychiatry: Past, Present and Future,” Journal of Mental Health, Vol. 11, No. 6, 2002, pp. 585-559. doi:10.1080/09638230020023930
[41] J. Suls, and A. Rothman, “Evolution of the Biopsychosocial Model: Prospects and Challenges for Health Psychology,” Health Psychology, Vol. 23, No. 2, 2004, pp. 119-125. doi:10.1037/0278-6133.23.2.119
[42] M. MacLachlan, “Culture, Empowerment and Health,” In M. Murray, Eds., Critical Health Psychology, Macmillian, Palgrave, 2004, pp. 101-118.
[43] D. F. Marks, “Health Psychology in Context,” Journal of Health Psychology, Vol. 1, 1996, pp. 7-21. doi:10.1177/135910539600100102
[44] N. Cooper, C. Stevenson and G. Hale, “The Biopsychosocial Model,” In N. Cooper, C. Stevenson and G. Hale, Eds., Integrating Perspectives on Health, Open University Press, Buckingham, 1996, pp. 1-17,.
[45] J. T. Cacioppo, G. C. Berntson, J. F. Sheridan and M. K. McClintock, “Multilevel Integrative Analyses of Human Behavior: Social Neuroscience and the Complementing Nature of Social and Biological Approaches,” Psychological Bulletin, Vol. 126, No. 6, 2000, pp. 829-843. doi:10.1037/0033-2909.126.6.829
[46] D. Ciccheti and D. Tucker, “Development and self-Regulatory Structures of the Mind,” Development and Psychopathology, Vol. 6, 1994, pp. 533-549. doi:10.1017/S0954579400004673
[47] J. W. Curtis and D. Cicchetti “Moving Research on Resilience into the 21st Century: Theoretical and Methodological Considerations in Examining the Biological Contributors to Resilience,” Development and Psychopathology, Vol. 15, 2003, pp. 773-810. doi:10.1017/S0954579403000373
[48] A. R. Hatala, “Resilience and Healing Amidst Depressive Experiences: An Emerging Four-Factor Model from Emic/Etic Perspectives,” Journal of Spirituality in Mental Health, Vol. 13, No. 1, 2011, pp. 27-51. doi:10.1080/19349637.2011.547135
[49] T. Bogg and B. W. Roberts, “Conscientiousness and Health-Related Behaviors: A Meta-Analysis of the Leading Behavioral Contributors to Mortality,” Psychological Bulletin, Vol. 130, No. 6, 2004, pp. 887-919. doi:10.1037/0033-2909.130.6.887
[50] S. Cohen, D. Janicki-Deverts and G. E. Miller, “Psychological Stress and Disease,” Journal of the American Medical Association, Vol. 298, 2007, pp. 1685-1687. doi:10.1001/jama.298.14.1685
[51] S. Lyubormirsky, K. L. Tucker, N. D. Caldwell and K. Berg, “When Poor Ruminators Are Poor Problem Solvers: Clues from the Phenomenology of Dysphoric Rumination,” Journal of Personality and Social Psychology, Vol. 77, 1999, pp. 1041-1060. doi:10.1037/0022-3514.77.5.1041
[52] S. Brownlee, E. A. Leventhal and H. Leventhal, “Regulation, Self-Regulation and Construction of the Self in Maintaining Physical Health,” In M. Boekartz, P. R. Pintrich and M. Zeidner, Eds., Handbook of Self-Regulation, Academic Press, Waltham, 2000, pp. 369-416.
[53] R. C. Ziegelstein, J. A. Fauerbach, S. S. Stevens, J. Romanelli, D. P. Richter and D. E. Bush, “Patients with Depression Are Less Likely to Follow Recommendations to Reduce Cardiac Risk during Recovery from a Myocardial Infarction,” Archive International Medicine, Vol. 160, 2000, pp. 1818-1823. doi:10.1001/archinte.160.12.1818
[54] K. Dracup, D. K. Moser, M. Eisenberg, H. Meischke, A. A. Alonzo and A. Braslow, “Causes of Delay in Seeking Treatment for Heart Attack Symptoms,” Social Science Medicine, Vol. 40, No. 3, 1995, pp. 379-392. doi:10.1016/0277-9536(94)00278-2
[55] U. Bronfenbrenner, “The Ecology of Human Development,” Harvard University Press, Cambridge, 1979.
[56] K. Chamberlain and M. Murray, “Critical Health Psychology,” In D. Fox, I. Prilleltensky and S. Austins, Eds., Critical Psychology: An Introduction, 2nd Edition, Sage, London, 2009, pp. 144-158.
[57] J. H. Jenkins and N. Cofresi, “The Sociosomatic Course of Depression and Trauma: A Cultural Analysis of Suffering and Resilience in the Life of a Puerto Rican Woman,” Psychosomatic Medicine, Vol. 60, No. 4, 1998, pp. 439-447.
[58] L. J. Kirmayer and A. Young, “Culture and Somatization: Clinical, Epidemiological, and Ethnographic Perspectives,” Psychosomatic Medicine, Vol. 60, No. 4, 1998, pp. 420-430.
[59] N. Ware, “Sociosomatics and Illness Course in Chronic Fatigue Syndrome,” Psychosomatic Medicine, Vol. 60, No. 4, 1998, pp. 394-401.
[60] A. Klienman, “Social Origins of Distress and Disease: Depression, Neurasthemia and Pain in Modern China,” Yale University Press, New Haven, 1986.
[61] A. Klienman, “A Writing at the Margin: Discourse between Anthropology and Medicine,” University of California Press, Berkeley, 1995.
[62] A. Kleinman and A. E. Becker, “‘Sociosomatics’: The Contributions of Anthropology to Psychosomatic Medicine,” Psychosomatic Medicine, Vol. 60, No. 4, 1998, pp. 389-393.
[63] S. E. Taylor, R. L. Repetti and T. Seeman, “Health Psychology: What Is an Unhealthy Environment and How Does It Get under the Skin?” Annual Review of Psychology, Vol. 48, 1997, pp. 411-447. doi:10.1146/annurev.psych.48.1.411
[64] B. R. Jasny and D. Kennedy, “The Human Genome [Special Issue],” Science, Vol. 291, 2001, p. 5507.
[65] P. S. Eriksson, E. Perfilieva, T. Bjork-Eriksson, A. M. Alborn, C. Nordborg, D. A. Peterson and F. H. Gage, “Neurogenesis in the Adult Human Hippocampus,” Nature Medicine, Vol. 4, 1998, pp. 1313-1317. doi:10.1038/3305
[66] B. Draganski, C. Gaser, V. Busch, G. Schuierer, U. Bogdahn and A. May, “Neuroplasticity: Changes in Grey Matter Induced by Training,” Nature, Vol. 427, 2004, pp. 311-312. doi:10.1038/427311a
[67] E. A. Maguire, D. G. Gadian, S. Johnsrude, C. D. Good, J. Ashburner, R. S. Frackowiak and C. D. Frith, “Navigation-Related Structural Change in the Hippocampi of Taxi Drivers,” Proceedings of the National Academy of Sciences of the United States of America, Vol. 97, 2000, pp. 4398-4403. doi:10.1073/pnas.070039597
[68] A. Pascual-Leone, A. Amedi, F. Fregni and L. B. Merabet, “The Plastic Human Brain Cortex,” Reviews of Neuroscience, Vol. 28, 2005, pp. 377-401. doi:10.1146/annurev.neuro.27.070203.144216
[69] E. Taub, G. Uswatte, D. K. King, D. Morris, J. E. Crago and A. Chatterjee, “A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity after Stroke,” Stroke, Vol. 37, 2006, pp. 1045-1049. doi:10.1161/01.STR.0000206463.66461.97
[70] J. L. McGaugh, “Memory—A Century of Consolidation,” Science, Vol. 287, 2000, pp. 248-251. doi:10.1126/science.287.5451.248
[71] D. Centonze, A. Siracusano, P. Calabresi and G. Bernardi, “Removing Pathogenic Memories: A Neurobiology of Psychotherapy,” Molecular Neurobiology, Vol. 32, 2005, pp. 123-132. doi:10.1385/MN:32:2:123
[72] R. Plomin and J. Crabbe, “DNA,” Psychological Bulletin, Vol. 126, No. 6, 2000, pp. 806-828. doi:10.1037/0033-2909.126.6.806
[73] R. Plomin, M. J. Owen and P. McGuffin, “The Genetic Basis of Complex Human Behaviors,” Science, Vol. 264, 1994, pp. 1733-1739. doi:10.1126/science.8209254
[74] R. Pinaud, “Experience-Dependent Immediate Early Gene Expression in the Adult Central Nervous System: Evidence from Enriched-Environment Studies,” International Forum of Neuroscience, Vol. 114, 2004, pp. 321-333.
[75] L. Eisenberg, “Social Psychiatry and the Human Genome: Contextualizing Heritability,” British Journal of Psychiatry, Vol. 14, 2004, pp. 101-103. doi:10.1192/bjp.184.2.101
[76] E. L. Rossi, “Psychosocial Genomics: Gene Expression, Neurogenesis, and Human Experience in Mind-Body Medicine,” Advances in Mind-Body Medicine, Vol. 18, No. 2, 2002, pp. 22-30.
[77] S. Cohen, “Social Relationships and Health,” American Psychology, Vol. 59, 2004, pp. 676-684. doi:10.1037/0003-066X.59.8.676
[78] S. Taylor, “Social Support,” In H. Friedman and R. Cohen, Eds., Foundations of Health Psychology, Oxford University Press, Oxford, 2007, pp. 145-171.
[79] S. Cohen and T. Wills, “Stress, Social Support, and the Buffering Hypothesis,” Psychological Bulletin, Vol. 98, 1985, pp. 310-357. doi:10.1037/0033-2909.98.2.310
[80] J. T. Cacioppo, L. C. Hawkley, G. G. Berntson, J. M. Ernst, A. C. Gibbs and R. Stickgold, “Lonely Days Invade the Nights: Social Modulation of Sleep Efficiency,” Psychological Science, Vol. 13, 2002, pp. 384-387. doi:10.1111/j.0956-7976.2002.00469.x
[81] S. W. Cole, L. C. Hawkley, J. M. Arevalo, C. S. Sung, R. M. Rose and J. T. Cacioppo, “Social Regulation of Gene Expression: Inflammation and the Human Transcriptional Response to Loneliness,” Genome Biololgy, Vol. 8, 2007, pp. 189-194. doi:10.1186/gb-2007-8-9-r189
[82] E. L. Garland and M. O. Howard, “Neüroplasticity, Psychosocial Genomics, and the biopsychosocial Paradigm in the 21st Century,” Health & Social Work, Vol. 34, No. 3, 2009, pp. 191-199. doi:10.1093/hsw/34.3.191
[83] A. R. Hatala, “Frankl & Freud: Friend or Foe? Towards Cultural & Developmental Perspectives of Theoretical Ideologies,” Psychology & Society, Vol. 3, No. 1, 2010, pp. 1-25.
[84] J. Valsiner, “Cultural Psychology Today: Innovations and Oversights,” Culture & Psychology, Vol. 15, No. 1, 2009, pp. 5-39. doi:10.1177/1354067X08101427
[85] D. Matsumoto, “Culture and Cultural Worldviews: Do Verbal Descriptions about Culture Reflect Anything Other than Verbal Descriptions of Culture?” Culture & Psychology, Vol. 12, No. 1, 2006, pp. 33-62. doi:10.1177/1354067X06061592
[86] E. B. Tylor, “Primitive Culture,” Murray, London, 1871.
[87] A. L. Kroeber and C. Kluckhohn, “Culture: A critical view of concepts and definitions,” Harvard University Press, Cambridge, 1952.
[88] G. A. Barnett and M. Lee, “Issues in Intercultural Communication Research,” In W. B. Gudykunst and B. Mody, Eds., Handbook of International and Intercultural Communication, 2nd Edition, Sage, Thousand Oaks, 2002, pp. 275-290.
[89] R. Keesing, “Theories of Culture Revisited,” Canberra Anthropology, Vol. 13, No. 2, 1990, pp. 46-60. doi:10.1080/03149099009508482
[90] R. L. Piedmont and M. M. Leach, “Cross-Cultural Generalizability of the Spiritual Transcendence Scale in India,” American Behavioral Scientist, Vol. 45, No. 12, 2002, pp. 1888-1901. doi:10.1177/0002764202045012011
[91] WHOQOL SRPB Group, “A Cross-Cultural Study of Spirituality, Religion, and Personal Beliefs as Components of Quality of Life,” Social Science & Medicine, Vol. 62, 2006, pp. 1486-1497. doi:10.1016/j.socscimed.2005.08.001
[92] D. Hollan, “Constructivist Models of Mind, Contemporary Psychoanalysis, and the Development of Culture Theory,” American Anthropologist, Vol. 102, No. 3, 2000, pp. 538-550. doi:10.1525/aa.2000.102.3.538
[93] V. De Munck, “Culture, Self and Meaning,” Waveland, Illinois, 2000.
[94] T. A. Schwandt, “Three Epistemological Stances for Qualitative Inquiry: Interpretavism, Hermeneutics, and Social Constructionism,” In N. K. Denzin and Y. S. Lincoln, Eds., Handbook Of Qualitative Research, 2nd Edition, Sage, Thousand Oaks, 2000, pp. 189-213.
[95] J. G. Ponterotto, “Qualitative Research in Counseling Psychology: A Primer on Research Paradigms and Philosophy of Science,” Journal of Counseling Psychology, Vol. 52, No. 2, 2005, pp. 126-136. doi:10.1037/0022-0167.52.2.126
[96] M. Crotty, “The Foundations of Social Research: Meaning and Perspective in the Research Process,” Sage, Thousand Oaks, 1998.
[97] D. Polkingorne, “Methodology for the Human Sciences: Systems of Inquiry,” University of New York Press, New York, 1983.
[98] D. P. Sulmasy, “A Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life,” The Gerontologist, Vol. 42, No. 3, 2002, pp. 24-33. doi:10.1093/geront/42.suppl_3.24

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.