Healthcare Hubris - blogs on the biopsychosocial model by Joanne Hunt

Structural dimensions of the biopsychosocial model. Series of blogs by Healthcare Hubris

A new series of 4 blogs by Healthcare Hubris.

Structural dimensions of the biopsychosocial model:

1) Beginnings:
https://www.healthcarehubris.com/post/structural-dimensions-of-the-biopsychosocial-model-beginnings

2) Constructs and propaganda:
https://www.healthcarehubris.com/po...opsychosocial-model-constructs-and-propaganda

3) Academic-state-corporate nexus:
https://www.healthcarehubris.com/po...hosocial-model-academic-state-corporate-nexus

4) Downstream effects of upstream corruption:
https://www.healthcarehubris.com/po...del-downstream-effects-of-upstream-corruption

Healthcare Hubris writes anonymously but describes themselves as a former therapist.

I’ve not managed to read the blogs yet but I shared them privately with a couple of forum members to check for errors of fact prior to publication at the author’s request.

 

I have not yet got very far into this , and I don't want to be picky, but there seems to be some uncertainty in respect of Waddell's formative role. The issue of lower back pain being treated with a BPS model including exercise is specifically addressed in 1985 by Arthur Cott of McMaster in

The disease-illness distinction: a model for effective and practical integration of behavioural and medical sciences

published in Illness behavior - a multidiciplinary model (1986)

edited by Sean McHugh T Michael Vallis

For some reason I have not yet been able to discover I have been unable to find any attribution to this. Mayou attended the conference. He might have pointed this out, to save embarrassment. It would have been a friendly gesture.

 

Ack, i find that very fine font used in the blog impossible to read, i get about 3 sentences in & my eyes start to really hurt. The MEA have used it on their new site as well so i wonder if it is good for some people, but it's inaccessible to me I'm afraid.

@Robert 1973 would you please, (in your own time of course no hurry) ask Healthcare Hubris if they would mind if I copied it into a word document just for me to read so i can make it accessible.

 

Have so far just read the first blog. It is a very important topic and covers much history that I was not aware of.

However, though agreeing with what is said, did the blog present enough evidence to draw such strong conclusions. Though I agree cost reduction and profit is the best fit for explaining why things developed as they did, do we need more evidence to unambiguously assert that this was a main motivating factor for the individuals involved.

Those involved, if challenged, are likely to say that they are motivated by the best interests of the patients/clients and any money saved is purely coincidental. I personally suspect for some academics and clinicians there was a wish to fit in with the political zeitgeist which favoured discrete marketable care packages suitable for administration by a technician rather than an autonomous professional, that ultimately could be rolled out on a large scale. So for the individual researcher or clinician professional advancement was the prime motivation rather than the cost cutting sought by their political masters.

I think we see this in the current ME/CFS related research out put from Bristol University. The cost saving aspect requires time limited input, with failure to be cured after the set number of weeks being the patient/client’s fault for not trying hard enough. Some of Bristol’s research is aimed at extending their current methods to new client groups such as ever younger children with ME/CFS or people with Long Covid, but relevant here is their attempts to create new modules as potential add ons for those that have not been cured. Tacitly admitting failure and doing more of the same, is ultimately adding to cost.

 

I managed to read the font but found it more tiring and consequently harder to understand the content. @JemPD, if you do get permission to create a more readable format would it be work asking if any files could be posted here or added as comments to the original blogs?

[added I struggled with the font and the pages seem very white and bright]

 

Its not the size of the font, i can enlarge it till it's huge, & adjust brightness on my laptop, but i still cant read more than a few sentences w/o eye strain. It's the width of the lines used to make the letters.

If you look at the width of the lines used to form the font they are half the thickness of the standard font here on S4, which i find very easy to read provided i get the screen brightness at the right intensity.
Its like when you bold a letter - it makes the font lines wider - wider, so they appear so much darker (which would also be unpleasant unless it was grey, but the font in the blog goes the opposite way & makes the lines narrower/finer finer. So it's the fine lettering in conjunction with the shape - which on the blog is much harder to read than the courier font i'm using here.

 

Like others I am having difficulty reading these papers and will need to look again. That is not a criticism. You know what we are like. However the work is very interesting .

In view of the "origins in Waddell's thinking" in paper 4, I have done further research and have modified my views somewhat. The limited understanding of Waddell's early work may be due to the form in which the 1987 paper is published. The 1987 paper in Spine to which the link leads is unobtainable except in PDF for a fee. The citations are not shown separately. This later paper

Waddell, Gordon; Pilowsky, Issy; Bond, Michael R. (1989). Clinical assessment and interpretation of abnormal illness behaviour in low back pain. , 39(1), 41–53. doi:10.1016/0304-3959(89)90174-7

does provide citations which show early papers by Waddell in 1980, 82 and 84. However he does not refer to the papers by Nachemson 1979 and 82 and Hall 1980 cited by Cott. What Waddell does do is give references to nine papers by Pilowsky in addition to the paper in which the references are included. This is interesting because Pilowsky was cited in the 1988 David Wessely Pelosi paper and the impression was given then that Pilowsky would show the way forward. They never referred to him again. There can be no doubt of the close links of Waddell to the illness behavior model discussed at the Adelaide and Toronto conferences. He also cites papers by Turk, Mechanic, Segal and Mayou who participated. His collaborator Pilowsky seems to have been the organiser of the Adelaide conference.

It does therefore seem odd that we are given to believe that a biopsychosocial model was created by Waddell and Aylward when all they had to do was read McHugh and Vallis and Cott and the other contributors to the 1985 conference. It seems hard to believe that group knowledge of the US/Canadian model could have been accidentally misplaced so quickly.

For those who do not know him, before decamping to Adelaide, Pilowsky was at the Maudsley and Sheffield. I sometimes wonder whether his influence in Sheffield is ongoing.

It does seem that we still only have a partial understanding of the BPS movement.

 

Is that reference to "more than 80 people per month" figure referring to suicides alone or deaths from all causes?

Just a heads-up... In that last sentence of the quote the word "than" is missing before the number 80.

 

I passed on comments above and a link to this thread to the author by email.

This is their helpful reply:

As well as adjusting the font, I think it’s an excellent idea to do an easier read version – not just for people with ME but also for healthy lay readers.

Many thanks to Healthcare Hubris for all their work on this. I’m looking forward to welcoming them to the forum in due course.

 

What a lovely response I cant wait to read it

Me too!

 

In the meantime, if you're using a computer, the article pastes very easily into a word processor document. I do this with most longish articles so that I can go through and break up the paragraphs into a manageable length before I attempt to read the text, but of course you can also change the typeface very easily.

Some articles have really weird web formatting that looks a bit of a mess when you copy and paste, but this one was fine.

ETA: Just realised I might be able to upload it here - will have a go. Haven't touched the paragraph spacing, as it's a very individual thing.

(Note from mods - the author has agreed to this copying. Please consider clicking through to the blog even if you read them here, in order to give the site traffic.)

 

#2: Constructs and propaganda

 

#3: Academic-state-corporate nexus

 

#4: Downstream effects of upstream corruption

 

Much easier to ready. Especially as I will need to read each several times to fully assimilate.

 

I'm eager to read these, but I'm having difficulties as described by others. I've failed to get them copied into a text file that I can manipulate.

Many thanks to Healthcare Hubris for this important work!

 

I had no trouble dragging the text to a Word document which is easy to read. Can't wait to get started.

 

If you use Firefox browser, you can easily toggle to "reader view" which gives you some options for making webpages more readable.

You just need to click on this button near the top:


Options will appear on the left side of the page for changing the font and colour theme. I use the 'dark' theme with sans serif font and the page looks like this:

Spoiler: example page

It strips webpages back to their bare bones and removes a lot of pictures and flashy graphics. It's very handy for reading newspaper articles in particular.