The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization, 2022, Stilwell et al

ABSTRACT

Introduction
There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel’s original BPSM. These deviations have led to confusion and suboptimal patient care.

Objectives
1) To review Engel’s original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an “enactive” modernization of the BPSM.

Methods
Critical narrative review in the context of musculoskeletal pain.

Results
The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a “humanistic” interpretation based on person- and relationship-centredness. The second version is a “causation” interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations.

Conclusion
The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an “enactive-BPS approach” to musculoskeletal care aligns with Engel’s vision yet addresses theoretical limitations and may mitigate misapplications.

Paywall, https://www.tandfonline.com/doi/full/10.1080/09593985.2022.2080130

 

Of course, the irony is that

is not true for us.

 

Yes, for us the BPS model has been ‘psychologised’, where even someone like Prof Crawley, who claims to regard ME as a biomedical condition explicitly believes that the underlying physiology can be corrected by talking therapies and behavioural change (and that anyone who disagrees with her understanding must have a psychiatric condition or be actively malicious).

 

This is basically identical to mouth-foaming over what the "founding fathers intended in writing the constitution in the late 18th century" that is crippling American politics. Or splits in a religion over a new text by some dude who liked to hammer papers on doors.

I have no idea how it makes sense to think that adhering to "the original vision" is worth any effort at all. Old ideas are almost always wrong about everything, good ideas always get many revisions and changes, sometimes completely reversing the original idea while keeping some of the basic facts.

The BPS model's main weakness, besides being completely vague, is that it explicitly rejects facts, has made everything about fuzzy maths from fake number being interpreted as generically as possible being representative of a whole person, which is absurd. So any revision is pointless since there is a fundamental rejection of reality and substituting with alternative explanations instead of actual facts. It's a hollow shape, nothing more.

 

the arrows got reversed, basically to make it look like the patient is the one causing all the nonsense of financial, social (e.g. bigotry, lack of support) - I still don't get how changing the way the 'victim' thinks ever conned anyone as a solution.

I can't find any way of getting more than the abstract for this one - which is a problem if that is the only way it is available, given that the one thing that is right is that the Engel model go Bas****ised, but I have a horrid feeling that those in the HCP who tend to think they can speak on these things only make it worse and base it not on 'pschology' or 'logic' but their own often warped trained-in/recruited to belief system. But hey, this might be the one in a million that's 'not that bad' etc.

God knows what his 'ised' terms mean - I'm guessing his mates know as it is some sort of 'in-code' usage - but it could go either way based on just looking at the words within the words

 

The first author runs a physio training company that pushes exercise as a basis for whatever.

This is just peudophilosophical drivel.

I doubt that an article in this sort of tortured language will make much difference. On the other hand it looks a if there is a widespread campaign going on to 'regroup' under the BP banner both to sell more physio and psychotherapy and to sidestep the criticism from NICE etc. 'BPS may have wandered off the straight and narrow but re-invented it can return to the true path.'

'Enactive' is a buzzword in philosophy of mind that will serve the same obfuscatory role as 'holistic'.

I see the more pernicious path forward as the 'multidisciplinary, patient centred, individualised' line, which effectively allows the BPS practitioners to claim they know best and that criticisms are simplistic. I have had recent correspondence with Charles Shepherd indicating just how deeply ingrained the BPS ideology is and the dangers of the NICE guidelines compromising in some places.

 

A few court cases might get the system on track - if you treat someone then, if harm occurs/is alleged, you need to be able to explain why you treated the patient and that there was some (defensible) logic to the treatment. E.g. the inability to explain the basis for a treatment involving "incremental increase in activity" might result in costs to the provider (NIH defending claims for damages) and the provider clamping down on its staff providing unevidenced treatments.