Biopsychosocial Medicine: An Integrated Approach to Understanding Illness
http://www.100md.com
《新英格兰医药杂志》
Many physicians may not be aware of internist George Engel's early concept of the biopsychosocial medical model, but a British professor of psychological medicine, Peter White, has tried to remedy that in the book Biopsychosocial Medicine.
Engel proposed that material lesions, life experiences, and current social situations are relevant when it comes to understanding the presentation of medical illness. His vision was to integrate psychosocial issues into medical practice. You may ask, Don't physicians already do that? Perhaps some do, but it was Engel's contention that not enough of what physicians do in their daily practice extends the biomedical model enough actually to examine the broad spectrum of causes of medical disease.
The idea for the book was born out of a two-day conference held at the Novartis Foundation in London in 2002, where an impressive cadre of experts in the fields of biosocial science and medicine were assembled to address the topic. You may ask, Why bother with this psychosocial business? Should we look beyond nerve, muscle, and synapse to what has been regarded for years by physicians as "social work"? White contends in the preface to this interesting and thought-provoking book that there is more to it. There are 14 chapters; 13 culminate with a discussion, creating a sometimes lively debate among the authors of the various chapters.
The goal? To provide a forum for the exchange of ideas in an attempt to answer the question of whether medical care should remain dualistic and not combine mind and body. Or is medicine "traveling up a blind alley," as White says some people contend, by assuming that all illness and disability are caused directly by diseases and their pathologic processes? This book suggests that the biomedical model may not explain much about chronic ill health or the disability associated with it.
The contributors address everything from an overview of Engel's work to a theoretical basis for the interaction between mind and body. Such topics as social and psychological factors in disease medicine, as well as a chapter on the neurobiologic explanation of the relationship between stress and disease, are at the heart of this book. Some chapters are well written and hold the reader's interest, whereas others are a bit dry and awkward, possibly because White decided to edit the chapters minimally so that the spirit of the raw text would be maintained.
Most of the chapters are supported by scientific data, which at times are impressive, such as animal studies that suggest how acute and chronic stress affect the central nervous system and how the human brain does or does not adjust. Anxiety and depression are also addressed, with emphasis on how they can affect preexisting pain and vice versa. The concept of disability is considered in a single chapter that is comprehensive and thought-provoking.
Toward the end of the book, one chapter provides an impressive example of how the biopsychosocial model might work within the context of medical practice. The featured case involves irritable bowel syndrome. The final two chapters discuss the potential barriers to the use of the biopsychosocial model and how medical practitioners can overcome those barriers.
In general, this book does a good job of presenting the biopsychosocial model, by explaining that the model does not refute the science of medicine and by asking that it be integrated with relevant psychological factors, all of which are amenable to examination through appropriate scientific methods — a theme that warrants serious contemplation.
Frank M. Dattilio, Ph.D.
Harvard Medical School
Boston, MA 02115
datt02cip@cs.com(Edited by Peter White. 24)
Engel proposed that material lesions, life experiences, and current social situations are relevant when it comes to understanding the presentation of medical illness. His vision was to integrate psychosocial issues into medical practice. You may ask, Don't physicians already do that? Perhaps some do, but it was Engel's contention that not enough of what physicians do in their daily practice extends the biomedical model enough actually to examine the broad spectrum of causes of medical disease.
The idea for the book was born out of a two-day conference held at the Novartis Foundation in London in 2002, where an impressive cadre of experts in the fields of biosocial science and medicine were assembled to address the topic. You may ask, Why bother with this psychosocial business? Should we look beyond nerve, muscle, and synapse to what has been regarded for years by physicians as "social work"? White contends in the preface to this interesting and thought-provoking book that there is more to it. There are 14 chapters; 13 culminate with a discussion, creating a sometimes lively debate among the authors of the various chapters.
The goal? To provide a forum for the exchange of ideas in an attempt to answer the question of whether medical care should remain dualistic and not combine mind and body. Or is medicine "traveling up a blind alley," as White says some people contend, by assuming that all illness and disability are caused directly by diseases and their pathologic processes? This book suggests that the biomedical model may not explain much about chronic ill health or the disability associated with it.
The contributors address everything from an overview of Engel's work to a theoretical basis for the interaction between mind and body. Such topics as social and psychological factors in disease medicine, as well as a chapter on the neurobiologic explanation of the relationship between stress and disease, are at the heart of this book. Some chapters are well written and hold the reader's interest, whereas others are a bit dry and awkward, possibly because White decided to edit the chapters minimally so that the spirit of the raw text would be maintained.
Most of the chapters are supported by scientific data, which at times are impressive, such as animal studies that suggest how acute and chronic stress affect the central nervous system and how the human brain does or does not adjust. Anxiety and depression are also addressed, with emphasis on how they can affect preexisting pain and vice versa. The concept of disability is considered in a single chapter that is comprehensive and thought-provoking.
Toward the end of the book, one chapter provides an impressive example of how the biopsychosocial model might work within the context of medical practice. The featured case involves irritable bowel syndrome. The final two chapters discuss the potential barriers to the use of the biopsychosocial model and how medical practitioners can overcome those barriers.
In general, this book does a good job of presenting the biopsychosocial model, by explaining that the model does not refute the science of medicine and by asking that it be integrated with relevant psychological factors, all of which are amenable to examination through appropriate scientific methods — a theme that warrants serious contemplation.
Frank M. Dattilio, Ph.D.
Harvard Medical School
Boston, MA 02115
datt02cip@cs.com(Edited by Peter White. 24)