Biopsychosocial Medicine

from Wikipedia, the free encyclopedia

Biopsychosocial medicine sees itself as a necessary addition to the previously predominant biomedical and scientific orientation of human medicine . The scientific machine paradigm (“the human being as a complex machine”) is being expanded into a holistic model (“the human being as a physical and mental being in his eco-social worlds”).

The bio-psychosocial model is based on the body-soul unit, which is based on general systems theory, which in medical practice supports a procedure according to the rules of "simultaneous diagnostics" and "simultaneous therapy".

The expanded biopsychosocial model as a theory of body-soul unity

Biopsychosocial medicine is based on the so-called biopsychosocial model of illness and health and extends the biomedical model of human medicine that has prevailed for well over a hundred years . The theoretical basis for this extension comes from general systems theory ( Ludwig von Bertalanffy ), the propagation of the model was carried out in particular by George L. Engel , although many other scientists and researchers contributed to the foundation and further development of this approach (e.g. Herbert Weiner , Eric R. Kandel , Aviel Goodman Alexander Romanowitsch Lurija and many others).

The current form of biopsychosocial medicine uses the so-called extended biopsychosocial model as a theory of body- mind unity . This overcomes conventional psychosomatics with its dichotomy of body and soul and postulates the simultaneity of psychological and physiological processes within one and the same event process, which in turn always takes place under eco-socio-cultural framework conditions. Every mental event (every thought, every feeling, every impulse to act, etc.) is always also a physiological event. Confirmations for this postulate of the "parallel connection" come from all relevant research areas, in particular z. B. also from psychoimmunology , neurobiology , behavioral medicine and health psychology .

Health is not defined as the absence of pathogens or eco-social disturbances, but as the competence of the organism, with any pathogenic factors (eg., Bacteria, viruses, toxins, harmful psychological or eco-socio-cultural circumstances) car regulatory finished to become (i.e. to keep this under control with one's own resources). Illness occurs when this autoregulative competence is not available in sufficient measure or the control circuits responsible for it are overwhelmed. This makes it clear that health is not a state, but a functional, dynamic process - health has to be “created” anew every second of life.

Practical consequences

The practical consequences in dealing with disease phenomena are mainly in a "simultaneous diagnosis" (ie a parallel organized diagnosis in which the diagnostically relevant information from the physiological, psychological and living environment-related areas are recorded and also integrated in parallel) and in a "simultaneous therapy" (ie a therapy organized in parallel, in which a parallel influence on all three system areas - body / psyche / living environment - is aimed at depending on the given resources and the respective level of knowledge about relevant factors).

This closes a circle that can be traced back almost three thousand years to the occidental art of healing sensu Asklepios , according to which the following should also apply to current scientific medicine: cure with all necessary means, with “word” (the psychological factors), “medicine” (the drugs or chemical Effect factors) and “knife” (the technical or surgical interventions).

Criticism of the biopsychosocial model

The original “bio-psychosocial model”, so named by George L. Engel in 1977, still has some serious weaknesses in terms of scientific theory. It goes z. B. continues to assume an interaction as in traditional psychosomatics and thus by no means resolves the old "body-soul dilemma". Only with the later integration of the “body-soul identity” going back to Spinoza could this problem be satisfactorily solved. With this, however, a “theory of the body-soul unity” emerged from the original biopsychosocial model, which is also labeled as an “extended biopsychosocial model”.

This latest version has the greatest competence to date for the integration of the relevant data volumes from the system levels involved and is therefore currently the best background theory for human medicine in the 21st century. But here, too, there remains a shortcoming on the semantic level: there is still no uniform language for the physiological phenomena on the one hand and for the psychological phenomena on the other. The observable events are still described and dealt with in two different terminologies (in one language for “physical” and one for “soul”), although they belong to a single reality. This linguistic and thus firmly entrenched semantic problem continues to lead us to believe that we have a “two-world view”. We are facing a challenge that only appears manageable with a cross-border scientific concept.

Medical training

Josef W. Egger was appointed to the first chair for biopsychosocial medicine in the German-speaking area at the Medical University of Graz in 2011 . Biopsychosocial medicine has become the guiding principle of this university and today forms the basis for significantly greater attention to " speaking medicine " at other medical universities and faculties (e.g. Heidelberg, Berlin, Groningen, Leiden, Bologna and many others) of medical training.

Further information

literature

  • Adler, RH (2009). Engel's biopsychosocial model is still relevant today. Journal of Psychosomatic Research, 67, 607-611.
  • Bertalanffy, L. v. (1972). General System Theory. Foundations, development, applications. New York: Braziller.
  • Egger, JW (2015). Integrative behavior therapy and psychotherapeutic medicine. A biopsychosocial model. Wiesbaden: Springer
  • Egger, JW (2017). Theory and practice of biopsychosocial medicine. Body-soul unity and speaking medicine. Vienna: Facultas
  • Fava, GA, Sonino, N., Wise, TN (eds) (2012). The Psychosomatic Assessment. Strategies to Improve Clinical Practice. Adv Psychosom Med. Basel: Karger, 2012, vol 32, pp. 1–18.
  • Weiner, H. (1986). The history of psychosomatic medicine and the mind-body problem in medicine. In: Psychotherapy, Psychosomatics, Medical Psychology (PPmP). Vol. 36, 1986, pp. 361-391.
  • Weiner, H. (2001). On the way to integrated medicine. In Deter, H.-C. (Ed.). Psychosomatics at the beginning of the 21st century. Chances of a bio-psychosocial medicine. Bern: Huber.

Magazines

  • Psychological Medicine, Int. Soc. Biopsychosocial Medicine, Vienna: Facultas Universitätsverlag, ISSN 1014-8167
  • BioPsychoSocialMedicine, Japanese Society of Psychosomatic Medicine, ISSN 1751-0759

Web links

Individual evidence

  1. ↑ a b Bertalanffy, Lv (1949). General System Theory. BiologiaGeneralis 1, 114-129.
  2. ↑ George L. Engel (1976). Mental behavior in health and illness. Bern: Huber.
  3. ↑ Weiner, H. (1977). Psychobiology and Human Disease. Elsevier, New York et al. 1977, ISBN 0-444-00212-X .
  4. ↑ Kandel ER (2006). Psychiatry, Psychoanalysis and the New Biology of Mind. Frankfurt am Main: Suhrkamp.
  5. ↑ a b Goodman, A. (1991). Organic unity theory. The mind-body problem revisited. American Journal of Psychiatry 148, 5, 553-563
  6. ↑ Lurija, AR (1992). The brain in action. Introduction to Neuropsychology (6th edition). Reinbek / Hamburg: Rowohlt
  7. ↑ Malgren H. (2005). The Theoretical Basis of the Psychosocial Model. In: White, P. (ed.). Biopsychosocial Medicine. Oxford: University Press 2005, pp.21-35
  8. ^ A b Egger, JW (2005). The biopsychosocial disease model - the basics of a scientifically based holistic understanding of disease. Psychological Medicine, 16, 2, 3–12. Vienna: Facultas
  9. ↑ a b Egger, JW (2008). Theory of body-soul unity: the extended bio-psychosocial disease model. In: Integrative Therapy. Vienna: Krammer / Edition Danube University Krems, 33 (4): 497-520.
  10. ↑ Petzold, HG (2001) Integrative Therapy - The “biopsychosocial” model of critical human therapy and cultural work. A "lifespan developmental approach". Paderborn: Junfermann.
  11. ↑ George L. Engel: The need for a new medical model: a challenge for biomedicine . In: Science . tape 196 , no. 4286 , April 8, 1977, p. 129-136 , PMID 847460 .
  12. ↑ Psychological Medicine, Int. Soc. Biopsychosocial Medicine