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Engel's biopsychosocial model is still relevant today

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Abstract

In 1977, Engel published the seminal paper, “The Need for a New Medical Model: A Challenge for Biomedicine” [Science 196 (1977) 129–136]. He featured a biopsychosocial (BPS) model based on systems theory and on the hierarchical organization of organisms. In this essay, the model is extended by the introduction of semiotics and constructivism. Semiotics provides the language which allows to describe the relationships between the individual and his environment. Constructivism explains how an organism perceives his environment. The impact of the BPS model on research, medical education, and application in the practice of medicine is discussed.

Section snippets

An illustration of a biopsychosocial vs. a biomedical approach

The novel Murder at the Gallop, by Agatha Christie, featuring Miss Marple, presents an opportunity to illustrate the characteristics of the biopsychosocial (BPS) model [1] as opposed to the traditional biomedical (BM) model: Miss Marple and her friend, the librarian, are canvassing for local charity in the streets of a small town. They come to the mansion of a rich man, Mr. Enderby. They enter the main door and call for the old man. He appears on the first floor landing, clutching his chest,

Further development of the BPS model

Examining Mr. Enderby isolated from his social context leads to the inspector's impression: sudden cardiac death, superimposed on chronic cardiac ailing. Sudden changes in the level of the central nervous system are, as we shall see later, not the only reasons for his sudden death. On the one-person system level, inclusion of his horror of cats, his wealth, and, on a several-persons level, his greedy heirs—integrating him as a person with social relationships—leads to the emergence of a new

Constructivism and semiotics

The organism does not react uniformly and thus mechanically and predictably to a defined stimulus. A psychobiological system, developing during the ontogenesis of an organism, which the mathematician Peirce (1834–1914) [7] designated the “interpretant,” imprints meanings on the receptor, which is activated by stimuli. (He constructs his environment. The interpretant as used in our context is akin to Freud's “ego.”) The interpretant encompasses the organism's unconscious, preconscious, and

Individual reality

The experience of Mr. Enderby stresses a further characteristic of the interpretant: “individual reality.” It is Mr. Enderby's individual reality which creates, i.e., constructs, a situation that another person without horror of cats would never have constructed. In summary, Engel's [1] model can be extended by semiotics and constructivism. By the immaterial nature of the sign, the separation into somatic and psychological stimuli has become obsolete.

This is well illustrated by Tom, the

Resistance against the introduction of the BPS model

Fear of the emergence of one's own feelings (designated as countertransference feelings by psychoanalysis), e.g., sadness, shame, anger, disgust, annoyance, impatience, confusion, helplessness and hopelessness, fear of death, fear of loss of control, and fear of loosing control over too many things have been discussed by several authors. These threats have led to the sacrifice of the recognition of the individual element (the interpretant) in favor of a more or less strictly mathematically

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