I’ve had a problem with the Biopsychosocial (BPS) model for a while, and I didn’t quite know what it was. For those unfamiliar with this model, in a nutshell, the idea is that we look at each patient not simply as a biological problem- a hurty leg, for example- but rather in the context of their psychological and social situation as well.
See… very separate circles. To me, this visually creates distinct portions to think about rather than a cohesive stuck together model
We know that there has been a fairly traditional issue in that a lot of therapists tend to focus on the bio much more than the other sides of the coin- as it were.
For the visual people such as myself- it is often presented as 3 circles meshing together in a venn diagram (see above)- but again, this is very much clarifying that the Bio, the Psycho and the Social are all separate things and although they affect the person, they are still distinct modules – not really the point. There have been attempts to look at people with differing levels of issues within the BPS model- some having more of a problem with the Psycological aspect of their problem, some the Social and some the Biological – but again, this is separating the person into three distinct parts.
After a bit of reflection, I realised that the problem I have with the Biopsychosocial model is that it is very much like gin and tonic with ice. (bear with me here).
If we imagine that you have a glass of Gin and Tonic with ice, it is quite obvious which bit is the Bio- it is the ice
Too much tonic? Too little gin?
– whereas the gin and the tonic are mixed together in the glass and are very very very difficult to tell apart. To use this analogy- imagine the ice is a little chipped and broken- we know that the bio is the issue, and so you sit there and try to fix the ice. Equally, you know if there is too much tonic, or too little gin.
This is the problem with the bps system- it is still- whether it wants to or not- separating out the bio, the psycho and the social.
To all intents and purposes, the biopsychosocial system is still descartian (ie. separating the body and the mind rather than seeing the patient as a single entity). Although it strives to point out that we should not just be considering the biological, or the psychological etc, it still manages to divide them in our heads.
I wonder if we should be thinking about the BPS model more in the way that we consider beer.
Yay- Hoppy Sugar Water
By this I mean that beer is essentially water, hops and sugar. Yet we don’t call it “hoppy sugar water”. We call it beer. It is greater than the sum of its parts, you can’t separate out of the final part of the liquid which bit was the hops, or the sugar, the whole thing is beer- there is no separating out.
Ok so I’m being a little facetious here, but it is worth us thinking about. By always talking about the BPS model are we inadvertently actually still unconsciously separating our patients into separate siloes? It is good to be aware of our biases- but I think that we are still only a little way beyond the resolution of descartian theory, we have a long way to go yet.
As an advancement on the model, most recently we have the vector model from Matt Lowe, which is fabulous – looking at whether various points of each part are a positive or a negative indicator for recovery- and whether these are things that can be changed, or if they are an issue which, just simply is. If you haven’t heard about the Vector model, have a google.