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Holistic or harmful? Examining socio-structural factors in biopsychosocial model of chronic illness,‘MUS’& disability, 2022, Hunt

Discussion in 'Other psychosomatic news and research' started by Sly Saint, Jul 25, 2022.

  1. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    Holistic or harmful? Examining socio-structural factors in the biopsychosocial model of chronic illness, ‘medically unexplained symptoms’ and disability

    Joanne Hunt

    A particular application of the biopsychosocial model is associated in peer-reviewed literature and patient testimony with harms done to chronically ill and disabled people. These harms derive from an empirically unsubstantiated, neoliberal narrative emphasising the role of personal responsibility and effort in ‘recovery’ from ill-health, ignoring socio-structural contributors to chronic illness and disability. Notably, this biopsychosocial model ignores the health-related impact of welfare and disability insurance reforms which the model has been employed to justify. The model and associated interests can thus be recognised as socio-structural phenomena that should be acknowledged in any truly holistic biopsychosocial approach to chronic illness and disability. A critically informed and reflexive approach to biopsychosocial theorising would allow a more holistic and nuanced understanding of chronic illness and disability, with implications for health and social policy that underline and address what ails society as opposed to what is ‘wrong’ with the individual.

    • Points of interest
    • The biopsychosocial approach suggests that health and illness should be understood ‘holistically’. This means considering not only a person’s biology, but also their psychology (thoughts and behaviour) and social context (for example, social support levels).

    • A particular variant of biopsychosocial model, dominant in UK health and social policy, has been associated with political agendas, predominantly: welfare reform, healthcare spending cuts, and creation of profits for the disability insurance industry.

    • This variant of the model has also been associated with harms experienced by chronically ill and disabled people.

    • Any truly holistic biopsychosocial framework should acknowledge the broader social (here, political) context that has shaped this model and recognise how the model, and associated practices, may contribute to chronic illness and disability.

    • Such a framework gives rise to recommendations for health and social policy and practice that address what is wrong with society as opposed to what is ‘wrong’ with the person.

    MSEsperanza, Hutan, oldtimer and 10 others like this.
  2. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

    London, UK
    This seems to be in danger of disappearing up its own holistic.
  3. Trish

    Trish Moderator Staff Member

    I have only read the abstract and points of interest so far.

    I think the points of interest spell out pretty clearly the harm being done by use of the BPS approach by governments and insurance companies. It's all things we are well aware of here, but that most of government and society including the medical and care establishment don't want to know about.

    We have seen similar ideas in, for example, articles from The Centre for Welfare Reform by George Faulkner such as this one:
    Centre for Welfare Reform: "In the Expectation of Recovery"
    And this one:
    Blaming the victim, all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability, 2016, Shakespeare et al

    The ideas, as I understand it, boil down to:
    - claiming it's the patient's responsiblity to get well;
    - that we're not really sick, we're malingering;
    - and that work is good for health for everybody, regardless of disability;
    - that we shouldn't be given support because of 'secondary gains'.

    - using these rationalisations based on no evidence to deny chronically sick people the support they need;

    - this lack of financial and medical support itself makes people sicker;
    - that this is the fault of society, not the fault of chronically sick people.
  4. strategist

    strategist Senior Member (Voting Rights)

    If one were to measure the harm and costs caused by neglecting sick people at the level of whole society, it might end up costing more than what is saved. But nobody has done this kind of calculation I think.

    Neglecting sick people soon results in the sick becoming very sick and needing even more care, from their own family, who don't have access to the therapies and knowledge needed to care for patients effectively.

    The neglected patients might disappear from the healthcare system for the most part and from statistics but they're still there and part of society. And they could be contributing more to society if some way to treat the illness was found.
    MSEsperanza, Missense, Hutan and 9 others like this.
  5. rvallee

    rvallee Senior Member (Voting Rights)

    One small benefit of the zealous application of the BPS model to chronic illness is that we know for a fact what it does all by itself, that is not in addition to competent medical care, but instead of it. And it's a complete disaster, incapable of producing anything useful or competent. It's not even capable of learning, which is an obvious problem when used in research.

    It could have been hard to say otherwise, but we know, have known for years in fact. The BPS model is like Disney's Button soup: by itself? just a button, inedible. In a soup with herbs, spices, vegetables and a big bone? The button is irrelevant, unless it melted or something and made the whole soup toxic, which is an apt metaphor.

    So it's either useless or superfluous, at best, massively harmful in real life outcome. And it's not surprising, because of course neither psychological nor social issues are actually taken into account here. Instead imaginary concerns are forced through a false attribution error, they are not our concerns, they are merely cheap excuses to blame us personally for the systemic failures of medicine.

    So it will be easy to drop this down a very deep shaft once people are ready. The whole thing could be wiped from existence as if it never happened and not only would the world be a better place, absolutely nothing of value would be lost. It would be equivalent to losing astrology, it changes some things, but so superficially it basically doesn't matter.
    Hutan, oldtimer, Wonko and 2 others like this.
  6. Josefina

    Josefina New Member

    Hi Professor Edwards, could you elaborate on this point? Thanks in advance, Jo Hunt (author of the paper)
    MSEsperanza, Wyva, oldtimer and 2 others like this.
  7. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    has anyone accessed the full article?
    MSEsperanza and Hutan like this.

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