There is still a lot of confusion regarding the word “biopsychosocial”. Yes it’s a compound word made up of three other words Biological (physical), Psychological (of the mind) and Social (of the environment). The trouble is that just like the word biopsychosocial is all one, so are humans.
Clinicians constantly talk about the three elements as separate drivers of pain and health, whilst forgetting that they all apply and are often intimately connected in a causal relationship that can not be found by separating them.
It may be more appropriate to think of the human organism as an ecosystem which requires the interactions of multiple parts to maintain homeostasis and health. I have proposed that looking at humans under a microscope to try and find the cause of a health issue or a pain episode, is doomed to failure. We need to think about putting people under the “macro-scope”, thus seeing the them in a “whole-istic” or a complex interactive (eco)-system view.
Seeing and thinking of the human organism as an ecosystem, speaks to the primary of the whole concept. Trying to break a complex ecosystem into its part to find how they produce the whole, is like trying to find out how an iPhone works by taking it apart. The functioning whole relies on synergy between the parts, no single part possess the function of the whole. In a synergistic ecosystem view, the function of the whole organism is greater than a the sum of it’s part.
Humans experience distress, often manifested as “yellow flags, this can be in response to multiple drivers. We talk about self efficacy (the belief you can do something) and locus of control (the belief you have control in yourself, internal locus, or that external factor control your situation an external locus.
These measures are part of the human experience and are a reflection of human suffering. It is normal to be distressed when experiencing ill health or pain. Everyone, bar none, will display some degree of psychological manifestation during times of suffering.
The hard part for clinicians is to realize distress responses are normal and are all part of the human condition.
I have proposed the analogy that trying to separate biopsychosocial into its composite part to find causation is like trying to separate water into hydrogen and oxygen to find out the properties of water.
As clinicians it may be time to utilize a “whole-istic” approach to understanding patient who present for treatment of painful conditions. Considering their social determinants of health, their coping strategies, their level of distress, including kinesiophobia, catastrophizing, self efficacy and locus of control, their physical and functional impairments, is all part of the big picture contributors of the clinical condition.
We cannot understand the whole by dissecting it into its constituent parts, just like we can’t uncook a pancake.
Adapted from a blog post by David Poulter PT. @retlouping on twitter
David Poulter is a physiotherapist and educator, specializing in patient centered care, and participant centered education. He is currently located in Minnesota, USA.
Causality, Complexity and Evidence in Health Sciences 