A Response from George Engel to Joseph Herman-May 5, 1989

Comments on the article by J. Herman (see record 2006-03022-002), originally published in Family Systems Medicine, 1989, Vol 7(1). This letter was written in 1989 but was not submitted for publication until 2005. Dr. Herman, Your discussion in the current issue of Family Systems Medicine of the need for a transitional model is a very valuable contribution because it touches on what I think is the most prevalent problem among those dissatisfied with the limitations of the biomedical model but not yet comfortable with the biopsychosocial model. I want to comment on your paper, but before doing so, I have some questions to pose to you. Briefly, the problem lies not so much in conceptualization as in method. The reality is that, as attractive as the model may seem in the abstract, Western physicians are all inured to a clinical approach that downgrades the value of clinical data, in part a cultural consequence of its biomedical categorization as "nonscientific." Thus, everyone struggling to apply the biopsychosocial model approaches the challenge with little or no background or experience, much less systematic training, in how to engage scientifically with patients. In a nutshell it is manifested in the attitude that there is something radically different in how one elicits from the patient information deemed "psychosocial," as compared with "biological" information. It is a small wonder that that perspective has been deeply embedded in our educational system for more than a century and basically remains unmodified to today. What it overlooks, of course, is that all clinical data, by which I refer to all the information derived in the course of the actual engagement of the physician with the patient in which the patient communicates verbally and/or nonverbally, is by definition psychosocial. The value of your article is that it so clearly articulates the travail that all of us have gone through in our struggle to make the transition from the biomedical to the biopsychosocial. All too many unfortunately fall by the wayside because they never succeed in mastering the interview, which is the royal road to understanding the biopsychosocial model. My question is whether you are in position to provide more information about the process rather than the outcome. (PsycINFO Database Record (c) 2016 APA, all rights reserved)