The "Biopsychosocial Model": 40 years of application in Psychiatry

In 1977, the American pathologist and psychiatrist George Engel (1913-1999) published in the Journal Science his paper "TheIn 1977, the American pathologist and psychiatrist George Engel (1913-1999) published in the Journal Science his paper "Theneed for a new medical model: A challenge for biomedicine", introducing the term Biopsychosocial Model. This model basedon the results of Engel's studies in ulcerative colitis, depression and psychogenic pain, constituted a challenge for biomedicineand the biomedical model. The basic principles of the model included the biological, psychological and social dimensions of the person's life and theperception that the person suffers as a whole and not as isolated organs. The doctor should use a holistic approach regardingillness and should consider his/her relation with the patient socially equal. The personality and the emotional reserves of thepatient, as well as the particular environmental conditions in which the person lives in should be taken into account. There is no doubt that the biopsychosocial model has established a more empathetic and compassionate approach in medical practice. Already since 1936, the general adaptation syndrome had been proposed by the Austrian-Canadian endocrinologist HansSeley (1907-1982), who emphasized that psychological stressful factors may have injurious consequences on health, while theresponse systems to stress may be dysregulated not only by genetic factors, but also from experiences and stressful life events,as well as by harmful behaviors such as smoking, alcohol consumption and lack of physical exercise. Psychosocial factors may co-determine the patient's vulnerability and the illness's severity and course. The biopsychosocialmodel consider the interactions with genetic susceptibility, personality, stressful events and, generally, with the patient's socialcontext. Environmental factors increase the probability of the clinical expression of a mental disorder, play a role in the time ofonset of an illness's manifestation, and they can also protect a vulnerable person from the disease. Stressful experiences modify immunological response and influence treatment compliance. Non adherence to pharmacotherapy,as well as to the psychosocial interventions, may cause defective recovery of psychosocial functioning, recurrence ofthe disorder, as well as insufficient use of health resources and a higher health care cost. The psychoeducation of patients andtheir relatives by the application