The biopsychosocial model: not dead, but in need of revival

Abstract

The biopsychosocial model, formalised by Engel in 1977, is at its core an acknowledgement that biological, psychological and social factors causally influence health and disease.Reference Engel1 The word ‘model’ is broadly defined by Engel as ‘nothing more than a belief system utilized to explain natural phenomena, to make sense out of what is puzzling or disturbing’. In this sense, ‘paradigm’ may be a more appropriate term.Reference Pies2 Indeed, a paradigm shift in psychiatry has occurred since Engel's original paper, with a biopsychosocial framing now cemented in education, training and the Royal College of Psychiatrists’ core values.Reference Richards and Lloyd3 Despite its widespread adoption, the model is far from uncontroversial. Criticisms are multi-levelled, from philosophical underpinnings through to application in clinical practice. Below is an assessment of the fundamental challenges the biopsychosocial model faces. Although the model is not dead in any paradigm-shifting sense, significant challenges remain in translating it to practice effectively, requiring more than mere statements of value.