SSWA 1053: FOUNDATION OF SOCIAL WORK

PRACTICE

TERM PAPER: BIOPSYCHOSOCIAL MODEL

Student’s Name: Zulkifli Bin Md Isa

Matric Number: 826205

School: School of Applied Psychology, Social Work and Policy

Programme : Master Social Work

Lecture’s Name: Dr Chan Cheong Chong

1.0 INTRODUCTION

A biopsychosocial model is an approach that postulates the interaction between biological (genetic and
biochemical), psychological (thoughts, emotions, and behaviors) and social factors (culture and family) in
the context of a pathological process. This model was initially designed by George Engel in the 70s, with
a relevant limitation such as its theoretical bases and principles cannot be validated by the experimental
scientific method. This model has a more integrative and less biological vision of the health and disease
process.

The biopsychosocial model was first defined by George Engel in the 1970s. The model was
created to explain the interaction between the patient’s biology, psychology and social
interactions in health and disease. It can be considered more as a philosophy than a scientific
approach to health and disease because many aspects of the model cannot be confirmed or
studied in an experimental design.

The biopsychosocial model aims to understand the patient’s suffering and disease from the
societal to the molecular level and in between. The model was put in place because science, at
the time, has started to become exclusively reductionistic, analytic and very specialized.

The main driving force for the creation of the biopsychosocial model was the observation that
many clinicians in the mid-20th century started to consider their patients as objects rather than
humans. Medicine has become emotionless and dehumanized in the eyes of George Engel.
2.0 HISTORY

The biopsychosocial perspective is an attempt to understand well-being by looking at the way

biological, psychological, and social elements interact with one another. The interconnections
between biology and psychology were documented as early as 1929 with Cannon’s empirical
exploration of the connection between psychological stress and physiological arousal, though the
inclusion of social concepts would not become popular until decades later. Engel's (1977, 1980)
innovative work within this perspective emphasized the benefits derived from the simultaneous
inclusion of biological considerations, psychological variables, and social context factors with
his efforts toward understanding the variations in an individual’s health.

McDaniel, Hepworth, and Doherty (1992) would further expand upon this model by looking at
the variables in not only an arranged hierarchical ordering, but also viewing them as consistently
having an impact on one another. Biological factors were found to interact with psychological
and both were hypothesized to interact with family and other social system factors. This model
seems to be a fruitful avenue for further research as it has begun to appear in a variety of areas
such as child adjustment (Calkins, 2011), ethnic differences (Debb, Blitz, & Choi, 2009),
hypersexual disorders (Samenow, 2010), and pediatric feeding (Berlin, Davies, Lobato, &
Silberman, 2009) to name a few.

The foundation of modern affective neuroscience has been attributed to the early workings of
Charles Darwin (1872) and William James (1884). These scientists began challenging the
philosophies of emotions by introducing the idea that emotional expressions have internal
structures, are evolutionary principles contrived for social purposes, and are consequences of the
nervous system. Although the term neuroscience has been used for an extended period of time as
a definition for classifications in the nervous system, it was not until 1992 that the term social
neuroscience was used; Cacioppo and Bernston popularized the phrase as an umbrella term for
biological mechanisms that influence social behavior in both humans and animals. In particular,
it has been defined as the “study of social networks, the individuals that create them and the
neural, hormonal, and genetic mechanisms that allow for their existence (Norman, Cacioppo, &
Bernston, 2009, p. 60).” Social neuroscience would later be used to redefine numerous theories
and concepts in the behavioral sciences such as the understanding of autistic children (e.g.,
Dapretto, Davies, Pfiefer, Scott, Sigman, et al., 2006), psychiatric patients (e.g., Frith & Frith,
1999), and stroke victims (e.g., Adolphs, 2001) to name a few. 6 This method of studying and
understanding the relationship between biology, social interactions, and individual differences
poses numerous challenges to researchers due to the inherent complexity of biological and social
systems, and the need for multiple levels of analysis (e.g., individual, familial, and social
contexts). Nonetheless, family researchers can no longer ignore the multiple factors that
intervene between genetic and behavioral phenomena. To evolve theoretical, empirical, and
clinical efforts in the family sciences, it is necessary for the field to account for the complex
interplay between biological, psychological, and social aspect.

The biopsychosocial approach was developed at Rochester decades ago by Drs. George Engel
and John Romano. While traditional biomedical models of clinical medicine focus on
pathophysiology and other biological approaches to disease, the biopsychosocial approach
emphasize the importance of understanding human health and illness in their fullest contexts.
The biopsychosocial approach systematically considers biological, psychological, and social
factors and their complex interactions in understanding health, illness, and health care delivery.

3.0 DEFINITION

The 'bio' component of this theory examines aspects of biology that influence health. These
might include things like brain changes, genetics, or functioning of major body organs, such as
the liver, the kidneys, or even the motor system. For example, let's say Sarah has an accident that
leaves her with reduced movement in her right arm. This biological change might influence how
she feels about herself, which could lead to depression or anxiety in certain situations.

The 'psycho' component of the theory examines psychological components, things like thoughts,
emotions, or behaviors. Sarah might go through many different psychological changes. She
might experience decreased self-esteem, fear of judgment, or feel inadequate in her life or job.
These changes in thoughts might lead to changes in behaviors, like avoiding certain situations,
staying at home, or quitting her job. As she engages in these behaviors, her injury might worsen,
or she could suffer further depression and anxiety.
The 'social' component of the biopsychosocial model examines social factors that might
influence the health of an individual, things like our interactions with others, our culture, or our
economic status. A possible social factor for Sarah could be her role in her household. Perhaps
Sarah is a new mother. An injured arm might reduce her ability to care for her new baby. Being
unable to fulfill this social role might trigger problems with her husband or other family
members, causing Sarah stress that could lead to further biological or psychological problems.

An important connection to make here is that the elements of the biopsychosocial model are all
connected. Biology can affect psychology, which can affect social well-being, which can further
affect biology, and so on. Sarah's biological state changed, which affected her psychological state
and social interactions, which all went on to affect each other again.

As we go through life and the environment changes, our brain and it functions also changes.
Likewise, a person’s genetic makeup and the environment they interact with will have a
profound effect on their mental health, biological health and their brain functions. In order to
truly understand someone’s mental health, we must take into account all of the factors affecting
them both positively and negatively in order to get a better picture of their overall health and
well-being.

According to Drs. George Engel and John Romano, the biopsychosocial perspective is more
appropriate when analyzing the causes of mental illness. This model introduces the idea that
there are biological, psychological, and social determinants to mental health. This idea links the
outside world to someone’s biology and psyche.  It also involves our consciousness, sentiments,
and behaviors.

One reason why the biopsychosocial perspective is so useful is because it explains how some
people who are seemingly “healthy” can get mental illnesses and why some are more prone to
mental illness than others. Those who are mentally healthy most likely exercise, have positive
energy and strong social bonds does not exempt them from mental illness. The biopsychosocial
perspective gives evidence that although someone can be mentally healthy at some point in their
life, they can still experience mental illness if their biopsychosocial balance is disturbed.
4.0 BIOPSYCHOSOCIAL MODEL IN SOCIAL WORK CONTEXT

Social work practitioners frequently provide services to client with conduct related disorders and
have a responsibility to provide the most effective treatment available to these client. Effective
treatment in social work necessitates the utilization of a biopsychosocial spiritual model of
practice. Social work embraces the biopsychosocial-spiritual approach as a means of engaging in
holistic assessment and effective intervention with individuals, families, groups, organizations
and communities. Yet, in practice the clinical models taught primarily focus on the psychosocial
forms of assessment and intervention, with little attention paid to the biological and spiritual
domains.

As a social work practitioner, I have made use of many theories; however, psychosocially
focused assessment and cognitive behavioral therapy (CBT) forms of intervention were the core
of my practice experience. As a social work practitioner working with children, elderly and
homeless people with conduct related behavior problems and or diagnoses of Conduct Disorder
(CD), Post-Traumatic Stress Disorder (PTSD), or Reactive Attachment Disorder (RAD), I found
that CBT approaches were limiting my ability to help clients.

My experiences with children’s biological reactions to stress and the closely ensuing
emotional, physical or sexual harm they caused others became of paramount importance to my
understanding and treatment of these children holistically. Understanding why social work
commits itself to a biopsychosocial-spiritual approach to practice, one finds that the approach
stems from models of practice utilized in the 1960’s and 1970’s. Through the 1970’s, social
work generally demonstrated a preference for the “person in environment” approach to practice.
Beginning in the 1960’s and 1970’s, the ecological model began to surface as a lead theoretical
approach to social work practice (Hepworth, Rooney, Rooney, Strom-Gottfried, & Larsen,
2006). The ecological model arose from the environmental movement in biology. This model of
thought promoted the importance of understanding an organism’s biology within the context of
its environmental habitat and niches .The social work profession soon adopted this model as a
mainstay for assessment and intervention, yet did not (for the most part) adopt the biological
components of the model. Combining this ecological model with a general systems approach to
practice, social work came to support the idea of a biopsychosocial-spiritual approach to macro,
mezzo, and micro work. The ecological perspective and application of general systems theory
provided the social work profession with a systematic overview of the profession’s commitment
to understanding the ways in which multiple systems in an individual’s life can impact his/her
functioning.

The Council on Social Work Education (2001) also emphasizes the importance of the
biopsychosocial-spiritual approach to practice by encouraging social work educators to provide
content which includes “theories and knowledge of biological, sociological, cultural,
psychological, and spiritual development across the life span” Yet, despite this profession’s
commitment to an integrated approach to practice, one of the criticisms of this broad perspective
is that it does not provide guidance in approaching specific populations or problem areas. In
order to enhance the ecological perspective (including the biological lens), it became clear that
social workers need to utilize theories and interventions developed for specific populations. The
profession’s selection of practice theories has changed over time.

As noted by Johnson (2001), social workers face many challenges today in their work
with individuals and families, and neurobiological knowledge is essential for a complete
biopsychosocial understanding of persons struggling with substance addictions, mental health
disorders, as well as in understanding human behavior in general. Johnson further notes that the
past 20 years of neuroscience research has dispelled the belief in mind-body dualism. She argues
that social workers are now finally taking note of recent research. Given the significance of
social neuroscience (the linkage of social processes and neuroscience), social workers are now
looking at ways to educate themselves, individuals, families and other providers about the
neurobiological applications of this research to various mental health diagnoses relevant to the
clients they serve.

Educating social work professionals and other professionals across child related
disciplines in the basics of neuroscience and neurodevelopment will “over time, lead to
innovations and improved outcomes” as well as improved “practice, programs, and policy for
child maltreatment” (Perry, 2009, p.253). Perry further notes that given the significance of
relational-related problems for youth who have experienced trauma, being trauma-informed is
not enough; professionals need to be attachment-informed as well. Attachment Theory
Attachment theory offers a beneficial foundation for understand.
5.0 IMPORTANCE OF BIOPSYCHOSOCIAL MODEL TO SOCIAL WORK

In 1977, Dr. George Engel proposed the biopsychosocial model of health and illness, which
suggests that behaviors, thoughts, and emotions may influence a person’s physical state.
The biopsychosocial model disputed the long-held scientific assumption that treatment of health
and disease were limited solely to biological factors.

Engel argued that not only should psychological and social factors be considered in assessing
health, but that these factors also influence biological functioning itself. He asserted this to be a
more realistic model in light of the role lifestyles play in a society on the cusp of the twenty-first
century. The goal of the biopsychosocial model, therefore, is to not only improve on the disease
approach but also change conventional wisdom of the proper way to assess and treat health and
illness held by the medical model.

Traditionally, the universally accepted approach toward health and disease has been the medical
or biological model. This model limits treatment of a person’s poor health almost exclusively to
medicinal remedies. Use of the medical model made sense as scientific advances yielded not
only direct cures but also preventative measures for serious diseases such as vaccinations. There
is nothing wrong with the medical approach; until recent decades, there was insufficient credible
scientific research to suggest an alternative approach. However, as our understanding of the
human mind continued to expand through research in psychology and the social sciences, new
ideas challenging the medical approach emerged. Instead of replacing the medical model, this
new model calls for the inclusion of psychological and social processes in the overall diagnosis.
The result is a more thorough model of human health intended for application in routine clinical
practice.

Engel cites the widespread discontentment with the medical model as an impetus for a shift to a
more holistic approach, even going as far as to describe the long-held medical model as dogma.
Engel said, “We are now faced with the necessity and the challenge to broaden the approach to
disease to include the psychosocial without sacrificing the enormous advantages of the
biomedical approach.”

To better demonstrate how the biopsychosocial model can be utilized in modern practice, let’s
return to the treatment of addiction.  The biopsychosocial model attempts to define the causes of
addiction, which are universally accepted to be quite complex.

The biological factor asserts that some people have an increased likelihood of developing an
addiction than others. Research suggests that a family history of addictions make a person more
likely to develop an addiction compared to people without a family history of addiction.
Therefore, it is possible that a person’s biological factors could play a role in the development of
addiction.

The psychological factor also plays a dominant role in developing an addiction. Many people
feel happy or relieved while engaging in self-rewarding but ultimately harmful acts, such as
drinking, smoking, overeating, using drugs, or gambling. The feeling of being rewarded is
psychological, not biological; in most cases, the biological impact of the addictive behavior is
actually damaging to the person’s physical well-being.

The social factor consists of the social and cultural environment surrounding the person,
including interpersonal relationships and peer groups. Additionally, the availability of an
addictive substance or the social mindset about activity best enjoyed in moderation can also
affect the probability of addiction. For example, if a person’s peer group consists of co-workers
who all drink heavily and consider it not only acceptable but somewhat necessary to navigate the
pressures of the job, then the odds of developing an addiction increase.

By combining all three factors of the biopsychosocial model, physicians, social workers, and
psychiatrists have more personalized data for analyzing a patient’s addiction. The broader
spectrum of information allows not only for a clearer path of treatment but also for monitoring
implementation and coordinating post-treatment preventative care. The result is a more thorough
analysis and a more comprehensive treatment plan.
REFERENCES

Adolphs, R. (2001). The neurobiology of social cognition. Current Opinions in Neurobiology,

11, 231–239.

Amchin, J. (1991). Psychiatric Diagnosis: A biopsychosocial approach using DSM-III-R.

Washington, DC: American Psychiatric Press.

Buchman, D. Z., Skinner, W., & Illes, J. (2010). Negotiating the Relationship Between
Addiction, Ethics, and Brain Science. AJOB Neuroscience, 1(1), 36–45.

Cacioppo, J. T., Tassinary, L. G., & Berntson, G. G. (2007). Handbook of psychophysiology.

New York: Cambridge University Press.

Calkins, S.D. (2011). Biopsychosocial models and the study of family processes and child
adjustment. Journal of Marriage and Family, 73, 817-821.

Dapretto, M., Davies, M. S., Pfiefer, J. H., Scott, A. A., Sigman, M., Bookheimer, S. Y., &
Iacoboni, M. (2006). Understanding emotions in others: Mirror neuron dysfunction in children
with autism spectrum disorder. Nature Neuroscience, 9, 28–30.

Debb, S. M., Blitz, D. L., & Choi, S. W. (2009). Quality of life differences in an African
American and Caucasian sample of chronic illness patients: Assessment of differential item
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Mcdaniel, S.H., Hepworth, J., & Doherty, W. (1992). Medical family therapy with couples
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Propper, C., Moore, G.A., Mills-Koonce, W.R., Halpern, C.T., Hill-Soderlund, A.L., Calkins,
S.D., et al. (2008). Gene-environment contributions to the development of infant vagal reactivity:
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Samenow, C. P. (2010). A biopsychosocial model of hypersexual disorder/sexual addiction.

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 SSWA1053 FOUNDATION OF SOCIAL WORK PRACTICE
DC181 UUMKL
Assessment Rubric for Individual Term Paper 30%
Name ZULKIFLI BIN MD ISA

Concept BIOPSYCHOSOCIAL MODEL

Scale of Evaluation:

1. Very Weak 5. Excellent

CRITERIA Marks

Accuracy of the Defining Concept ( /5) x 20 = [ ]

Organisation of the Writing ( /5) x 20 = [ ]

Personal Insights/Experiences ( /5) x 20 = [ ]

Language ( /5) x 10 = [ ]

Reference(s) ( /5) x 10 = [ ]

Total

[ ]
30 =
80