In this latest open-access study funded by the ME Association Ramsay Research Fund, Dr Keith Geraghty and Charlotte Blease examine the controversial biopsychosocial (BPS) model that is still applied in ME/CFS.
They identify several ways the BPS approach can lead to patient distress and harm and compare it with the preferred biomedical model – highlighting implications, and making suggestions, for the clinician-patient relationship.
| “BPS model rhetoric may be partly responsible for influencing the way in which doctors and health professionals perceive the illness, not as a serious physical or organic disease (a biomedical model), but as a psycho-somatic syndrome (a biopsychosocial model).” “These two models offer very contrasting ideas about what causes ME/CFS and what generates symptoms. The BPS model posits that symptoms are a consequence of patients’ actions and thoughts, whereas the biomedical model asserts that symptoms are a direct result of biological dysfunction, often triggered by infection.” “The two models are incongruent and hamper progress in understanding the illness and treatment development.” ME/CFS and the biopsychosocial model (2018) |
Dr Geraghty kindly agreed to provide a summary explanation of what his latest research discovered:
“ME/CFS patients consistently report problems with accessing good quality medical care and support. Many recount distressing encounters with doctors. Despite such consistent anecdotal reports, there has been little research into harms and distress in ME/CFS.
| “Engel et al. hoped that the biopsychosocial model would move the focus of medicine away from viewing illness in terms of disease pathology, to a more patient-centred approach that takes account of the individual, their life-course, social history and mental health.” “Ironically, ME/CFS patients argue that the BPS model applied to their illness downplays the important role of biological abnormalities and over-states the role of psychological and social factors.” ME/CFS and the biopsychosocial model (2018) |
“Our paper sought to investigate the types of harms and distress reported in the literature. The sociologist Ivan Illich published a controversial book, Medical Nemesis, that argued that doctors and the medical community commonly cause harm to patients, not just at the level of the individual patient, but also on a societal level. Such views move harm far beyond simple medical error…”
Read the full review from Dr Geraghty online or as a free download
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I have CFS/ME. I am an occupational therapist primarily working with people who have had a stroke or traumatic brain injury. Occupational therapists are trained to use a BPS model which is holistic and integrated, and where rehabilitation is much more of a partnership between the professional the individual and their carers. I have never known it be referred to as “controversial” as it has been in this article. I use it in my practice because it acknowledges that humans are not just a set of symptoms but that we have a mind, that we live in a specific environment and in a wider community. All of these factors need to be taken in to account whether you have had a stroke or have ME. the fact that most health professionals ignore the “bio” part of the BPS model is not a fault of the model but of its application. To suggest we go back to a medical model (used by most NHS GP’s) is throwing the baby out with the bath water. I am sure that most people with CFS/ME recognise that the biomedical cause and effect model is too limited to address the many varied symptoms of any complex long term illness, including ME/CFS.