LAUSR

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.1 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. 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. Despite its widespread adoption, the model is far from uncontroversial. Criticisms are multilevelled, 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. In his original paper, Engel argued that the biomedical model of the day had become a ‘cultural imperative’; a framework so embedded in medicine that its limitations were not easily discernible. Likewise, the embedding of the biopsychosocial model within core values suggests that it too has now reached a similar status in Psychiatry. Therefore, in the interests of being undogmatic, the model will be discussed through the lens of three fundamental questions: is it valid, is it useful and is it used?