The Evolution of the Biopsychosocial Model: Type II Diabetes
The Evolution of the Biopsychosocial Model: Type II Diabetes
Type II Diabetes
Diabetes is a deficiency, wherein the internal chemistry of an individual is changed, resulting for the blood to contain too much glucose, caused by the inefficiency of the hormone ‘insulin’. The hormone insulin is the only hormone responsible for reducing the amount of glucose in the blood through the increase of glycogen in the liver, preventing the release of too much glucose from the liver, and by the increase of the take up of glucose by the other cells of the body. However, if this fails then the amount of glucose will be increased in the blood. There are two types of diabetes, namely, Type 1 or the Insulin-dependent diabetes mellitus, and the Type 2 or the Non-insulin-dependent diabetes mellitus. The Type-2 diabetes is more commonly regarded as age-related diabetes, being common to middle aged or older individuals and can be controlled by medications or dietary modification. The supply of insulin is low in this type of diabetes, thus, exhibiting inefficiency in controlling the levels of glucose in the blood. Several causes are determined in relation to this type of diabetes mellitus, namely, genetic factors, infection or other diseases, stress, and the environment. It has been perceived that genetic factors and heredity play an important role in the acquisition of diabetes, especially with identical twins. However, it does not always follow that if the parent has type 2 diabetes, then the offspring would also have it. Infections or diseases that may cause Type 2 diabetes may be related to diseases that may damage the pancreas, such as mumps and Coxsackie. Damage to the pancreas may also be brought about by excessive drinking, thus, relating alcoholism to this type of diabetes mellitus. Environmental factors pertain to the lifestyle of individuals, such as having an unhealthy diet and being overweight. This is also related to stress, as stress nowadays has become the major factor contributing to the change in the lifestyle of many individuals in all types of societies (2004). The recognition of the upsurge in cases of Type 2 diabetes mellitus leads many medical practitioners to adapt a number of models and approaches in terms of diagnosis and treatment. In fact, 85 to 90% of patients with diabetes exhibits the type 2 diabetes symptoms ( 1998), thus, becoming much more alarming. As such, this paper aims to discuss the evolution of the biopsychosocial model and its effects in the practice of medicine, specifically in Type 2 diabetes mellitus. This will be done with reference to a number of articles and journals regarding the subject matter.
Biopsychosocial and Biomedical Model
In the treatment of any disease, it is essential for any medical practitioner to diagnose the disease based on its symptoms and manifestations. However, due to the drastic changes that happen in the environment and the lifestyle of the many individuals, the diagnosis done based only on the symptoms of the disease may not be enough. As such, this relates to two models used in medicine, namely, the biopsychosocial and the biomedical models. The biomedical model refers to the model of illness that is being predominantly used for the past centuries, and emphasizes on biological factors in understanding the causes of any disease, without giving consideration on the psychological and social factors that may caused the disease or disorder (2004; 2003). The use of this model of illness somehow contributes to the reduction of healthcare given to patients, as this is based on a number of beliefs that may hinder one to fully understand the disease. Beliefs of the biomedical model of illness emphasize that the illness and its symptoms come from an abnormality in the body of the patient, mental disorders are different from bodily dysfunction, thus, must be treated separately, and the patient is only a passive recipient of the treatment, thus, cooperation is expected ( 2004). In this regard, it can be understood that medical practitioners exhibit reductionism or becoming the detached observer in terms of treating and diagnosing patients, thus, becoming cold and impersonal towards patients and making them feel that they are not valued and ignored (2004). As such, George Engel proposed and challenged the existing biomedical model of illness, and offered a model that aims to further understand the determinants of diseases to be able to arrive at balanced patterns of treatment in terms of healthcare ( 2003). This led to the recognition of many medical practitioners of the biopsychosocial model of illness, which, on the contrary to the biomedical model, integrates the psychological, social and biological factors in the diagnosis and treatment of any disease. In addition, this model of illness recognizes the fact that both the mind and the body interact with one another, thus, contradicting the biomedical model of emphasizing that a separate approach must be done in order to diagnose and treat mental and bodily illnesses. In relation to the treatment of Type 2 diabetes mellitus, it can be perceived that instead of using the biomedical model of illness alone, the use of biopsychosocial model would be more appropriate. This is because understanding the acquisition of Type 2 diabetes mellitus and the disease itself is not only based on the symptoms and manifestations of the disease, but of its various causes, which stem from biological, psychological, and social factors.
Evolution of the Biopsychosocial Model
As mentioned earlier, the evolution of the biopsychosocial model began with the recognition of Engel of the limited healthcare provided to patients, due to the reductionism approach and of being a detached observer of the medical practitioner. With such a new model of illness, the scope of the gaze of medical practitioners has been broaden, thus, presenting new ways and approaches in understanding the diseases of the patient through expansion of the domain of the knowledge involved in medicine. In addition, the foundation of the biopsychoscial model of illness is the content of emotions that is built upon the relationship of the patient and the medical practitioner. Integrated in such emotions is the fact that to be able observe the biopsychosocial model, the medical practitioner must be effective in influencing the behavior of the patient, thus, developing a good relationship. This leads to building trust between the medical practitioner and the patient, through extending empathy, basing decisions on race, sex, and gender, making intelligent decisions based on knowledge and learning, using informed intuition, and the use of effective communication between the patient and the medical practitioner (2004). As such, these practices would help enable the medical practitioners, including the doctors, clinicians, psychologists, and general physiologists to determine the causes of the diseases of a certain patient not only based on its symptoms and manifestations, but on social and psychological factors in the environment.
A number of models of illness have been based from the biopsychosocial model of illness with its introduction in the medical field. One of these models is the new model proposed by (2004), which is also based or similar to the approach of the biopsychosocial model. It recognizes the fact that illness is both a physical and social dysfunction, and in this regard, illness must be both a dysfunction of the self and the organs, must be influenced by personal beliefs, values and attitudes, and free will, must be physical and cultural or social, and serves to hinder from social and physical activities. However, from its context, it can be perceived that this model is quite primitive or basic compared to other models developed for it is still incomplete with regards to the elements of providing substantial and effective healthcare to patients. Although this model presents a good basis and definition of illness, it does not provide concrete suggestions on how to address the illness itself. Nevertheless, its approach would still be helpful and beneficial in the medical field, with which it can be used as a basis for the consideration of what is illness and what it is not. In relation to the treatment and diagnosis of Type 2 diabetes, it can be perceived that from the definition of illness in this model, Type 2 diabetes mellitus is not much of an illness, as nowadays, more and more medications and preventive measures have already been dissipated in the public. In addition, nowadays, becoming a Type 2 diabetic is not anymore a hindrance in terms of social and physical functions, except for individuals who are suffering from extreme obesity and other complications such as visual impairment.
From this model, another model was developed from the biopsychosocial model proposed by in 1977, and is the IBM or the Interactive Biopsychosocial Model, which offers a dynamic framework that aims to build scientific hypotheses regarding health and disease, thus, even useful as a teaching tool in the aim of many individuals to share information and knowledge regarding health and disease. This model was used by (2003), being essential in aging and human sexuality. In relation to Type 2 diabetes, the IBM was also used to hypothesize that sexual dysfunction of individuals may be the effect of having diabetes due to physical manifestations, such as obesity, lack of energy, and visual impairments. In this regard, the authors relates sexuality with the severity of Type 2 diabetes, as their hypothesis suggest that sexual health helps prevent or helps reduce the development of Type 2 diabetes, in relation to aging. In addition to this is the conclusion of the authors, suggesting that many Type 2 diabetics have their conditions worsened due to compromised or poor sexuality, physical and mental health, and social activities (2003). From this, it can be understood that one way in understanding Type 2 diabetes is through the help of the Interactive Biopsychosocial Model, which emphasizes the importance of having social, mental, physical, and sexual activities in order to help preserve and maintain the health and well-being of a Type 2 diabetic.
In support of such claims that the determination of biopsychosocial factors being much more useful in terms of providing effective and efficient treatment to patients, physicians have done a certain study, which emphasizes the importance of the roles their attitudes play in the diagnosis and treatment of their patients using psychosocial factors. This particular study done by (2006) suggests that although many physicians recognize the significant role of psychosocial factors in the diagnosis and treatment of a particular disease, not all physicians would opt to use “mind-body methods”, such as therapies and focus groups. This is because the findings suggested that many physicians, who do not opt for alternative method states that they either lack the time, they lack the expertise, or there is the lack for available methods. This study also suggested the difference between male and female physicians in terms of adopting mind-body methods, as more female physicians might consider the role of psychosocial factors in the diagnosis and treatment of diseases more than men physicians do. Thus, in this regard, it can be understood that female more often recognize the importance of emotions and the factors that contribute to it than men. From this study, it can be understood that due to the lack of time and the lack of expertise of many physicians, it must be suggested that physicians must be provided with more knowledge and exposure to such alternative methods to provide them the information of its uses and implications to their patients. In this regard, these physicians would be able to realize the importance of psychosocial factors in the development of a particular disease. In relation to Type 2 diabetes mellitus, it can be perceived that the diagnosis and the treatment of this illness would be more effective if psychosocial factors would be given importance and significance. This is because its development is caused by a variety of factors, not only confined to the organic or functional dysfunction of an individual. With the changes in the environment and the lifestyle of individuals in today’s generation, the role of the society and the person’s environment could be contributory to the development of Type 2 diabetes mellitus. As mentioned earlier, one of the causes of Type 2 diabetes mellitus is the environment, including infections and stress.
From the discussion, it can be deduced that the introduction of the biopsychosocial model in the medical field has produced a number of positive effects, especially in the diagnosis and treatment of diseases, such as Type 2 diabetes mellitus. The evolution of this model from the biomedical model has provided many medical practitioners the opportunity to further and better understand their patients through the use of integrative and rational approaches that include the recognition of the significant role of the interaction of biological, social, and psychological factors in the development of a particular disease. As such, many changes have been observed and gone through by medicine practice, such as providing many medical practitioners with alternative approaches in treatment, including therapies and focus groups in order to cater to the social and psychological needs of their patients.
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