5.2 Theoretical orientations
5.2.1 The biopsychosocial theory
The researcher will use the biopsychosocial theory to understand how clinical psychologists understand the clinical conditions reflected in the case vignettes. The theory will further aid the researcher to understand and carry out the management of such conditions. The choice of the biopsychosocial theory for the present study was informed by the shortfalls of the other western-oriented theories which were discussed in chapter two, which often look at individuals and phenomena from either the psychological, social and biological domains in isolation. The biopsychosocial theory has proven itself to be a theory that acknowledges the interplay of psychological, social and biological aspects in the understanding of psychopathology. The literature further suggests that it has proved itself to be effective in the psychological management of mental disorders.
The choice of the biopsychosocial theory was further prompted by the acknowledgement of its ability to advocate for a multidisciplinary approach to the management of mental health issues. Furthermore, it is commended for its integrative and holistic approach to mental illness and its discouragement of the mind-body split that was the case with the biomedical approach (Babalola, Noel & White, 2017). The applicability of this theory has been echoed by Hulla, Brecht, Stephens, Salas, Jones and Gatchel (2019) due to its effectiveness in the management of pain and its association with physical deconditioning, postural control, gait, sleep quality, and psychosocial well-being. This theory was also found to be valid, especially in medicine and psychiatry, on the account that it denotes the reality that mental illness is caused by multi-level mechanisms at the biological, psychological and social levels (Tripathi, Das,
& Kar, 2019).
5.2.1.1 Historical developments of the biopsychosocial theory
The biopsychosocial theory is a product of George Engel‟s work as a deviation from the commonly used biomedical model which only focused illness causation on biological and chemical factors. Engel believed that the biomedical model was reductionistic, further proposing and advocating for a holistic approach anchored in the general
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systems theory to address health-related issues (Henriques, 2015). Without any denial or ignorance of the advances in medicine that the biomedical research has fostered (Gatchel, Howard, Haggard, Contrada, & Baum, 2011), Engel developed the Bio- Psycho-Social theory in 1977 with the view that, unlike the bio-medical model which considered only biological factors in understanding illness, to understand and respond satisfactorily to patients‟ suffering, and to give patients a sense of being understood, clinicians had to acknowledge the interplay of psychological and social dimensions of illness (Borrell-Carrió, Suchman, & Epstein, 2004).
Engel believed that as a medical illness became more chronic, the psychological and social factors in the form of either distress, illness behaviour, or the sick role often have a role in the complication of the assessment and treatment process (Gatchel, Howard, Haggard, Contrada, & Baum, 2011). The theory was later applied in different settings including research on pain, where the pain was viewed as a dynamic interaction of the biological, psychological and social factors which may on many occasions differ from one individual to another (Gatchel, Howard, Haggard, Contrada, & Baum, 2011). The theory also brought about developments in medicine and psychiatry in the last decades of the 20th century through new ways of conceptualizing mental health challenges and brought about changes in research, medical teaching and practice (Babalola, Noel, &
White, 2017).
5.2.1.2 The biopsychosocial view of illness
The biopsychosocial theory is one of the biomedical models that emphasise the interplay of the biological (genetic predisposition), psychological or behavioural (lifestyles, explanatory styles, health beliefs), and social factors (family relationships, socioeconomic status, social support) tenets in the clarification of pathogenesis and health aetiology (Hatala, 2012). This theory explains that all three domains play an equal part in the manifestation of all the health situations and that none of them may be used in isolation to elucidate any patient or pathology with the exclusion of the other two (Ghaemi, 2009). This model further asserts that the determinants for, and the prognosis of, mental health difficulties are the result of an interaction between biological,
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psychological, and social factors with no factor having a “monopoly” on the explanation and/or cure (Babalola, Noel & White, 2017).
As the biopsychosocial approach was anchored on the primary tenet that mental illness was a reaction of the personality to biological, psychological and social factors, Michael Wilson outlined the basic assumptions of the bio-psychosocial model. He argued that:
“(i) the boundary between the mentally well and the mentally ill is fluid because normal persons can become ill if exposed to severe enough trauma; (ii) mental illness is conceived along a continuum of severity – from neurosis to borderline conditions to psychosis; (iii) the untoward mixture of noxious environment and psychic conflict causes mental illness; and, (iv) the mechanisms by which mental illness emerges in the individual are psychologically mediated (the principle of psychogenesis)” (Wilson, 1993; Makgabo, 2013: 20).
In the assertion made by Kinderman, (2005) a disruption in psychological or cognitive processes contributes as a pathway to the development of mental illness. Therefore, positive interaction between the biological and social factors together with a person‟s individual experiences may guide to mental illness through their interplay with those disrupted psychological processes. Papadimitriou (2017) emphasizes in addition to biological factors, the role of environmental factors in increasing the probability of the clinical expression of a mental illness and the role they may have on the time of onset of illness manifestation. Though the adoption and implementation of the biopsychosocial approach in the primary care settings grow fairly slowly, this approach has been deemed imperative through its likelihood to improve clinical outcomes for chronic diseases and functional illnesses seen in the primary care settings (Kusnanto, Agustian,
& Hilmanto, 2018).
5.2.1.3 The biopsychosocial management of illness
Unlike the previous one-sided biomedical model, the biopsychosocial model advocates for a multidisciplinary advance to the management of illness that should take into cognisance, the biological, psychological and social domains of a human. In the
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assertion made by Cardoso (2013) the biopsychosocial approach has proven effective and with many benefits for clinical workers, especially when treating mental illness. It enhances the ability to treat the patient holistically and fosters the patient‟s ability to gain self-awareness and the interplay of several parts that function together in their health. Schotte, Van Den Bossche, De Donker, Claes & Cosyns, (2006) argues that the biopsychosocial approach has proven its effectiveness in the management of depression. The biological management encompasses the stabilisation of underlying medical problems, substance-related disorders and primary psychiatric symptoms with medication and electroconvulsive therapy. Psychotherapy is then incorporated to addressing psychological symptoms while the assessment and referrals to relevant stakeholders for social support addresses the social aspects of depression.