The Biopsychosocial Model

Question 1

What is the WHO definition of health?

Answer 1

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” This was formulated in 1948.

Question 2

What are the five causes of the association between ill-health and deprivation

Answer 2

ARTEFACT-observed associations are not genuine but are observed because of the way we measure health and deprivation.
SOCIAL SELECTION -health determines socio-economic status (eg if poor health, less likely to be able to work and so more ‘deprived) rather than socio-economic status determining health.
BEHAVIOURAL/CULTURAL -people in deprived areas are more likely to smoke, eat poor diets and not exercise.
PSYCOLOGICAL -The stress of working in a poorly paid, low status job with little autonomy creates biological changes in the body which in turn create paths-physiological changes
MATERIAL -the direct effects of poverty (eg no car, earn housing ect.)

Question 3

In the past 100 years, why has there been a huge decrease in infant mortality and increase in life expectancy?

Answer 3

Medical Advances -eg vaccines, new drugs, advances in surgical techniques

Social Improvements -eg better housing, sanitation and diet

Question 4

What is the biomedical model of disease?

Answer 4

This is the theory that health is the absence of disease. The biomedical model of health focuses on purely biological factors and excludes psychological, environmental, and social influences. It is still the main method if diagnosis in western medicine.

Question 5

In the biomedical model, does the patient have responsibility for their health? Who is responsible for treating them if they get ill?

Answer 5

In this model, the individuals are not to blame for there condition since causes are mostly outside of there control. This then means that the responsible for treatment rests squarely with the medical profession who would then treat them using drugs and/or surgery.

Question 6

What is the biopsychosocial model of disease?

Answer 6

The biopsychosocial model is a broad view that attributes disease outcome to the intricate, variable interaction of biological factors (genetic, biochemical, etc), psychological factors (mood, personality, behavior, etc.), and social factors (cultural, familial, socioeconomic, medical, etc.).

Question 7

In the biopsychosocial model, does the patient have responsibility for their health? Who is responsible for treating them if they get ill?

Answer 7

In this model, health and illness is seen as a consequence of a variety of factors including lifestyle so the individual is no longer seen as a passive victim. . This also means that the responsibility for treatment is shares between the doctor and the patient and that the whole person should be treated, rather than just the illness.

Question 8

What is chronic illness?

Answer 8

This term encompasses a wide range of conditions: long term, significant impact on other and have many co-morbidities.
Their manifestations may vary greatly day to day and the condition can only be managed and not cured.
Long Term Conditions will increase with the ageing population but, it is not only older people who live with a long term condition.

Question 9

What is Rheumatioid Arthritis?

Answer 9

This is a chronic, progressive, inflammatory autoimmune disease of unknown cause, insidious onset.
It usually arises between the ages of 40-60 but may occur at any age,
Signs and symptoms include joint tenderness, sewing, anaemia, pain, fatigue, muscle atrophy, osteoporosis. It is marked by exacerbations and remissions.

Question 10

What proportion go total healthcare spend in England is attributed to caring for people with long term conditions?

Answer 10

70%. Inevitably, social and psychological factors are bought to the fore so not all appointments would be for the LTC.

Question 11

What are the different types of work of chronic illness?

Answer 11

illness work - Symptoms management
Everyday life work - managing daily living
Emotional work -managing ones own emotions and those of others
Biographical and narrative work - reconstruction of biography
Identity work - work to maintain an acceptable identity

Question 12

What are the pros and cons of self managements interventions?

Answer 12

Good because:
Coping and condition management skills
Aims to reduce hospital admissions
Patient centres

Bad because:
Responsibility for care placed on (very ill) patients
Real agency and understanding
There is little evidence of efficiency / cost savings (more patients know, more questions patients have)

Question 13

What is defined as emotional work?

Answer 13

Work that people do to protect the emotional well-being of others
Maintaining normal activities become deliberately consious
People find friendships disrupted and may strategically withdraw or restrict their social terrain
May involve downplaying pain to other symptoms
Presenting “cheery self”

This may have a devastating impact in your role (eg breadwinner, wife, mother). It can also lead to dependancy, therefore a feeling of uselessness to self and others. It may be especially devastating to young people.

Question 14

What is biographical work?

Answer 14

This is a loss of self. This is when a former self-image crumbles away without simultaneous development of equal values new ones. This is the interaction between body and identity.

Question 15

What is stigma?

Answer 15

Stigma is a negatively defined condition, attribute, train or behaviour conferring ‘deviant’ status.

Question 16

What is the difference between discreditable and discredited stigma?

Answer 16

Discreditable: Nothing seen, but found out if…. eg HIV, mental illness.

Discredited: Physically visible characteristics or well known stigma which sets them apart eg physical disability, known suicide attempt.

Some conditions are both eg epilepsy

Question 17

What is the difference between felt and enacted sigma?

Answer 17

Enactedt: The real experience of prejudice, discrimination and disadvantage. As the consequence of a condition.

Felt: Fear of enacted stigma, also encompasses a feeling of shame (associated with having a condition) -Selective concealment.

Question 18

What is illness work?

Answer 18

This relates to the period leading up to getting the diagnosis and or dealing with the physical; manifestations of illness.
This is how an individuals self-conception changes as a result of living with their condition.

Question 19

What are examples of illness work?

Answer 19

• Undergoing multiple tests
• Encountering uncertainty- diagnosis of a condition where they may be no clear structural or pathological explanation, but patient has symptoms
• Addressing issues with eating, bathing, going to the bathroom
• A change in personal relationships e.g. family members becoming carers (this also links with Everyday life work)
• Attending health services deigned to improve management of condition/symptoms e.g. DESMOND

Question 20

What is everyday life work?

Answer 20

• Everyday life work refers to the actions and processes involved in managing the condition and its impact
• In its essence, it refers to the daily tasks one may complete to keep the household going.

Question 21

What are examples of everyday life work?

Answer 21

• Decisions about mobilisation of resources
• Balancing demands on others and remaining independent
• Attempting to minimise or disguise presentation of symptoms

Question 22

What is identity work?

Answer 22

• Identity work refers to the establishment and maintenance of an acceptable identity

Question 23

What are examples of identity work?

Answer 23

• Managing the actual and imagined reactions of others
• Presentation of one’s self to avoid stigma e.g. continuing to walk without the aid of a walking stick although it may cause further deterioration of condition as well as pain (discredited stigma)
• Not sharing some or all aspects of one’s illness due to fear of being treated differently e.g. withholding information about current or past mental illness with employer/employees

Question 24

What is emotional work?

Answer 24

• The work people do to protect the emotional well-being of others (linked to identity work) that may also lead to a changed role and/or purpose for the person living with a chronic illness

Question 25

What are examples of emotional work?

Answer 25

• Taking conscious decisions to demonstrate continued ability to remain active and partake in activities if one was without an illness e.g. taking part in 5KM run, tasks around the home
• Experiencing social isolation or withdrawing from social circles e.g. spending less time with family and/or friends
• May lead to increased dependency on close others e.g. spouse undertaking greater responsibilities within the home

Question 26

What are examples of biographical work?

Answer 26

• Patient attempts to reconnect their life prior to diagnosis with the present and future e.g. suddenly taking greater interest in sports, joining social clubs/societies, re-establishing past friendship groups
• During diagnosis and/or post diagnosis, patient may encounter a phase a period of uncertainty as a result of subsequent loss of what was previously a `taken-for-granted’ continuity of life
• Patient may ask themselves the following questions:

Why me and why now?
What should I do now?
What will happen to me?