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A pathway to full integrated biopsychological medicine
We need to overcome our own professional mind/body dualism and to stop distinguishing between ‘mental’ and ‘physical’ health if we want to achieve an integrated biopsychosocial medicine.
So says ACLP president (2019-2020) Michael Sharpe, MD, FACLP—now president of the European Association of Psychosomatic Medicine—who presented a plenary at EAPM’s 11thscientific convention in Lausanne on Biopsychosocial Medical Care: Past, Present, and Future.
The concept of a medicine that encompasses the whole person (body, mind and social context)—as eloquently described by American internist and psychiatrist George Engel in the later twentieth century—incorporated all these interacting domains. This view challenged the Cartesian ‘conceptual dualism’ which has driven the separation of mental and physical health care.
“Certainly, progress toward realizing Engel’s vision has been made over the last 50 years—the expansion of C-L Psychiatry being an example,” says Dr. Sharpe. “But we are still far from achieving a fully biopsychosocial medicine.”
As Engel predicted, its implementation has been obstructed by a variety of factors. These include not only the vested interests of biomedical industry, but also the professional vested interests of physicians themselves: “Professional dominance has perpetuated prevailing practices, deflected criticism, and insulated the profession from alternative views that could improve health care,” Engel wrote in 1977.
So, how do we continue to make more progress toward a biopsychosocial medicine, asks Dr. Sharpe? We need not only to overcome the outdated conceptual dualism of body and mind, but also to transcend its reflection in how we think about illness.
The distinguished British psychiatrist Professor Robert Kendell (1935-2002) wrote about the “unhelpful linguistic distinction between mental and physical illnesses, and the mind-body distinction from which this was originally derived, that still encourages many lay people, and some doctors and health professionals, to assume that the two are fundamentally different.” He argued they are not.
“Importantly, we need to overcome our own professional dualism,” says Dr. Sharpe. “We need to see psychiatrists not as specialists in a category of illnesses that are deemed to be ‘mental’ in nature, but rather as clinicians who bring special skills, like surgeons.
“As Engel wrote in 1977: ‘The outcome [of trying to implement biopsychosocial medicine] will depend upon those who have the courage to try new paths and the wisdom to provide the necessary support.’”