What colour is YOUR biopsychosocial model?

Just browinsg through the program for the Canadian Physiotherapy Association National Congress in Whistler BC this July.  Incidentally, the roster of speakers looks fabulous.  Really nice to see Michele Sterling, Jim Elliot and Mick Sullivan on the docket for this year.  All three will bring a nice, holistic flavour to what is often a biomedical-heavy conference.  If you're near Whistler, or looking for an excuse to travel to a beautiful part of Canada, then strongly consider attending.

One of the items in the program is a round-table discussion called Bio? Psycho? Social?  I love this idea, and can't wait to hear how it goes.  It reminded me of a session I delivered on the BPS model of health and wellness for an advanced teaching skills course I attended last year.  The course required participants to deliver mini-lectures that werre videotaped and the reviewed by a group of peers.  Being an advanced level, we were being challenged to try methods that we wouldn't normally for our subject area.  I was given the challenge of teaching some aspect of health science using art.  I thought the BPS model would work perfectly for this.  I found a painting hanging in the library where the course took place, and used it to try to explain my take on health, wellness and deviations from it (including deviations due to pain).

The painting had the primary colours of red, blue and yellow, which I labeled for my peers as the primary pillars of health: biological, psychological and sociological influences (and areas that are all influenced to greater or lesser extents by deviations from health).  But the painting had many other colours, and I drew attention to the fact that the painting couldn't adequately be described in terms of red, blue and yellow only.  Fortunately, this particular painting also contained the secondary colours oranges, greens and purples.  These I was able to label biosocial, psychosocial, and psychobiological, respectively.  Now we were getting closer to understanding the intergrated biopsychosocial model of health.  But it still wasn't whole.  Fortunately this particular painting had a lot of brown in it.  Artists will know that you can mix a nice messy brown using a combination of secondary colours (orange, purple and green) in varying amounts.  To me, the brown is where the domain of health lives.  It's messy, and it can only exist with the three pillars of the BPS model to create it.

It wouldn't make any sense for me to call up my mom, tell her I found a really nice painting, then describe in terms of orange, green and purple only.  And makes even less sense to describe it in terms of red, blue and yellow only.  Yet, this is what we often try to do with health and pain - deconstruct it into its component parts.  I do it too.  In research terms, understanding the various contributions to health or pain makes sense, but only if we then reconstruct health to understand that: there is no 'bio' without 'pscyho' or 'social', there is no 'social' without 'bio' or 'psycho', and there is no 'psycho' without 'bio' or 'social'.  Sort of like the way that good cannot exist without evil I guess.

In research and practice, we like to look for the mechanisms driving patients' pain.  That's not a bad thing, in fact it's probably a good thing in that hit helps with clinical decision making.  But we have to realize that none of the three pillars of the BPS exist in a vaccuum.  If I hear one more clinician tell me something like 'this patient is very psychosocial', I think I'm going to lose it.  What does that even mean?  We're all psychosocial.  If what you're trying to say is that you believe the patient is either intentionally or unintentionally exaggerating their complaints of pain, then say so.  And be prepared to defend your statement.  And further, don't think that means we can't help them.  By definition of what I'm presenting here, if you focus your treatment on one of the primary pillars or secondary strata, you will have an effect on the whole system.  Even social - reflect on that a moment.

There's lots more that could be said here, but I'll save some for another post.  Enjoy your weekends everyone.