BioPsychoSocial Model Plus

The biopsychosocial model is framework that posits that biological, psychological, and social factors interact to influence health and illness. Developed by George Engel in 1977, Engel suggests that to understand a person’s actual condition requires considering their body (genetics, brain chemistry, sleep, diet, exercise, body disease diagnoses), mind (thoughts, emotions, mental framework), and social environment (friends, culture, economic status). This is in contrast to the purely biomedical model of disease which posits that genetics and environment conditions are all that affect body health, and general psychology that posits that mental illness is either genetics or trauma. While the BioPsychoSocial Model covers more than either of these common models, it under sells the costs of financial stability by calling that “social”, and it misses the self worth of what is often called the Spiritual component in the BioPsychoSocioSpiritual variant, hence why this is titaled BioPsychoSocial Model Plus.

A psychiatrist once put it to me like this: “It is hard enough to battle the things you can’t control without having to also fight the things you can influence. If you get your bio-psycho-social as balanced as you can, then you have more energy to win those other battles.” I found that to be very profound, which is why looking at all of these elements is a fundamental aspect to the therapy I bring to my clients.

Interconnected: Bio Psycho Socio Eco Spiritual

Put in another way, if one of these sections is in poor health, such as you are not sleeping well, then it will have an adverse consequence to your total health and affect every other section. If you are not sleeping well:

  • Bio:
    • You will feel greater fatigue and your immune system will be weaker, from leaving you open to catching a virus or increasing your risk of cancer.
    • You reaction speed will be lower, increasing your risk of accidents.
    • Your body will heal slower from any injury.
    • Fatigue can lead to not having the energy to make quality food, which can lead to undernourishment which can increase the risk of burnout.
  • Psycho:
    • To compensate for low sleep, people’s bodies produce addtional adrenaline which shortens tempers, increases mood reactivity and can lead to anxiety and or depression.
    • Poor results due to fatigue can negatively impact self esteem, leading to greater self criticism.
    • Fatigue leads to poor cognitive function, making it harder to understand situations and solve problems.
    • Fatigue leads to poor motivation to get tasks done.
  • Social:
    • Shortened temper can lead to increased social friction.
    • Loneliness that may result from social problems can lead to decreased self-esteem.
  • Economic:
    • Fatigue can lead to poor decisions at work, which may lead to unemployment.
    • Fatigue can lead spending additional finances on medicaitons to offset fatigue, or purcahsing food, or purchasing goods to feel better to offset a decrease in self-esteem.
    • Poor health, or extreme fatigue, can lead to time off work, which reduces income, which creates stress and pressure on other aspects.
  • Spiritual:
    • Fatigue can decrease activities of self-worth
    • Loss of job due to the inability to work well can affect how you feel you are able to give back to the world
    • Illness can halt your ability to interact positively in community, leading to a feeling of worthlessness, being a burden or being “surplus” to the world.

A single night’s poor sleep is not going to cause all of the above example, but a few nights poor sleep can lead to a few of the above other concesquences and chronic poor sleep can lead to all of them becoming true. The example here is to highlight how a single factor in our health can affect all of the factors in our total health.

Bio – Biological

The Biological Model of Health is not just about what diagnoses you have to describe your physical ill health, such as diabetes, heart conditions, neurological conditions etc; it is about what you do to maintain good health, or decrease a decline in health.

  • Biological Health Maintenance
    • Food – eating 3 to 4 meals of quality food per day
    • Sleep – around 8 / 24 hours of sleep per day with no more than 1 interruption [more: Beating Insomnia, which addresses sleep myths]
    • Exercise – 2 hours of solid exercise [can be specific for exercise, can be an activity that exercise happens, such as hiking with a friend, gardening etc]
    • Healthy Bloodwork
      • Minerals: eg Ferritin
      • Vitamins: esp B6, B12, C, D
      • Hormones: primary sex hormones, adrenaline, cortisol, thyroid
  • Biological Diagnoses
    • There are too many to list, but getting these to be as healthy as you can will minimise the impact on other areas

Psycho – Psychological

The Psychological Model of Health is not just about what diagnoses you have to describe your mental ill health, such as anxiety, depression etc, but also how you see the world, what you do to maintain your mental health.

  • Psychological Health Maintenance
    • Having fun
    • Rest
    • Learning
  • Psychological Health Repair
    • Healthy Boundaries
    • Healthy Self-Esteem
      • Self-Image

Socio – Social

he Social Model of Health is not just about what diagnoses you have to describe your social conflicts [toxic people] or difficulties [missing cues, not knowing how to make friends], but also how you make time to interact with positive people. If you are surrounded by people who belittle and taunt you, it is hard to have positive mental health or want to look after your body health (eat, sleep etc). If you are surrounded by accepting, supportive and inspiring people, it is much easier to grow and become whatever you want to become.

  • Social Health Maintenance
    • Time alone
    • Time with positive friends
    • Time with positive family
  • Social Health Repair
    • Knowing how to manage toxic people, and knowing when to get away from them
    • Boundaries (same as psychological above)
    • Understanding the limits of generocity and self-sacrifice
    • Knowing how to make and maintain positive friends

Eco – Economic / Financial

Traditionally this is in the Social category, however I feel that it is lost there. We often forget that poverty is the biggest driver for illness, and the most common consequence of long term illhealth is poverty.

  • Economic Health Maintenance
    • Being able to aquire a good job
    • Keeping your good job
    • Work / Life balance
    • Knowing how to walk away from a bad job
    • Financial impulse control / mitigation
    • Insurance, Superannuation,
  • Economic Health Repair
    • Reducing un-needed costs without reducing life enjoyment & quality
    • Improving job satisfaction (which does not offset a bad work place)
    • Efficiently paying off debts

Spirtual / Soul / the Being in Human Being

For some people, Spiritual means religion, and if that works for you, by all means gain this aspect from there. For many people, though, this has nothing to do with religion and religious groups.

This is more about feeding the spirit or soul – the core of who you feel you are. While scientifically we have zero evidence for a seprate version of ourselves from the physical, concepctually this is a handy short hand. This is the being of your human being. Who are you that does things, what do you bring to the table in a social setting, and how do contribute or take part in this world?

When I discuss Spiritual component with other professionals in terms of the Biopsychosocial Model, often they put part of it in Psychological and part of it in Social. I can see a benefit of that simplification, but I feel that connecting to nature and connecting to land are completely missed in this. I also feel that how we view our contribution to our people, our culture and the world in general is missed.

There is a concept around this spoken about by a Japanese concept: Ikigai.

Ikigai – Life worth / Life value

Ikigai is Japanese word that roughly translaters to “to a passion that gives value and joy to life” [Link], or a “person or thing that brings meaning and joy to your life”, “the happiness of always being busy” [Ikigai: The Japanese Secret to a Long and Happy Life].

The concept of Ikigai approximately tries to helpyou find

  • Fullfillment – a deeper satisfaction with your life
  • Longevity and Happiness – the belief that you will live longer if you are happier
  • Accessibility – recognises that your actions can be great or small, so long as you are doing actions that feel good to you and feel rewarding

Ikigai askes these four questions to prompt your discovery of your path:

  1. What you love: your personal passionas and interests
  2. What you are good at: your skills and talents
  3. What the world needs: How you contribute to the community or world (it doens’t have to be local)
  4. What you can be paid for: How your skills and efforts can also bring a livable income (it doesn’t have to be done for free)