Medically unexplained symptoms: the biopsychosocial model found wanting

Abstract

The recognition that all illnesses have both mental and physical components and that there is a dynamic relationship between components of systems (general systems theory) led to criticisms of the biomedical model and to the development of the biopsychosocial model of Western medicine.1,2 From this model emerged the concept of triple diagnosis, whereby clinicians make diagnoses at three levels, the biological or physical, the personal or psychological and the social and contextual.2,3 By understanding relevant factors at all three levels and their interactions, clinicians are better able to treat the whole person—the patient-centred clinical method.4 However, McWhinney and other proponents of this idea may have been premature in celebrating a ‘Kuhnian paradigm shift’.2 An exploration of the concept of somatization suggests that the biopsychosocial model has not adequately addressed important anomalies associated with the previous biomedical paradigm. The biopsychosocial model is unsatisfactory because it remains essentially within the analytic philosophical tradition. In the ‘interpretivist’ philosophical tradition, human experience is inherently ‘bodily’. We offer a view that allows both patients and clinicians to see ‘medically unexplained symptoms’ as unambiguously medical.