Nicole Jaquette

Engl 137H

Professor Babcock

11/3/17

Imagine going to your doctor’s office to refill some important anxiety medication, but

instead the doctor says that there’s nothing physically wrong, and therefore he cannot prescribe

any medication. Think about how demeaning it would feel to have a mental illness viewed as “all

in your head.” This is just one example of the old fashioned views that went along with the

biomedical model of medicine. Thankfully though, this is an issue that is extremely rare today.

For centuries, society had the idea that if there was no physical or biological explanation, then

there was no true illness. Sociological, psychological, and environmental factors were never

considered. It wasn’t until 1977 when George Engel proposed the biopsychosocial model that the

concepts around medicine changed. It also took another few decades after that for the new

concepts to be fully accepted and applied. Society wasn’t extremely accepting of the changes at

first, but with time the new viewpoints were accepted and taught more thoroughly. Throughout

the last century, the outlook on medicine as a whole has been completely remodeled. By taking a

more holistic approach to medicine, the old standards of the biomedical model were pushed aside

and the outlook of the biopsychosocial model was put into place, which greatly affects the way

disease is viewed and the way medicine is practiced today.

Since the steadfast biomedical model was put in place in the early 19th century, it became

the sole outlook of physicians globally. For over a century, everyone who practiced medicine had

the exact same beliefs and outlooks. To be exact, the biomedical model is defined as,

"a conceptual model of illness that excludes psychological and social factors and includes only
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biologic factors in an attempt to understand a person's medical illness or disorder” (“Biomedical

Model”). The definition clearly states the exclusion of psychology and sociology from the

viewpoint. Looking back at what made the shift possible, it is first necessary to examine the man

who made it all possible. George Engel was an American physician, and later psychiatrist, who

was born and lived most of his life in New York. He attended Dartmouth College at a very

young age to please the hopes of his elders. He later attended Johns Hopkins Medical School

with a strict biomedical focus. Clearly Engel was extremely motivated, hardworking, and

successful in all of his endeavors. Like most physicians of the time, Engel also believed in the

sole concept of the biomedical model. The first exposure Engel had to any psychology was the

psychosomatic approach his chief of medicine began taking when he worked at Mount Sinai

Hospital. This approach was becoming more and more popular in hospitals across America, and

yet it was still not even close to being culturally accepted. Engel especially laughed off the

psychosomatic views. He soon left the too-modern Mount Sinai to work with an old friend,

Soma Weiss, who Engel had known, recognized, and loved for having a sturdy biomedical

viewpoint. However, in Engel’s absence from him, Weiss had hired a psychiatrist and

completely shifted his views. The psychiatrist listened to the patient’s history and developed an

all-inclusive medical plan which brought their experiences and environment into play. This was

the beginning of the extremely important doctor-patient relationship. Weiss’ views had shifted so

much that he had even stated, “mental factors represent as active a force in the treatment of

patients as chemical and physical agents” (Brown). Even though Engel was surprised by this new

change and rejected his friend’s views at first, he later accepted a position in the Department of

Psychiatry at the University of Cincinnati Medical School, going against all of his prior beliefs.

Engel’s principles did a complete 180 all because of one influential friend. At this time, Engel
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could no longer deny the social and psychological influences in medicine. It went against

everything he had previously known, but society and the culture of medicine were shifting, and

that was now undeniable. After Weiss’ unexpected death, Engel devoted his work to developing

the psychosomatic outlook even further. He took some of the most famous practices from his

past and applied psychology to them to create something brand new. Soon after this new work

had begun, Engel and his new colleague Romano began presenting their findings to the

American Psychosomatic Society. This was one of the major events that pushed the

biopsychosocial model into existence. Their findings would soon become publicly known, which

was the first step in having society accept their new beliefs. However, it wasn’t until 1977 that

Engel finally wrote and published a holistic paper that emphasized the importance of a patient’s

emotional and social needs, focused on the training of a brand new generation of physicians that

would be focused on all aspects of patients. Engel was aware that this new model would most

likely not be fully accepted for years, if not decades, but he was one of the few people with the

courage to put it out there in order to try to make a difference (Brown).

Before the biopsychosocial model was completely accepted by society, physicians had

very different views and opinions of the patients who did not have strictly biological issues. It

used to be the belief of both doctors and society that if there was no physical or biological cause

for an illness, then there was no “real” problem. This specifically affected one very important

group of people: mentally ill patients. Before the 1950s, and even some years after, people with

mental illness were treated in ways that would be considered extremely inhumane today. Since

physicians rarely even considered mental illness or the psychological state of a person, they

could never come up with an explanation for what was wrong with the patient. This usually led

to families putting their loved ones in mental institutions, which were a crime unto themselves.
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Society viewed mental asylums as places where “crazy” people went and lived out their days,

when in reality they contained a misfit of people. The types of people in these asylums ranged

from truly psychotically ill, to kids with minor personality disorders, to elderly people with

dementia that didn’t have families to care for them (Braslow). Other people with true mental

illnesses were sometimes put in prisons purely out of convenience for a community. Truly

“mentally deranged” people at that time were subjected to horrible treatments which included

lobotomies, heavy medication, shock treatment, and medically induced comas. Nobody at that

time thought anything of these treatments, despite how horrific they are seen today. They were a

common occurrence and seemed like an easy fix to any mental problem at the time. Since

nobody considered the social, cultural, environmental, or psychological aspects of patients, they

were never given fair treatment or assessment. Somewhere in the 1950s, it was realized that how

society had gone about treating mental illness was horribly wrong, and the deinstitutionalization

movement began. It was in this decade that more research on psychosomatics was being

conducted and some was even being published. This went hand in hand with George Engel’s

work at the time. When he published his paper on the biopsychosocial model in 1977, society

could no longer ignore this new attitude towards mental illness and the use of psychology in

medicine. Clearly the stigma society had associated with mental illness and the mentally

disabled was overtly wrong, but the research done by George Engel and many other physicians

of the time helped to change everyone’s opinions and give them new outlooks on what mental

illness truly was (Braslow).

Now that institutions were closing down and psychosomatic research was reaching all-

time highs, our culture had no choice but to be open to the new idea that psychology plays a role

in medicine that is just as big as the role of biology. To go along with the new outlooks that
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medicine had developed, society had to develop some new outlooks too. After the

deinstitutionalization movement, people were moved out of asylums and they were put into

communities where they had access to counseling, life skill training, and social support. These

communities were more integrated into society than ever before. People could no longer ship off

their problems to an institution and pretend like they never existed. Now that doctors were

officially diagnosing and treating patients with mental illness more and more, it was beginning to

become much more of a cultural norm. Physicians began sitting down with patients and

discussing their emotions, their environment, their social standing, anything that could have an

effect on their well-being. According to Drs. George Engel and John Romano and their research

and previous experience, the biopsychosocial perspective is more appropriate when analyzing the

causes of mental illness (Brown). This meant that there were no more excuses for people to not

accept the diagnosis of mental illness. There was research being done and published to prove that

the new medical model was much more effective and holistic than the old one. Since the

biopsychosocial model was presented and further accepted, society as a whole has changed their

perspective on mental illness and the medical field, and it continues to grow and change today.

There have been so many positive effects and changes since the path for the shift was

created and the biomedical model was pushed to the background, bringing the psychosomatic

viewpoint to be more widely accepted. With psychology now playing a much larger role in

society, the effects are obvious. There is absolutely no doubt that this shift of medical models

was huge and made a lasting imprint. This new attitude towards mental health and sociological

issues will lead to a multitude of great things in the future because of what has been learned from

the lack of it in the past. To prove that society has completely changed how they feel about

mental illness, there is now a mental health awareness week, established in 1990, which is a huge
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step forward from where the views of mental illness were just decades earlier. In the span of 60

years, society went from torturing, locking away, and killing mental patients to celebrating,

helping, offering support, and publically acknowledging them. Additionally, countless other

forms of illness have been acknowledged since the shift other than just biological ones.

Addiction used to be seen as a personal fault. People used to believe that the addict could change

if they really wanted to. Today, physicians everywhere acknowledge that addiction is a

legitimate disease. There is scientific evidence, including dopamine, the stress response, and

genetics, that prove that addiction can be uncontrollable (“Monitor on Psychology”). Without the

new holistic medical approach, some of this evidence would have never been found. Chronic

pain is another issue that used to be ignored. Physicians used to not be able to find a physical

cause of the pain, so they denounced it and sent the patient home to suffer unendingly. With the

new biopsychosocial outlook, chronic pain can be better controlled and is no longer thought to be

in the patient’s head. Adding to the list of positive effects of the new model, grief counseling is

popular now whereas it never even existed before. The stages of grief are now seen as a

legitimate psychological issue, where it was never considered a factor in any disease a few

decades ago. Mental institutions were affected just as much as any illness. After they were

liberated, most were either torn down or converted into new mental facilities. These facilities are

not scary, and people aren’t afraid of the things that go on inside. Most people that enter these

facilities come out a few short months later with nothing but improvement to show from their

time there. The one thing that has been affected most by this new model is the doctors. Proof of

how important psychology and sociology are to a physician’s everyday life is seen on the

MCAT, the test that every student must take to get into medical school to even consider

becoming a doctor. This test recently added on sociology as a huge section. In fact, this section
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of information is just as predominant as the biology section, which speaks numbers (“Monitor on

Psychology). In hospitals, doctors are also taught to have close doctor-patient relationships. They

learn to get to know every aspect of their patient including family members, social status,

work status, and living environment, just to name a few. All of this information is now crucial in

a physician’s diagnosis, whereas before it was not even a factor. There have been so many new

psychological developments in the medical field past few decades, and these are just paving the

way for even more new practices to come (Cardoso).

Therefore, there is extensive proof that the shift to the biopsychosocial model has

completely changed the way medicine is practiced in today’s standards. When the biomedical

model was disregarded and proof for the need of the new model came into existence, the way

disease was diagnosed and treated was changed forever. The benefits of this new viewpoint are

undoubtedly positive, making the old outlook on medicine seem useless in today’s standards.

Thanks to George Engel and his shift in ideology, he was able to catalyze a shift in society.

Mentally ill patients were treated horribly decades ago, whereas today they are celebrated.

Society can never be reverted to the old views because of the deep paths that were carved to get

medicine where it is today. Seeing how far medicine and the treatment of mental illness has

come due to the biopsychosocial model is inspiring and should give everyone a deeper

appreciation for mental health and where our healthcare system is today.
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Works Cited/Consulted

Biomedical Model. The Free Dictionary. Farlex, medicaldictionary.thefreedictionary.com/

biomedical+model.

Braslow, Joel. Where Biopsychiatry Came From: A Short History Of Somatic Therapies From

1900. Harvard Mental Health Letter 16.2 (1999): 5. MasterFILE Main Edition.

www.web.b.ebscohost.com/.

Brown, Theodore M. The Growth of George Engel's Biopsychosocial Model. Free Associations.

24 May 2000. www.human-nature.com/free-associations/engel1.html.

Cardoso, Julia. The Biopsychosocial Perspective to Mental Health and Illness. Social Work

Helper. 4 May 2017. www.socialworkhelper.com/2013/07/16/the-biopsychosocial-

perspective-to-mental-health-and-illness/.

History of Mental Health Treatment. Dual Diagnosis. www.dualdiagnosis.org/mental-health-

and-addiction/history/.

Monitor on Psychology. American Psychological Association. www.apa.org/monitor/nov04/

grief.aspx.