The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization

ABSTRACT

Introduction

There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel’s original BPSM. These deviations have led to confusion and suboptimal patient care.

Objectives

1) To review Engel’s original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an “enactive” modernization of the BPSM.

Methods

Critical narrative review in the context of musculoskeletal pain.

Results

The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a “humanistic” interpretation based on person- and relationship-centredness. The second version is a “causation” interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations.

Conclusion

The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an “enactive-BPS approach” to musculoskeletal care aligns with Engel’s vision yet addresses theoretical limitations and may mitigate misapplications.

KEYWORDS:

• Biopsychosocial
• enactivism
• George Engel
• humanism
• person-centered care

Acknowledgments

The authors thank Dr. Roger Kerry (University of Nottingham) for providing helpful feedback on an earlier version of this paper.

Disclosure statement

All authors are involved in education initiatives offered to students and clinicians. This often includes discussing the biopsychosocial model.

Additional information

Funding

Peter Stilwell reports funding from the Canadian Chiropractic Research Foundation. Sabrina Coninx reports funding from the Deutsche Forschungsgemeinschaft (DFG - German Research Foundation) under grant GRK-2185/1 (DFG Research Training Group Situated Cognition).