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Mansel Aylward said:Biopsychosocial models
None of the above models on its own succeeds in taking account of the range of factors which can influence the nature and extent of physical or psychological dysfunction. They all fail in one way or another to acknowledge attitudes and beliefs, psychological distress, social, and cultural influences, and personal experiences brought to greater or lesser extent by an individual person to the display of functional limitations and restrictions in its social context. A better understanding of chronic low back pain and disability, and management, is best provided by a
biopsychosocial model which considers all the physical, psychological, and social factors which may be involved (Engel 1977; Waddell 1987; Mendelson, Chapter 17). Many patients with medically unexplained symptoms do not have psychiatric disorders; these may be the result of minor pathology, physiological perceptions, and other factors including previous experience of illness (Nimnuan et al. 2000).
According to the attractive biopsychosocial model developed byWaddell (1998) and Main and Spanswick (2000), an initiating physical problem or perception, when filtered through the affected individual’s attitudes, beliefs, coping strategies, cultural perspectives, and social context, may be experienced as magnified or amplified and predispose to illness behaviour. Thus, the development and maintenance of chronic pain and fatigue, chronic disability and, indeed, long term incapacity for work, particularly in the context of low back pain and chronic fatigue states, rests more on psychological and psychosocial influences than on the original benign and mild forms of physical or mental impairments.
Waddell (1998) further argues that disability is not static but a dynamic process which evolves through distinct phases over time: the relevant model of disability may be different at various stages of this process. Waddell (2002) argues that the medical model may well be the most appropriate for most patients in the immediate aftermath of a physical injury, acute illness or disease. But within a few short weeks psychosocial issues start to predominate, and following the lapse of 1 or 2 years the initiating physical or psychological dysfunction will bear little, if any, relevance to the manifest illness behaviour. Psychosocial factors, expectations, and behaviours are thus very different at the acute, sub-acute, and chronic stages in the development of chronic disability. Capacity for work deteriorates and the chances of effective rehabilitation and return to work recede. Social Security statistics also demonstrate that some 40 per cent of new claimants for incapacity benefits return to work within 6 months, but those on benefit at 6 months have a very strong likelihood of remaining on benefit for years. Of those beginning a claim in 2000 around 30 per cent will be on benefit for at least 4 years (Aylward 2002).
Illness behaviour itself is not considered to be a formal diagnosis but is a melange of an affected individual’s observable activities, conduct and performance to express, and to transmit to others, his/her self-perception or interpretation of an altered state of health. Nor should it be defined in terms of a continuum of pathology. The manifestations of illness behaviours according to this model do not necessarily provide information about the initiating biomedical stimulus whether this be pain, fatigue or psychological distress. Nonetheless, in keeping with the traditional medical model, the biopsychosocial model recognizes that psychological and behavioural change are secondary to pain, fatigue or some other distressing complaint that most frequently has its origins in musculoskeletal and neurophysiological processes. As pointed out by Sharpe and Carson (2001), biopsychosocial models offer the potential (and indeed a danger) for an explanation and re-medicalization of unexplained symptoms around the notion of a functional disturbance of the nervous system. A paradigm shift indeed, or just a return to some of the competing theories offered to explain neurastheria in the nineteenth century (Aylward 1998)?
Is there any place for volition and or intentionality within the constraints of biopsychosocial models of disability? (See Halligan et al., Chapter 1, and Malle, Chapter 6.) For the most part, the assumption is that ‘patients cannot help how they react to pain’. Emotions are outside our conscious control and most illness behaviour is involuntary. Our professional role is not to sit in judgement but to understand the problem with compassion to provide the best possible management for each patient’ (Waddell 1998). This view reflects the philosophy that humans are not freely determined creatures: thought, behaviour, actions, and apparent free will are determined by factors beyond the individual’s control. And yet, if evolutionary psychology defines the human as the moral animal endowed with a capacity to make value-driven choices and an intentional approach to life then the emergence of a moral sense in human consciousness drives us away from genetically programmed behaviour, instinctive responses and the overriding effect of emotion. No doubt, we are creatures who are in conflict with ourselves; creatures in whom the life-force has started observing itself (Holloway 2001). Frankl (1963) called this our ‘ultimate freedom’—the potential freedom to exercise individual choice about one’s attitudes, behaviours, and responses to a given situation (see Halligan et al., Chapter 1).
The recent International Classification of Functioning, Disability and Health (ICFDH) (World Health Organization 2000) no longer focuses solely on people with disabilities, but by attempting to describe functional states associated with health conditions is applicable to all. The limitations of the medical model are recognized and thus assumptions on cause and effect are avoided. Functional states are classified across three dimensions. Disability encompasses all of these interrelated and interacting biopsychosocial dimensions. According to a biopsychosocial model a person’s functioning or disability in the social context is affected by complex interactions between their health condition, environmental, social and personal factors (Table 22.5). Activity limitations (equivalent to disability) are no longer required to be described as ‘resulting from an impairment’. The biopsychosocial model is triumphant; aetiology no longer features in the equation.
Yes, of course that is true because their magical thinking protects them from all weakness like a shield of steel.Of course, people who have never had a severe illness or disability would know best right?
Yes, of course that is true because their magical thinking protects them from all weakness like a shield of steel.
I like the sentence "If it was true, ......that self interest and self aggrandisement were the engines of society and the individual, then how could the testimony of (claimants) be believed?"
Why only claimants? Substitute any other group for claimants and the sentence makes equal sense. Employers? Doctors? Pschiatrists?
My arse.substantial state benefits
yeah tell me about it I'm literally fighting for my life at momentMy arse.
Attempting but failing to reassure himself that he measures up to the girth boasted of in the two-handed gesture of the guy on his right.What's the chap in the mac, front row, doing with his hands?
You are right @SilverbladeTE , I was thinking Batfink "Your bullets cannot harm me! My wings are like a shield of steel!" is one of my all time favourite catch phrases.
I understand where you're coming from. People repeat familiar patterns of behaviour and psychs are no different, in fact they are more likely to have underlying trauma which is the reason they chose the profession in the first place.
It takes a lot of strength and self awareness to identify and correct poor behaviour in oneself. Many people kick the metaphorical cat when they've had a bad day - as Mr S says "Shit rolls downhill". Those of us with a conscience try not to take our feelings of inadequacy out on those weaker than ourselves.
When trying to understand the thinking of some of the BPS crowd I wonder how many are baby boomers, grammar school scholarship boys who've fought their way up the class ladder and achieved power, influence and status. I wonder how this affects their thinking and judgement. They will have been raised by the traumatised survivors of the war. They must carry the burden of being made to feel inferior to their peers who have come from the public school system whilst feeling superior to the people from the communities they came from. And of course when an individual has achieved power they must maintain it.
I'd imagine a person must need to do some complicated cognitive gymnastics to cope with all that dissonance.
Sorry if this post makes little sense, I'm having problems with nausea while my new meds settle in and it's hard to think in straight lines today. And really sorry you're having a bad time at the moment, it's disgusting what the Tories are doing to the benefit system, they obviously hope we'll all just give up and die quietly in a corner. Hang on in there SilverbladeTE.
Rudel flew 2,530 combat missions on the Eastern Front of World War II. The majority of these were undertaken while flying the Junkers Ju 87, although 430 were flown in the ground-attack variant of the Focke-Wulf Fw 190. He was credited with the destruction of 519 tanks, severely damaging the battleship Marat, as well as sinking a cruiser, a destroyer and 70 landing craft. Rudel also claimed to have destroyed more than 800 vehicles of all types, over 150 artillery, anti-tank or anti-aircraft positions, 4 armored trains, as well as numerous bridges and supply lines. Rudel was also credited with 9 aerial victories, 7 of which were fighter aircraft and 2 Ilyushin Il-2s. He was shot down or forced to land 30 times due to anti-aircraft artillery, was wounded five times and rescued six stranded aircrew from enemy held territory
He looks like he’s getting ready to flash someone. The entire picture looks like something out of a Monty Python sketch.What's the chap in the mac, front row, doing with
@SilverbladeTE , your style of writing has reminded me of someone for quite some time, but I couldn't quite remember.
It just hit me: Hunter S. Thompson. He was an American political journalist. I thought he was the best. My kids were politically weaned on his writings. He held nothing back. He could accurately and vividly vilify politicians of his day and make you grin while he did.
I just wanted to volunteer that.
I've worked it out! He has castration anxiety, unresolved Oedipal complex and fears emasculation by the other, bigger BPS boys onto whom he's projecting his fear of his father... Either that or he's just holding it for reassuranceHe looks like he’s getting ready to flash someone. The entire picture looks like something out of a Monty Python sketch.
I've worked it out! He has castration anxiety, unresolved Oedipal complex and fears emasculation by the other, bigger BPS boys onto whom he's projecting his fear of his father... Either that or he's just holding it for reassurance