Assignment 1: Case Study of Amaya

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Assignment 1: Case Study of Amaya 作者: Mind Map: Assignment 1: Case Study of Amaya

1. Explain Biopsychosocial Model

1.1. Strengths

1.1.1. From The biopsychosocial model – history, controversy and Engel (1)

1.1.1.1. Biological reductionism in psychiatry can be dehumanizing and/or demeaning. In many cases it exemplifies the faulty and simplistic logic that renders psychiatry liable to criticism; it can also be frankly unscientific.

1.1.1.1.1. An aetiological construct for mental disorders that incorporates biological, psychological and sociocultural factors in myriad complex, interacting, irreducible, and yet often simplified and hitherto not fully understood ways, is arguably both an approximation and extremely useful – that is, it is a model. And whilst the “BPS model” cannot, by definition, explain everything, on the basis of Box’s definition, it certainly holds validity

1.1.2. From Limitations of the biopsychosocial model in psychiatry (2)

1.1.2.1. challenge the biomedical model itself, which, as far he was concerned, had outlived its usefulness, had become a dogma rather than a model, and most importantly, it neglected to take into consideration the “psychological, social, and behavioral dimensions of illness

1.1.2.2. called for a more inclusive model (hence the BPS model) that would be relevant to medicine as well as to psychiatry. Such an inclusive model would not neglect the biological dimension, nor would it exclude key psychosocial concerns. For Engel, the BPS model, with its conceptual roots in general systems theory (GST), would potentially address certain issues that the biomedical model alone cannot, such as the doctor–patient context as well as issues pertaining to an individual’s willingness or otherwise to assume the sick role.

1.1.2.3. physician–patient dyadic factors – including physician empathy – can influence the outcomes of various pathologies

1.1.2.4. an open system such as the GST, by its very nature, leaves room for multiperspectival conceptualizations of any given mental health problem and multiple points of intervention as well as a degree of freedom on the part of both the clinician and patient with respect to giving more or less preference to any given modality of treatment.

1.1.3. From The Biopsychosocial Model: The End of a Reign of Error (3)

1.1.3.1. . An integrated understanding of the biological, psychological and social aspects of mental health problems enables psychiatrists to recognise and treat both the physical and emotional effects of psychiatric disorder

1.1.3.2. a beacon for a balanced and humanistic approach to clinical encounters. Indeed, it has become a beacon for the soul of medicine and psychiatry

1.2. Limitations

1.2.1. From The biopsychosocial model – history, controversy and Engel (1)

1.2.1.1. Jim van Os and colleagues have advocated for the addition of an “existential” (E) component to the BPS model (i.e. a BPSE model)

1.2.1.1.1. whilst the BPS model provides a useful avenue to conceptualise mental health, illness and treatment, it says little about the ultimate purpose of doing so. The addition of an existential component would arguably therefore inject a sense of meaning and purpose into the model - “restoration of health is not the goal, but rather the means to enable the patient to find and pursue meaningful goals.”

1.2.2. From The Biopsychosocial Model: The End of a Reign of Error (3)

1.2.2.1. It does not allow for nonbiological factors in the full explanation of all mental disorder

1.2.2.2. . Psychiatry places a bad bet for itself and for its patients if it expects quick biological breakthroughs, and tamely accepts a restricted role as a pill prescriber. The biopsychosocial model can’t by itself cure the mental health mess or rejuvenate the clinical practice of psychiatry, but it is a useful and perhaps necessary starting point

1.2.2.3. its inherent eclecticism could lead to “anything goes,” which was but a small step removed from psychiatrists indulging their prejudices

1.2.2.4. The biopsychosocial model was valuable in its day as a reaction to biomedical reductionism, but its historical role has played out. Mental illness is complex; biology is not enough; but the biopsychosocial model does not thereby follow. Other less eclectic, less generic, less vague alternatives exist. Psychiatry would do well to look to them, rather than revisit an outworn label.

1.2.2.5. , the terms biopsychosocial and psychobiological are not interchangeable

1.2.2.6. . In psychiatry, it is the case that almost all mentions of the BPS model are as opinion

1.2.2.6.1. they talk about the BPS model without referencing it but, if they do, almost all refer to Engel’s 1977 paper as the definitive description

1.2.2.6.2. Specifically, Engel talked about what such a model might do but he never actually wrote it.

1.2.2.6.3. e total absence in Engel’s many publications of anything that could provide a basis of practice

1.2.2.6.4. e Engel never specified what his model would actually do

1.2.2.6.5. he had found an intellectual/humanitarian gap in medicine); he decided that if we had an integrative model of mind, body, and society, we could do better for our patients

1.2.2.7. von Bertalanffy’s singular approach hung upon a critical point, which he termed the matter–energy transfer functions. If, in any complex system (and the human brain and mind are surely complex), these cannot be isolated, identified, and formalized as mathematical functions, then his theory cannot address that system

1.2.2.8. . Insofar as anybody claims that there is a valid BPS approach or method which can be used as a rational guide in clinical practice, that claim has no scientific warrant.

1.2.3. From Limitations of the biopsychosocial model in psychiatry (2)

1.2.3.1. nothing inherent in Engel’s theoretical commitment to interactive dualismthat might guide a clinician to be reflective and self-aware of his or her emotional tone and to be concerned with such issues as trustworthiness, genuineness, empathy, and curiosity. - presents no guarantee that the above will be cultivated by the clinician

1.2.3.1.1. a physician’s endorsement of the major tenets of the BPS model confers no guarantee that s(he) will bring to each therapeutic moment qualities such as genuineness and empathy etc.

1.2.3.2. fails to conform to the criteria for a model - whereas theories may be abstract, an altogether more stringent set of criteria – including methodological robustness – are applicable to models: “… models are real and their material consequences can be measured.”

1.2.3.2.1. the BPS model cannot be claimed to relate to GST (General Systems Theory)in this way.

1.2.3.3. relative neglect in its conceptualizations of psychopathology of large social units (community, culture, subculture, society–nation). GST acknowledged the reciprocal nature of the relationship between all these social units and the individual

1.2.3.4. acknowledged the BPS perspective’s role in combating psychiatric dogmatism but was critical of its ethos of “eclectic freedom,” which he held to engender an undisciplined, even arbitrary approach: “one can emphasize the “bio” if one wishes, or the “psycho” … or the “social”.”

1.2.3.5. BPS model has failed to stave off the forces of biomedical reductionism

1.2.3.5.1. biomedical conceptual model of mental illness was dominant among the papers published in the American Journal of Psychiatry between the years 2002 and 2006

1.2.3.5.2. biologically orientated thinking has come to dominate psychiatry in recent decades

1.2.3.5.3. imbalance between the “bio,” the “psychological,” and the “social” is also evident in fields other than psychiatry that purport to embrace the BPS model

1.2.3.6. fails to explain “medically unexplained symptoms.” Such symptoms cannot be understood without a so-called “interpretivist perspective,” which, according to the authors, the BPS model fails to accommodate.

1.2.3.7. fails to honor human subjectivity – especially in cross-cultural settings – despite the best intentions of the clinician

1.2.3.7.1. fraught with misunderstandings, distrust, and disconnection – the author’s argument being that the physician’s sympathetic orientation to the BPS model did not translate into guaranteed patient-centered communication or culturally sensitive care

1.2.4. From The rise and fall of the biopsychosocial model (4)

1.2.4.1. he believed the model would apply in all illness, but he never tried to show its relevance to mental illness; he assumed it

1.2.4.2. biopsychosocial advocates really seek eclectic freedom, the ability to ‘individualise treatment to the patient’, which has come to mean, in practice, being allowed to do whatever one wants to do. This eclectic freedom borders on anarchy: one can emphasise the ‘bio’ if one wishes, or the ‘psycho’ (which is usually psychoanalytical among many biopsychosocial advocates), or the ‘social’. But there is no rationale why one heads in one direction or the other: by going to a restaurant and getting a list of ingredients, rather than a recipe, Reference McHugh and Slavney7 one can put it all together however one likes

1.2.4.2.1. This results in the ultimate paradox: free to do whatever one chooses, one enacts one's own dogmas (conscious or unconscious)

1.2.4.2.2. The biopsychosocial model, as classically advanced, does not guide us on how to prioritise. Consequently, prioritisation happens on the run, with each person's own preferences, and the model devolves into mere eclecticism, passing for sophistication.

1.2.5. From The Biopsychosocial Model in Health Research: Its Strengths and Limitations for Critical Realists (5)

1.2.5.1. Engel did not provide us with a formal definition of the biopsychosocial model

1.3. From The biopsychosocial model – history, controversy and Engel (1)

1.3.1. predominant theoretical framework underpinning contemporary psychiatric training and practice

1.3.2. George Engel did not create the BPS model and the concept arose well before 1977

1.3.2.1. Roy Grinker, who had been trained and personally analysed by Freud, first coined the term “psycho-somatic-social” in an address to the Chicago Psychoanalytic Institute in 1952 where he emphasised the biological aspects of mental health and illness in a pushback against psychoanalytic dogma and stressed the importance of being a doctor first and a psychiatrist or psychoanalyst second

1.3.2.2. Victor Frankl who, drawing on his own personal experience in Auschwitz, and through the lens of “making meaning through suffering,” sought to draw more attention to the spiritual aspects of the human condition. In his 1946 book The Doctor and the Soul, Frankl wrote of the “somatopsychospiritual” essence of humanity.5

1.3.2.3. 1947, psychiatrist John Romano wrote about the need for “a more comprehensive frame of reference... in which psychological and social facts exist or coexist with more impersonal biological factors, eventually to cause, provoke, or otherwise modify variations in the total human biological behaviour.

1.3.2.4. , Engel’s 1977 paper was not actually directed at a psychiatric audience but a general medical one

1.3.3. Like Grinker, Engel was interested in “Systems Theory” and drew heavily on the work of Weiss and von Bertalanffy.8 In his 1980 paper, Engel detailed how the various components of the BPS model may interact in complex, yet irreducible, ways and how the application of its principles served to benefit patients – in his view, not in a fluffy humanistic way, but in a scientific way.

1.3.3.1. Pertinent to his theory was the idea of a “continuum of natural systems” that are organised within a hierarchy – from subatomic particles, through to cells and organs, the individual person, the doctor-patient dyad, all the way up to society, nation and the biosphere at large

1.3.3.1.1. Any perturbation of one domain may lead to various “intrasystem changes” that occur at different levels within the hierarchy

1.4. From The rise and fall of the biopsychosocial model (4)

1.4.1. ‘all three levels, biological, psychological, and social, must be taken into account in every health care task’. No single illness, patient or condition can be reduced to any one aspect. They are all, more or less equally, relevant, in all cases, at all times.

1.4.2. Engel was trying to psychologise medicine (current biopsychosocial proponents seek to avoid medicalising psychiatry)

1.4.3. Roy Grinker coined the term ‘biopsychosocial’ in 1954 - applied it to psychiatry to emphasise the ‘bio’ against psychoanalytic orthodoxy; Engel applied it to medicine to emphasise the psychosocial.

1.4.3.1. Grinker forthrightly argued for a ‘struggle for eclecticism’ Reference Grinker4 as opposed to psychoanalytic dogmatism.

1.5. From The Biopsychosocial Model in Health Research: Its Strengths and Limitations for Critical Realists (5)

1.5.1. argued that particular disease states are multi-determined and may result from biological, psychological or social processes in variable forms of interaction

1.5.1.1. Engel complained that the crisis of modern medicine emerged with a bio-reductionist norm in training and practice, which meant that medical researchers had become scientifically limited and clinicians had become insensitive to the psychological features of their patients and their biographical contexts.

1.5.2. Wikipedia (Citation2014) definition is: The biopsychosocial model is a general model or approach stating that biological, psychological, and social factors all play a significant role in human functioning in the context of disease or illness.

2. How psychological frameworks can be used to interpret and enhance wellbeing

3. Amaya's

3.1. Resilience Factors

3.1.1. Biological

3.1.1.1. Regular walking and gym routine

3.1.1.1.1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934999/ (20)

3.1.2. Psychological

3.1.2.1. Optimistic outlook on future

3.1.2.1.1. https://www.proquest.com/docview/2778312945 (24)

3.1.3. Social

3.1.3.1. Close relationship with mother and siblings

3.1.3.1.1. From https://journals-sagepub-com.ezproxy.ecu.edu.au/doi/10.1177/2156869315577631 (6)

3.1.3.2. Volunteers at hospital and has mentor there

3.1.3.2.1. Creaven, A., Healy, A.E., & Howard, S. (2018). Social connectedness and depression. Journal of Social and Personal Relationships, 35, 1400 - 1417. (22)

3.1.3.2.2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623346/ (21)

3.1.3.3. Attends cultural arts club

3.1.3.3.1. https://www-emerald-com.ezproxy.ecu.edu.au/insight/content/doi/10.1108/JPMH-12-2012-0022/full/html (23)

3.2. Risk Factors

3.2.1. Biological

3.2.1.1. Recent stage 1 melanoma diagnosis

3.2.1.1.1. From https://journals-sagepub-com.ezproxy.ecu.edu.au/doi/10.1177/2156869315577631 (7)

3.2.1.1.2. From https://onlinelibrary-wiley-com.ezproxy.ecu.edu.au/doi/full/10.1002/jts.22005?sid=worldcat.org (8)

3.2.2. Psychological

3.2.2.1. Sri Lankan Immigrant - arrived as teen

3.2.2.1.1. Sri Lankan Context

3.2.2.2. Grew up in poverty

3.2.2.2.1. From https://www-tandfonline-com.ezproxy.ecu.edu.au/doi/epdf/10.1080/07256868.1998.9963454?needAccess=true&role=button (13)

3.2.2.3. Lack of job satisfaction

3.2.2.3.1. https://www-sciencedirect-com.ezproxy.ecu.edu.au/science/article/pii/S0001879113000948 (12)

3.2.2.4. Financial issues due to reduced work (due to Pandemic)

3.2.2.5. Stress

3.2.2.5.1. From https://journals-sagepub-com.ezproxy.ecu.edu.au/doi/epub/10.1177/09722629221104212 (9)

3.2.2.6. Difficulty Sleeping

3.2.3. Social

3.2.3.1. Social isolation and loneliness (due to Pandemic need to WFH)

3.2.3.1.1. From https://link-springer-com.ezproxy.ecu.edu.au/article/10.1007/s12529-018-9752-x (14)

3.2.3.1.2. From https://journals-sagepub-com.ezproxy.ecu.edu.au/doi/epub/10.1177/09722629221104212 (15)

3.2.3.1.3. From https://link-springer-com.ezproxy.ecu.edu.au/article/10.1007/s11482-015-9401-3 (16)

3.2.3.1.4. From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9582845/pdf/fpubh-10-875198.pdf (17)

3.2.3.1.5. https://www.apa.org/monitor/2019/05/ce-corner-isolation (18)

3.2.3.1.6. https://academic.oup.com/ppar/article/27/4/127/4782506 (19)