Is the Biopsychosocial Approach Enough?
by Renee Quiring
Have you ever enjoyed the architecture and grandeur of European cathedrals? When you enter the sanctuary, candles, artistry and grand music create an ethereal experience. These buildings were constructed for a specific purpose and meaning. The spire was intended to point to God and the bells called the community together to worship in unity. The church was the centre of the community where births, marriages, and the painful experience of death were commemorated. Within the walls, the teaching of stories, proverbs and poetry brought conversion of thoughts and beliefs and gave hope to those in pain. Compassion, kindness, gratitude and forgiveness were understood to bring healing to the suffering and those in pain. Existential questions were examined and studied. Unfortunately, many of these ancient buildings are vacant because the modern world has abandoned their teachings.
Albert Einstein once said, “Science without religion is lame, religion without science is blind.” In 2015, an Angus Reid poll showed that 26% of the Canadian population reject religion, 30% embrace religion, and 44% are undecided. Prior to our post-modern era, the idea of a person possessing a spirit or a soul was a common belief. It was accepted that each body houses a soul, a distinct embodiment of a person’s mind, heart, and will. As the science of psychology developed in the 19th century, Freud stated, “Psychotherapists function as ‘secular priests’.” During this time, religion had a prominent place in the discussion of healing the maladies of the body, mind and soul. This is no longer the case. The current biopsychosocial approach to the treatment and management of physical and emotional pain lacks a spiritual aspect. Maslow’s hierarchy of needs includes moral safety and moral character, but does not mention faith or belief in something bigger than humanity.
I believe spirituality and the innate desire for transcendence are integral parts of the human experience. The resultant faith and belief system is the missing link within the biopsychosocial approach and should be discussed in the healing process. However, integrating this concept in a clinical setting is controversial because we have been taught that there is separation between personal beliefs and professional practices.
In 2015, I took the PHS Level 111 course. This course changed my physiotherapy practice significantly. I learned that the connection between mind and body and the effects of our emotional state on the chemicals in our bodies are more important than we sometimes realize. Thoughts, anxiety and imagined threats can cause the stress response. These nerve impulses release cytokines which cause pain.
Did you know that pain is actually meant to protect us? Pain works as an alarm system to forewarn us when we need to do something about our state of mind!
As I sat through this course, my thoughts kept wandering back to the faith system I was taught as a child. I kept thinking of the biblical quote from 2 Corinthians 10:5, “We are taking every thought captive to the obedience of Christ.” One of my favourite Christian authors, C. S. Lewis, writes, “God whispers to us in our pleasures, speaks to us in our conscience and shouts to us in our pain: it is His megaphone to rouse a deaf world.” By submitting our thoughts and beliefs to a higher wisdom, we can give meaning and purpose to our lives.
In PHS Level 111, we watched “A Very Happy Brain” by Dr. Sood. The video acknowledged that millennia-ago spiritual minds described, in their devotions, hymns and rhymes, the same truths that the scientists of today write in their theses, journals, and essays. These truths include compassion, kindness, gratitude, forgiveness and healing. Sood says, “When you pray for others, share their feelings, in touching their lives, you will find healing.”
The course material offered several recommendations to treat clients with persistent pain, stress and anxiety. Listening to the patient’s pain story and explaining pain in stories can help treat people with persistent pain. Meditation, mindfulness and yoga can reduce anxiety. The daily practice of being grateful, altruistic and part of a community helps reduce stress and evokes a relaxation response. These treatment techniques are similar to the practices religions have known for thousands of years. After learning the research proving the benefits of these practices that are similar to my faith, I was motivated to include them in my professional practice.
On a personal note, my family has been affected by suicide twice in the last month. Suicide rates continue to rise. There’s no simple answer to why this is happening. You have to wonder if the corresponding decrease in the belief in God or a higher purpose is correlated to the increase in feeling despair and meaninglessness. The lack of community in our busy world downplays the metaphysical and increases isolation. This void of hope, purpose and meaning in life and the lack of community support makes pain and suffering unbearable.
In addition to the biopsychosocial approach to treating our patients and looking at the mind and emotions, I believe we should be asking them about their belief system. What is their worldview? What would their cultural and religious beliefs and practices be? We should encourage prayer, meditation, compassion, forgiveness and gratitude within a religious context. After all, it has already been done for thousands of years.
Einstein, A. (1941) Science and Religion II: Science, Philosophy and Religion, A Symposium. Retrieved from http://www.sacred-texts.com/aor/einstein/einsci.htm#TWO
Hutchins, A. (2015, March 26) What Canadians Really Believe. Macleans. Retrieved from http://www.macleans.ca/society/life/what-canadians-really-believe/
Sigmund Freud, “The Question of Lay Analysis” and “Postscript” in The Standard Edition of the Complete Psychological Works of Sigmund Freud(London: Hogarth Press, 1926 and 1927, volume 20) pp 255f,250 retrieved from https://monoskop.org/Sigmund_Freud
Maslow’s Hierarchy of Needs. (n.d) retrieved from http://fileserver.net-texts.com/asset.aspx?dl=no&id=7153
C.S. Lewis “The problem of Pain” 1940, Macmillan, NY
Bible. English. NASB. 1993
Sood, A. A Very Happy Brain. (Jan. 12, 2015) retrieved from https://www.youtube.com/watch?v=GZZ0zpUQhBQ
Harvey, Shannon: The Connection. Elemental Media, 2015
Suicides and suicide rate, by sex and by age group (2008-2012) retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66a-eng.htm