BIOPSYCHOSOCIAL WAY TO HEALTH

The term biopsychosocial was originally used by Dr Stacey B. Day as the title of a lecture series given at the University of Minnesota Medical School during the winter session 1971-1972. These lectures emphasized the need to bridge fields of learning through interdisciplinary integration of the health sciences, enforcing Dr Day’s long standing efforts to see the patient as a person rather than solely as a “medical case”. Throughout his academic career Dr Day had sought to explore integrative strategies of health taking into account Biosocial Development, Sociological Aspects of Medicine, Interacting Cultures, and Environmental Existential Ecological issues, especially as they related to International Health and health in the Lesser Developing Countries. Seeking an expression that would encompass this plurality of forces integrated within a General Systems Framework and philosophical structure Professor Day articulated two words that would help to circumscribe disease within this network of cultural, social, biologic, and economic perspectives of Man’s total environment (Bios and Logos). These critical words were biopsychosocial and biologos. Dr Day’s thesis persuaded that every experience that we undergo is taken into our “wholeness”. Psychophysiological interactions universally provoked contribute to our allness and illness. It was Dr John Dorsey, colleague and friend of Dr Stacey Day who had long stressed that illness is part of wholeness.

Dr Day gave as his definition of the biopsychosocial way, “the understanding of biologic paradigms within psychological and sociological parameters”. The early work of Dr Day found resonance with Professor John Dorsey, MD, of Wayne State University, Detroit, Michigan. The friendship between the two men lasted from 1969 until Professor Dorsey’s death in 1979. Another close friend of Dr Day was Professor Yujiro Ikemi, “Father” of Psychosomatic Medicine in Japan and Chairman of the Department of Psychosomatic Medicine, Kyushu University, Fukuoka. Dr Day was a frequent Visiting Professor to Fukuoka, and his academic interaction with Dr Ikemi was life-long. Others early associated with Professor Day were Professor Fernando Lolas, MD, of Santiago, Chile; Dr Amador Neghmi, MD, Presidente de la Academia Chilena de Medicina, Instituto de Chile; Dr Marc Kusinitz Ph.D. of New York, and Dr Terence Lear MD., FRCPsych. (UK).

The imperative in the first efforts of Professor Day and his colleagues was to get away from the entrenched Cartesian Dualism inherent in Western Medicine that held that psyche (spirit) was separate from body. The spirit was confined to the realm of conceptual theology and body was heir to materialistic life forces that included “illness”. Such “Mind-Body” dualism, so deeply rooted in Western Life is quite alien to Indian and Oriental thinking, where both mind and body are viewed as two aspects of one single whole rather than as two independent entities. Teaching of the Biopsychosocial Way is based on the understanding that control of the body is directly related to control of the mind within the existential environment.

It is of historical interest that Professor George Engel of Rochester, New York, advocated, in 1977, what has become known as the biopsychosocial medical model. The then Dean of his medical school at the University of Rochester, New York, declined to introduce this model into the teaching curriculum for medical students. The first authenticated test of this medical model was by Professor Stacey Day in the new College of Medical Sciences, University of Calabar, Nigeria, in 1982. After discussions with Professor Engel, then retired, at his home in Rochester, Professor Day introduced the medical model into his Department of Biopsychosocial Medicine and Community Health at Calabar, in Eastern Nigeria. It was there that Dr Day found that any such “medical model” must take account not only of environment but also of culture. It is of further historical interest that the first two classes of medical students graduating MB.BS. from the University of Calabar, 1983, 1984, were required to present an original bound thesis of work recording aspects of biopsychosocial practice that they had undertaken in the villages of Cross River State. These early studies in Self-Help and Self-Health, incorporating lessons learned in Tropical West Africa, including issues relating to tribal and clan living; Traditional African Medicine, and tropical environment led to the recognition of the importance of “ecological existential” aspects of the biopsychosocial way. Professor Ikemi had always stressed these forces in his work in Japan validating somatopsychic self control.

From the point of view of Comprehensive Medicine and Quality of Life, the biopsychosocial existential way facilitates a harmonious understanding of the role of health in our every day life.