Saturday, 15 June 2013

Disease Management vs Biopsychosocial Health

The North American health care system's next evolution is from a disease management system to a biopsychosocial health care system that embraces the mind-body connection to bring it closer in-line with what we are learning about our own biology.

In 1977 psychiatrist George L. Engel at the University of Rochester, stated "the need for a new medical model" in an article he wrote for Science magazine.  He called for a biopsychosocial model for the investigation and treatment not only of mental disorders but also physical disease.  The biological-psychological-sociological model is based on the premise that human beings are biological beings who feel, think, imagine, act, and interact with others in sometimes complex relationships.  Our brains are not separate from our bodies or each other and each element affects the others, sometimes in profound ways.

In her 2005 book, The Body Never Lies - The Lingering Effects of Cruel Parenting Dr Alice Miller cites dozens of case histories of the famous and not so famous who developed physical disease as a direct result of abuse suffered as children.  Many of the cases were her own patients who were suffering from diseases as grim as cancer that was diagnosed terminal by physicians.  Yet these patients saw their disease go into remission or even vanish once the psychological problems caused by their childhood abuse was successfully treated.

Though many mental health practitioners like Miller have pursued the biopsychosocial model since Engel first proposed the idea, the medical community has been glacially slow to embrace it.

Dr Gabor Maté, a best selling author and world-renowned leader in mind-body wellness, recently delivered two seminars in Penticton, BC, hosted by the Penticton & District Community Resources Society.

Maté reported that he had recently been invited to speak by students at the University of British Columbia Faculty of Medicine.  When he described the biopsychosocial model - the mind-body connection - none of the students had heard of it. This model is not yet included as part of medical training despite decades of research producing compelling evidence to support it.

With the advent of Magnetic Resonance Imaging (MRI) in the early 1980s, we began to be able to see within the living human brain and in recent years actually witness it functioning.  What we found in the images generated startled the medical community and confirmed what many in the mental health field have suspected for decades; psychological and sociological events physically impact both the brain and body.

Post-Traumatic Stress Disorder (PTSD) can occur after a person experiences a shocking, sometimes life-threatening event.  Individuals affected develop a cluster of symptoms that include; anxiety, hypervigilance, avoidance of things that remind them of the event, nightmares, flashbacks, and panic attacks that combined we call PTSD.  As time goes on they also develop difficulties with concentration and memory.

MRI images of those suffering with Post-Traumatic Stress clearly show that in these individuals the cortex (executive function) has grown thinner and the hippocampus (memory storage and retrieval) has shrunk, indicating that their mental state is not due to a “disorder” but an actual physical injury caused by a horrific experience.  The shock of the traumatic event causes the brain to become “plastic” and change its structure in the form of an injury without direct physical contact.  The term for this is neuroplasticity and it is a double-edged sword.

More recent MRI studies on sufferers of PTSD indicated that Mindfulness practice also promotes neuroplasticity and saw the cortex of participating trauma patients thicken by 10% and their hippocampus grow by 25% after only 18 weeks of treatment.

We are learning that what can be done, can be undone by connecting the body to the mind and the mind to the body.

A research study just released in 2013, (see: The Deep Wounds of Early Childhood Trauma), has shown that trauma also affects the expression of our DNA itself; Early childhood trauma negatively impacts brain development and our immune system, while trauma later in life changes how our very cells grow or die.  In both instances, physical health is negatively impacted by psychological trauma, and in both, the successful treatment of the trauma improves physical health.

Seeing this growing body of evidence, some clinicians are coming to realize that the old mechanical model of the human brain as a separate independent organ is incorrect.  The body and brain are integral parts of the same interconnected system and we need to recognize that in order to work toward a holistic health system that promotes wellness both psychologically and physically.

The scientific evidence is there, all we need are some bold leaders in the medical community to embrace it.

Aaron D. McClelland, RPC -