Is The Biopsychosocial Approach Enough?

One of my favourite pastimes in Europe is to enjoy the incredible architecture and grandeur of cathedrals. These buildings were constructed with purpose and meaning. The spire was intended to point to God and bells called the community to worship. Upon entering the sanctuary candles, incredible artistry and grand music gave an ethereal experience. The teaching of stories, proverbs and poetry brought conversion of thoughts and beliefs and gave hope to those in pain. Concepts such as compassion, kindness, gratitude and forgiveness were understood to bring healing to pain and suffering. The church was the center of the community where births, marriages and even the painful experiences of death were commemorated and supported. The existential questions of where have we come from, why are we here and where are we going were examined and studied. Unfortunately, many of those ancient buildings sit empty and their teachings abandoned because they are thought to be useless in a modern world.

 

Notre Dame

Albert Einstein said: “Science without religion is lame, religion without science is blind.” An Angus Reid poll in 2015 showed that 26% of the Canadian population reject religion, 30% embrace it and 44% said they were somewhere in between. Prior to our post-modern era, the idea of each of us possessing a spirit or soul was a well-accepted concept. The body housed the soul which include mind, emotions (heart), and will. As the science of psychology was developing in the beginning of the 19th century, Freud said “Psychotherapists function as ‘secular priests’”. It used to be that religion had a valid place in the discussion of healing of the maladies of the body, mind and soul. The current biopsychosocial approach to the treatment and management of physical and emotional pain in our lives lacks a spiritual aspect. Maslow’s humanistic motivational theory lists moral safety in level two and moral character in the highest level but no belief in something bigger than ourselves is mentioned. I believe spirituality and our innate desire for transcendence are an integral part of the human existence. The resultant faith and belief system is the missing link of the biopsychosocial approach and should be included in our concern for our patients in pain. Integrating that concept in a clinical setting goes against cultural norms since we have been taught there should be a clear separation of our personal beliefs and professional lives.

 

The PHS Level III course (2015) significantly changed my physiotherapy practice. The mind-body connection and the effect of our emotional states on the chemicals in our bodies are more important than we realized. Thoughts, anxiety and imagined threats can cause the stress response and these nerve impulses release cytokines which cause pain. Pain is actually meant to protect us and work as an alarm system to forewarn us when we need to do something about it. As I sat through that course, my thoughts kept wandering back to the faith system I was taught as a child. One of my favorite 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.” I also kept thinking about the Biblical quote: “We are taking every thought captive to the obedience of Christ” (2 Corinthians 10:5). Submitting our thoughts and beliefs to a higher wisdom can give meaning and purpose to our lives. As I sat through the PHS Level III for the second time this year, a cute video, “A Very Happy Brain” by Dr. Sood, was shown and acknowledged that ”millennia ago spiritual minds, described in their devotions, hymns and rhymes, the same truths that the scientists of today, write in thesis, journals and essays”. These truths included compassion, kindness, gratitude, forgiveness and healing. Sood goes on to say “When you pray for others, share their feelings, in touching their lives, you will find healing.” Recommendations to treat people with persistent pain now include listening carefully to their pain story and to explain pain with stories. Meditation, mindfulness and yoga help reduce anxiety. Teaching people to be breathe and be body aware and respond to what they feel will reduce pain. The daily practice of being grateful, altruistic and part of a community helps to reduce our stress and evoke a relaxation response. These treatment techniques look a lot like what many religions around the world have already known for thousands of years. It was very affirming to my faith to see the research surrounding the benefit of these practices and motivated me to include them in my professional life.

 

Our family has been touched personally by suicide twice in the last month. Suicide rates continue to rise. Why? There is no simple answer to that question. One has to wonder if the corresponding decrease in belief in God or in a higher purpose, has increased 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 make pain and suffering unbearable. I’d like to suggest that in addition to the biopsychosocial approach to treating our patient’s tissues and looking at the mind and emotions, we should be asking them about their belief system. What is their world view? What would their cultural and religious beliefs and practices be? Encouraging prayer, meditation, compassion, forgiveness and gratitude within a religious context makes sense. After all, it has already been done for thousands of years.

 

Written by:

Renee Quiring
Lab Assistant

 

Resources:

 

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