The biomedical model of health focuses on the biological aspects of disease, and has dominated western healthcare settings since the 1800’s (Ogden, J. 2022).  The theory behind this model suggest that illnesses can be attributed to physiological dysfunction caused by disease, and that the absence of disease would indicate a person is 'healthy'. 

For patients with MS, this model would focus solely on the physical impairment that arises from the condition, and emphasise a pharmaceutical approach to treatment. In a similar way, any psychiatric abnormality would be explained by a mixture of genetic irregularity, neuro-chemical imbalance in the brain, or central nervous system (CNS) dysfunction caused by the disease (Deacon, B.J.2013). 

Diagnosis of MS is usually sought by blood or urine samples, and the use of X-ray equipment or MRI screening (Rocca, E. et al. 2020). 

MRI (MAGNETIC RESONANCE IMAGING) 

The progression of multiple sclerosis can vary greatly between individuals, and symptoms of the disease are not always the same for all patients. This can make it difficult to predict a diagnosis. Therefore, the integration of clinical data, and biological imaging procedures advocated by this model, can be an efficacious method of diagnosing and monitoring the efficacy of treatment (Brummer, T. et al 2022).  

Clinical testing for MS can be further complicated by the subtypes of the disease. For example, if you are suffering with primary progressive MS, you will experience differing symptoms or relapse rate, to someone else suffering from secondary progressive relapsing MS (Lassmann, H. 2019).   Therefore, to help you understand the underlying cause of symptoms and define the ascent of illness, the use of MRI scanning imagery, and the replicable, and measurable data it produces can prove invaluable. 

For instance, a biomedical approach using scanning machinery, allows for predictions that may identify whether an episode of neurological symptoms sufficiently disseminates over time,  (i.e. your episodes are spread out over separate occasions). This can both confirm your diagnosis of MS, and demonstrate the stage of its progression. This enables clinicians to form a timely treatment plan (Brownlee, W. J. et al 2019).  

ENVIRONMENTAL FACTORS

The scientific outlook of health care professionals adhering to this model of health, will consider factors such as genetics, obesity, smoking, and diet that may have implications for your biological mechanisms. Whilst the exact cause of MS remains unknown, research has shown that a history of MS within your family can increase your genetic predisposition to the disease by up to 50% (Hecker, M. et al. 2021). It is therefore, standard practice for the clinician to undertake a full medical history to find out about your lifestyle, including dietary, and exercise habits. If you are considered overweight, and/or smoke, with an existing family tendency towards MS, then they would be able to determine you as high risk for developing the disease. Despite some research pertaining towards the idea that smoking alone does not increase the risk of MS (Micthell, R. E. et al. 2020). It has been shown to be a combination of factors that increases your susceptibility. 

If you are considered high risk,  they may be able to implement a more urgent referral for an MRI scan which increases the likelihood of an early diagnosis. This has been proven to be beneficial for reducing the extent of disability that can arise from the disease (Ziemssen, T. et al. 2023).  

DISEASE MODIFYING THERAPY

There are a number of ways that medicines can help to control the condition of multiple sclerosis. Certain pharmaceutical drugs are given in the form of a pill, injection or infusion (Zeimssen, T. et al. 2023). These can help to reduce the worsening of disability caused by relapsing-remitting MS, but will not cure the disease. A list of these medications is included in the treatment section of this website, alongside information detailing how they each manage a variation of symptoms. Here, you will also find some additional resources explaining how to manage your physical symptoms through exercise and physiotherapy (Warutkar, V. et al, 2022). 

WHAT ABOUT MENTAL HEALTH?

Overall, the biomedical model demonstrates an effective way to diagnose and treat disease. However, other environmental and important social changes in your life may not be addressed. These may include adequate access to healthcare or social services, help with employment and/or relationship issues. The biomedical approach to healthcare can initiate a relief from symptoms, and slow the progression of physical disability using medications. However, this will not treat any underlying causes for mental health problems you may have as a result of MS (Ensari, I. et al . 2020).

This approach to health and wellbeing goes against the traditional view held by the biomedical model: that the mind and body are separate entities (Deacon, B. J. 2013).  Instead, it focuses on how biological systems are connected to our psychological states, and that these need to be considered within a social context (Lehman, B.J. 2017). 

This model of healthcare was first theorised by George Engel in 1977, and his proposals have been supported by several studies demonstrating how our neurochemistry is ultimately affected by our physical well being (Uchino, B.N.et al. 2017).  This means our mental and emotional states may be influenced by changes to our physical health (and vice versa). Bio- psychosocial methods do not discount the need for understanding biological mechanisms that underlie disease, but advocate for an approach that looks at a patients psychology and social status in the hope that it compliments medical care in hospitals (Engel, G. 1977). 

WHAT DOES THIS MEAN FOR YOU IN PRACTICE?

Health care professionals adhering to this model of health, aim to understand your suffering and disease by examining the potential for psychological and social stressors in your life. These include, a reduced familial support network, occupational stresses, marriage problems, or poor socioeconomic status (Farre. A,  2017). These are all factors that are well known to precipitate mental illness,  particularly in patients suffering with a chronic disease (Kasikci. E,  2020). For example, mobility issues or extreme fatigue in patients with MS can make household tasks more difficult. This may result in relational strain, and lead to marriage difficulties. Or, a job loss could result in additional financial pressure for the entire whole family (Janssens, A.C. et al, 2003). 

THESE FACTORS CAN AFFECT YOUR MOOD

Experiences such as these can lead to low mood, anxiety, and depression, increasing the risk and severity of MS exacerbations and disease progression (Ratajska, A. et al. 2020).  In-fact, it is widely acknowledged that more than 50% of MS patients suffer with depression compared to the rest of the population, due to the uncertainty and unpredictability of living with the disease (Patten, B.S, et.al, 2017). 

Therefore, clinical attendance to these factors, in line with this model of health, may preempt a decline in mental well-being and prevent disease worsening. 

WHAT ARE THE BIOPSYCHOSOCIAL APPROACHES TO TREATMENT? 

Whether it be your support network, interpersonal relationships, or social status, that impact your opportunity to live a fulfilling life. According to methods employed by this model, there are a variety of ways medical staff can devise a plan to support your mental wellbeing (Farre, A. et al. 2017). Whilst the relationship between psychological factors and physical illness is complex (Benning, T.B. 2015). Building a relationship with your GP to discuss subjective experiences in your life that may not be reduced to one physical cause, can help. 

For example, patients often report how living alone, struggling with daily tasks contributes to low self esteem (Kasikci, E. (2020). This in turn may lead to a negative self view and a worsening of your condition. Your GP may offer you ways to find community support  (Andersen, A.H. et al. 2020). This may be in the form of care workers visiting your home to aid with daily chores. Or physiotherapy to strengthen your physical functioning and maintain independence (Warutkar, V. et.al.2022). 

COGNITIVE BEHAVIOURAL THERAPY (CBT) 

Cognitive impairment is sadly a common feature among patients with progressive MS (Ziemssen, T.et.al.2023). The full description of CBT therapy and the impact of cognitive decline in patients living with the disease, can be found under the ‘symptoms and diagnosis’ section of this website. 

 Strategies employed by the BPS model, promote CBT as a useful way for patients to set short and long term goals and practise new methods for coping with problems that arise from living with MS (Kiropoulos, L. et.al, 2020). For instance, as well as fatigue and mobility issues, pain is a common symptom that is associated with higher levels of anxiety and depression. In this situation, patients commonly incur unhealthy behaviours or negative thought patterns that can be addressed with this targeted approach to therapy (Delgadillo, J. et.al, 2020).  

CLINICAL TRIALS

Results of a randomised clinical trial conducted in the US in 2020, showed an overall improvement of pain intrusion and severity among MS patients who underwent CBT, when compared with standard care. Further, when rating treatment outcomes, participants of the study described lower levels of depression and anxiety, alongside the accomplishment of personal behavioural goals (Gromisch, E.S, et al. 2020).  

ADVANTAGES OF THE BPS MODEL.

In the general MS population, many patients describe how this approach to healthcare has helped them to feel more ‘in control’ of their lives, changing thought patterns, and improving habits concerning diet and exercise, empowering them to become more resilient to the debilitating effects of MS (Stephanou, M. 2022). Aswell, techniques employed by CBT therapy can be accessed from home, so patients with poor mobilty or painful relapses of MS do not have to attend clinical appointments to achieve their personal healthcare goals. 

The central advantage of the BPS model is its integrative approach to patient-centred health care, and the potential to recognise and treat mental health problems associated with MS more quickly (Martins, P.N, 2021). This has been shown to have a positive effect on the level of physical disability endured by patients living with the disease and reduce negative experiences for them, and their families (Probst, Y. et al. 2022).  Also, its focus on all three factors: biological, psychological and social, allows for a wider understanding of a patients individual needs and analysis of their responses to treatment.  

DISADVANTAGES 

However, some MS patients report feeling they are burdening their GP by disclosing mental health concerns, and that their personal and cultural beliefs were not taken into consideration (Anderson, A. H. et al 2020). This highlights a potential problem for both patients and medical staff due to time constraints, making it difficult to fully appreciate a person's subjective experience (Benning, T.B, 2015). As well, a noteworthy finding from studies conducted on MS patients with depression, is that patients with brain and spinal lesions had higher levels of depression that those just with spinal lesions. This indicates that depression may well be associated with the biology of the disease. (Rocca, E. 2020). 

However, it is commonly accepted that a persons mental wellbeing is dependent upon a multitude of factors. As a patient, these important findings may help you to exhibit more self compassion. By appreciating how the biology of your disease may act as a predictor of depression, it may help to reduce the likelihood of social and self stigmatisation (Grothe, L. et al. 2022). 

 Overall, the biopsychosocial model can succeed in building stronger relationships between yourself and your practitioner, and address some important symptoms of mental health conditions that may otherwise be overlooked (Andersen, A.H. et al. 2020). Therefore, paving the way for a better quality of life for both you and your family (Probst, Y. et al. 2022).