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Schizophrenia and the Biopsychosocial Model
In 1977, University of Rochester psychiatrist George Engel posited a theory that disease, and health in general, is a combination of biological, psychological, and social factors, rather than simply biological ones. Researchers have discovered that the need to involve "consideration of function in daily life, productivity, performance of social roles, intellectual capacity, emotional stability and well-being" is an important part of clinical tests and patient care. ("Biopsychosocial Model") But it is not only the patient's psychology but social interaction and the environment in which all of this takes place that are also factors. Biopsychosocial factors may work to facilitate, maintain, or alter the course of an illness and can vary with different diseases. These factors can also vary between individuals with the same disease, or between two different episodes of the same illness in the same individual. For instance, research has indicated that "unexplained symptoms appear to be the rule in primary care and affective disturbances (such as depression, anxiety, hostility) and illness behaviour." ("Biopsychosocial Model") This could include the ways patients experience, perceive, evaluate, and respond to their care, and may affect the course, response to, and outcome of a disease.
One example of this is the effect of racism on the health of African-Americans. Researchers have discovered that perceived racism can serve as a source of stress among African-Americans and that this can contribute to chronic health problems. (Clark, 1999) Another is the research done on chronic conduct problems in adolescents by Dodge and Pettit. These researchers assert that "biological dispositions and sociocultural contexts place certain children at risk early in life, but that life experiences with parents, peers, and social institutions increment and mediate this risk." (Clark, 1999) In other words, the researchers discovered that it was not only biological factors which led to antisocial behavior, but contexts, dispositions, and life experiences which led to and exacerbated conduct problems.
Since it was first created, the Biopsychosocial model of health care has become an important influence in the field of medicine. In fact, this model began a "revolution in medical thinking by providing an argument and rationale that better linked medicine to science." (Smith, 2002) The advantages of the Biopsychosocial model is that it takes into account the body and the mind, in effect, both health and illness. This model also takes into account the relationship between the doctor and patient, and its effect on the health of the patient. And since it takes a comprehensive view of medicine, it has been incorporated into the modern medical services system in the hopes that recognizing all the factors which influence disease, prevention of disease may be attained.
But this model is not only being applied to modern day medicine and modern day problems, it can be used to study cases from the past that have baffled scientists. For instance, there is the famous 1848 case of Phineas Gage, one of the very first documented cases of a person suffering major personality changes after a brain trauma. Phineas Gage was a foreman of a crew of railroad workers who had an accident which sent a tamping iron through Gage's skull, entering under the left cheekbone and exiting through the top of his skull. Within minutes of the accident, Phineas Gage was able to get up and walk, but was then taken by cart to a boarding house where a doctor was called. After cleaning the would of residual bone fragments, the doctor then covered the wound with adhesive straps and a wet compress. Gage never underwent a surgical procedure, and his wound was allowed to drain into the bandages. While Gage did develop a fungal infection, and was close to death, after the doctor removed an abscess from under the scalp, allowing for several ounces of fluid to drain, Gage eventually recovered.
After the accident doctors who examined Gages declared him "quite recovered in faculties of body and mind," ("The Incredible Case of Phineas Gage") but his wife and friends soon began to notice dramatic changes in his personality. In fact, his behavior was so different that he was unable to perform his previous job. His employers stated that he was "fitful, irreverent, indulging at times in the grossest profanity (which was not previously his custom) manifesting but little deference for his fellows, impatient of restraint of advice, & #8230;abstinent, yet capricious and vacillating." ("The Incredible Case of Phineas Gage") One of his friends said that he was no longer the same man who he knew before.
Doctors have come to the conclusion that Gage's frontal cortex had been damaged resulting in a complete loss of social inhibitions, often leading to inappropriate behavior. Since there were no X-Rays or other scans available at that time, this biophysical explanation has come from the only data available on the case, the direction the tamping iron took went it traveled through Gage's skull. From this data, researchers have determined that there was physiological cause for Gage's change in behavior.
Gage suffered a severe physiological trauma to his brain, this resulted in severe psychological changes and social problems. At the same time was a researcher named David Ferrier, who carried out physiological studies which indicated that certain areas of the brain were connected to certain functions. Ferrier used Gage as a model in a famous lecture in 1878 and asserted that "there are certain regions in the cortex to which definite functions can be assigned." ("The Incredible Case of Phineas Gage") and the case of Phineas Gage was the proof. According to Ferrier, Gage's case confirmed his findings that damaging the prefrontal cortex could result in psychosis while leaving other functions completely intact.
The mid-nineteenth century was a time of great advances in science, but not everything scientists asserted would be found to be true. Francis Gaulton was an explorer, geographer, meteorologist, statistician, as well as a geneticist and psychologist. Gaulton was one of the first experimental psychologists and the founder of the field known as Differential Psychology. His brand of psychology dealt mainly with the differences between individuals, rather than the commonalities. He invented most of the statistical tools of psychology which are still used today. In his book Hereditary Genius, Gaulton asserted that there were hereditary effects on intellectual abilities. While he also went on to support the theory of Eugenics, which led to theories of genetic supremacy and the rise of Nazism, his studies, many involving twins, did indicate that there were correlations between brain structure and mental disorders like schizophrenia. He also was responsible for the discovery that certain brain structures were inherited traits, and thus there was also a connection between genetics and mental disorders.
Most researchers accept the idea that there is a genetic role in the causation of schizophrenia, and the genetic causes of schizophrenia are currently the most widely type of research being conducted because "it is hoped that such studies will lead to the identification of one or more disease related genes." (Torrey, 1994, p. 43) What is known is that those who have an immediate relative who exhibit's a psychiatric disease such as schizophrenia, have a significantly increased risk of developing schizophrenia than the average person. However, studies with twins, pioneered by Gaulton, indicate that "if one identical twin has schizophrenia, the risk for the other twin (who has the exact same genes as his/her sibling) is only about 50%." ("The Causes of Schizophrenia") This is a clear indication that while there are genetic factors in the development of schizophrenia, there must also be other environmental factors as well. It also indicates that the genetic and environmental factors are extremely complex and not yet fully understood.
Those who perform Schizophrenia research are becoming increasingly convinced that the disease is a combination of genetics and environmental conditions. In other words, if one has the gene, it is only a starting point and if one then does not experience the environmental triggers for schizophrenia, they will not develop the disease. But if they do experience the proper triggers for schizophrenia, and they have the gene, then the disease will develop in that individual. For instance, researchers have discovered that people who had multiple copies of the COMT gene and who smoked marijuana had a 1000% increase in the risk of developing shizophrenia. ("The Causes of Schizophrenia")
But environmental factors not only increase the risk of developing schizophrenia, they can decrease the chances as well. A study done in Finland has asserted that adopted children who had a high genetic risk of developing schizophrenia, for example, their birth mother may have had the disease, had a 86% lower rate of developing schizophrenia when brought up in a healthy family structure. The researchers claim that their study demonstrates that if children who have a genetic predisposition for developing schizophrenia, but are raised in a family that is socially healthy and non-dysfunctional, then they have a greater chance of not developing schizophrenia. And that the same type of children raised in dysfunctional…[continue]
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