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Chapter 2 - The Biopsychosocial Model Advanced by Evolutionary Theory

Published online by Cambridge University Press:  08 September 2022

Riadh Abed
Mental Health Tribunals, Ministry of Justice, UK
Paul St John-Smith
Hertfordshire Partnership University NHS Foundation Trust, UK
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The currently dominant model of health and disease in psychiatry and medicine is Engel’s biopsychosocial (BPS) model, proposed in the 1970s to advance reductionistic biomedicine by integrating psychological and social factors. Although the BPS model represented progress, its scientific and philosophical foundations remain questionable and it cannot be considered complete or sufficient. In this chapter, we provide a historical and conceptual analysis of the BPS model before showing that the integration of evolutionary theory can provide a suitable next step from the BPS model, much as the BPS model was a step forward from the biomedical approach. Evolutionary theory justifies and enhances the BPS model’s recognition of multiple levels of causation and expands it by recognising both ultimate and proximate causation. It allows a clearer distinction of biological function from dysfunction and encourages a phylogenetic perspective on biology, which can guide research in new directions. In connecting the model of health with the most fundamental theory of biology, this approach provides the philosophical and scientific coherence that the BPS model sorely lacked.

Evolutionary Psychiatry
Current Perspectives on Evolution and Mental Health
, pp. 19 - 34
Publisher: Cambridge University Press
Print publication year: 2022

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Abbott, D. H. et al. (2003) ‘Are subordinates always stressed? A comparative analysis of rank differences in cortisol levels among primates’, Hormones and Behavior, 43, pp. 6782.Google Scholar
Abed, R. and St John-Smith, P. (2016) ‘Evolutionary psychiatry: a new College special interest group’, BJPsych Bulletin, 40, pp. 233236.CrossRefGoogle ScholarPubMed
Abrams, M. (2020) The New CBT: Evolutionary Clinical Psychology. San Diego, CA: Cognella Press.Google Scholar
Adler, R. H. (2009) ‘Engel’s biopsychosocial model is still relevant today’, Journal of Psychosomatic Research, 67, pp. 607611.Google Scholar
Alami, S. et al. (2020) ‘Mother’s social status is associated with child health in a horticulturalist population’, Proceedings of the Royal Society B: Biological Sciences, 287, p. 20192783.Google Scholar
Albott, C. S., Forbes, M. K. and Anker, J. J. (2018) ‘Association of childhood adversity with differential susceptibility of transdiagnostic psychopathology to environmental stress in adulthood’, JAMA Network Open, 1, p. e185354.Google Scholar
Alonso, Y. (2004) ‘The biopsychosocial model in medical research: the evolution of the health concept over the last two decades’, Patient Education and Counseling, 53, pp. 239244.Google Scholar
Álvarez, A. S., Pagani, M. and Meucci, P. (2012) ‘The clinical application of the biopsychosocial model in mental health: a research critique’, American Journal of Physical Medicine and Rehabilitation, 91, pp. S173S180.Google Scholar
Andreasen, N. C. (1984) The Broken Brain: The Biological Revolution in Psychiatry. New York: Harper & Row. Available at: (accessed 10 May 2019).Google Scholar
Andrews, P. W. et al. (2015) ‘Is serotonin an upper or a downer? The evolution of the serotonergic system and its role in depression and the antidepressant response’, Neuroscience and Biobehavioral Reviews, 51, pp. 164188.Google Scholar
Assary, E. et al. (2018) ‘Gene–environment interaction and psychiatric disorders: review and future directions’, Seminars in Cell and Developmental Biology, 77, pp. 133143.CrossRefGoogle ScholarPubMed
Barabási, A. L. and Oltvai, Z. N. (2004) ‘Network biology: understanding the cell’s functional organization’, Nature Reviews Genetics, 5, pp. 101113.CrossRefGoogle ScholarPubMed
Beall, C. M. (2007) ‘Two routes to functional adaptation: Tibetan and Andean high-altitude natives’, Proceedings of the National Academy of Sciences of the United States of America, 104, pp. 86558660.Google Scholar
Benedetti, F. (2008) ‘Mechanisms of placebo and placebo-related effects across diseases and treatments’, Annual Review of Pharmacology and Toxicology, 48, pp. 3360.CrossRefGoogle ScholarPubMed
Benning, T. (2015) ‘Limitations of the biopsychosocial model in psychiatry’, Advances in Medical Education and Practice, 6, p. 347.Google Scholar
Bigham, A. et al. (2010) ‘Identifying signatures of natural selection in Tibetan and Andean populations using dense genome scan data’, PLoS Genetics, 6, p. e1001116.Google Scholar
Boehm, C. (2012) ‘Costs and benefits in hunter-gatherer punishment’, Behavioral and Brain Sciences, 35, pp. 1920.Google Scholar
Bolton, D. and Gillett, G. (2019) The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments. London: Palgrave Macmillian.Google Scholar
Borell-Carrió, F., Suchman, A. L. and Epstein, R. M. (2004) ‘The biopsychosocial model 25 years later: principles, practice, and scientific inquiry’, Annals of Family Medicine, 2, pp. 576582.CrossRefGoogle Scholar
Borsboom, D., Cramer, A. O. J. and Kalis, A. (2019) ‘Brain disorders? Not really: why network structures block reductionism in psychopathology research’, Behavioral and Brain Sciences, 42, pp. 154.CrossRefGoogle Scholar
Boyd, K. M. (2000) ‘Disease, illness, sickness, health, healing and wholeness: exploring some elusive concepts’, Medical Humanities, 26, pp. 917.CrossRefGoogle ScholarPubMed
Bracken, P. et al. (2012) ‘Psychiatry beyond the current paradigm’, British Journal of Psychiatry, 201, pp. 430434.Google Scholar
Braveman, P. and Gottlieb, L. (2014) ‘The social determinants of health: it’s time to consider the causes of the causes’, Public Health Reports, 129, pp. 1931.CrossRefGoogle ScholarPubMed
Brenner, S. L. et al. (2015) ‘Evolutionary mismatch and chronic psychological stress’, Journal of Evolutionary Medicine, 3, p. 11.Google Scholar
Brown, E. S., Varghese, F. P. and McEwen, B. S. (2004) ‘Association of depression with medical illness: does cortisol play a role?’, Biological Psychiatry, 55, pp. 19.Google Scholar
Bullmore, E. T. (2019) The Inflamed Mind: A Radical New Approach to Depression. London: Short Books Ltd.Google Scholar
Bynum, W. F. et al. (2006) The Western Medical Tradition: 1800 to 2000. Cambridge: Cambridge University Press.Google Scholar
Campbell, M. C. and Ranciaro, A. (2021) ‘Human adaptation, demography and cattle domestication: an overview of the complexity of lactase persistence in Africa’, Human Molecular Genetics, 30, pp. 98109.Google Scholar
Chagnon, N. A. (2013) Noble Savages: My Life among Two Dangerous Tribes – The Yanamamö and the Anthropologists. New York: Simon & Schuster.Google Scholar
Cohen, S., Murphy, M. L. M. and Prather, A. A. (2019) ‘Ten surprising facts about stressful life events and disease risk’, Annual Review of Psychology, 70, pp. 577597.Google Scholar
Colloca, L. and Benedetti, F. (2005) ‘Placebos and painkillers: is mind as real as matter?’, Nature Reviews Neuroscience, 6, pp. 545552.CrossRefGoogle ScholarPubMed
Conrad, P. and Kern, R. (1981) The Sociology of Health and Illness: Critical Perspectives. New York: St. Martin’s Press.Google Scholar
Darwin, C. (1859) On the Origin of Species by Means of Natural Selection, or the Preservation of Favoured Races in the Struggle for Life. Available at: (accessed 10 August 2019).CrossRefGoogle Scholar
Deacon, B. J. (2013) ‘The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research’, Clinical Psychology Review, 33, pp. 846861.Google Scholar
Del Giudice, M. (2018) Evolutionary Psychopathology: A Unified Approach. New York: Oxford University Press.CrossRefGoogle Scholar
Doyal, L. (1979) The Political Economy of Health. London: Pluto Press.Google Scholar
Drescher, J. (2015) ‘Out of DSM: depathologizing homosexuality’, Behavioral Sciences, 5, pp. 565575.Google Scholar
Elovainio, M. et al. (2017) ‘Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study’, Lancet Public Health, 2, pp. e260e266.Google Scholar
Engel, G. L. (1977) ‘The need for a new medical model: a challenge for biomedicine’, Science, 196, pp. 129136.Google Scholar
Engel, G. L. (1980) ‘The clinical application of the biopsychosocial model’, American Journal of Psychiatry, 137, pp. 535544.Google Scholar
Evers, A. W. M. et al. (2014) ‘Incorporating biopsychosocial characteristics into personalized healthcare: a clinical approach’, Psychotherapy and Psychosomatics, 83, pp. 148157.Google Scholar
Fabrega, H. and Brüne, M. (2017) ‘Evolutionary foundations of psychiatric compared to nonpsychiatric disorders’, in Shackelford, T. K. and Zeigler-Hill, V. (eds.), The Evolution of Psychopathology. Cham: Springer, pp. 135.Google Scholar
Finniss, D. G. and Benedetti, F. (2005) ‘Mechanisms of the placebo response and their impact on clinical trials and clinical practice’, Pain, 114, pp. 36.Google Scholar
Frazier, L. D. (2020) ‘The past, present, and future of the biopsychosocial model: a review of The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments by Derek Bolton and Grant Gillett’, New Ideas in Psychology, 57, p. 100755.Google Scholar
Ghaemi, S. N. (2009) ‘The rise and fall of the biopsychosocial model’, British Journal of Psychiatry, 195, pp. 34.Google Scholar
Ghaemi, S. N. (2010) The Rise and Fall of the Biopsychosocial Model: Reconciling Art and Science in Psychiatry. Baltimore, MD: Johns Hopkins University Press.Google Scholar
Gilbert, P. and Allan, S. (1998) ‘The role of defeat and entrapment (arrested flight) in depression: an exploration of an evolutionary view’, Psychological Medicine, 28, pp. 585598.Google Scholar
Greenberg, G. (2013) ‘The Rats of N.I.M.H.’, The New Yorker. Available at: (accessed 15 June 2020).Google Scholar
Hamilton, M. J. et al. (2007) ‘The complex structure of hunter-gatherer social networks’, Proceedings of the Royal Society B: Biological Sciences, 27, pp. 21952203.Google Scholar
Harrell, C. J. P. et al. (2011) ‘Multiple pathways linking racism to health outcomes’, Du Bois Review, 8, pp. 143157.Google Scholar
Heinrich, L. M. and Gullone, E. (2006) ‘The clinical significance of loneliness: A literature review’, Clinical Psychology Review, 26, pp. 695718.Google Scholar
Hider, J. L. et al. (2013) ‘Exploring signatures of positive selection in pigmentation candidate genes in populations of East Asian ancestry’, BMC Evolutionary Biology, 13, p. 150.Google Scholar
Hoke, M. K. and McDade, T. (2014) ‘Biosocial inheritance: a framework for the study of the intergenerational transmission of health disparities’, Annals of Anthropological Practice, 38, pp. 187213.Google Scholar
Janko, M. M. et al. (2018) ‘The links between agriculture, Anopheles mosquitoes, and malaria risk in children younger than 5 years in the Democratic Republic of the Congo: a population-based, cross-sectional, spatial study’, Lancet Planetary Health, 2, pp. e74e82.Google Scholar
Kelly, M. P. et al. (2009) ‘A conceptual framework for public health: NICE’s emerging approach’, Public Health, 123, pp. e14e20.Google Scholar
Krakauer, J. W. et al. (2017) ‘Neuroscience needs behavior: correcting a reductionist bias’, Neuron, 93, pp. 480490.CrossRefGoogle ScholarPubMed
Krieger, N. (1994) ‘Epidemiology and the web of causation: has anyone seen the spider?’, Social Science and Medicine, 39, pp. 887903.Google Scholar
Krieger, N. (2001) ‘A glossary for social epidemiology’, Journal of Epidemiology and Community Health, 55, pp. 693700.Google Scholar
Lea, A. J. et al. (2017) ‘Developmental plasticity: bridging research in evolution and human health’, Evolution, Medicine, and Public Health, 2017, pp. 162175.Google Scholar
Linden, D. E. J. (2012) ‘The challenges and promise of neuroimaging in psychiatry’, Neuron, 73, pp. 822.CrossRefGoogle ScholarPubMed
Ludwig, J. et al. (2011) ‘Neighborhoods, obesity, and diabetes – a randomized social experiment’, New England Journal of Medicine, 365, pp. 15091519.Google Scholar
Ludwig, J. et al. (2012) ‘Neighborhood effects on the long-term well-being of low-income adults’, Science, 337, pp. 15051510.Google Scholar
Mai, F. M. (1995) ‘Clinical and basic science aspects of the biopsychosocial model’, Journal of Psychiatry & Neuroscience, 20, pp. 335336.Google Scholar
Marmot, M. (2005) ‘Social determinants of health inequalities’, Lancet, 365, pp. 10991104.Google Scholar
Marmot, M. (2006) ‘Status syndrome: a challenge to medicine’, Journal of the American Medical Association, 295, pp. 13041307.CrossRefGoogle ScholarPubMed
Marmot, M. and Wilkinson, R. (eds.) (1999) Social Determinants of Health. Oxford: Oxford University Press.Google Scholar
Mayr, E. (1961) ‘Cause and effect in biology’, Science, 134, pp. 15011506.Google Scholar
McElroy, A. (1990) ‘Biocultural models in studies of human health and adaptation’, Medical Anthropology Quarterly, 4, pp. 243265.Google Scholar
McGee, R., Williams, S. and Elwood, M. (1994) ‘Depression and the development of cancer: a meta-analysis’, Social Science and Medicine, 38, pp. 187192.Google Scholar
McLaren, N. (1998) ‘A critical review of the biopsychosocial model’, Australian & New Zealand Journal of Psychiatry, 32, pp. 8692.Google Scholar
McQueen, D. et al. (2013) ‘Rethinking placebo in psychiatry: how and why placebo effects occur’, Advances in Psychiatric Treatment, 19, pp. 171180.Google Scholar
Medicus, G. (2005) ‘Mapping transdisciplinarity in human sciences’, in Lee, J. W. (ed.), Focus on Gender Identity. New York: Nova Science Publishers, pp. 95114.Google Scholar
Moore, T. H. M. et al. (2017) ‘Interventions to reduce the impact of unemployment and economic hardship on mental health in the general population: a systematic review’, Psychological Medicine, 47, pp. 10621084.CrossRefGoogle ScholarPubMed
Nesse, R. M. (2001) ‘The smoke detector principle. Natural selection and the regulation of defensive responses’, Annals of the New York Academy of Sciences, 935, pp. 7585.Google Scholar
Nesse, R. M. (2019) Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry. London: Allen Lane.Google Scholar
Norton, H. L. et al. (2007) ‘Genetic evidence for the convergent evolution of light skin in Europeans and East Asians’, Molecular Biology and Evolution, 24, pp. 710722.Google Scholar
Pilgrim, D. (2002) ‘The biopsychosocial model in Anglo-American psychiatry: past, present and future?’, Journal of Mental Health, 11, pp. 585594.CrossRefGoogle Scholar
Pollard, T. M. (2008) Western Diseases: An Evolutionary Perspective. Cambridge: Cambridge University Press.Google Scholar
Price, J. et al. (1994) ‘The social competition hypothesis of depression’, British Journal of Psychiatry, 164, pp. 309315.Google Scholar
Quirke, V. and Gaudillière, J. P. (2008) ‘The era of biomedicine: science, medicine, and public health in Britain and France after the Second World War’, Medical History, 52, pp. 441452.Google Scholar
Raison, C. L. and Miller, A. H. (2013) ‘The evolutionary significance of depression in Pathogen Host Defense (PATHOS-D)’, Molecular Psychiatry, 18, pp. 1537.CrossRefGoogle ScholarPubMed
Rantala, M. J. et al. (2018) ‘Depression subtyping based on evolutionary psychiatry: proximate mechanisms and ultimate functions’, Brain, Behavior, and Immunity, 69, pp. 603617.Google Scholar
Rubio-Ruiz, M. E. et al. (2015) ‘An evolutionary perspective of nutrition and inflammation as mechanisms of cardiovascular disease’, International Journal of Evolutionary Biology, 2015, p. 179791.Google Scholar
Sadler, J. Z. and Hulgus, Y. F. (1990) ‘Knowing, valuing, acting: clues to revising the biopsychosocial model’, Comprehensive Psychiatry, 31, pp. 185195.CrossRefGoogle ScholarPubMed
Sadler, J. Z. and Hulgus, Y. F. (1992) ‘Clinical problem solving and the biopsychosocial model’, American Journal of Psychiatry, 149, pp. 13151323.Google Scholar
Scheinfeldt, L. B. et al. (2012) ‘Genetic adaptation to high altitude in the Ethiopian highlands’, Genome Biology, 13, p. R1.Google Scholar
Schwartz, T. (2013) ‘Psychopharmacological practice: the DSM versus the brain’, Mens Sana Monographs, 11, pp. 2541.Google Scholar
Shively, C. A. and Willard, S. L. (2012) ‘Behavioral and neurobiological characteristics of social stress versus depression in nonhuman primates’, Experimental Neurology, 233, pp. 8794.Google Scholar
Shorter, E. (1997) A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. Hoboken, NJ: John Wiley & Sons.Google Scholar
Shorter, E. (2005) ‘The history of the biopsychosocial approach in medicine: before and after Engel’, in White, P. (ed.), Biopsychosocial Medicine: An Integrated Approach to Understanding Illness. New York: Oxford University Press, pp. 119.Google Scholar
Sloman, L., Gilbert, P. and Hasey, G. (2003) ‘Evolved mechanisms in depression: the role and interaction of attachment and social rank in depression’, Journal of Affective Disorders, 74, pp. 107121.Google Scholar
Smith, G. D. (2000) ‘Learning to live with complexity: ethnicity, socioeconomic position, and health in Britain and the United States’, American Journal of Public Health, 90, pp. 16941698.Google Scholar
Smith, R. C. et al. (2013) ‘An evidence-based patient-centered method makes the biopsychosocial model scientific’, Patient Education and Counseling, 91, pp. 265270.Google Scholar
Suls, J. and Rothman, A. (2004) ‘Evolution of the biopsychosocial model: prospects and challenges for health psychology’, Health Psychology, 23, pp. 119125.Google Scholar
Surís, A., Holliday, R. and North, C. S. (2016) ‘The evolution of the classification of psychiatric disorders’, Behavioral Sciences, 6, p. 5.Google Scholar
Sweet, E. et al. (2013) ‘The high price of debt: household financial debt and its impact on mental and physical health’, Social Science and Medicine, 91, pp. 94100.Google Scholar
Syme, S. (1987) ‘Social determinants of disease’, Annals of Clinical Research, 19, pp. 4452.Google Scholar
Szasz, T. (2008) Psychiatry: The Science of Lies. Syracuse, NY: Syracuse University Press.Google Scholar
Tinbergen, N. (1963) ‘On aims and methods of ethology’, Zeitschrift für Tierpsychologie, 20, pp. 410433.Google Scholar
Troisi, A. (2020) ‘Social stress and psychiatric disorders: evolutionary reflections on debated questions’, Neuroscience and Biobehavioral Reviews, 116, pp. 461469.Google Scholar
Valtorta, N. K. et al. (2016) ‘Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies’, Heart, 102, pp. 10091016.Google Scholar
Van Norman, G. A. (2016) ‘Drugs, devices, and the FDA: part 1: an overview of approval processes for drugs’, JACC: Basic to Translational Science, 1, pp. 170179.Google ScholarPubMed
von Bertalanffy, L. (1968) General System Theory. New York: Braziller.Google Scholar
von Rueden, C. R. and Jaeggi, A. V. (2016) ‘Men’s status and reproductive success in 33 nonindustrial societies: effects of subsistence, marriage system, and reproductive strategy’, Proceedings of the National Academy of Sciences of the United States of America, 113, pp. 1082410829.Google Scholar
Wakefield, J. C. (1992) ‘The concept of mental disorder: on the boundary between biological facts and social values’, American Psychologist, 47, pp. 373388.Google Scholar
Wakefield, J. C. (1997) ‘When is development disordered? Developmental psychopathology and the harmful dysfunction analysis of mental disorder’, Development and Psychopathology, 9, pp. 269290.Google Scholar
Wakefield, J. C. (2015) ‘Biological function and dysfunction: conceptual foundations of evolutionary psychopathology’, in Buss, D. M. (ed.), The Handbook of Evolutionary Psychology. Hoboken, NJ: John Wiley & Sons, pp. 119.Google Scholar
Weatherall, D. J. and Clegg, J. B. (2001) ‘Inherited haemoglobin disorders: an increasing global health problem’, Bulletin of the World Health Organization, 79, pp. 704712.Google Scholar
Weiss, P. A. (1969) ‘The living system: determinism stratified’, in Koestler, A. and Smythies, J. R. (eds.), Beyond Reductionism: New Perspectives in the Life Sciences. London: Hutchinson, pp. 355.Google Scholar
Wootton, D. (2006) Bad Medicine: Doctors Doing Harm since Hippocrates. Oxford: Oxford University Press.Google Scholar
Xu, S. et al. (2011) ‘A genome-wide search for signals of high-altitude adaptation in Tibetans’, Molecular Biology and Evolution, 28, pp. 10031011.Google Scholar
Zachar, P. and Kendler, K. S. (2017) ‘The philosophy of nosology’, Annual Review of Clinical Psychology, 13, pp. 4971.CrossRefGoogle ScholarPubMed

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