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  • Writer's pictureAdam

'Evobiopsychosocial Medicine' article published in EMPH

Myself, Riadh Abed and Paul St-John Smith have published a paper in the journal Evolution, Medicine and Public Health, titled ‘Evobiopsychosocial Medicine’. You can find it here.

Below is a summary, also provided in this Twitter thread.

The biopsychosocial model of medicine can be enhanced by taking the biological, psychological and social levels and asking evolutionary questions about each of them…

Engel’s biopsychosocial model improved medicine by pushing against pure biomedical reductionism, encouraging consider a patient’s psychology and social circumstances. But it had various scientific and philosophical flaws. It was too vague, allowed individual practitioners to pick which paradigm they preferred. It wasn’t causational, and didn’t prescribe particular research agendas. It’s paid lip-service, but hasn’t really changed how medicine is practiced.

We suggest that evolutionary medicine offers an appropriate scientific and philosophical grounding for the BPS, presenting the ‘Evobiopsychosocial’ model. Engel’s three biopsychosocial levels can be expanded with Tinbergen’s four questions:

When these levels and questions interact, they provide 12 questions which can be applied to any medical condition to get an evobiopsychosocial perspective on the problem:

These boxes encompass multiple areas of science and medicine: biomedical research (1&2) evolutionary biology (3&4) psychotherapy (5&6) evolutionary psychology (7&8) public health and epidemiology (9&10) evolutionary anthropology (11&12).

We apply this schema to psychiatric, immunological and infectious examples (depression, rheumatoid arthritis and COVID-19) to display how the Evobiopsychosocial approach can be widely applied, with various interesting connotations…

Depression research could benefit from closer animal models in the phylogeny; distinguishing functional and dysfunctional subtypes may be clinically useful and destigmatising.

Rheumatoid arthritis has damaging psychological effects. Psychosocial factors leading to treatment seeking and adherence may be better understood and enhanced with the evolutionary perspective.

COVID-19 is a simple infection, but psychosocial factors are what allow it to spread from human to human: again, the evolutionary approach may better our understanding and mitigation of harms here, whilst preparing us for viral evolution.

We finish by noting evolutionary medicine recognizes the complementarity of biopsychosocial approaches, and that different areas have different applications. Also, every area can be enhanced by an evolutionary perspective. The EBPS provides a more systematic and scientifically sound method of approaching the BPS, as Tinbergen’s questions help distinguish questions of causation at every level. This can be widely applied, to any given medical condition.

If you’d like to read the paper (it’s quite short!) do so here. Also, we’ve written up a longer chapter on a similar topic, concentrating on how evolutionary approaches are particularly beneficial in enhancing the biopsychosocial perspective in psychiatry.

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