In medieval times, it was believed that for the soul to ascend to heaven, the human body had to be preserved intact. These beliefs greatly hindered the study of the human body since the study of anatomy required dissecting corpses which was a strictly forbidden, blasphemous practice. It was only in the 14th century that human dissection was permitted by the church and used as a tool for teaching anatomy in Bologna, Italy after a hiatus of over 1,700 years.
George Engel postulates that the church's permission to study the human body included a tacit prohibition against corresponding scientific investigation of the human mind and behavior, since in the eyes of the church these had more to do with religion and the soul and should therefore remain in the church’s domain.
In the 17th century Rene Descartes proposed the concepts of Cartesian dualism. This theory postulated that the mind and body were actually two very distinct entities and that events in the body are very separate from events that happen in the mind. The widespread adoption of this approach solidified the separation of mind and body in the evolving science of medicine.
Research and study mainly focused on the anatomy, physiology and the chemistry of the body thus establishing the supremacy of the biomedical model. This separation lasted and became entrenched for hundreds of years until the 20th century, when the “psychosomatic movement” began to emerge in Europe and the United States.
Psychosomatic theories were formulated to try and bridge the divide between mind and body by exploring the relationships among physical, psychological, and social factors in the causation, prognosis, and treatment of illness. Psychosomatic medicine was initially met with some criticism as there was overemphasis on the ways in which mental disorders and distress could directly cause disease, by postulating a single cause of disease theory, rather than a multifactorial approach to the origins of disease. Many unexplained symptoms became the domain of psychosomatic medicine, in ways that at times alienated physicians and patients alike. Angela Kennedy pointed out that diseases which could be explained by measurable biological and physiological changes were attached a more legitimate and worthy “value,” whereas diseases in which these changes could not be measured were delegitimized and stigmatized. This was unfortunate, as it clearly slowed the progress towards a wholistic view of human illness integrating both mind and body.
In 1977 George Engel proposed the biopsychosocial model which recognized the nuanced and multifactorial causality of disease, suggesting that in any and every disease state there is an interplay among biological, psychological and social factors. This model and its acceptance and integration into medicine’s mainstream provide the theoretical underpinning of modern-day integrated care.
In a second upcoming blog devoted to this topic, we will explore the integrated care model and review a recent Annals of Internal Medicine article devoted to a study of the factors influencing adoption of the integrated care model.