2.3 The Biomedical and the Holistic Biopsychosocial, Spiritual Systems Approaches

In considering the individual as a system, and a complex, whole being we adopt a holistic biopsychosocial, spiritual (health) perspective as opposed to a narrow biomedical approach. The disease or biomedical model is premised in on a linear, reductionist, positivist conceptualization of phenomena (A causes B and therefore intervention C will produce result D), on the notion of the practitioner as a detached, neutral expert who makes a “diagnosis” and determines the “prognosis”, and the person as passive receiver of “treatment” provided. While this might seem absurd, it has unfortunately become infused into social work thinking over the years, with the inordinate influence of psychiatry on the profession, and the so-called “scientific” casework approach of Mary Richmond, who in 1917, in trying to emulate the medical profession published “Social Diagnosis”, in an effort to grant legitimacy to social work as a profession.

The holistic biopsychosocial, spiritual (BPSS) approach, which is reflected in the IASSW/IFSW (2014) Global Social Work Definition and the IASSW (2018) Global Social Work Statement of Ethical Principles (GSWSEP), underscores the importance of holistic assessments and interventions, social indicators of disease and illness and the importance of inter-disciplinary collaboration in dealing with the complexities of human development and human suffering. Linked to systems theory, the BPSS approach calls for an understanding of multiple and circular causality, not linear, and thus for assessments and interventions at multiple system levels, which is core to generalist social work practice.

The BPSS approach makes a meaningful differentiation between illness and disease. Illness is what a person experiences as symptoms and suffering and the meanings attributed to these, whereas disease is the underlying biological pathology. A person may have underlying pathology, without any experience of symptoms, just as a person may experience illness without any underlying pathology. Medical practitioners are usually preoccupied with disease, whereas people are more concerned with their personal experiences of distress and suffering (Kleinmann, 1988; 1998). Authur Kleinmann, whose treatise on human suffering bears much relevance for social work, exhorts us to see the bigger picture when dealing with human phenomena, including mental illness. In his words: “Here is where fear and aspiration, desire and obligation, mesh in the close encounters of ordinary men and women with the pain and disaster and with the infrapolitics of power that apportion those threats unequally and distribute responses to them unfairly across social fault lines in actual worlds” (Kleinman, 1998, p. 376).