Editorial: The Biopsychosocial Model

In this issue the Journal adopts a new feature. From time to time we will be republishing important articles relevant to the field of psychodynamic psychiatry accompanied by an editorial. We are starting the series with the article in which George Engel first discussed the biopsychosocial model of health and illness. Our editorial comments are followed by the article reproduced in its entirety.

In a classic article published in Science in 1977, George Engel, M.D., an internist and psychoanalyst, challenged reductionistic medical thought and proposed a new health-illness model which he termed “biopsychosocial” (Engel, 1977). Reproduced in this issue, Engel's article couldn't be timelier than if it were written today. We republish it in order to place the work of modern psychodynamically oriented psychiatrists in historical context. It also provides a major component of the anchoring philosophy of this journal. An informal survey of colleagues revealed that many have not read Engel's piece although almost everyone is familiar with the term “biopsychosocial.” The fact that Engel chose to publish his ideas in a premier scientific journal rather than a medical or psychiatric one provides food for thought.

1977, the same year that Engel's article was published, happened to be the year in which the total eradication of smallpox occurred. The only major human disease to have been totally eradicated, smallpox had been endemic in many countries as recently as 1967. There is no treatment for smallpox. Its fatality rate was 20-40% and many survivors were permanently disfigured. The total eradication of smallpox was one of the great triumphs of modern biomedicine (Fenner, Henderon, Arita, Jezek, & Ladnyi, 1988). Having accomplished this, the future of medical progress seemed promising, and in many ways it has been. Whereas many areas of biomedicine have prospered, one would