These limitations were extensive,

Prospective epidemiological studies suggest that risks for many

with the psychological and the social as much as the biomedical, primary care (family medicine) being the clearest example

In his classic paper published in 1977 George Engel proposed a new model for medicine, the biopsychosocial model, contrasted with the existing biomedical model [1].

comprising failure to take account of the following: the person who has the illness, the person’s experience of, account of and attitude towards the illness ;

Such radical criticisms are of two main types: first, that the model lacks specific content, is too general and vague; and second, that it lacks scientific validity and philosophical coherence.

Nassir Ghaemi , a psychiatrist at Tufts, in his 2010 book with the telling title: ‘The Rise and Fall of the Biopsychosocial Model’ [2]. Ghaemi argues that the model is vague, too general, tells us nothing specific of value, hence is inefficient and sometimes distracting; it ‘gives mental health professionals permission to do everything but no

Engel argued that a broadening of the biomedical approach, a new biopsychosocial model, was needed to take account of all these factors ‘contributing to both illness and patienthood’ ([1], p. 133).

major illnesses, physical and mental, start early in development, many in childhood, and that risks include social factors such as poverty and other forms of social exclusion , some specific family level factors such as neglect and abuse, and life-style factors such as exercise and diet.