Engel, George L.

   (1913–1999)

   Coiner of the phrase "biopsychosocial model," Engel was born in New York City and graduated with an M.D. from Johns Hopkins University in 1938. He trained in internal medicine at Peter Bent Brigham Hospital in Boston, then in 1946 was appointed to the departments of medicine and psychiatry of the University of Rochester, where he remained. As his interest in psychoanalysis strengthened, in the years 1949 to 1955 he underwent training at the New York Psychoanalytic Institute and the Chicago Institute for Psychoanalysis. Engel set out to apply psychoanalytic doctrine, where appropriate, to medical illnesses and became noted for his thoughtful integration of psychosocial issues in the care customarily provided in internal medicine. (See Delirium.) It was, however, for his coinage of the term "biopsychosocial model"—as opposed to the "medical model"—in an article in Science in 1977 that he became most celebrated. The title was: "The need for a new medical model: a challenge for biomedicine," and the concept was not merely that social aspects of care must be considered but that the system of care itself should be revamped. Engel argued in particular that psychiatry had come to a crossroads: "Psychiatry’s crisis revolves around the question of whether the categories of human distress with which it is concerned are properly considered ‘disease’ as currently conceptualized and whether exercise of the traditional authority of the physician is appropriate for their helping functions." Engel concluded, "The dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioral dimensions of illness" (pp. 129, 135). These words became a banner for many medical reformers in their efforts to make medicine more patient-centered, and psychiatrists often came to pride themselves on using the "BPS" model, although it was in stark contradiction to the teaching of the St. Louis School and the views of Samuel Guze that "psychiatry is a part of medicine." Indeed, Anthony W. Clare (1942–), at the Institute of Psychiatry in London, later slaked such BPS thinking as "a voice hostile to medicine. This voice preaches ‘holism’ and beckons psychiatry out into the soft, doughy area of gestalt psychology and encounter therapy to minister to the needs of people less ill than dissatisfied and more appropriately classified as demoralised than disordered." He said this, without mentioning the BPS model as such, in a 1982 volume that Michael Shepherd edited called Psychiatrists on Psychiatry, p. 21.