Table 1.

Engel’s Critique of Biomedicine

  1. A biochemical alteration does not translate directly into an illness. The appearance of illness results from the interaction of diverse causal factors, including those at the molecular, individual, and social levels. And the converse, psychological alterations may, under certain circumstances, manifest as illnesses or forms of suffering that constitute health problems, including, at times, biochemical correlates

  2. The presence of a biological derangement does not shed light on the meaning of the symptoms to the patient, nor does it necessarily infer the attitudes and skills that the clinician must have to gather information and process it well

  3. Psychosocial variables are more important determinants of susceptibility, severity, and course of illness than had been previously appreciated by those who maintain a biomedical view of illness

  4. Adopting a sick role is not necessarily associated with the presence of a biological derangement

  5. The success of the most biological of treatments is influenced by psychosocial factors, for example, the so-called placebo effect

  6. The patient-clinician relationship influences medical outcomes, even if only because of its influence on adherence to a chosen treatment

  7. Unlike inanimate subjects of scientific scrutiny, patients are profoundly influenced by the way in which they are studied, and the scientists engaged in the study are influenced by their subjects