Introduction to Biosocial Medicine

Book Title: Introduction to Biosocial Medicine

Book Author: Donald A. Barr

Publication Information: Baltimore, MD, Johns Hopkins University Press, 2015, 216 pp., $44.95 (paperback)

Family physicians care for patients from womb to tomb. Whether prince or pauper, citizen or immigrant, black or white, insured or uninsured, rural or urban, addicted or sober, wise or foolish, weak or strong, genius or less intelligent, family physicians care for all.¹

While this soaring vision of family medicine implies care in multiple dimensions across multiple contexts, it remains unclear how well suited we are to educate our learners in such care. The “biopychosocial” approach was initially articulated by George Engel, MD, in the 1970s and specifically applied to family medicine in the 1980s.² Over the intervening years, however, the scant attention that has been paid to the model per se in the medical literature has primarily served to demonstrate the need for more comprehensive training regarding the role of psychological and social factors in health and medical care.^3,4

Donald Barr’s Introduction to Biosocial Medicine is thus a welcome and overdue contribution. Dr Barr is a professor of pediatrics and education at Stanford University, and his previous work includes a high-quality educational text on health disparities in the United States.^5,6 With his Introduction to Biosocial Medicine, designed for learners in the health care professions, he sets out to provide “a fundamental understanding of just what behavior is in the human context and what factors influence behavior” (p 1). Acknowledging the challenges inherent in defining well-being 
(p 11), he concisely marshals a variety of research and data to argue that the key behaviors affecting well-being are smoking, diet, physical exercise, and alcohol use (p 25).

The introductory first chapter is the proverbial 30,000-foot overview of the book’s principal arguments. Each chapter is concisely summarized, and this first chapter could well serve as a foundational reading in biopsychosocial medicine for the entry-level learner. The second chapter explores the interrelationship between the key behaviors and well-being, and the relationship between these behaviors and the concepts of social networks and social capital. The remainder of the book explores, chapter by chapter, topics such as society and culture, identity, motivation, personality, the brain, and inequality, all as they relate to behavior.

The chapters are well-written and concise, yet of remarkable depth as they examine the essential ideas, issues, and thinkers for understanding the topic at hand. For example, Chapter 3 (“Inequality and Well-being”) covers the history of race, racism, and racial identity in the United States, and specifically explores how these issues affect medical care and health more broadly. Chapter 7 (“Personality, Behavior and Well-being”) surveys the contributions of major psychological thinkers to our understandings of personality and mental illness, beginning with the contributions of Sigmund Freud and continuing through the more recent contributions of Carol Gilligan. The book ends in Chapter 11 with a discussion of the ways that social inequalities, operating through each of the influences explored in the book, can affect individuals through childhood experiences that then shape adult behaviors and, subsequently, adult well-being.

Each chapter in this book could be used as a stand-alone introductory reading for learners at any level of medical education, and the entire text would provide a solid introduction for medical students to the broader contextual issues of health and medical care.

Dr Barr’s training as a pediatrician is evident in the developmental approach he takes throughout the book. He makes a strong case for the influence of social and psychological factors on the behaviors of adults through their early experiences. While as a family physician I would have appreciated seeing further exploration of the impact of such factors specifically on grown adults and on the elderly, the developmental approach in this work is a welcome reminder that some of the most important windows of opportunity for influencing healthy behavior across the lifespan occur in childhood.

It is one thing to say that we in family medicine care for all patients with attention to their many and varied social contexts. It is an entirely different matter to teach and practice in a way that intentionally addresses biopsychosocial medicine. For those seeking a solid introduction to the breadth of scope that this entails, Introduction to Biosocial Medicine will be a valuable resource.