The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization

Review written by Dr Sandy Hilton info

Key Points

  1. An enactive-BPS approach requires clinicians to be flexible and comfortable with uncertainty.
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The biopsychosocial model (BPSM) has been described in clinical literature as a framework for practice since Engel first proposed it in 1977 (1). The meaning has shifted over time, in some cases becoming highly biomedical with little attention to social and psychological contributions of health and illness.

The authors reported this as having negative effects in research and clinical practice. They presented a “humanistic” variation which was person focused, and a “causation” variation which was focused on the multifactorial contributions of health and illness.

In order to reconceptualize and modernize the BPSM, the authors aimed to propose an enactive approach that combined experience, practical and action-oriented approaches, and cognition.

The biopsychosocial model has been described as a framework for practice since 1977.
The BPS model allows for patients to not just feel listened to, but to also have their treatments reflect their connection to the larger environment outside of the clinic.


This paper was a critical narrative review of the BSPM in terms of healthcare and musculoskeletal pain. The scope of the review was limited to the introduction of core literature on enactivism and highlighted work on advancing the BPSM.

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