Challenging the Biopsychosocial Model in a Chronic Constipation Clinic

Abstract

The full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-prot purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. AbstractIn this article we discuss the results of an ethnographic study of professionals' and patients' experiences within a specialist constipation clinic in England. Chronic constipation tends to be poorly understood and inadequately treated. Eleven patients were followed through their illness trajectory during a 5-month field work period, involving 21 home interviews, clinic-based interviews, participant-observation, and a focus group. Professionals were likewise observed and interviewed. The clinic could broadly be described as biopsychosocial in its approach. However, professionals expressed uncertainty about how best to provide biospychosocial care and suggested that some patients were not "open" to psycho-social therapies or to discussing psychosocial aspects of their disease. Patients' concerns were with being taken seriously, receiving treatment and narrating intersections of life events, emotional well-being and the bowels. We situate these findings within the discourse of "functional" disorders and discuss why implementing a biopsychosocial approach is problematic in this case. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 Medicine has made creditable strides in prolonging life and enhancing the quality of life for people with a number of chronic diseases. However, "functional" diseases are a class of health conditions about which western biomedicine generally has little understanding and even fewer answers. These diseases cause significant suffering, yet routine investigatory tests do not detect any pathological cause. They have therefore come to be a category of exclusion existing in almost every medical specialty (e.g. functional paralysis or functional arthritis). Other commonly applied terms to designate functional disease are "idiopathic", "ambiguous chronic illness" (Johnson & Johnson, 2006) or even "medically unexplained physical symptoms" (MUPS) (Burton, 2003). Functional constipation belongs to the category of functional gastrointestinal disorders (FGIDs). It is defined as "infrequent or incomplete defecation not caused by medication, or specific medical or psychiatric disease" (Drossman, 1994, p. 11). In other words, it is a condition which occurs without any "definable dietary, systemic or local structural cause"(Lennard-Jones, 1994, p. 7). Essentially the organ/structure (in this cas...

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