primhe 2011

Iain Caldwell

MUS and Pain management

Critique of medical model

over-reliance on "categories", "ideals", and "objectivity"

failure to appreciate the significance of internal experiences

lack of appreciation for diversity and for the essential role played by individuals in their own evolution

lack of appreciation for the role of culture in mental health

Psychological model

Around 40% of outpatients with MUS have diagnosable anxiety and depression (RCP, 2009); Up to 70% of people suffering with MUPS will suffer from depression and/or anxiety disorders (IAPT MUS, 2008)

In many cases physiological and psychological factors co-exist in symptoms presenting (e.g. IBS) i.e. MUS resulting from complex interactions between physiological, social and psychological processes

Problems with Psychological model

Mad All in the mind Putting it on Not listening

Functional (medical) Model (Jon Stone)

Introduce how systems and mechanisms function

Neutral model Separate the Why and How.

Problems with Functional (medical) model

No Why (explanations important) Person story not validated Wellbeing not included No context –culture, personal history

Whole Context Approach’s (WCA): Functional Wellbeing model.

The Whole Context Approach’s key aspects are:

Integrated approach Reflexive monism Complexity Wholeness and context

Whole Context Approach’s (WCA): Functional Wellbeing model.

Needs and wishes met in people lives Explanations (models and beliefs) Use of Metaphors Pain and Physical activity Recovery Validation – personal stories – medically

unexplained stories.

Functional Wellbeing Model

Fits with person’s world view (and family view) Context.

Stress management skills