Collaborative Efforts in Liaison Psychiatry

Abstract

There is compelling evidence that psychological, social, and cultural—as well as biological—factors are involved to varying degrees in the initiation, course, and outcome of pathophysiological processes. Lipowski (1975) for example, has proposed an ecological viewpoint which states that “the study of every disease must include the person, his body, and his human and nonhuman environments as essential components of the total system” (p. 6). Reiser’s (1975) biopsychosocial field theory of disease emphasizes the interaction and interrelationship of all systems—physical, mental, psychological, environmental, and so on. Finally, Engel (1977) has vigorously urged the adoption of a biomedicopsychosocial model of disease that would be applicable to psychological as well as physiological dysfunction and would recognize that complex interactions between the individual and his or her total environment are major determinants of health and disease. For example, such life stresses as bereavement, crowding, and so on are now considered to play a critical role in the onset and exacerbation of certain forms of physiological dysfunction. It follows, then, that psychological care is coordinate with medical care. In fact, 50 to 70 of all medical patients seen by primary-care physicians present with a primary psychological problem or manifest psychological dysfunction secondary to their physical illness (Lipowski, 1967).