Historical context: psychological mislabeling and the emergence of the biopsychosocial model

Abstract

Since the end of the last century, we have approached chronic pain through the assumptions of the biopsychosocial model. Not without its critics, this model provides useful scaffolding for the multiple determinants of human illness. The same cannot be said of its predecessor, the psychogenic model. Grounded in 19th century psychoanalysis, this model understood headache, fibromyalgia, and many other pain disorders as psychological problems in disguise. Only in recent decades has the psychogenic model begun to relax its grip on medicine. This chapter traces the origin and demise of the psychogenic model and its replacement by the biopsychosocial model. It contrasts psychoanalytic and psychobehavioral case studies in order to underline the distinction between psychogenically-based treatment and contemporary pain management training. And it describes a procedure for reducing the risk of psychological mislabeling that is inherent in an overtly psychological medical model.