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CHONGQING MEDICAL
UNIVERSITY
2012 GRADE FOREIGN
STUDENTS

Social Medicine
EXAM REPORT

SUBMITTED BY:
NAME:
ID NO: 20125100

1)What do you think of medical model? Why is Biopsycho-social medical model regarded as the key
point of medical model?

Medical model is the term cited by psychiatrist Ronald D.

Laing in his The Politics of the Family and Other Essays
(1971), for the "set of procedures in which all doctors are
trained." This set includes complaint, history, physical
examination, ancillary tests if needed, diagnosis, treatment,
and prognosis with and without treatment. Sociologist
Erving Goffman, in his Asylums , favorably compared the
medical model, which was a post-Industrial Revolution
occurrence, with the conduct in the tinkering trades (watch,
radio, TV repair). The medical model is an approach to
pathology that aims to find medical treatments for
diagnosed symptoms and syndromes and treats the human
body as a very complex mechanism (hence, Goffman's
tinkering trade analogy).
Among critics of medical psychiatry, Laing observed that
because the diagnosis of a mental illness was based on

conduct or patient behavior and not on physical pathology,

such a "diagnosis" essentially contravened standard medical
procedure and hence the medical model: physical
examination and ancillary tests were conducted, if at all,
only after the diagnosis was made. Whereas heart diseases,
cancers, and broken bones were diagnosed by evident
physical pathology discovered during examination and
ancillary tests, a mental illness was diagnosed by examining
the patient's behavior rather than physical signs or
symptoms.

The medical model drives research and theorizing about

physical or psychological difficulties on a basis of causation
and remediation.

It can be contrasted with the holistic model of the

alternative health movement and the social model of the

disability rights movement, as well as to biopsychosocial

and recovery models of mental disorders.

The biopsychosocial model (abbreviated "BPS") is a general

model or approach positing that biological, psychological
(which entails thoughts, emotions, and behaviors), and
social factors, all play a significant role in human
functioning in the context of disease or illness. Indeed,
health is best understood in terms of a combination of
biological, psychological, and social factors rather than
purely in biological terms. This is in contrast to the
traditional, reductionist biomedical model of medicine that
suggests every disease process can be explained in terms of
an underlying deviation from normal function such as a
pathogen, genetic or developmental abnormality, or
injury.The concept is used in fields such as medicine,
nursing, health psychology and sociology, and particularly
in more specialist fields such as psychiatry, health

psychology, family therapy, chiropractic, clinical social work,

and clinical psychology. The biopsychosocial paradigm is
also a technical term for the popular concept of the "mind
body connection", which addresses more philosophical
arguments between the biopsychosocial and biomedical
models, rather than their empirical exploration and clinical
application.

The model was theorized by psychiatrist George L. Engel at

the University of Rochester, and putatively discussed in a
1977 article in Science,where he posited "the need for a
new medical model." He discusses his model in detail in his
paper in the American Journal of Psychiatry [Engel GL The
clinical application of the biopsychosocial model, American
Journal of Psychiatry 1980;137:535-544] where he discusses
the fate of a hypothetical patient, a 55 year old Mr Glover
who has a second heart attack six months after his first.
Engel elegantly indicates that Mr Glover's personality helps
to interpret his chest pain, that he is in some degree of

denial and that it is only the intervention of his employer

that gives him permission to seek help. Whereas
reductionistically his heart attack can be understood as a
clot in a coronary artery, the wider personal perspective
helps to understand that different outcomes may be
possible depending on how the person responds to his
condition.

Subsequently Mr Glover in the emergency room develops a

cardiac arrest as a result of an incompetent arterial
puncture. Once again systems theory can analyse this event
in wider terms than just a cardiac arrhythmia. It sees the
event as due to inadequate training and supervision of
junior staff in an emergency room. Thus while there may be
"no single definitive, irreducible model has been published."
Engel's elegant exposition of his model in this paper gives
plenty of scope for this broader understanding of clinical
practice.

The novelty, acceptance, and prevalence of the

biopsychosocial model varies across cultures.

2)How do social factors affect people's health? Please give some

examples.
Many factors combine together to affect the health of
individuals and communities. Whether people are healthy or
not, is determined by their circumstances and environment.
To a large extent, factors such as where we live, the state of
our environment, genetics, our income and education level,
and our relationships with friends and family all have
considerable impacts on health, whereas the more
commonly considered factors such as access and use of
health care services often have less of an impact.
The determinants of health include:
The social and economic environment,
The physical environment, and

The persons individual characteristics and

behaviours.

The context of peoples lives determine their health, and so

blaming individuals for having poor health or crediting them
for good health is inappropriate. Individuals are unlikely to
be able to directly control many of the determinants of
health. These determinantsor things that make people
healthy or notinclude the above factors, and many others.
Income and social status - higher income and social status
are linked to better health. The greater the gap between the

richest and poorest people, the greater the differences in

health.
Education low education levels are linked with poor health,
more stress and lower self-confidence.
Physical environment safe water and clean air, healthy
workplaces, safe houses, communities and roads all
contribute to good health. Employment and working
conditions people in employment are healthier, particularly
those who have more control over their working conditions
Social support networks greater support from families,
friends and communities is linked to better health. Culture customs and traditions, and the beliefs of the family and
community all affect health.
Genetics - inheritance plays a part in determining lifespan,
healthiness and the likelihood of developing certain
illnesses. Personal behaviour and coping skills balanced
eating, keeping active, smoking, drinking, and how we deal
with lifes stresses and challenges all affect health.

3)What do you think of four major bad behaviours? Do you have any
of them? Can you tell the other bad behaviours?

Behaviour:
people's response for maintaining their own survival, ethnic
continuity
and adapting to environmental change.
Behaviour's main features:
(1) Acquired habit
(2) Long-term stability
(3) Good behaviour is beneficial to physical and mental
health
bad behaviour is harmful to physical and mental
health.

Four major bad behaviours

1) Smoking: WHO estimates that about 1.1 billion people
are smoking in the world.By 2025, the smoking people
will be more than 1.6 billion, mainly from the developing
countries.
Harmful substances in tobacco:

Nicotine,

benzopyrene,

arsenic

etc.benzopyrene

damage P53 gene (tumor-suppressing gene)

causing cancer

Smoking impact on health:

causing lung cancer, oral cavity cancer, bronchitis,
cardiovascular disease, hypertension etc.
Reasons for smoking are very complicated and related
to mental, physiological, social factors. May 31 of each
year is No Smoking Day in the World.

2) Alcohol addiction:
The harm of excessive drinking to health:causing acute
and chronic alcoholism, cirrhosis, fatty liver etc. Some
data show: liver cirrhosis incidence of alcohol drinkers is
twice that of non-drinkers.
In western countries, 50% of fatty livers are caused by
alcohol-drinking and 40% of deaths caused by liver
cirrhosis are related to alcohol-drinking.
In China, the prevalence rate of alcohol-drinking for male
is about
37.7%, for female is about 2.2%. Alcoholics are about 120
million. The prevalence number of alcohol poisoning are

more than 0.1 million and death people are near 10000
per

year.

In

cities,

the prevalence rate

of alcohol-

depending people is 3.8%. Alcohol can promote body to

absorb tobacco toxin (benzopyrene).The harm
(tobacco + alcohol) to health is greater. Reasons for
alcohol
addiction are very complicated and related to biological,
mental,
social factors.
Individual exists susceptibility to alcohol in genetics.
Males are
more susceptible than females.

3) Improper diet :
Unhealthy diet, starting from mouth, causes many
health

problems.

4) Lack of exercise :
Exercise can prevent cancer happening.

I dont have any of such bad behaviours. I support healthy

living

and

completely

behaviours. Such

avoiding

such

bad

community

habbits spoil the social reputations and

give rise to disputes which result in psychological and

physiological malfunctioning of living beings. Therefore it is
good to stay away from such demarcated behaviours.

Examples of some other bad behaviours:

1)Biting
2)Temper Tantrums
3)Bullying
4)Swearing

4. Why does prevention and control of sociopathy need whole society

to work together? Please give some examples.

The term antisocial often is mistaken as a synonym for

asocial. In fact, these two terms are very different.
Antisocial is better described as a rule-breaker. Think
anti-societal rules rather than anti-socialization. A
person who suffers from antisocial personality disorder
historically has been described as a person without a
conscience, a sociopath. However, recent research
suggests that the brains of people with antisocial
personality disorder function differently than those of
people without antisocial personality disorder. Those
with the disorder do not have emotional reactions to
words like puppies or babies, but neither do they
have reactions to words like rape or murder. People
without the disorder show significant activity in the
temporal lobes of the brain, the areas associated with
emotions. Traits of Antisocial Personality Disorder
The traits of antisocial personality disorder are:

Frequent lying

Often, the antisocial person seems to deceive just simply

because they can. If you notice frequent lying early in a
relationship, this should be a red flag.

Charismatic and charming

Charisma and charm are tools of the antisocial person. The

charming antisocial person knows they need friends and
romantic partners, so charm is used to gain trust and
relationships. Often, friends and loved ones will say they did
not know the depth of the problem until they were already
very involved.

Impulsivity

Impulsive behaviors can seem fun at first. Who doesn't want

a friend or partner who is exciting? However, a lack of
personal responsibility accompanies this aspect. The
antisocial person will opt to do fun things rather than take
care of obligations, like picking up the kids from daycare or

taking you to a doctor's appointment. Instead, he/she will

suddenly change plans to do the more fun thing.

Manipulative

People with antisocial personality disorder are skilled

manipulators. You see this often in abusive relationships.
After the abuse, the antisocial person convinces the abused
partner that the abuse will never happen again; he/she will
get treatment; they bring flowers and show outward signs
of remorse; yet there is no actual behavior change over the
long-term.

Lack of regard for safety

Lack of regard for safety involves the antisocial person and

those around them. They may drive too fast even with
children in the car, abuse drugs, have multiple sex partners
without using protection, etc.

Does not pay bills or honor debts

Beware of loaning money to an antisocial person. You likely

will not be repaid. In fact, the antisocial person may
manipulate the situation to make you feel like they
somehow earned or deserved the money you loaned them.

Lack of loyalty in romantic relationships

Antisocial people often cheat in romantic relationships. Akin

to the manipulation you see after episodes of abuse,
afterwards they may seem very remorseful and make
promises to change or offer explanations or even blame you
for their cheating.

Easily agitated and can be aggressive

When the antisocial person does not get his way through
charm and manipulation, often the behavior escalates to
aggression. Imagine being on a date and a having the suitor
try to charm you out of your pants, literally. When the
charm fails, the antisocial person may become aggressive
and sexually assault the victim.

Breaks laws

The antisocial person may break laws. In the extreme, they

may be serial rapists and murderers, money launderers,
etc.. Petty acts involve stealing a friend's clothes or CD
collection or taking money from your wallet without asking
permission.

Shows a lack of remorse

Remorse is not just saying your sorry. The antisocial person

may be very good at apologizing and have lots of practice at
it. True remorse involves behavior change so as not to cause
hurt in the future. An antisocial person rarely has long-term
behavior change without skilled treatment.
Keep in mind that the PDs have a range of mild (e.g. lies,
cheats, and manipulates) to severe (e.g. rapists, murderers)
and one does not have to have all of the traits to be
diagnosed with antisocial PD.
The reason that the sociopath does this is because, when he
makes new promises, he is (to his mind) starting again and
putting on a fresh mask. However, because he is unable to
learn from past mistakes, his brain works on default, so
when faced with a new opportunity or temptation, he will
will cease this opportunity and act on the temptation.