Bio-Psycho-Social model: The L-shaped room

Qualification, induction, together with continuing professional development and mandatory training should see all health professionals having due regard for the 'political' in their respective roles. The 'Law and the Nurse' session, used to be, and remains a welcome reminder; also appropriately scary for this time of year. While at work the meaning of 'political' is nuanced with so many aspects and dimensions, e.g.

Public Service

Safety - Statistics - Quality

Zero tolerance - Never events

Leadership

Operating Procedures

Audit - Reports

churn of policy cranked by governments / parliaments

cost - savings - budgets - the plan

pay negotiation - Unions, Professional Organisations

Litigation

Administration Human Resources

Recruitment & Retention 

Disciplinary processes

Planning

Estates - Procurement - Supplies

The organisational tree - communications

structures - providers, commissioners, integrated

News: NHS, private sector, Social Care, Gov. 'Papers'

organisational (footprint) footprint

sustainability, green initiatives

signage - national - local

combined local policy initiatives and national emphasis e.g.

equality, equity, inclusion, 

management of violence abuse in the workplace, bullying, 

managing complaints, confidentiality
changes in reporting incidents, data returns,

information systems, governance and records management)

Is it me, or do the medical model, bio-medical model and the bio-psycho-social model somehow seem lacking?^

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC =========================  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

psycho	bio
social	?

In surgical terms, how is the political domain best realised within a model of health and social care: anastomosis or transplant?

^As seen by a certain lens.

Previously: 'models' : 'bio-psycho-social' : surgery

In Browder, 'care' is mentioned over 150 times!

OK - so now you're teasing ...

'Surgery theory investigates the homotopy types of manifolds, using a combination of algebra and topology. It is the aim of these notes to provide an introduction to the more algebraic aspects of the theory, without losing sight of the geometric motivation.' Ranicki, 2001. 

'IV. Surgery and the Fundamental Theorem

In this chapter we develop the techniques of surgery for constructing normal cobordisms and use them to prove the Fundamental Theorem. The ideas of surgery have their origins in the theory of 2-manifolds, in the process of "cutting off handles", and in general, in the theory of Marston Morse of non-degenerate critical points of differentiable functions.' Browder, 1972.

In Browder, care is mentioned over 150 times!

'Poincaré' that is.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

	'The Classifying Spaces for Surgery and Cobordism of Manifolds'
Try to - follow the language* ...	"Follow the money!"

Ranicki, A. (2001) An introduction to algebraic surgery. Surveys on Surgery Theory, Volume 2, edited by Sylvain Cappell, Andrew Ranicki and Jonathan Rosenberg, Princeton: Princeton University Press, 2001, pp. 81-164. https://doi.org/10.1515/9781400865215-005

Browder, W. (1972) Surgery and the Fundamental Theorem. In: Surgery on Simply-Connected Manifolds. Ergebnisse der Mathematik und ihrer Grenzgebiete, vol 65. Springer, Berlin, Heidelberg.

https://doi.org/10.1007/978-3-642-50020-6_4

Madsen, I. H., and Milgram, R.J., (1979) The Classifying Spaces for Surgery and Cobordism of Manifolds. Princeton University Press.

Image: https://m.media-amazon.com/images/I/41THEeVvpdL.jpg

*concepts!

Normansfield Theatre in Teddington

Normansfield Theatre in Teddington

'My favourite building is the amazing Normansfield Theatre in Teddington that John Langdon Down (1828-1896) built to provide positive and stimulating education for learning disabled people (Down syndrome is named after him). At a time when most disabled people would have been shut away in horrific asylums, Down adapted his own house as a residential home, and built a beautiful theatre for creative rehabilitation. It's one of the few surviving private theatres from the period, with original painted scenery and other ornate fixtures, recently remodelled. For me, it's also a reminder of how the wealthy often used their money for good causes, which feels less common now. Jos Boys, guest curator and co-director of The DisOrdinary Architecture Project'

My source: The pick of London Open House. House&Home, FTWeekend. 6/7 September 2025. p.8.

Image: Langdon Down Centre

Previously: 'learning disability' : 'theatre' : 'architecture'

Careif report: The Health Needs of the Indo-Caribbean Community in the United Kingdom

'The Indo-Caribbean community has played a key part in the life of the United Kingdom, but this has not often been recognised. Little is known about this populations’ physical and mental health needs and its experience of health and social services in the UK.

This report, The Health Needs of the Indo-Caribbean Community in the United Kingdom, examines the history of the Indo-Caribbean community in the UK, the prevalence of mental health conditions among the community, barriers to accessing mental health services, and the existing services available.'



Includes:

"The absence of a unique category designating ‘Indo-Caribbean’ as a unique category in the UK Census was identified as a major barrier to obtaining vital epidemiological data on the UK’s Indo-Caribbean population."

Above text:
https://www.careif.org/news-and-events/2025-10-9-careif-report-the-health-needs-of-the-indo-caribbean-community-in-the-united-kingdom

n.b. 
In my community mental health nursing career in Chorley, Preston, and West Lancashire as services were established, the diversity of the local populations was evident, but there was an assumption that many communities were essentially 'closed': one explanation for lack of referrals from specific racialised communities - was that some communities 'looked-after their own'.

Of course this can be racism (acute or subtle), an excuse for inaction, delayed response, lack of action - outreach and translation services. There were marked examples of intervention. I have seen first-hnad interpreting and translation services in action since full-time retirement and the services offered are amazing for the insights and care delivery they can facilitate. Is this why we also need mental health nurses and the team? To translate in challenging circumstances, even by being there, seeking avenues, giving time - especially in instances of psychoses and doing so safely (for all)?

In addition to the main body of Careif's report and its recommendations, it may be helpful to consider the report's key terms relating them to the domains of Hodges' model? I also note reference to the bio-medical model as an explanatory framework. A conference abstract has been submitted today for April 2026, highlighting the need for bio-psycho-socio-political model / framework (Hodges' model - of course?).

See also:

RCN North West Multicultural Group

Health, planet, self: after - 'Can molecular Lego save the planet?'

Ack: © Johan Jarnestad /
The Royal Swedish Academy of Sciences

'This morning’s Nobel Prize in Chemistry is one that’s been anticipated for several years now: it goes to Susumu Kitagawa of Kyoto, Richard Robson of Melbourne, and Omar Yaghi of Berkeley for metal-organic frameworks.'

'So what’s a MOF? This goes back to the idea of “coordination chemistry”, a huge topic in the inorganic and metal-organic fields.'

 

The 2025 Nobel Prize in Chemistry: Metal-Organic Frameworks 

Can conceptual Lego - 'human-metal organic frameworks' -
save healthcare, planetary and self-care?

'One astonishing characteristic is the amount of surface area locked away in these new materials: a MOF weighing one gramme can have an internal surface area the size of a football pitch^. MOFs are often likened to Hermione Granger's bottomless handbag in the Harry Potter books: a tiny exterior concealing a seemingly infinite interior. Rice University chemist Stavroula Alina Kampouri has called MOFs "magical sponges", describing them as "not just elegant crystals you'd admire under a microscope; they're an entire universe of structures, each like a miniature city of tunnels and rooms waiting to be filled."'

Anjana Ahuja, Can molecular Lego save the planet?, Opinion Science. Financial Times, 15 October 2025, p.22.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

'This is not an ivory-tower sort of topic, though: the importance of these sorts of complexes cannot be overstated. They were the basis for the first Nobel awarded in inorganic chemistry (1913, Alfred Werner) and metal coordination is how the iron atoms in hemoglobin carry oxygen to the cells of your body to keep you alive, for starters. You can say the same thing about photosynthesis in plants, and about the actions of the many crucial enzymes in every living creature on the planet that have metal-ion centers in them. Outside of biology and biochemistry, the structures of minerals similarly cannot be understood without a knowledge of coordination chemistry.'

The 2025 Nobel Prize in Chemistry: Metal-Organic Frameworks

Popular information. NobelPrize.org. Nobel Prize Outreach 2025. Mon. 27 Oct 2025. <https://www.nobelprize.org/prizes/chemistry/2025/popular-information/>

^Is this a question for BBC Radio 4 More or Less?

Of course, I keep posting about the Nobel Prize in the hope of a prize - due recognition for Hodges' model. Discretely of course, given a limited readership. 
Go figure: in 3D naturally.

'Politics as a science' ...

'The science of politics is the oldest of the social sciences but still perhaps the most dependent: it derives much of its methodology from statistics (the science of the state turned into the science of numerical data), from economics and from sociology and it steals much of its substance from anthropology, from history and from law. Yet there is little doubt about the core of the subject: it focuses on the ways in which decisions are taken by men acting within territorially or functionally defined networks and constellations of organizations. And the hallmark of the discipline is 'its systematic analysis', whether couched in verbal and literary terms or in the formalized language of statistics or of mathematical logic.' Preface vii

Hayward R. Alker, Karl W. Deutsch, Antoine H. Stoetzel (eds.), Mathematical Approaches to Politics, Amsterdam, Elsevier, 1973, pp. 475.

Come on Healthcare: catch up will you!

Within philosophy it is recognised that Immanuel Kant provided a means by which the rationalists and empricists can be reconciled. Some background:

In philosophy, rationalism is the epistemological view that "regards reason as the chief source and test of knowledge"[1] or "the position that reason has precedence over other ways of acquiring knowledge",[2] often in contrast to other possible sources of knowledge such as faith, tradition, or sensory experience. More formally, rationalism is defined as a methodology or a theory "in which the criterion of truth is not sensory but intellectual and deductive".[3]  https://en.wikipedia.org/wiki/Rationalism

In philosophy, empiricism is an epistemological view which holds that true knowledge or justification comes only or primarily from sensory experience and empirical evidence.[1] It is one of several competing views within epistemology, along with rationalism and skepticism. Empiricists argue that empiricism is a more reliable method of finding the truth than purely using logical reasoning, because humans have cognitive biases and limitations which lead to errors of judgement.[2] Empiricism emphasizes the central role of empirical evidence in the formation of ideas, rather than innate ideas or traditions.[3] Empiricists may argue that traditions (or customs) arise due to relations of previous sensory experiences.[4]

Historically, empiricism was associated with the "blank slate" concept (tabula rasa), according to which the human mind is "blank" at birth and develops its thoughts only through later experience.[5] https://en.wikipedia.org/wiki/Empiricism

If health and social care, must be evidence-based, then as far as Hodges' model is concerned we are then duty-bound to use the most readily available 'evidence' to us, including (while taking liberties?):

• The structure of national health and social care organisations (NHS, DHSS ...)
• Physical infrastructure
• Human Resources Organisation
• Unions and Labour relations
• Texbooks, journal papers, conferences
• Organisational structures from the regional to the local
• Professional bodies and governance of licensing/registration
• Curricula that students follow^
  
• Models, frameworks, teaching and learning tools and methods
• Data, statistics, information and reporting (national, international)
• Research projects ongoing (whatever scale, methods, methodology)
• Accounts from lived experience of patients, carers and public (^and students)
• Policy
• Funding
• Law relating to Health and Social Care
• Public (Mental) Health? Discuss
• Media (Social) Control, Advertising
• . . .
  

Hodges' model: Structure and Content

Using this evidence, we still see the Cartesian divide, the mind-body distinction writ large in health and social care. The continuing impact is evident in theory, practice, (hence) lived experience, policy and managment. Since its creation in the 1980s, Hodges' model mirrors (literally) this philosophical, epistemological and ontological legacy, thereby acknowledging the ancient history of medicine, and 'modern' development of healthcare and nursing. Through this device, Hodges' model can facilitate debate, critique, reflection, and critical thinking; to encourage progress in our thought, motivations, action and subsequent evaluation.

This explains the structure of Hodges' model and predicts the range (contextual signature) of content when the model is applied.

Evidence permitting of course!

See also: BBC The Great Philosophers:

Series 1: 4. Descartes

Series 1: 5. Spinoza and Leibniz

Series 1: 8. Kant

n.b. I video taped this marvellous series when first screened. When studying for my BA(Hons), audio taped, they also provided a great learning resource in the car. The programmes are on BBC 4 (UK) once again, but are readily accessible.

Free online mindfulness programme & ¥3800 (≈ £20) reward - research study

Dear all,

My name is Francesco Saldarini. I am a postdoctoral fellow at Waseda University (Japan) and a visiting researcher at the University of Surrey. My research focuses on investigating the (potential) effects of mind-body practices (e.g., mindfulness and martial arts) on psychology.

I am running a longitudinal intervention study investigating the effects of a digital mindfulness-based programme on a variety of health and cognitive outcomes and I would like to invite you to participate.

The study takes place entirely online and will require you to participate in two or three main experimental sessions, when you will be asked to complete a task and answer some questions. Each session will take approximately 40 minutes to complete. Moreover, you will get to participate in an online NHS-approved mindfulness-based programme! The programme is pre-recorded and you can flexibly choose when to attend a session. I will also reward you ¥3800 (≈ £20) for your participation.

This study was approved by the Waseda University research ethics committee (REF : 2024 - 314).

If you are interested in participating in the study and wish to know more about it, please contact me at:
w.iac23317 AT kurenai.waseda.jp.

Basic inclusion criteria:

- Currently feeling stressed
- Between 18 and 65 years of age
- Willing to complete a screening questionnaire
- No previous mindfulness experience
- Willing to practice mindfulness for minimum 2 hours per week for 4 weeks

Thank you,

Francesco Saldarini

My source: https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=VIRTUAL-METHODS