I was Dr George Engel's assistant and associate for 14 years. His biopsychosocial model was a conceptual effort designed to get beyond the reductionistic biomedical model that still prevails. In his letter, Dr Victor Schwartz reads Dr Engel much more closely and to the point than does Dr Waterman ("Biopsychosocial Model: Helpful or Hindering?" Psychiatric Times, May 2007).
At the end of his life, Dr Engel wanted to shift metaphors because he thought that his model was not understood or taught as he had hoped it would be. He was working with some philosophers of science and wanted to elaborate on an information model with a central focus on how systems at all levels are able to share information and modify biological responses. He knew that he did not have enough time left to finish this process, so after he passed, I went back to his papers and pulled his ideas together into the book, Information Medicine. The Biopsychosocial Model and Beyond: Narrative Practices for Medicine and Healthy Living in the 21st Century (Philadelphia: Xlibris Corporation, 2005). Readers might find the essay interesting, since we try to use helpful language and metaphors in our clinical work.