The Agent-Structure Problem in International Relations ThMoseStaton39
The Agent-Structure Problem in International Relations Theory
Author(s): Alexander E. Wendt
Source: International Organization, Vol. 41, No. 3 (Summer, 1987), pp. 335-370
Published by: The MIT Press
Stable URL: http://www.jstor.org/stable/2706749
Accessed: 28-12-2016 23:35 UTC
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted
digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about
JSTOR, please contact [email protected]
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
http://about.jstor.org/terms
The MIT Press is collaborating with JSTOR to digitize, preserve and extend access to International
Organization
This content downloaded from 131.94.16.10 on Wed, 28 Dec 2016 23:35:36 UTC
All use subject to http://about.jstor.org/terms
The agent-structure problem
in international relations theory
Alexander E. Wendt
Two theories, neorealism and world-system theory, strongly influence con-
temporary academic discourse about international relations. Both claim to
provide "structural" explanations of how states behave in the international
system. Despite their common commitment to structural analysis, however,
their understanding of system "structure," and therefore of structural expla-
nation, is quite different. Neorealists define international system structures
in terms of the observable attributes of their member states (the "distribu-
tion of capabilities"), and as a result, they understand the explanatory role
of those structures in individualist terms as constraining the choices of pre-
existing state actors. World-system theorists, on the other hand, define inter-
national system structures in terms of the fundamental organizing principles
of the capitalist world economy which underlie and constitute states, and
thus they understand the explanatory role of structures in structuralist terms
as generating state actors themselves. These differences, and their implica-
tions, have yet to be explicated in the international relations literature.1 In
An earlier version of this article was presented at the 1986 meeting of the International
Studies Association. I want to thank Hayward Alker, Richard Ashley, Raymond Duvall, Jeffrey
Isaac, Brian Job, Stephen Krasner, Peter Manicas, David Sylvan, Jutta Weldes, and two
anonymous referees for their helpful comments and suggestions on previous drafts.
1. There are a number of discussions of the meanings and uses of "structural theory" in
neorealism and world-system theory, but as far as I know, none explicitly compares or differ-
entiates the neorealist and world-system approaches to structure and structural analysis. On
neorealism see, for example, Kenneth Waltz, Theory of International Politics (Reading, Mass.:
Addison-Wesle ...
"Herbert Alexander Simon was an American economist, political scientist and cognitive psychologist, whose primary research interest was decision-making within organizations and is best known for the theories of "bounded rationality" and "satisficing". He received the Nobel Prize in Economics in 1978 and the Turing Award in 1975. His research was noted for its interdisciplinary nature and spanned across the fields of cognitive science, computer science, public administration, management, and political science. He was at Carnegie Mellon University for most of his career, from 1949 to 2001."
The Agent-Structure Problem in International Relations ThMoseStaton39
The Agent-Structure Problem in International Relations Theory
Author(s): Alexander E. Wendt
Source: International Organization, Vol. 41, No. 3 (Summer, 1987), pp. 335-370
Published by: The MIT Press
Stable URL: http://www.jstor.org/stable/2706749
Accessed: 28-12-2016 23:35 UTC
JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted
digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about
JSTOR, please contact [email protected]
Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at
http://about.jstor.org/terms
The MIT Press is collaborating with JSTOR to digitize, preserve and extend access to International
Organization
This content downloaded from 131.94.16.10 on Wed, 28 Dec 2016 23:35:36 UTC
All use subject to http://about.jstor.org/terms
The agent-structure problem
in international relations theory
Alexander E. Wendt
Two theories, neorealism and world-system theory, strongly influence con-
temporary academic discourse about international relations. Both claim to
provide "structural" explanations of how states behave in the international
system. Despite their common commitment to structural analysis, however,
their understanding of system "structure," and therefore of structural expla-
nation, is quite different. Neorealists define international system structures
in terms of the observable attributes of their member states (the "distribu-
tion of capabilities"), and as a result, they understand the explanatory role
of those structures in individualist terms as constraining the choices of pre-
existing state actors. World-system theorists, on the other hand, define inter-
national system structures in terms of the fundamental organizing principles
of the capitalist world economy which underlie and constitute states, and
thus they understand the explanatory role of structures in structuralist terms
as generating state actors themselves. These differences, and their implica-
tions, have yet to be explicated in the international relations literature.1 In
An earlier version of this article was presented at the 1986 meeting of the International
Studies Association. I want to thank Hayward Alker, Richard Ashley, Raymond Duvall, Jeffrey
Isaac, Brian Job, Stephen Krasner, Peter Manicas, David Sylvan, Jutta Weldes, and two
anonymous referees for their helpful comments and suggestions on previous drafts.
1. There are a number of discussions of the meanings and uses of "structural theory" in
neorealism and world-system theory, but as far as I know, none explicitly compares or differ-
entiates the neorealist and world-system approaches to structure and structural analysis. On
neorealism see, for example, Kenneth Waltz, Theory of International Politics (Reading, Mass.:
Addison-Wesle ...
"Herbert Alexander Simon was an American economist, political scientist and cognitive psychologist, whose primary research interest was decision-making within organizations and is best known for the theories of "bounded rationality" and "satisficing". He received the Nobel Prize in Economics in 1978 and the Turing Award in 1975. His research was noted for its interdisciplinary nature and spanned across the fields of cognitive science, computer science, public administration, management, and political science. He was at Carnegie Mellon University for most of his career, from 1949 to 2001."
Helping Darwin: How to think about evolution of consciousness (Biosciences ta...Aaron Sloman
ABSTRACT
Many of Darwin's opponents, and some of those who accepted the theory of evolution as regards physical forms, objected to the claim that human mental functions, and
consciousness in particular, could be products of evolution. There were several reasons for this opposition, including unanswered questions as to how physical mechanisms could produce mental states and processes an old, and still surviving, philosophical problem.
A new answer is now available. Evolution could have produced the "mysterious" aspects of consciousness if, like engineers developing computing systems in the last six or seven decades, evolution encountered and "solved" increasingly complex problems of representation and control (including self-monitoring and self-control) by using systems with increasingly abstract mechanisms based on virtual machines, including most
recently self-monitoring virtual machines.
These capabilities are, like many capabilities of computer-based systems, implemented in non-physical virtual machinery which, in turn, are implemented in lower level physical mechanisms.
This would require far more complex virtual machines than human engineers have so far created. Noone knows whether the biological virtual machines could have been
implemented in the discrete-switch technology used in current computers.
These ideas were not available to Darwin and his contemporaries: most of the concepts, and the technology, involved in creation and use of sophisticated virtual machines were developed only in the last half century, as a by-product of a large number of design decisions by hardware and software engineers solving different problems.
Probability Concepts
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Probability in Daily Life
Pascals Wager: A Philosophical Argument
Different Research Philosophies Essay
Value of Philosophy Essay
Theorems of Probability
Probability Theory In Health And Social Care
The Multiverse Theory
Questions on Probability
Analysis Of Noonans Argument From Probabilities
Philosophy in Mathematics Essay
Mathematics: Probability
Common Themes Of Probability And Outcome
…if one of the primary purposes of education is to teach young .docxanhlodge
“…if one of the primary purposes of education is to teach young people the skills, knowledge, and critical awareness to become productive members of a diverse and democratic society, a broadly conceptualize multicultural education can have a decisive influence.” Textbook page 338.
What steps do you think schools can or should take to promote our democracy in today’s very diverse country?
Food festivals and celebrating a cultural holiday will not be accepted as an answer. Those are examples of tokenism to make the dominant culture feel like they are doing something. These two activities are fun and interesting, but not how we will strengthen our democracy.
.
✍Report OverviewIn this assignment, you will Document an.docxanhlodge
✍
Report Overview
In this assignment, you will
Document and reflect on your university education and on learning experiences outside of the university;
Articulate how your upper-level coursework is an integrated and individualized curriculum built around your interests; and
Highlight the experiences, skills, and projects that show what you can do.
A successful report submission will be the product of many hours of work over several weeks.
A report earning maximum available points will be a carefully curated and edited explanation of your work that provides tangible evidence of—and insights into—your competencies and capabilities over time. In each section of this report, you are (1) telling a story about your own abilities, and (2) providing specific examples and evidence that illustrate and support your claims.
✍
Required Report Sections
Here the sections are listed as they must appear in your final graded submission. You’ll arrange the sections in this order when
submitting
the final report BUT you won’t follow this order when
writing
drafts of each section.
Note that each section description contains a Pro Tip that tells you how to proceed with the work – what to attempt first, second, and third, etc.
❖ I. Statement of Purpose ❖
Step 1.
Read these four very different
examples of successful Statement of Purpose sections
.
Step 2.
Consider the differences in tone, style, level of detail etc. Your own statement of purpose may resemble one of these. Indeed, writing a first draft based on an example or combination of examples is a good idea. BUT don’t let these examples limit your thinking or personal expression. You may want to begin with a quote from a famous person, use a quote from your mom, or skip the quote. You may want to discuss your personal motivations or get right down to the facts. You may want to list your classes or discuss how your work-life led you to this path.
Step 3.
Write a rough draft – let’s call that Statement of Purpose 1.0. Write Statement of Purpose 1.0 as quickly as you can and then put it away until after you have completed most of the report. Forget about Statement of Purpose 1.0 until most of your report is at least in draft form.
Step 4.
Once you have a draft of all sections of your report, you are in a good position to revise Statement of Purpose 1. You are ready for Step 4. Take Statement of Purpose 1.0 out its dusty vault and hold it up to the sun. Ah. Now read your report draft and compare it to the claims you made in Statement of Purpose 1.0. Ask yourself these questions:
Does Statement of Purpose 1.0. accurately introduce my report?
Are there important ideas or representative experiences in the report that should be highlighted in the Statement of Purpose but aren’t? Remember this isn’t a treasure hunt where its your reader’s job to figure out what matters. It’s your job to show the reader what matters.
If Statement of Purpose 1.0. isn’t the best map it can be for th.
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Helping Darwin: How to think about evolution of consciousness (Biosciences ta...Aaron Sloman
ABSTRACT
Many of Darwin's opponents, and some of those who accepted the theory of evolution as regards physical forms, objected to the claim that human mental functions, and
consciousness in particular, could be products of evolution. There were several reasons for this opposition, including unanswered questions as to how physical mechanisms could produce mental states and processes an old, and still surviving, philosophical problem.
A new answer is now available. Evolution could have produced the "mysterious" aspects of consciousness if, like engineers developing computing systems in the last six or seven decades, evolution encountered and "solved" increasingly complex problems of representation and control (including self-monitoring and self-control) by using systems with increasingly abstract mechanisms based on virtual machines, including most
recently self-monitoring virtual machines.
These capabilities are, like many capabilities of computer-based systems, implemented in non-physical virtual machinery which, in turn, are implemented in lower level physical mechanisms.
This would require far more complex virtual machines than human engineers have so far created. Noone knows whether the biological virtual machines could have been
implemented in the discrete-switch technology used in current computers.
These ideas were not available to Darwin and his contemporaries: most of the concepts, and the technology, involved in creation and use of sophisticated virtual machines were developed only in the last half century, as a by-product of a large number of design decisions by hardware and software engineers solving different problems.
Probability Concepts
John Smith The Probability Of Life
Probability and Statistics
Philosophy of Ethics Essay
Probability in Daily Life
Pascals Wager: A Philosophical Argument
Different Research Philosophies Essay
Value of Philosophy Essay
Theorems of Probability
Probability Theory In Health And Social Care
The Multiverse Theory
Questions on Probability
Analysis Of Noonans Argument From Probabilities
Philosophy in Mathematics Essay
Mathematics: Probability
Common Themes Of Probability And Outcome
…if one of the primary purposes of education is to teach young .docxanhlodge
“…if one of the primary purposes of education is to teach young people the skills, knowledge, and critical awareness to become productive members of a diverse and democratic society, a broadly conceptualize multicultural education can have a decisive influence.” Textbook page 338.
What steps do you think schools can or should take to promote our democracy in today’s very diverse country?
Food festivals and celebrating a cultural holiday will not be accepted as an answer. Those are examples of tokenism to make the dominant culture feel like they are doing something. These two activities are fun and interesting, but not how we will strengthen our democracy.
.
✍Report OverviewIn this assignment, you will Document an.docxanhlodge
✍
Report Overview
In this assignment, you will
Document and reflect on your university education and on learning experiences outside of the university;
Articulate how your upper-level coursework is an integrated and individualized curriculum built around your interests; and
Highlight the experiences, skills, and projects that show what you can do.
A successful report submission will be the product of many hours of work over several weeks.
A report earning maximum available points will be a carefully curated and edited explanation of your work that provides tangible evidence of—and insights into—your competencies and capabilities over time. In each section of this report, you are (1) telling a story about your own abilities, and (2) providing specific examples and evidence that illustrate and support your claims.
✍
Required Report Sections
Here the sections are listed as they must appear in your final graded submission. You’ll arrange the sections in this order when
submitting
the final report BUT you won’t follow this order when
writing
drafts of each section.
Note that each section description contains a Pro Tip that tells you how to proceed with the work – what to attempt first, second, and third, etc.
❖ I. Statement of Purpose ❖
Step 1.
Read these four very different
examples of successful Statement of Purpose sections
.
Step 2.
Consider the differences in tone, style, level of detail etc. Your own statement of purpose may resemble one of these. Indeed, writing a first draft based on an example or combination of examples is a good idea. BUT don’t let these examples limit your thinking or personal expression. You may want to begin with a quote from a famous person, use a quote from your mom, or skip the quote. You may want to discuss your personal motivations or get right down to the facts. You may want to list your classes or discuss how your work-life led you to this path.
Step 3.
Write a rough draft – let’s call that Statement of Purpose 1.0. Write Statement of Purpose 1.0 as quickly as you can and then put it away until after you have completed most of the report. Forget about Statement of Purpose 1.0 until most of your report is at least in draft form.
Step 4.
Once you have a draft of all sections of your report, you are in a good position to revise Statement of Purpose 1. You are ready for Step 4. Take Statement of Purpose 1.0 out its dusty vault and hold it up to the sun. Ah. Now read your report draft and compare it to the claims you made in Statement of Purpose 1.0. Ask yourself these questions:
Does Statement of Purpose 1.0. accurately introduce my report?
Are there important ideas or representative experiences in the report that should be highlighted in the Statement of Purpose but aren’t? Remember this isn’t a treasure hunt where its your reader’s job to figure out what matters. It’s your job to show the reader what matters.
If Statement of Purpose 1.0. isn’t the best map it can be for th.
☰Menu×NURS 6050 Policy and Advocacy for Improving Population H.docxanhlodge
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NURS 6050 Policy and Advocacy for Improving Population Health
Back to Course Home
Course Calendar
Syllabus
Course Information
Resource List
Support, Guidelines, and Policies
Module 1
Module 2
Module 3
Module 4
Module 5
Module 6
.
▪ Learning Outcomes1.Understand the basic concepts and termin.docxanhlodge
▪
Learning Outcomes:1.
Understand the basic concepts and terminology used in Strategic Management. (Lo 1.2)2.
Understand the Corporation Social Responsibility
(Lo 1.4).3.
Explain how executive leadership is an important part of strategic management (Lo 3.4)
✓
Question 1
: How does strategic management typically evolve in a corporation? (
1Mark)
✓
Question 2
: Discuss the influence of globalization, social responsibility and environmental sustainability on strategic management of a corporation.(
2 Marks
)
✓
Question 3:
In what ways can a corporation’s structure and culture be internal strengths or weaknesses? Justify your answer by examples from real market. (
1Mark)
✓
Question 4:
When does a corporation need a board of directors? Justify your answer by an example from Saudi market.
(1 Mark)
Notes:
-
Your answers
(for the
4
questions)
MUST include at least
three scholarly peer-reviewed references
,
using a proper referencing style (APA).
Keep in mind that these scholarly references
can be found
in the
Saudi Digital Library (SDL).
-
Make sure to support your statements with logic and argument, citing all sources referenced.
Your answers should not include m
.
● What are some of the reasons that a MNE would choose internationa.docxanhlodge
● What are some of the reasons that a MNE would choose international expansion through an acquisition? An IJV? An alliance?
● What are the variables that would influence the decision?
● Which choice do you believe is best for the likely benefit of the firm? (Cite and reference).
.
▶︎ Prompt 1 Think about whether you identify with either Blue or .docxanhlodge
▶︎ Prompt 1:
Think about whether you identify with either Blue or Red or "Left vs. Right" characteristics of conservative or liberal, left or right America. Do you see yourself, or the people in the place you grew up, on either side of the divide, or perhaps in a different political category? Share some ways in which you identify with some of the descriptions, or ways in which they seem foreign to you.
I'll attach the picture below
.
⁞ InstructionsChoose only ONE of the following options .docxanhlodge
⁞ Instructions
Choose only
ONE
of the following options below and, in your post, write a paraphrase that avoids plagiarism of the paragraph you have chosen. Your paraphrase can be as long as the excerpt you have chosen, but should not duplicate any phrasing from the excerpt. If you must, you can quote up to three words in a phrase.
Choose to paraphrase ONE of the excerpts below:
Option 1
Morrison began writing Sula in 1969, a time of great activism among African Americans and others who were working toward equal civil rights and opportunities. The book addresses issues of racism, bigotry, and suppression of African Americans; it depicts the despair people feel when they can't get decent jobs, and the determination of some to survive. Eva, for example, cuts off her leg in order to get money to raise her family. Morrison shows how, faced with racist situations, some people had to grovel to whites simply to get by, as Helene does on a train heading through the South. Others, however, fought back, as Sula does when she threatens some white boys who are harassing her and Nel.
or
Option 2
In 1993, Morrison was awarded the Nobel Prize for literature, and thus became the first African American and only the eighth woman ever to win the award. According to Maureen O'Brien in Publishers Weekly, Morrison said, "What is most wonderful for me personally is to know that the Prize has at last been awarded to an African American. I thank God that my mother is alive to see this day." In 1996, she received the National Book Foundation Medal for Distinguished Contribution to American Letters.
.
⁞ InstructionsChoose only ONE of the following options below.docxanhlodge
⁞ Instructions
Choose only
ONE
of the following options below and, in your post, write a paraphrase that avoids plagiarism of the paragraph you have chosen. Your paraphrase can be as long as the excerpt you have chosen, but should not duplicate any phrasing from the excerpt. If you must, you can quote up to three words in a phrase.
When you are done posting your paraphrase, reply to at least one classmate’s paraphrase, commenting on what s/he has done well and what s/he can improve with the wording. Your response should be written in no fewer than 75 words.
Choose to paraphrase ONE of the excerpts below:
Option 1
Morrison began writing Sula in 1969, a time of great activism among African Americans and others who were working toward equal civil rights and opportunities. The book addresses issues of racism, bigotry, and suppression of African Americans; it depicts the despair people feel when they can't get decent jobs, and the determination of some to survive. Eva, for example, cuts off her leg in order to get money to raise her family. Morrison shows how, faced with racist situations, some people had to grovel to whites simply to get by, as Helene does on a train heading through the South. Others, however, fought back, as Sula does when she threatens some white boys who are harassing her and Nel.
or
Option 2
In 1993, Morrison was awarded the Nobel Prize for literature, and thus became the first African American and only the eighth woman ever to win the award. According to Maureen O'Brien in Publishers Weekly, Morrison said, "What is most wonderful for me personally is to know that the Prize has at last been awarded to an African American. I thank God that my mother is alive to see this day." In 1996, she received the National Book Foundation Medal for Distinguished Contribution to American Letters.
Your discussion post will be graded according to the following criteria:
- Clear paraphrase the selected text in your own words with minimal use of quotations
.
⁞ InstructionsAfter reading The Metamorphosis by Frank .docxanhlodge
⁞ Instructions
After reading
The Metamorphosis
by Frank Kafka , choose
one
of the following assertions and write a 200-word response supporting why you agree or disagree with it.
Gregor’s transformation highlights his isolation and alienation before his metamorphosis.
Or
Despite having become an insect, Gregor is more humane and sensitive than his family.
Or
If Gregor had been a stronger person, he would have been able to avoid all of the suffering and alienation he endures.
.
⁞ InstructionsAfter reading all of Chapter 5, please se.docxanhlodge
⁞ Instructions:
After reading all of
Chapter 5
, please select
ONE
of the following
primary source readings
:
“Utilitarianism” by John Stuart Mill
(starting on page 111)
-or-
“A Theory of Justice” by John Rawls
(starting on page 115)
-or-
“The Entitlement Theory of Justice” by Robert Nozick
(starting on page 122)
Write a short, objective summary of
250-500 words
which summarizes the main ideas being put forward by the author in this selection. Your summary should include no direct quotations from any author. Instead, summarize in your own words, and include a citation to the original. Format your Reading Summary assignment according to either MLA or APA formatting standards, and attach as either a .doc, .docx, or .rtf filetype. Other filetypes, or assignments that are merely copy/pasted into the box will be returned ungraded.
.
⁞ InstructionsAfter reading all of Chapter 2, please select.docxanhlodge
⁞ Instructions:
After reading all of
Chapter 2
, please select
ONE
of the following
primary source readings
:
“Anthropology and the Abnormal” by Ruth Benedict
(starting on page 33)
-or-
“Trying Out One’s New Sword” by Mary Midgley
(starting on page 35)
Write a short, objective summary of
250
which summarizes the main ideas being put forward by the author in this selection.
Write a short summary that identifies the thesis and outlines the main argument.
Reading summaries are not about your opinion or perspective – they are expository essays that explain the content of the reading.
All reading summaries must include substantive content based on the students reading of the material.
Reading Material: Doing Ethics
ORIGINIAL WORK. NO PLAGIARISM
.
⁞ Instructions After reading all of Chapter 9, please .docxanhlodge
⁞ Instructions:
After reading all of
Chapter 9
, please select the following
primary source reading
:
“A Defense of Abortion” by Judith Jarvis Thomson
(starting on page 237)
Write a short, objective summary of
250-500 words
which summarizes the main ideas being put forward by the author in this selection. Your summary should include no direct quotations from any author. Instead, summarize in your own words, and include a citation to the original. Format your Reading Summary assignment according to either MLA or APA formatting standards, and attach as either a .doc, .docx, or .rtf filetype. Other filetypes, or assignments that are merely copy/pasted into the box will be returned ungraded.
.
…Multiple intelligences describe an individual’s strengths or capac.docxanhlodge
“…Multiple intelligences describe an individual’s strengths or capacities; learning styles describe an individual’s traits that relate to where and how one best learns” (textbook quote, [H2] Learning Styles].
This week you’ve read about the importance of getting to know your students in order to create relevant and engaging lesson plans that cater to multiple intelligences and are multimodal.
Assignment Instructions:
A. Using
SurveyMonkey
, create a survey that has:
At least five questions based on Gardner’s theory
Five questions on individual learning style inventory
A specific targeted student population grade level (elementary/ middle/ high school/adults)
Include the survey link for your peers
B. Post a minimum 150 word introduction to your survey, using at least one research-based article (cited in APA format) explaining how it will:
Evaluate students’ readiness
Assist in the creation of differentiated lesson plans.
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•••••iA National Profile ofthe Real Estate Industry and.docxanhlodge
•••••i
A National Profile of
the Real Estate Industry and
the Appraisal Profession
by J. Reid Cummings and Donald R. Epley, PhD, MAI, SRA
FEATURES
T
J- he
he real estate industry has been devastated on many fronts' in the years
following the Great Recession, whieh began in 2007^ due to the bursting of the
housing bubble and the subsequent finaneial crisis relating to the mortgage
market meltdown.' The implosion of the mortgage markets initially began when
two Bear Stearns mortgage-backed securities hedge funds, holding nearly $10
billion in assets, disintegrated into nothing.* Panie quickly spread to financial
institutions that could not hide the extent of their toxic, subprime exposures, and
a massive, worldwide credit squeeze ensued; outright fear soon replaced panic.
Subsequent eredit tightening and substantial illiquidity in the financial markets
rapidly and severely affected the housing and construction markets.' Throughout
the United States, properties of all kinds saw dramatic value declines.
In thousands of cases, real estate foreclosures disrupted people's lives,
forced businesses to close, eaused financial institutions to falter, capsized wbole
market segments, devastated entire industries, and squeezed municipal and state
government budgets dependent upon use and property tax revenues.* While the
effeets of property value declines and the waves of foreclosures in markets across
the country captured most of the headlines, one significant impact of the upheaval
in US real estate markets has gone largely unreported: its impact on employment
in the real estate industry, and specifically, the real estate appraisal profession.
This article presents a
current employment
profile of the US real
estate industry, with
special attention given
to appraisal profes-
sionals. It serves as an
informative picture of
the appraisal profession
for use as a benchmark
for future assessment
of growth. As a
component of the real
estate industry, the
appraisal profession
ranks as the smallest
in employment, is
highly correlated to
movements in empioy-
ment of brokers and
agents, and relies on
commerciai banking,
credit, and real estate
lessors and managers
to deliver its products.
1. James R. DeLisle, "At the Crossroads of Expansion and Recession," TheAppraisalJournal 75, no. 4 (Fall 2007):
314-322; James R. DeLisle, "The Perfect Storm Rippiing Over to Reai Estate," The Appraisal Journal 76, no,
3 (Summer 2008): 200-210.
2. Randaii W. Eberts, "When Wiii US Empioyment Recover from tiie Great Recession?" International Labor Brief
9, no. 2 (2011): 4-12 (W. E. Upjohn Institute for Employment Research): Chad R. Wilkerson, "Recession and
Recovery Across the Nation: Lessons from History," Economic Review 94, no. 2 (2009): 5-24.
3. Kataiina M. Bianco, The Subprime Lending Crisis: Causes and Effects of the Mortgage Meltdown (New York:
CCH, inc., 2008): Lawrence H. White, "Fédérai Reserve Policy and the Housing Bubbie," in Lessons Fro.
Let us consider […] a pair of cases which I shall call Rescue .docxanhlodge
“Let us consider […] a pair of cases which I shall call Rescue I and Rescue II. In the first Rescue story we are hurrying in our jeep to save some people – let there be five of them – who are imminently threatened by the ocean tide. We have not a moment to spare, so when we hear of a single person who also needs rescuing from some other disaster we say regretfully that we cannot rescue him, but must leave him to die. To most of us, this seems clear […]. This is Rescue I and with it I contrast Rescue II. In this second story we are again hurrying to the place where the tide is coming in in order to rescue the party of people, but this time it is relevant that the road is narrow and rocky. In this version, the lone individual is trapped (do not ask me how) on the path. If we are to rescue the five we would have to drive over him. But can we do so? If we stop he will be all right eventually: he is in no danger unless from us. But of course, all five of the others will be drowned. As in the first story, our choice is between a course of action that will leave one man dead and five alive at the end of the day and a course of action which will have the opposite result. (Philippa Foot, “Killing and Letting Die,” from Abortion and Legal Perspectives, eds. Garfield and Hennessey, 2004, University of Massachusetts Press)
1. What would Mill tell the rescuer to do, in Rescue I and Rescue II, according to his theory of utilitarianism? Be clear in explaining Mill’s recommendation, and how he would justify it. In doing so, you must include a discussion of the following:
o The Principle of Utility and how it would specifically apply in this situation—who gets “counted” and how?
2. What would Kant tell the rescuer to do, in Rescue I and Rescue II, according to his deontological theory? Be clear in explaining Kant’s recommendation and how he would justify it. In doing so, you must include a discussion of the following:
o The first version of the Categorical Imperative and how it would specifically apply in these two situations (hint, you have to say what the maxim would be and what duty would be generated according to it).
o The second version of the Categorical Imperative and how it would specifically apply in this situation.
3. Explain one criticism of both Mill and Kant. Afterward, argue for which ethical approach, on your view is superior. Be specific and provide reasons for your claim.
.
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• Here’s the approach you can take for this paperTitle.docxanhlodge
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Title page (ensure team members and IDs are listed)
Introduction – provide a background of the selected organization.
Risk #1
Description
Impact on organization
Recommendation on how to manage it
Risk #2
Description
Impact on organization
Recommendation on how to manage it
Risk #3
Description
Impact on organization
Recommendation on how to manage it
Conclusion
References (minimum of 12 reputable sources)
Appendix (if any)
The paper will range from 15-to-20-pages includes title page, content, and references.
Please write in APA Style.
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•Your team will select a big data analytics project that is intr.docxanhlodge
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•Provide a background of the company chosen.
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•Provide a summary and conclusion.
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•your reason for applying to Waldorf •your academic and p.docxanhlodge
•your reason for applying to Waldorf
•your academic and professional goals
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.
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■ Research PaperGeneral Systems Theory Its Past andPote.docx
1. ■ Research Paper
General Systems Theory: Its Past and
Potential†
Peter Caws1,2*
1Department of Philosophy, The George Washington
University, Washington, DC, USA
2American Association for the Advancement of Science,
Washington, DC, USA
This paper has three parts. First, I discuss what I take as the
original stimulus and the pur-
pose of general systems theory (GST) to be, why I think it is
important, and how I came to
be involved in it. I reflect on von Bertalanffy’s general system
(sic) theory and the early
debates on the topic, stressing the essential concept of
isomorphism, with its rewards in
following up parallel developments in different domains, and its
risks and temptations
in the projection of grand and all-inclusive systems. Second, I
discuss the direction my
own work took after my term as President of the Society for
General Systems Research
(1966–1967), and how it diverged from the early program, in
particular in its emphasis
on the difference between system and structure and on the
essential role of individual
subjectivity in the latter. I stress the importance of the concept
of ‘relation’ as underlying
that of ‘system’, and in particular the difference between
4. probably would not have been here at all. But I
am very glad I am.
Some of what I have to say will inevitably be
autobiographical. My claim to attention is pre-
sumably that I was once President of the Society
for General Systems Research, the precursor of
your own ISSS. Bringing back a former President
after almost 50years has its risks. For one thing,
unless he has been following things closely, which
I have not, he was bound to be out of touch. For
another, anyone who has had the responsibility
of addressing an annual meeting as its President,
and who has taken that responsibility seriously,
probably is, or at any rate was, pretty opinionated.
I thought I had a necessary task back in 1966,
and I tried to carry it out; but it was not popular.
At that time, I took my job to be deflationary.
People were getting carried away by the idea of
an overarching, all-embracing system, of which
all the sciences were to be partial instantiations.
I remember in particular a paper, which I had
especially in mind in writing my address, that
argued from a local distribution of small-mouth
bass to a layered hierarchy of systems from the
microscopic to the cosmic. I thought this was
extravagant, if not megalomaniacal, and would
give systems theory a bad name, so I was at pains
to point out its limitations. As I put it in the intro-
duction to the reprinting of the address, in my
book Yorick’s World,
‘among some of my colleagues in the Society I
had detected a rampant tendency to suppose,
5. somewhat after the manner of Hegel, that
ontology could be read off from logic – that if
one could build a layered edifice of theoretical
systems the world must contain somewhere
their real counterparts. The argument of the
address served as a gentle rebuke to these
pansystematists’(Caws,1993, 16).
Some of my listeners probably thought I was a
killjoy – although I admit that I took some satis-
faction in the fact that, after I had made my point
in the presidential address, Anatol Rapoport
thanked me for making it and said he wished
he had done it himself.
All this was, of course, partly von
Bertalanffy’s fault, because he was something
of an evangelist for what he originally called
general system theory, in the singular, that is,
the theory of a system that would embrace the
diversity of the sciences and subsume the partic-
ular systems that he was confident would be
found repeating themselves at various levels of
complexity. To do him justice, he himself did
not yield to the lofty pretensions I was gunning
for. In his ‘Response’ to the papers offered to
him on his 70th birthday, compiled by Ervin
Laszlo as The Relevance of General Systems Theory,
he says: ‘I did not find ultimate truth or “noth-
ing-but” solutions, and never aspired toward
…. a secular “extra ecclesiam nulla salus.”
Rather, whatever I may have been able to con-
tribute, leaves plenty for others to do better’
(Laszlo, 1972, p.483),
Von Bertalanffy started at a middle level, that
7. ing, whose practitioners have what may seem
the grandiose task of anticipating all possible
boundary crossings at all degrees of scale or
detail and in all interacting domains, whether
natural or social, financial or logistical, physical
or biological, ecological or meteorological, etc.,
not missing any contingencies but not
overestimating any either, with huge conse-
quences for budgets and human welfare hanging
on every decision.
But I am getting ahead of myself here. I pro-
mised some reflection on what the field was like
when I got into it. I arrived in the United States,
with a degree in Physics under my belt but
not otherwise committed, at an exciting time,
catching the wave of what Gregory Bateson
characterized as
‘the growing together of a number of ideas
which had developed in different places dur-
ing the second world war. We may call the
aggregate of these’, he continued, ‘cybernet-
ics, or communication theory, or information
theory, or systems theory. …. All these sepa-
rate developments in different intellectual
centers dealt with communicational prob-
lems, especially with the problem of what
sort of thing is an organized system’
(Bateson, 1972, p.483).
This is worth dwelling on too, given how
cybernetics, and information, and communica-
tion, and our own systems, have been rivals for
dominance ever since. As David Rousseau
remarked to me yesterday, everyone wants to
8. be the mother ship.
I was able to switch fields to philosophy, thanks
to the generosity of Yale and my mentor there,
Henry Margenau, who used to work closely with
C. West Churchman, at that time, one of the edi-
tors of the journal Philosophy of Science, in which
I published some of my early papers. In my dis-
sertation work in 1956, I realized the importance
of the concept of isomorphism as it applied to
conceptual schemes and their mirroring (pace
Rorty) of physical structures. I did not then know
von Bertalanffy’s work, or that he had spoken
about ‘the structural isomorphy of laws in the dif-
ferent fields of science and reality’ (von
Bertalanffy, 1951), although I may have been
indirectly influenced by it, because one of my
professors was Carl G. (‘Peter’) Hempel, who
had commented on the paper in which von
Bertalanffy used the expression and may possibly
have referred to it in class.
By an accident of academic fate, my first teach-
ing job was not in philosophy but in ‘general
science’, which meant that I had to read up on
chemistry and genetics and geology, to add to
the meteorology to which I had been introduced
in school by an eager young physics teacher fresh
out of the Air Force. This constituted a pretty
good basis for doing comparative work. I special-
ized in the philosophy of science – and I have
always believed that scholars who do that must
have a first-hand acquaintance with as broad a
range of the natural and social sciences as
possible.
10. my first book on the philosophy of science (Caws,
1965), I found myself delivering the address to
which I have referred in 1966.
I want to pay special tribute to Oliver Wells, a
neglected figure in this history. He self-published
a series of periodical pamphlets for Artorga and
one small book, HOW COULD YOU Be So Na-
ïve? (Wells, 1970) from his home in southern En-
gland, and was responsible for bringing a lot of
original work to the attention of his mailing list.
I am not sure whether to mention this, but I re-
member being startled at the time, and maybe
you will be too: one of the articles he
republished in his book bore the title ‘Science
Fiction – Sex for Ever: A New Cybernetic Project
called Interfuck’ (Wells, 1970, 140-143), which
proposed ‘the development of a group of sys-
tems for the two-way transmission of sensory-
sexual information’, based on the apparatus
developed by Masters and Johnson for measur-
ing the human sexual response. It contained
the laconic remark ‘the project is difficult to
name in English,’ although Oliver Wells seems
to have had no trouble with this. It seems to
me a case of boundary crossing worth drawing
to your attention. I also owe to Wells a pithy
formula, ‘the brain computes the world’, which
summed up admirably a causal theory of per-
ception that still holds water today.
Artorga engaged in a collective effort to build
a self-reproducing machine, based on some ge-
netic work by Lionel Penrose. In the Penrose
archive at University College London, I recently
came across an interview with Wells, in French,
11. in the journal Science et Vie, in which the
interviewer, Gerald Messadié, expressed his ad-
miration for the systems work going on in the
English-speaking world and concluded rather
enviously:
‘There is today no creative mind which does
not direct all its wishes to a profound re-
newal of all the ideas with which we live. In-
numerable original works are sleeping in the
files of scientists and technologists. It is per-
haps Artorga that is preparing the synthesis
and the reorganization that are necessary, a
veritable work of the Encyclopedists [quite
a compliment for a Frenchman]. It only re-
mains for France to join in’ (Messadié, 1961).
In view of the plethora of systems literature to
which Gerald Midgley referred the other day, it
would seem that this work is as urgent as ever.
In my Presidential address, which I entitled
‘Science and System: on the Unity and Diversity
of Scientific Theory’, I commented on the change
from ‘theory’ to ‘research’ in the name of the soci-
ety, which seemed to me to mark a becoming
modesty. A theory, as I pointed out, is really a
way of looking at things – theoros in Greek meant
an official observer, who accompanied people to
the consultation of oracles or to competition in
the regional games, to ensure that things were
done in proper order and reported correctly. So
a theory is not just any old way of looking, but
one which carries some gravitas and will stand
against challenge. A general theory would be a
13. General Systems Theory: Its Past and Potential 517
(1) Object constancy across knowing subjects,
including agreed nomenclature (this means
being surewe are talking about the same thing);
(2) Replicable observations and predictions, sub-
ject to common reporting standards (thismeans
looking at the same elements of theworld in the
same way); and
(3) Theoretical consistency, including to the
extent possible, simplicity and plausibility
(this means arguing openly and convincingly
in the face of doubt or criticism).
These last conditions are sometimes definitive.
One notable case for the test of simplicity is the
switch from the Ptolemaic to the Copernican
account of the solar system. As I pointed out in
an earlier paper (Caws, 1963), the advent of com-
puters would have made predictions according
to the Ptolemaic view quite feasible, but the
simpler Copernican picture was easier to visua-
lize and its predictions quicker to compute. A
contemporary challenge to the test of plausibility
is presented by Big Bang theory and particularly
by inflationary cosmology, which make extra-
ordinary claims on belief in matters of time and
causality.
PART 2
14. There followed a series of changes in my field of
work, although not all at the same time. One of
them was an existentialist turn, thanks to
students in Kansas who persuaded me to read
Kierkegaard and Sartre with them, in spite of
my appointment in logic and the philosophy of
science. Later, there was a structuralist turn,
thanks to the French (their answer to Messadié?).
In the summer of 1966, at the conference center of
Cerisy-la-Salle in Normandy, I met a young
French scholar of whom I inquired what was
going on of interest in French philosophy at the
time. Knowing that I taught philosophy in the
United States, she tried to pin me down: ‘was I
a positivist?’ ‘No’, I said. ‘A Marxist, then?’ ‘Not
that either’. ‘So you must be a structuralist’,
she said. I did not know what that was, not at
any rate as a philosophical position. But the inter-
esting philosophical work is not going on in
philosophy, she said – you should talk to the
anthropologists and the literary critics and the
psychoanalysts and the linguists.
I proceeded to do just this, spending some-
thing like a decade in preparation for my book
on structuralism that came out some time later
(Caws, 1989, 2000). In the meantime I published
in the technical journals of all these fields, with
the exception of linguistics. Does that make me
then a jack of all trades? I suppose I may be said
to have earned my union card with my work on
Sartre, if not on structuralism itself, but just as
in the case of teaching general science I have
never regretted my apprenticeship in those other
fields. What they all had in common was
15. starting, not from the objects under investigation,
but from the minds that recognized, learned,
appreciated and, in the end, created those objects.
As I put it in Yorick, structuralism ‘is a view of
mind as a structuring agent, which puts together
a world of thought comparable in its complexity
to the world of experience’ (Caws, 1993, 110).
Reducing all this to the point now at issue, it
represented a shift from an interest in systems
to an interest in structures. This distinction is of
critical importance. As I see it, systems are sets
of independently existing elements in (func-
tional) relations with one another, whereas struc-
tures (leaving aside the everyday meaning of the
term as referring to physical buildings) are sets of
relations, whose elements come into being and
are defined by the very relations that determine
them. Systemic relations are embodied; structural
ones are intended. And it is important to know
what ‘relation’ means. There are relations (a) that
are straightforwardly embodied in physical
objects, (b) that are defined as ordered pairs of
elements, physical or otherwise (mapping or not
onto classes of type a) or (c) that are established
by intentionality and apposition. This last class
is by far the most interesting and important.
By intentionality, I mean the capacity human
beings have of directing thought towards chosen
objects (attention is the special case in which the
objects are presented; intention when they are
more freely chosen or even created), and by ap-
position I mean the companion capacity to take
any two such objects and hold them in relation
to one another. Obvious cases are naming, and
17. sciences, perceptual/physical versus intentional/
cultural.
So structural elements are defined as relational
and constitute whole domains of the objects that
are of the most interest to us – kinship, language,
law, literature, theory, etc. – and, I would claim,
the domains of mathematics and theology also.
A quick example of the sort of situation that
may arise: the Greek Simonides set a riddle,
‘The son is the father of his father’, the solution
to which is the observation that the father does
not come into being as a father until the son
brings him into being as such by being born to
him.
The great difference then is between relations
as embodied in physical systems and relations
as components of intentional structures that
may or may not correspond to physical systems.
The natural sciences deal with systems, what I
call the human sciences with structures. But
structures can be superimposed upon systems,
and this regularly happens when objects and
their relations are named and made elements of
theoretical structures having empirical reference.
The natural sciences deal with objects that would
be as they are, whether or not anyone takes any
interest in them, and events that would happen
anyway once the relevant conditions are realized,
but the human sciences deal with objects that
come into being only through human intention
and intervention, events that are brought about
by human action.
18. Natural processes without contrivance do not
have ends but do have consequences. Natural
processes contrived for human ends (which we
call technology) lead in principle to desirable
consequences – but may also have undesirable
ones (often lumped under the catchall designa-
tion of ‘unintended consequences’). Human pro-
cesses that lead to action (always on the part of
individuals) are normally intended to have desir-
able consequences, but whether they do so
depends on the good will, the knowledge and
the wisdom of those individuals. A lot of work
remains to be done on such human systems.
Having introduced human agents, I should
perhaps make one further remark about putting
the observer into the system. The problem is this:
suppose system S to be observed by observer O,
O being external to the system under observation.
Bringing the two together, we have the more
inclusive system [S+O]. This in turn becomes an
object for theoretical reflection on the part of a sec-
ond observer, O′, who once again is external to
the system, yielding the new system [[S+O]+O′],
to be reflected on by a third observer, Oʺ, and so
on. This is a classic problem, going back at least
to the Hegelian System, which was supposed to
encompass everything – except, as Kierkegaard
pointed out, there was no room in it for Hegel him-
self. If we are to grasp the system, we have to have
a point of view outside it fromwhich to do so. The
real advantage of the second-order cybernetic
strategy comes into play when the observer is also
an agent, but the distinction between the two roles
must be kept clear.
20. that is no reason not to look for those that are.
So the assumption is premature, but as a goal,
it is worthy. One of the virtues of general sys-
tems theory was and is its breaking down of
the partitions between the sciences that left
each busy in its own domain without talking
of the synergy their cross-fertilization could
generate.
The supplementing of systemic relations with
structural ones means not only stressing but also
exploiting the distinction between what I have
been calling the natural sciences and the human
sciences, recognizing that they have different
ontologies and different dynamics. The natural
sciences deal with physical objects that behave
according to laws discernible through studies of
their behavior, while the human sciences deal
with cultural objects that behave according to
the beliefs and intentions of human agents. One
cardinal principle that emerges from a consider-
ation of this distinction is that it is futile to try
to solve problems in the human sciences with
tools appropriate to the natural sciences, for
example, by attempting to settle ideological
differences with weapons of war (the converse
case is not so clear-cut, partly because the objects
governed by the natural sciences have them-
selves to be conceptualized and subjected to
measurement).
The great lesson here is to keep the natural and
human sciences in a collaborative tension with
one another, and to regard them, if you will, as
components of a larger system; to have both as-
21. pects openly in mind in all our work, but not to
confuse them with one another; and to have per-
meable boundaries between domains (gates, not
just fences). We should learn everything possible,
even from apparently competing disciplines.
And we should maintain an active theoretical
stance, not allowing technology – invaluable as
it is – to supersede the intimate and immediate
working of the mind. Theories require observers
(remember the theoros), but they may make them-
selves practically unnecessary by being embod-
ied in technology, and in this lies a practical
danger. Think, to take a banal but telling exam-
ple, of how it used to be necessary for clerks in
stores to be adept at mental arithmetic, whereas
now all that mind work is done by an automated
cash register. It is not that the mind of the cashier
is necessary to compute the customer’s change –
it is rather than computing the customer’s
change would be useful for the maintenance …
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The Biopsychosocial Model 25 Years Later:
22. Principles, Practice, and Scientifi c Inquiry
ABSTRACT
The biopsychosocial model is both a philosophy of clinical care
and a practical
clinical guide. Philosophically, it is a way of understanding how
suffering, disease,
and illness are affected by multiple levels of organization, from
the societal to the
molecular. At the practical level, it is a way of understanding
the patient’s subjec-
tive experience as an essential contributor to accurate diagnosis,
health outcomes,
and humane care. In this article, we defend the biopsychosocial
model as a nec-
essary contribution to the scientifi c clinical method, while
suggesting 3 clarifi ca-
tions: (1) the relationship between mental and physical aspects
of health is com-
plex—subjective experience depends on but is not reducible to
laws of physiology;
(2) models of circular causality must be tempered by linear
approximations when
considering treatment options; and (3) promoting a more
participatory clinician-
patient relationship is in keeping with current Western cultural
tendencies, but may
not be universally accepted. We propose a biopsychosocial-
oriented clinical prac-
tice whose pillars include (1) self-awareness; (2) active
cultivation of trust; (3) an
emotional style characterized by empathic curiosity; (4) self-
calibration as a way to
reduce bias; (5) educating the emotions to assist with diagnosis
and forming thera-
peutic relationships; (6) using informed intuition; and (7)
23. communicating clinical
evidence to foster dialogue, not just the mechanical application
of protocol. In con-
clusion, the value of the biopsychosocial model has not been in
the discovery of
new scientifi c laws, as the term “new paradigm” would suggest,
but rather in guid-
ing parsimonious application of medical knowledge to the needs
of each patient.
Ann Fam Med 2004;2:576-582. DOI: 10.1370/afm.245.
GEORGE ENGEL’S LEGACY
The late George Engel believed that to understand and respond
adequately to patients’ suffering—and to give them a sense of
being understood—clinicians must attend simultaneously to the
biologi-
cal, psychological, and social dimensions of illness. He offered
a holistic
alternative to the prevailing biomedical model that had
dominated indus-
trialized societies since the mid-20th century.1 His new model
came to be
known as the biopsychosocial model. He formulated his model
at a time
when science itself was evolving from an exclusively analytic,
reductionis-
tic, and specialized endeavor to become more contextual and
cross-disci-
plinary.2-4 Engel did not deny that the mainstream of
biomedical research
had fostered important advances in medicine, but he criticized
its exces-
sively narrow (biomedical) focus for leading clinicians to
regard patients
24. as objects and for ignoring the possibility that the subjective
experience of
the patient was amenable to scientifi c study. Engel championed
his ideas
not only as a scientifi c proposal, but also as a fundamental
ideology that
tried to reverse the dehumanization of medicine and
disempowerment of
patients (Table 1). His model struck a resonant chord with those
sectors of
the medical profession that wished to bring more empathy and
compassion
into medical practice.
In this article we critically examine and update 3 areas in which
the
biopsychosocial model was offered as a “new medical
paradigm”5,6: (1) a
Francesc Borrell-Carrió, MD1
Anthony L. Suchman MD2,3
Ronald M. Epstein MD4
1Department of Medicine, University of
Barcelona, CAP Cornellà, Catalonian
Institute of Health (ICS), Cornellà de
Llobregat, Spain
2Relationship Centered Health Care,
Rochester, NY
3Department of Medicine, University of
Rochester School of Medicine and Dentistry,
Rochester, NY
25. 4Department of Family Medicine,
University of Rochester School of Medicine
and Dentistry, Rochester, NY
CORRESPONDING AUTHOR
Francesc Borrell-Carrió, MD
Department of Medicine
University of Barcelona
CAP Cornellà, Catalonian Institute of
Health (ICS)
C/Bellaterra 39
08940 Cornellà de Llobregat, Spain
[email protected]
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world view that would include the patient’s subjective
experience alongside objective biomedical data, (2) a
model of causation that would be more comprehensive
and naturalistic than simple linear reductionist models,
and (3) a perspective on the patient-clinician relation-
26. ship that would accord more power to the patient in
the clinical process and transform the patient’s role
from passive object of investigation to the subject and
protagonist of the clinical act. We will also explore the
interface between the biopsychosocial model and evi-
dence-based medicine.
DUALISM, REDUCTIONISM,
AND THE DETACHED OBSERVER
In advancing the biopsychosocial model, Engel was
responding to 3 main strands in medical thinking that
he believed were responsible for dehumanizing care.
First, he criticized the dualistic nature of the biomedi-
cal model, with its separation of body and mind (which
is popularly, but perhaps inaccurately, traced to Des-
cartes).7,8 This conceptualization (further discussed in
the supplemental appendix, available online at http://
www.annfammed.org/cgi/content/full/2/6/576/
DC1) included an implicit privileging of the
former as more “real” and therefore more worthy
of a scientifi c clinician’s attention. Engel rejected this
view for encouraging physicians to maintain a strict
separation between the body-as-machine and the nar-
rative biography and emotions of the person—to focus
on the disease to the exclusion of the person who
was suffering—without building bridges between the
two realms. His research in psychosomatics pointed
toward a more integrative view, showing that fear, rage,
neglect, and attachment had physiologic and develop-
mental effects on the whole organism.
Second, Engel criticized the excessively materialis-
tic and reductionistic orientation
27. of medical thinking. According
to these principles, anything that
could not be objectively verifi ed
and explained at the level of cel-
lular and molecular processes was
ignored or devalued. The main
focus of this criticism—a cold,
impersonal, technical, biomedi-
cally-oriented style of clinical
practice—may not have been
so much a matter of underlying
philosophy, but discomfort with
practice that neglected the human
dimension of suffering. His semi-
nal 1980 article on the clinical
application of the biopsychoso-
cial model5 examines the case of a man with chest pain
whose arrhythmia was precipitated by a lack of caring
on the part of his treating physician.
The third element was the infl uence of the observer
on the observed. Engel understood that one cannot
understand a system from the inside without disturbing
the system in some way; in other words, in the human
dimension, as in the world of particle physics, one can-
not assume a stance of pure objectivity. In that way,
Engel provided a rationale for including the human
dimension of the physician and the patient as a legiti-
mate focus for scientifi c study.
Engel’s perspective is contrasted with a so-called
monistic or reductionistic view, in which all phenom-
ena could be reduced to smaller parts and understood
as molecular interactions. Nor did he endorse a holis-
tic-energetic view, many of whose adherents espouse
28. a biopsychosocial philosophy; these views hold that
all physical phenomena are ephemeral and control-
lable by the manipulation of healing energies. Rather,
in embracing Systems Theory,2 Engel recognized that
mental and social phenomena depended upon but
could not necessarily be reduced to (ie, explained in
terms of) more basic physical phenomena given our
current state of knowledge. He endorsed what would
now be considered a complexity view,9 in which differ-
ent levels of the biopsychosocial hierarchy could inter-
act, but the rules of interaction might not be directly
derived from the rules of the higher and lower rungs
of the biopsychosocial ladder. Rather, they would be
considered emergent properties that would be highly
dependent on the persons involved and the initial con-
ditions with which they were presented, much as large
weather patterns can depend on initial conditions and
small infl uences.9 This perspective has guided decades
of research seeking to elucidate the nature of these
interactions.
Table 1. Engel’s Critique of Biomedicine
1. A biochemical alteration does not translate directly into an
illness. The appearance of illness
results from the interaction of diverse causal factors, including
those at the molecular, individ-
ual, and social levels. And the converse, psychological
alterations may, under certain circum-
stances, manifest as illnesses or forms of suffering that
constitute health problems, including,
at times, biochemical correlates
2. The presence of a biological derangement does not shed light
on the meaning of the symp-
toms to the patient, nor does it necessarily infer the attitudes
29. and skills that the clinician must
have to gather information and process it well
3. Psychosocial variables are more important determinants of
susceptibility, severity, and course of
illness than had been previously appreciated by those who
maintain a biomedical view of illness
4. Adopting a sick role is not necessarily associated with the
presence of a biological derangement
5. The success of the most biological of treatments is infl
uenced by psychosocial factors, for
example, the so-called placebo effect
6. The patient-clinician relationship infl uences medical
outcomes, even if only because of its infl u-
ence on adherence to a chosen treatment
7. Unlike inanimate subjects of scientifi c scrutiny, patients are
profoundly infl uenced by the way in
which they are studied, and the scientists engaged in the study
are infl uenced by their subjects
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COMPLEXITY SCIENCE: CIRCULAR
AND STRUCTURAL CAUSALITY
30. Engel objected to a linear cause-effect model to
describe clinical phenomena. Clinical reality is far more
complex. For example, although genetics may have
a role in causing schizophrenia, no clinician would
ignore the sociologic factors that might unleash or con-
tain the manifestations of the illness.
Complexity and Causality
Few morbid conditions could be interpreted as being
of the nature “one microbe, one illness”; rather, there
are usually multiple interacting causes and contributing
factors. Thus, obesity leads to both diabetes and arthri-
tis; both obesity and arthritis limit exercise capacity,
adversely affecting blood pressure and cholesterol lev-
els; and all of the above, except perhaps arthritis, con-
tribute to both stroke and coronary artery disease. Some
of the effects (depression after a heart attack or stroke)
can then become causal (greater likelihood of a second
similar event). Similar observations can be made about
predictors of relapse in schizophrenia. These obser-
vations set the stage for models of circular causality,
which describes how a series of feedback loops sustain
a specifi c pattern of behavior over time.10-13 Complex-
ity science is an attempt to understand these complex
recursive and emergent properties of systems14,15 and to
fi nd interrelated proximal causes that might be changed
with the right set of interventions (family support and
medications for schizophrenia; depression screening and
cholesterol level reduction after a heart attack).
Structural Causality
In contrast to the circular view, structural causality
describes a hierarchy of unidirectional cause-effect
relationships—necessary causes, precipitants, sustaining
forces, and associated events.16 For instance, a neces-
31. sary cause for tuberculosis is a mycobacterium, precipi-
tants can be a low body temperature, and a sustaining
force a low caloric intake. Complexity science can
facilitate understanding of a clinical situation, but most
of the time a structural model is what guides practical
action. For example, if we think that Mr. J is hyperten-
sive because he consumes too much salt, has a stress-
ful job, poor social supports, and an overresponsible
personality type, following a circular causal model,
possibly all of these factors are truly contributory to his
high blood pressure. But, when we suggest to him that
he take an antihypertensive medication, or that he con-
sume less salt, or that he take a stress-reduction course,
or that he see a psychotherapist to reduce his sense of
guilt, we are creating an implicit hierarchy of causes:
Which cause has the greatest likely contribution to his
high blood pressure? Which would be most responsive
to our actions? What is the added value of this action,
after having done others? Which strategy will give the
greatest result with the least harm and with the least
expenditure of resources?
Interpretations, Language, and Causality
Causal attributions have the power to create reality and
transform the patient’s view of his/her own world.17 A
physician who listens well might agree when a patient
worries that a family argument precipitated a myo-
cardial infarction; although this interpretation may
have meaning to the patient, it is inadequate as a total
explanation of why the patient suffered a myocardial
infarction. The attribution of causality can be used to
blame the patient for his or her illness (“If only he had
not smoked so much.…”), and also may have the power
of suggestion and might actually worsen the patient’s
condition (“Every time there is a fi ght, your dizziness
32. worsens, don’t you see?”).
TOWARD A RELATIONSHIP-CENTERED
MODEL
Power and Emotions in the Clinical Relationship
Patient-centered, relationship-centered, and client-cen-
tered approaches18-24 propose that arriving at a correct
biomedical diagnosis is only part of the clinician’s task;
they also insist on interpreting illness and health from
an intersubjective perspective by giving the patient
space to articulate his or her concerns, fi nding out
about the patient’s expectations, and exhorting the
health professional to show the patient a human face.
These approaches represent movement toward an egali-
tarian relationship in which the clinician is aware of
and careful with his or her use of power.
This “dialogic” model suggests that the reality of
each person is not just interpreted by the physician,
but actually created and recreated through dialogue25-31;
individual identities are constructed in and maintained
through social interaction.32 The physician’s task is to
come to some shared understanding of the patient’s
narrative with the patient. Such understanding does not
imply uncritical acceptance of whatever the patient
believes or hypothesizes, but neither does it allow for
the uncritical negation of the patient’s perspective, as
so frequently occurs, for example, when patients com-
plain of symptoms that physicians cannot explain.33,34
The patient’s story is simultaneously a statement about
the patient’s life, the here-and-now enactment of his
life trajectory, and data upon which to formulate a
diagnosis and treatment plan.
Underlying the analysis of power in the clinical
relationship is the issue of how the clinician handles the
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strong emotions that characterize everyday practice. On
the one hand, there is a reactive clinical style, in which
the clinician reacts swiftly to expressions of hostility or
distrust with denial or suppression. In contrast, a proac-
tive clinical style, characterized by a mindful openness to
experience, might lead the clinician to accept the patient’s
expressions with aplomb, using the negative feelings to
strengthen the patient-clinician relationship.35 The clini-
cian must acknowledge and then transcend the tendency
to label patients as “those with whom I get along well”
or “diffi cult patients.” By removing this set of judgments,
true empathy can devolve from a sense of solidarity with
the patient and respect for his or her humanity, leading
to tolerance and understanding.18 Thus, in addition to the
moral imperative to treat the patient as a person, there is
a corresponding imperative for the physician to care for
and deepen knowledge of himself or herself.35,36 Without
a suffi cient degree of self-understanding, it is easy for the
physician to confuse empathy with the projection of his
or her needs onto the patient.
Implications for Autonomy
Most patients desire more information from their
physicians, fewer desire direct participation in clinical
decisions, and very few want to make important deci-
34. sions without the physician’s advice and consultation
with their family members.37-40 This does not mean that
patients wish to be passive, even the seriously ill and the
elderly.41 In some cases, however, clinicians unwittingly
impose autonomy on patients.19,42,43 Making a reluctant
patient assume too much of the burden of knowledge
about an illness and decision making, without the advice
from the physician and support from his or her family,
can leave the patient feeling abandoned and deprived
of the physician’s judgment and expertise.42 The ideal,
then, might be “autonomy in relation”—an informed
choice supported by a caring relationship.19 The clini-
cian can offer the patient the option of autonomy41
while considering the possibility that the patient might
not want to know the whole truth and wish to exercise
the right to delegate decisions to family members.40,44
The Social Milieu
There is an ecological dimension of each encounter—it
is not just between patient and physician, but rather an
expression of social norms.45 Sometimes clinicians face
a dilemma: can or should a private clinical relationship
between patient and physician be a vehicle for social
transformation? Or, should the relationship honor and
conform to the cultural norms of patients?19 Our view is
that adaptation normally should occur before transfor-
mation—the physician must fi rst understand and accom-
modate to the patient’s values and cultural norms before
trying to effect change. Otherwise, the relationship
becomes a political battleground and the focus of a pro-
cess to which the patient has not consented and may not
desire. This debate, however, becomes much more diffi -
cult in situations in which patients have suffered abuse—
for example domestic violence or victims of torture.46
35. In those cases, not trying to remedy the social injustices
that resulted in the patient seeking care may interfere
with the formation of a trusting relationship. The physi-
cian may be tempted to effect a social transformation in
these cases, for example, to advise the patient to leave an
abusive situation, even though the patient may state that
she only wants care for the bruises. Premature advice
may interfere with enabling the patient to be the agent
of change, however. Stopping short of attempting to
transform social relationships until the patient has given
consent should not be interpreted as indifference to,
acceptance of, or complicity in such situations; rather, it
should be viewed as a prudent course of action that will
ultimately be validating and empowering.
Caring, Paternalism, and Empathy
Taking Engel’s view, perhaps it is not paternalism that is
the problem but practicing as a cold technician rather
than a caring healer.47,48 The physician who sees his or
her role as nothing more than a technical adviser can
regard empathy as a useless effort that has no infl uence
on clinical decisions, or, worse, a set of linguistic tricks
to get the patient to comply with treatment. Because
it is entirely possible to advocate for shared decision
making without challenging the notion of the cold
technician, we propose to move the emphasis to an
approach that emphasizes human warmth, understand-
ing, generosity, and caring.
THE BIOPSYCHOSOCIAL MODEL
AND RELATIONSHIP-CENTERED CARE
The practical application of the biopsychosocial model,
which we will call biopsychosocially oriented clinical prac-
tice does not necessarily evolve from the constructs of
interactional dualism or circular causality. Rather, it may
36. be that the content and emotions that constitute the
clinician’s relationship with the patient are the funda-
mental principles of biopsychosocial-oriented clinical
practice, which then inform the manner in which the
physician exercises his or her power. The models of
relationship that have tended to appear in the medical
literature, with a few notable exceptions,19 have perhaps
focused too much on an analysis of power and too little
on the underlying emotional climate of the clinical
relationship. For this reason, we suggest a reformulation
of some of the basic principles of the biopsychosocial
model according to the emotional tone that engraves the
relationship with such characteristics as caring, trustwor-
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thiness, and openness.49,50 Some principles of biopsycho-
social-oriented clinical practice are outlined below.
Calibrating the Physician
The biopsychosocial model calls for expanding the
number and types of habits to be consciously learned
and objectively monitored to maintain the centrality of
the patient.51 The physician is in some ways like a musi-
cal instrument that needs to be calibrated, tuned, and
adjusted to perform adequately.36 The physician’s skills
should be judged on their ability to produce greater
health or to relieve the patient’s suffering—whether they
37. include creating an adequate emotional tone, gather-
ing an accurate history, or distinguishing between what
the patient needs and what the patient says he or she
wants. In that regard, a clinical skill includes the ethical
mandate not only to fi nd out what concerns the patient,
but to bring the physician’s agenda to the table and infl u-
ence the patient’s behavior. Sometimes doing so may
include uncovering psychosocial correlates of otherwise
unexplained somatic symptoms (such as ongoing abuse
or alcoholism) to break the cycle of medicalization and
iatrogenesis.33 To abandon this obligation, in our view, is
breaking an implicit social contract between physicians
and society. This deliberative and sometimes frankly
physician-centered approach has its perils, however.
The physician must be capable of an ongoing self-audit
simply because his or her performance is never the same
from moment to moment. Weick and Sutcliffe52 regard
this constant vigilance as a fundamental requirement for
professions that require high reliability in the face of
unexpected events. Mindfulness—the habits of attentive
observation, critical curiosity, informed fl exibility, and
presence—underlies the physician’s ability to self-moni-
tor, be vigilant, and respond with compassion.35,53,54
Creating Trust
The expert clinician considers explicitly, as a core skill,
the achievement in the encounter of an emotional tone
conducive to a therapeutic relationship. For that reason,
all consultations might be judged on the basis of cordial-
ity, optimism, genuineness, and good humor. By receiv-
ing a hostile patient with respect,55 it clarifi es for the cli-
nician that the patient’s emotions are the patient’s—and
not the physician’s—and also sets the stage for the
patient to refl ect as well. Similarly, the physician must
know how to recognize and when to express his or her
own emotions, sometimes setting limits and boundaries
38. in the interest of preserving a functional relationship.
Cultivating Curiosity
The next step in the application of clinical evidence
to medical care is the cultivation of curiosity. Thus,
cultivated naïvete56 might be considered one of the
fundamental habits characteristic of expert practitioners.
Another aspect of this emotional tone is an empathic
curiosity about the patient as person. Empathic curiosity
allows the clinician to maintain an open mind and not
to consider that any case is ever closed. If the patient
does not surprise us today, perhaps he or she will
tomorrow. We have described this capacity using the
term, beginner’s mind.35,57 It is the capacity for expecting
the unexpected, just as if the physician were another cli-
nician seeing the patient for the fi rst time. There is also
an ethical component of this emotional tone—there are
no “good” or “bad” patients, nor are there “interesting”
and “boring” diseases. Patients should not have to legiti-
mize their suffering by describing illnesses that make
the clinician feel comfortable or confi dent.58
Recognizing Bias
The grounding of medical decisions based on scientifi c
evidence while also integrating the clinician’s professional
experience is now a well-accepted tenet of the founders
of the evidence-based medicine movement.59 The method
for incorporation of experience, however, has been less
well described than the method for judging the quality of
scientifi c evidence. For example, clinicians should learn
how their decisions might be biased by the race and sex
of the patient, among other factors,51 and also the ten-
dency to close the case prematurely to rid oneself of the
burden of attempting to solve complex problems.60
39. Educating the Emotions
There are methods for emotional education, just as
there are for learning new knowledge and skills.35
Tolerance of uncertainty, for example, is amenable to
observation and calibration—making decisions in the
absence of complete information is a characteristic of
an expert practitioner, in contrast to the technician
who views his role as simply following protocols.
Using Informed Intuition
The role of intuition is central. Just as Polanyi and
Schön maintain that professional competence is based
in tacit, rather than explicit, knowledge,61,62 expertise
often is manifest in insights that are diffi cult to track
on a strictly cognitive level. If a clinician, encountering
a situation in which he normally would use a particu-
lar treatment, has the intuition, for a reason that has
not yet become clear, that treatment might not be the
best for this particular patient, we suggest, rather than
considering it a feeling from nowhere that might be dis-
carded, perhaps the intuition can later be traced to a set
of concrete observations about the patient that were not
easy for the clinician to describe at the time. Because
these observations often are manifest only when cases
are reviewed after the fact does not diminish the ethical
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40. obligation that the clinician use all of his or her capa-
bilities, not only those which can be readily explained.
Communicating Clinical Evidence
Evidence should be communicated in terms the patient
can understand, in small digestible pieces, at a rate
at which it can be assimilated. Information overload
may have two effects—reduction in comprehension
and increasing the emotional distance between physi-
cian and patient. Communication of clinical evidence
should foster understanding, not simply answers.63
FURTHER DEVELOPMENT OF
THE BIOPSYCHOSOCIAL MODEL
George Engel formulated the biopsychosocial model as
a dynamic, interactional, but dualistic view of human
experience in which there is mutual infl uence of mind
and body. We add to that model the need to balance a
circular model of causality with the need to make linear
approximations (especially in planning treatments) and
the need to change the clinician’s stance from objective
detachment to refl ective participation, thus infusing
care with greater warmth and caring. The biopsycho-
social model was not so much a paradigm shift—in the
sense of a crisis of the scientifi c method in medicine
or the elaboration of new scientifi c laws—as it was an
expanded (but nonetheless parsimonious) application of
existing knowledge to the needs of each patient.
In the 25 years that have elapsed since Engel fi rst
proposed the biopsychosocial model, two new intellec-
tual trends have emerged that could make it even more
robust. First, we can move beyond the problematic
issue of mind-body duality by recognizing that knowl-
41. edge is socially constructed. To some extent, such
categories as “mind” or …