Introduction to Health Psychology
Reading
Curtis. A.J., Health Psychology, Routledge, 2000, Ch 1.
Ogden. J., Health Psychology, Open University Press, Ch 1.
Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. (WHO 1946).
Banyard (1996) a state of complete physical, mental and social well-being is very difficult to achieve. The definition ignores wider social, political and economic factors. Implies that people who are not fulfilled are also not healthy.
From the seventeenth century to the beginning of the 20th century illness was deemed unavoidable. Some saw it as the work of the devil. People tended to die of acute (sudden onset) illnesses such as influenza, pneumonia and tuberculosis.
Today's illnesses are Chronic (slow onset, long-term, diseases of living) such as Cancer, Heart disease and diabetes. These diseases can not be cured but instead are managed.
Monastic view – thoughts and emotions – purely physical processes are on the opposite view may be taken that physical processes are purely “mental”.
The bio-medical model views physical illness as being linked to a specific pathogen (disease-causing organism). Infectious diseases such as tuberculosis, measles and chicken pox have been dealt with effectively in terms of the bio-medical model. Chronic diseases need a broader model in order to explain the contributing factors and possible ways of dealing with such diseases.
17th Century Cartesian dualism made a clear distinction between the mind and the body (René Descartes 1596 - 1650). Descartes thought that the “Mind” or “soul” lives within the body communicating through the pineal gland, located in the front of the midbrain. Freud (1856-1939) challenged dualism. He found that mental illness could lead to physical symptoms in what he called conversion hysteria. Consider also the psycho somatic rash reported by Zimbardo. Shell shock is an example of a physical illness caused by psychological factors. Health Psychology will also show that there is an overlap between mind and body.
Greeks-body influences the mind.
Middle Ages-demons-mind-mental explanations of illness.
Biomedical model
Biological normality – the bio medical model would say that the person is healthy if the body is in “normal” working order. A criticism of this is that in old age one experiences many unpleasant symptoms yet this is perfectly normal and blind people would consider themselves as healthy.
Scientific – objective – if they are nophysical signs then the patient is considered to be malingering.
Criticisms
- Reductionist
- Only physical causes
- Ignores influence of mind.
Biopsychosocial
model
Health seen as not passive. Health can be defined on a health-illness continuum. The model emphasises the link between psychological factors and illness.
Two-way interaction between physical-biological-psychological-social-ecological.
Exercise
Think of the last time that you were unwell. Can you think of biological, psychological and social factors that may have contributed to this? List them in a table using these three headings:
Biological factors, psychological factors, social factors.
Before biological cures were developed environmental factors were improving. Health improved because of the improvements in the environment such as improved food hygiene.
Model (Downey et al. 1996).
True well-being -good life - well-being.
Fitness - strength, stamina, suppleness, skills.
Positive-negative health.
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Biomedical model |
Biopsychosocial model |
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What causes illness? |
Diseases come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases are caused by a number of factors, including chemical imbalances, bacteria, viruses and genetic predisposition. |
Human beings should be seen as complex systems and illness is caused by a multitude of factors and not by a single causal factor. Health psychology therefore tends to move away from a simple linear model of health and claims that illness can be caused by combination of biological (e.g. a virus), psychological (e.g. behaviours, beliefs) and social (e.g. employment) factors. This approach reflects the bio psychosocial model of health and illness, which was developed by Engel (1977, 1980). The bio psychosocial model represented an attempt to integrate the psychological and the environmental into the traditional biomedical model of health as follows: the bio contributing factors included genetics, viruses, bacteria and structural defects. The psycho aspects of health and illness were described in terms of cognitions (e.g. expectations of health), emotions (e.g. fear of treatment) and behaviours (e.g. smoking, diets, exercise or alcohol consumption). The social aspects of health were described in terms of social norms of behaviour (e.g. the social norm of smoking or not smoking), pressures to change behaviour (e.g. peer group expectations, parental pressure), social values on health (e.g. whether health was regarded as a good or a bad thing), social class and ethnicity. |
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Who is responsible for illness? |
Illnesses arise from biological changes beyond the patients control; individuals are therefore not seen as being responsible for the illnesses. They are regarded as victims of some external force causing internal changes. |
Illnesses regarded as the result of a combination of factors, the individual is no longer simply seen as a passive victim. |
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How should illness be treated? |
Treatment is in terms of a vaccination, surgery, chemotherapy, and radiotherapy, all of which aimed to change the physical state of the body. |
The whole person should be treated, not just the physical changes that have taken place. This can take the form of behaviour change, encouraging changes in beliefs and coping strategies, and compliance with medical requests. |
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who is responsible for treatment? |
The responsibility for treatment rests with the medical profession. |
The patient is in part responsible for their treatment. This may take the form of responsibility to take medication, responsibility to change beliefs and behaviour. They are not seen as a victim. |
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what is the relationship between health and illness? |
Health and illness are seen as qualitatively different-you are either healthy or ill, there is no continuum between the two. |
Health and illness are not qualitatively different, but exist on a continuum. Rather than being either healthy or ill, individuals progress along this continuum from health to illness and back again. |
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What is the relationship between the mind and the body? |
The mind and body function independently of each other. The mind is incapable of influencing physical matter. The mind is seen as abstract and relating to feelings and thoughts, and body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in state of mind. |
There is an increasing focus on an interaction between the mind and the body. This shift in perspective is reflected in the development of a holistic or a whole person approach to health. The mind and body interact. The mind and body are considered as separate but there is interaction between distinct structures. |
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What is the role of psychology in health and illness? |
Illness may have psychological consequences, but not psychological causes. For example, cancer may cause unhappiness but mood is not seen as related to either the onset or progression of the cancer. |
Psychological factors are seen as not only possible consequences of illness but as contributing to it's aetiology. |
What are the aims
of health psychology?
Health
psychology-uses
- Lowering blood pressure
- Controlling cholesterol levels
- Stress
- Alleviating pain
- Reducing or stopping risky behaviours.
- Health promotion-exercise, check ups, safer behaviours (e.g. safer sex).
Health psychology
aims to understand, explain, develop and test theory by:
- Evaluating the role of behaviour in the aetiology of illness.
- Predicting unhealthy behaviours – investigating the psychological correlates of illness for
- Understanding the role of psychology in the experience of illness
- Evaluating the role of psychology in the treatment of illness.
The second aim of
health psychology, putting theory into practice, can be implemented by:
- Promoting healthy behaviour
- Preventing illness
- Improving the health care system and policy.
Buzz words
Holistic
Micro-level
Macro
level
Acculturation- moving from one country to another; the illnesses are likely to increase or decrease towards the host country’s (Berry 1998). Immigrants could choose to follow the host country’s bad habits in order to assimilate – “behavioural shift”. An alternative explanation is that the stress of adapting to the new culture produces illness – acculturative stress (Berry 1998).
What health risks are there in your culture?
Which factors have you control over?
Worksheet
Biomedical vs. biopsychosocial model
Lecture 1 - Introduction to Health Psychology (HTML)
(Powerpoint)
http://www.lgu.ac.uk/psychology/staff/elander/health/IntroToYP337MainPage.html