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Summary for Health and Medical Psychology
- Instelling
- Universiteit Leiden (UL)
A full extensive summary for the specialisation course of Health and Medical Psychology
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Health and Medical Psychology SummaryChapter 1: What is Health?
What are the changing perspectives on health?
According to Stone (1979) there are a number of questions that cannot be answered in
concrete terms. For example, the question of how we maintain, protect and recover health,
as long as there is no clear meaning to health and how it can be measured. Most people will
not realise that 'health' has / can have a totally different meaning for other people, cultures,
social classes, etc.
What is meant by mind-body relationships?
Holes were sometimes found in skulls from the Stone Age from a skull drilling process to
allow evil spirits that caused diseases to be released. Illness was also sometimes interpreted
as a punishment from the gods by ancient Hebrew texts.
The ancient Greeks saw body and mind as a whole, but did not attribute illness to spiritual
matters. Hippocrates was one of the first who talked about a balance between the four bodily
fluids, also called humours (mucus, blood, yellow bile and black bile). Each humour has a
different trait. In addition, the humours are also linked to the seasons and the four conditions:
dry, wet, cold and warm. Mucus is connected to winter (cold and wet) and large amounts of
mucus is linked to a calm temperament. Blood is connected to spring (wet and warm) and
large amounts of blood are linked to an optimistic personality. Large amounts of yellow bile
are associated with an angry temperament and belong to the summer (hot and dry). Finally,
black bile is related to sadness and autumn (cold and dry). If the juices are in balance, a
person is healthy. Hippocrates also recognized the link between (healthy) eating and health
and that physical factors can influence the mind.
Galen, another influential Greek, talked about the physical basis of disease some 300 years
after Hippocrates. The bodily fluids would not only affect our character, but would also be
responsible for certain diseases. The mind plays no role in the development of a disease.
The occurrence of a disease is also called aetiology.
In the Middle Ages, health was again seen primarily as a function of spirituality. Illness was
declared to be God's punishment for misconduct or to be caused by evil spirits who had
taken possession of someone, as people used to think before. Individuals had little or no
control over their health.
In the fourteenth and fifteenth centuries, the Renaissance period, much attention was paid to
individual thinking and doing. The scientific revolution around 1600 caused a lot of
developments in physical medicine. Statements for illness had an organic and physiological
perspective, psychological explanations were not present.
At the beginning of the 17th century, Descartes came with dualism. According to Descartes,
body and mind are separated, but interaction between the two was possible.
,Doctors were there to protect and heal the material body and spiritual scholars to protect the
non-material mind.
Dualists, such as Descartes, saw the body as a machine. This so-called mechanism implies
that behaviour can be reduced to the physical functioning of the body. This approach is the
basis for the biomedical model, which assumes that disease symptoms are caused by a
pathology and can be remedied with medical treatment. The biomedical model is sometimes
also described as reductionism. Body, mind and human behaviour can be reduced to the
level of cells, neural activity and biochemical activity. There is no space for the fact that
people are different and can react differently to the same diseases, et cetera. Dissection and
autopsy were accepted by the church, resulting in an enormous growth in medical insight.
Biopsychosocial model of illness
A model that in many respects is more similar to what we currently find most plausible in
regular healthcare is the biopsychosocial model. This model is based on the assumption that
there is a type of matter that you can approach in two ways. One type of matter can be
approached in a subjective and objective manner. Someone who is sick has symptoms
associated with that illness, but responds to it in an individual, unique way. The
biopsychosocial model therefore takes physical, social, psychological and cultural aspects
into account when illness or symptoms are explained.
Since the bi-directional relationship (two-way relationship) between body and mind gains
more understanding, the tension between monists and dualists has decreased. Psychology
and Freud have contributed to this. Monists believe that there is one kind of matter, so body
and mind are of the same matter. In contrast, dualists say that the body is physical but the
mind is not. They believe that the mind and the body are seperated.
In his time (first half of the 20th century) Freud spoke of consciously or unconsciously
instead of body or mind. According to him, unconscious conflicts caused physical problems,
we now would call this psychosomatic. Health is more than just the absence of illness,
individual behaviour also plays a role in health and illness.
Behaviour, death and disease
Not only have our views on disease changed a lot over the centuries. The knowledge about
physical functioning and any possible treatments is very extensive. In the 20th century, life
expectancy has risen sharply in Western countries. Explanations for this are treatments with
medicines, vaccinations, developments in education and in agriculture.
Infectious diseases are becoming less common. Instead, diseases such as cancer, heart,
lung and liver diseases have become more common. This development mainly occurs in
developed countries. Behaviour such as smoking, extreme alcohol consumption, poor diet
and a 'sedentary' lifestyle are associated with the diseases just mentioned. Cancer deaths
account for approximately two-thirds of our behaviour. In addition, because humans
nowadays prevent or survive the diseases that we previously died of, which means that
humans now reach ages where the cancer incidence is higher. Incidence is the number of
,new cases of an illness per unit of time. This is often confused with prevalence, which
indicates how many people suffer from a particular disease at a given time.
A striking development in recent decades is that people from Western cultures are
increasingly considering traditional medicine and that people from traditional or developing
countries are learning more and more about modern medicine.
What are the individual, cultural and lifespan perspectives on health?
Lay theories of health
If you want to offer individuals optimal health care, it is important to know what they mean by
'health' and 'health behaviour'. Because it differs per culture, gender, age category, or health
how someone interprets these concepts. Young people and people who are not sick often
describe health as observing health behaviour, while elderly and sick people describe health
as the absence of symptoms and illness. Health can also be defined as the things that a
physically fit person can do.
Social representations of health
How people assess their own health also depends on who, what and where they are.
Someone who often eats unhealthy will consider this less serious if they have many people
in their environment who eat unhealthy more often. But there are more perspectives for
viewing health:
● Health as not ill: no symptoms, no visits to the doctor.
● Health as reserve: someone comes from a healthy family and often recovers quickly.
The person will sooner think that he can handle unhealthy behaviour.
● Health as behaviour: usually when it comes to others. The neighbour is very healthy,
because we see him running every morning.
● Health as physical fitness and vitality: this definition is often used by young people,
especially men. Men see the concept of health more as the feeling of being fit, while
women define health more as 'full of energy'.
● Health as psychosocial well-being: someone who feels good is probably also healthy.
● Health as function: health is increasingly described as being able to work and being
able to do what you want to do.
People who have to indicate whether they consider themselves healthy often compare
themselves with others. When people are in good health, there are more young people than
older people who compare themselves to people of their own age. Young people are
generally in good health. When people are in less good health, there are more older people
than young people who compare themselves to their peers. Older people more often have
, poor health. People try to get the best out of their evaluations. Health is therefore a relative
term.
World Health Organisation definition of health
The World Health Organisation (WHO) describes health as "a state of physical, mental and
social well-being and the absence of disease." What is missing in these definitions are the
socio-economic and cultural influences on health. The definition also does not make clear
what the role of the psyche is, but it plays an important role in the experience of health and
disease.
Cross-cultural perspectives of health
Opinions about health can differ per culture. A good example is the approach to alcohol
addiction. In some cultures, alcohol addiction is seen as a legal and moral problem: addicts
are seen as victims of a substance. In other cultures, alcohol consumption is seen more as a
sign of personal weakness. It also differs per culture if someone's health is their own concern
or is dealt with collectively. In many African regions, it is common for the residents of a
village to be concerned about the health of all villagers. Everyone has their own task in this
and thus contributes to collective health. In Eastern cultures there is often a holistic
approach in addition to the collectivist approach. They are concerned with the whole being,
the well-being of their environment, instead of the visible or physical part. In the West you
often see an individualistic approach. People must ensure that they become or remain
healthy. How someone behaves in this case is also largely determined by their personal
needs.
Lifespan, ageing and beliefs about health and illness
It goes without saying that a toddler has little knowledge about health and healthy behaviour.
People usually acquire this knowledge automatically as they develop. There are various
theories about this.
Developmental theories
The development process is a function of the interaction between three factors:
1) Learning: a relatively permanent change of knowledge, skill or ability as a result of
experience.
2) Experience: what we do, see, hear, feel and think.
3) Maturation: thoughts, behaviour or physical growth, attributed to the genetically
determined order of ageing and not to experiences.
Erik Erikson (1959 and 1989) described eight development phases that have to do with the
development of an image and a character with regard to health. These eight phases can be
roughly divided into the following four points.
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