CLINICAL HEALTH PSYCHOLOGY IN MEDICAL SCIENCE
LECTURE 1: Introduction
Brief history
The mind-body relationship
• During prehistory:
- People thought that mind and body were intertwined
- It was believed that diseases arise when evil spirits enter the body and therefore getting
rid of the diseases meant possibly letting evil spirits out of the body
o Treatment consisted primarily of attempts to exorcise these spirits (e.g.,
amputating an arm)
• Ancient Greeks: Humoral theory of illness
- Diseases resulted when the four humors, or circulating
fluids of the body, were out of balance
Four humors are associated with personality types:
1. Blood: passionate temperament
2. Black bile: sadness
3. Yellow bile: angry disposition
4. Phlegm: a laid-back approach to life
➢ If there was a disbalance in the system, you would get sick;
excess of yellow bile → choleric
excess of black bile→ melancholic
excess of blood→ sanguine
excess of phlegm→ phlegmatic
- Healing meant restoring balance in fluids
• Middle Ages:
- Disease regarded as God’s punishment
- Treatment: Driving out evil forces by torturing the body. Later, it was replaced by prayer
and doing good
• Renaissance to present day:
- More enhanced scientific knowledge and assessment as before
- Practice is dependent on laboratory findings and reported or observed bodily factors
- Diagnosis and treatment are based on organic and cellular pathology (not evil spirits
anymore)
- This resulted in the biomedical model
The Biomedical Model
• States that all illness can be explained through aberrant somatic bodily processes (through
purely physical processes), such as biochemical imbalances or neurophysiological
abnormalities
• Health is seen as biochemical or physical in nature and not psychological
• The model assumes that psychological and social processes are largely irrelevant to the disease
process and therefore also fails to include the prevention of the diseases
• This is the most traditional view → Medicine is traditionally using
• The body is separate from the psychological and social processes of the mind;
• All diseases and physical disorders can be explained by disturbances in physiological processes,
resulting from injury, biochemical imbalances, bacterial or viral infection, and so on;
• The model is ill-suited to understanding illness because of it:
- Reduces illness to low-level processes
- Fails to recognize social and psychological processes as powerful influences—assumes a
mind-body dualism
- It neglects the social and psychological aspects of the individual
, - It assumes that we can objectively identify biological causes of disease
- Emphasizes illness rather than focusing on behaviors that enhance health (only on illness
and not how to treat illness)
- Cannot address puzzles that face practitioners (for example, 6 people are exposed to
COVID-19 and only 3 get it, why so)
Conversion Hysteria
• The biomedical viewpoint started to change with the rise of modern psychology
o Jean-Martin Charcot demonstrated hypnosis in a hysterical patient to his students
o Hypnosis was used to treat hysteria, but as a clinical diagnosis it was later replaced by
conversion disorder
• It was believed that specific unconscious conflicts produce physical disturbances symbolizing
repressed psychological conflicts. This view was conceptualized by Sigmund Freud.
• These developments gave rise to the field of psychosomatic medicine
Psychosomatic Medicine
• Is the idea that specific illnesses (e.g., ulcers, asthma, hypertension) are produced by people’s
internal conflicts (e.g., stress, depression, anger).
o This is partly true, how you feel does affect certain physical problems, but not always
• Dunbar (1943) and Alexander (1950) linked patterns of personality to specific illnesses
- Ulcer-prone personality: someone with an excessive need for dependency and love,
attention. You might not always get the attention; this conflict causes anxiety that results
in the secretion of acid in the stomach that erodes the lining of the stomach and has the
potential to result in ulcers (physiological toll)
- Criticism: Conflict or personality type is not sufficient to produce illness
Biopsychosocial model (Engel, 1977)
• This model states that health and illness arise from the interplay of biological, psychological,
and social factors
• Advantages:
- Maintains that the macrolevel and microlevel processes continually interact to influence
health and illness
- Emphasizes both health and illness (it is very broad)
- Focuses on both health and how to improve it
• Also received criticism:
- Social aspects are not well captured in research
- To be studied over time, complex interaction systems need to be explored
- …
Biomedical versus Biopsychological
,Clinical implications of the Biopsychosocial Model
• Understanding the interacting role of biological, psychological, and social factors informs the
diagnosis
• The model is still being worked on and the three factors do not have an equal role
• Emphasis on the relationship between patient and their practitioner, which improves:
- Patient’s use of services
- Emphasis is placed on the patient-physician relationship, therefore the patients are more
involved in the diagnosis and treatment. This also results in more effective treatment since
illness is resolved quicker
Epidemiology
Ranking (the Netherlands)
Which illness is most common?
1. Neck-and-back problems
2. Lung infections
3. Arthrosis
Most common cause of death?
1. Covid-19
2. Dementia
3. Lung cancer
- But if we do not look at cancer in terms of separate diagnoses, it would be the number one
cause of death
Epidemiology in the Netherlands
10.3 million persons in the Netherlands (59%) have one or more chronic illnesses
62% of women more than 56% of men
About 32% of the population has two or more illnesses (multimorbidity)
Over 95% of the persons older than 75 have at least one chronic disease
87% of the people older than 75 have two or more chronic diseases (almost everyone)
, Different disciplines
Mental problems and Physical illness
1. What is the relationship between mental problems and physical
illness?
2. Which major fields contribute to our knowledge of mental
problems and/or physical illness and what is the role of these
fields (professions) in a medical setting?
- Mental problems can cause physical problems and physical
problems can cause mental problems but they can also
interact.
Psychology and medicine in schematics
Many fields contribute to treating patients with mental and physical problems, and they all have
different perspectives. Psychology is different from medicine.
Psychology is different from Medicine
• Mono-causal explanation of disease in medicine (traditionally)
• Medicine emphasizes the biological pathways and has a clear distinction between body and
mind
➢ Disease vs. illness
“Disease is something an organ has; illness is something a man has.” Cassell (1976)
• Disease is something that needs to be cured. Illness is something that needs to be managed.
• They are not mutually exclusive and often occur together.
➢ Illness:
- What the patient feels when he goes to the doctor
- The experience of not feeling quite right as compared with one’s normal state
- Sickness behavior and the subjective experience
➢ Disease:
- What the patient has on the way home from the doctor’s office
- Being something of the organ, cell, or tissue (really physical/biological)
- Obvious signs and symptoms that signal a physical disorder or pathology
Psychology and medicine in schematics
