Psyche en Soma 2017
H1: Psychology and medicine
There are a number of barriers for medical students to incorporate psychological aspects into
practice.
1. Psychology is a ‘soft science’ (Roughly speaking, the natural sciences are considered "hard",
whereas the social sciences are usually described as "soft")
2. Psychology’s breadth of scope makes it hard for healthcare professionals to work out which
parts are most relevant to clinical practice
3. Difficult to screen out evidence-based information from popular ‘fact’
Health is not easy to define and is very individual. Moreover, health and illness are subjective states
of wellbeing. We generally think of health in six different ways:
1. Not having symptoms of illness
2. Having physical or social reserves
3. Having healthy lifestyles
4. Being physically fit or vital
5. Psychological wellbeing
6. Being able to function
The World Health Organisation (WHO) defined health as ‘a state of complete physical, mental, and
social wellbeing and not merely the absence of disease or infirmity’. Problems with such a broad
definition are however that:
- It would put unrealistic pressures on countries to provide social circumstances and medical
systems
- Complete wellbeing confuses happiness with health
The multidimensional nature of health makes finding an adequate definition difficult. Therefore it is
proposed that we view health as a continuum from optimal wellness to death.
Why is psychology important?
- Psychology is not just common sense
● It tests common sense views empirically to confirm or disconfirm them.
● It goes beyond common sense
● People don’t always act according to common sense
- Psychology is interesting and useful
● In order to treat people effectively we need to be able to diagnose the problem
accurately and treat the problem appropriately. Psychology can help in both these
areas.
● The majority of patients with psychological symptoms will present physical symptoms
. Psychology can help us understand psychological symptoms as well as diagnostic
disorders.
● There is a strong link between physical health and psychological health and if we
concentrate only on one side we risk missing important information and prescribing
ineffective treatment
- Body and mind are not independent
● Medical understanding grew exponentially as doctors and researchers focused on
increasingly detailed psychological processes and identified the causes of pathology.
● The disadvantage of dualism is that it resulted in the biomedical approach.
,Biomedical approach
Assumes that all disease can be explained in terms of physiological processes: therefore the
treatment acts on the disease and not on the person. This approach does not consider the influence
of social or psychological factors on health
- Example ‘decline in mortality from infectious diseases in the UK’: the largest decreases in
deaths from infectious diseases occurred before most vaccines were introduced. A lot of this
decrease was due to changes in people’s understanding of illness and the effect of lifestyle
instead of explanation stemming from effective treatment.
- The role of lifestyle in illness illustrates the importance of psychosocial factors, yet these are
not considered by the biomedical model
- Individual factors such as personality, health behaviours and beliefs also affect health
Biopsychosocial approach
Takes into account the effect of biological, psychological, and social factors. This approach was later
expanded to include factors such as ethnicity and culture. This should lead to a more holistic
approach. The biopsychosocial approach is still not widely used. It tends to be taught more as a
theoretical framework than applied to clinical work.
Poverty, available support structures,
Access to health care, legislation that
Impacts on health
Bing exposed to a virus, passive
smoking, living in a high-radiation area lifestyle, sociability, personality
mood, perception of symptoms,
adherence to
treatment
, ethnicity, learned behaviour,
developmental proceses,
previous illnesses
External Internal
The biopsychosocial approach suggests a circular or nonlinear causality (in contrast to the biomedical
approach). In other words, physical, psychological and social factors all influence, and are influenced
by each other. This raises difficulties in clinical practise because we need to choose or prioritise one
treatment. To do this, we have to think in terms of a hierarchy of causes and linearity of treatment.
Other barriers include that:
- It is not possible to address all the factors that influence illness
- In order to plan treatment we need to think in terms of linear causality rather than circular
causality.
