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Health psychology, biopsychosocial interactionsPart 1: An introduction: basic issues and processes
Chapter 1: An overview of psychology and health
We commonly think about health in terms of an absence of objective signs that
the body is not functioning properly or subjective symptoms of disease or injury.
Health and sickness are not entirely separate concepts, but they overlap. We
consider wellness and illness as ends of a continuum with different degrees. The
term health is used to mean a positive state of physical, mental, and social well-
being, not simply the absence of injury or disease, that varies over time along a
continuum. At the wellness end of the continuum, health is the dominant state. At
the other end of the continuum, the dominant state is illness or injury, in which
destructive processes produce characteristic signs, symptoms, or disabilities.
During the 17th, 18th and 19th centuries, people in North America suffered and
died from two types of illness: dietary and infectious. Dietary diseases result
from malnutrition and infectious diseases are caused by harmful matter of
microorganisms, such as bacteria or viruses, in the body. In much of the world
today, infectious diseases continue to be a main cause of death. Specifically in
lower income or developing countries, lower respiratory infections such as
pneumonia and tuberculosis, diarrheal diseases, and HIV/AIDS are the leading
causes of death.
From the early colonial days in America through the 18th century, colonists
experienced periodic epidemics of many infectious diseases, especially smallpox,
diphtheria, yellow fever, measles and influenza. Two other infectious diseases,
malaria and dysentery, were widespread and presented an even greater threat.
Although these two diseases generally did not kill people directly, they
weakened their victims and reduced the ability to resist other fatal diseases.
Most of these diseases did not exist in North America before the European
settlers arrived and caused the death of many Native Americans. This high death
rate occurred for two reasons: the native population had never been exposed to
these new microorganisms and lacked a natural immunity, and the immune
functions of Native Americans were probably limited by a low degree of genetic
variation among these people.
In the 19th century infectious diseases were still the greatest threat to the health
of Americans. New diseases began to appear, like tuberculosis. But by the end of
the 19th century, deaths from infectious diseases had decreased sharply.
Although medical advances helped to some degree, the decrease occurred before
effective vaccines and medications were introduced. It appears that the decline
resulted chiefly from preventive measures such as improved personal hygiene,
greater resistance to diseases (owing to better nutrition), and public health
innovations. Many people had become concerned about their health and began to
heed the advice of health reformers.
The 20th century witnessed great changes in the patterns of illness afflicting
people. The death rate from life-threatening infectious diseases declined, and
people’s average life expectancy increased dramatically. People die at later ages
,now and from different causes. The main health problems and causes of death in
developed countries today are chronic diseases, degenerative illnesses such as
heart disease and cancer, that develop or persist over a long period of time.
Worldwide chronic diseases account for more than half of all deaths. A major
reason for the current prominence of chronic diseases is that more people are
living to the age when they are at high risk for contracting them. In addition, the
growth of industrialization increased people’s stress and exposure to harmful
chemicals. Expected is that deaths due to infectious diseases other than
HIV/AIDS will decrease and deaths from cardiovascular disease; tobacco-relates
chronic disease; and chronic diseases related to obesity, such as diabetes, are
likely to rise. In the US the leading cause of death in children is accidental injury.
The next four most frequent causes of death are homicide, suicide, cancer and
cardiovascular diseases. All five of these causes of death are far more common
among 15- to 24-year-olds than for younger ages.
It appears that thousands of years ago people believed physical and mental
illness were caused by mystical forces, such as evil spirits. Researchers found
skulls with circular holes in them that probably were made with sharp stone
tools in a procedure called trephination. This procedure was done presumably
for superstitious reasons. Because there are no written records from those times,
we can only speculate about the reasons.
The philosophers of ancient Greece produced the earliest written ideas about
psychology, disease processes, and the mind between 500 and 300 B.C.
According to Hippocrates, the father of the medicine, the body contains four
fluids called humors. When the mixture of these humors is harmonious, or
balanced, we are in a state of health. Disease occurs when the mixture is faulty.
Hippocrates recommended eating a good diet and avoiding excesses to help
achieve humoral balance. The Greek philosophers, especially Plato, were the first
to propose that the mind and the body are separate entities. The mind was
considered to have little or no relationship to the body and its state of health.
Today, the body and mind are still separate concepts: the body refers to our
physical being, including our skin muscles, bones, heart and brain; the mind
refers to an abstract process that includes our thoughts, perceptions, and
feelings. The question of their relationship is called the mind/body problem.
In the Middle Ages the influence of the Church in slowing the development if
medical knowledge was enormous. The Church prohibited dissection of human
beings and animals as well, as they were thought to have souls too. People’s ideas
about the cause of illness took on pronounced religious overtones, and the belief
in demons became strong again. Sickness was seen as God’s punishment for
doing evil things. Priests became increasingly involved in treating the ill, often by
torturing the body to drive out evil spirits.
In the Renaissance (14th and 15th century) scholars became more human-
centered than God-centered in their search for truth and believed that truth can
be seen in many ways, form many individual perspectives. These ideas set the
stage for important changes in philosophy once the scientific revolution began
after 1600. The 17th century French philosopher Descartes probably had the
greatest influence. He introduced three important innovations. First, he
,conceived of the body as a machine and described the mechanics of how action
and sensation occurred. Second, he proposed that the mind and body, although
separate, could communicate through the pineal gland, an organ in the brain.
Third, he believed that animals have no soul and that the soul in humans leaves
the body at death. This belief meant that dissection could be an acceptable
method of study.
In the 18th and 19th centuries, knowledge in science and medicine grew quickly,
helped greatly by improvements in the microscope and the use of dissection in
autopsies. The field of surgery flourished after antiseptic techniques and
anesthesia were introduced in the mid 19th century. Before then hospitals were
more likely to spread diseases than cure them. Over time, the reputation of
physicians and hospitals began to improve and people’s trust in the ability of
doctors to heal increased. These advances laid the foundation for a new
approach called the biomedical model. This model proposes that all diseases or
physical disorders can be explained by disturbances in physiological processes,
which result from injury, biochemical imbalances, bacterial or viral infection, and
the like. The biomedical model assumes that disease is an affliction of the body
and is separate from the psychological and social processes of the mind. This
viewpoint still represents the dominant view in medicine today. Yet some
physicians took the view that the mind could influence health.
The biomedical model has been very useful and conquered many diseases
through the development of vaccines and antibiotics. Despite this the biomedical
model needs improvement. Countries worldwide have been facing escalating
costs in health care. Because medical costs continue to rise rapidly, we need to
consider new approaches for improving people’s health. Many individuals are
more aware of signs and symptoms of illness, more motivated to take care of
their health, and better able to afford visits to physicians than they were in the
past. These factors are clearly important and relate to psychological and social
aspects of the person, but are not included in the biomedical model.
People’s lifestyles are their everyday patterns of behaviour, such as in washing,
preparing, and eating healthful foods. Changes in people’s lifestyles can also
reduce chronic illnesses. Although some risk factors are biological, others are
behavioural. Some behavioural risk factors associated with the five leading
causes of death in the US are:
1. Heart disease: smoking, high dietary cholesterol, obesity and lack of
exercise.
2. Cancer: smoking, high alcohol use, and diet.
3. Stroke: smoking, high dietary cholesterol, and lack of exercise.
4. COPD (chronic lung diseases): smoking.
5. Accidents (including motor vehicle): alcohol/drug use and not using seat
belts.
People’s practicing of healthful behaviors can reduce their risk of illness and
early death substantially. Research concluded that behavior matters.
, The term personality refers to a person’s cognitive, affective, or behavioural
tendencies that are fairly stable across time and situations. Researchers have
found evidence linking personality traits and health. For example, people whose
personalities include:
Low levels of conscientiousness measured in childhood or adulthood are
more likely to die at earlier ages, such as from cardiovascular diseases,
than individuals high in conscientiousness.
High levels of positive emotions, such as happiness or enthusiasm, tend to
live longer than individuals with low levels of these emotions.
High levels of anxiety, depression, hostility or pessimism are at risk for
dying early and developing a variety of illnesses, particularly heart
disease.
Illness can affect one’s emotional adjustment and outlook too. People who suffer
from serious illness and disability often experience feelings of anxiety,
depression, anger and hopelessness. People who are ill and overcome their
negative thoughts and feelings can speed their recovery.
Sigmund Freud noticed that some patients showed physical symptoms with no
detectable organic disorder. Using his psychoanalytic theory, Freud proposed
that these symptoms were converted form unconscious emotional conflicts. He
called this condition conversion hysteria. The need to understand such
conditions led in the 1930s to the development of psychosomatic medicine, the
first field dedicated to studying the interplay between emotional life and bodily
processes. The term psychosomatic means that the mind and the body are both
involved. Early research in psychosomatic medicine focused on psychoanalytic
interpretations for specific, real health problems. It is currently a broader field
concerned with interrelationships among psychological and social factors,
biological and physiological functions, and the development and course of illness.
In the 1970s two new fields emerged: behavioural medicine and health
psychology. The field of behavioural medicine has two defining characteristics,
first it’s membership is interdisciplinary, second it grew out of the perspective in
psychology called behaviorism. Behaviorism proposed that people’s behavior
resultst from two types of learning:
Classical (or respondent) conditioning, in which a stimulus gains the
ability to elicit a response through association with a stimulus that
already elicits that response.
Operant conditioning, in which behavior is changed because of its
consequences: reinforcement (reward) strengthens the behavior,
punishment suppresses it.
Conditioning methods had shown a good deal of success as therapeutic
approaches in helping people modify problem behaviors and emotions. An
important therapeutic technique called biofeedback developed, whereby a
person’s physiological processes, such as blood pressure, are monitored by the
person so that he or she can gain voluntary control over them. This process
involves operant conditioning: the feedback serves as reinforcement.
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