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INTRODUCTION

Welcome to the world of health psychology. At the beginning of this topic youwill learn the definition of health and health psychology. Then we will discussthe history of health psychology and its importance in our lives. Finally, we willlearn about some basic concepts in health psychology, with a special look at the

biopsychosocial model.

TTooppiicc

11 Introduction

to HealthPsychology

LEARNING OUTCOMES

By the end of this topic, you should be able to:1. Describe the meaning of health;

2. Describe the history of health psychology;

3. Explain the importance of health psychology; and

4. Explain the biopsychosocial model.

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TOPIC 1 INTRODUCTION TO HEALTH PSYCHOLOGY2

DEFINITION OF HEALTH

Take a few moments to read the conversation that is taking place in the cartoonbelow (see Figure 1.1).

Figure 1 1: Health problems

In the scenario above, who do you think is not healthy? What is your definitionof health?

Health does not simply mean to be in good physical condition. You are saidto be healthy if your body is healthy, your mind is healthy, you have healthyinteraction with your environment and you can function appropriately.

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TOPIC 1 INTRODUCTION TO HEALTH PSYCHOLOGY 3

The definition of health by the World Health Organization (1948) is:

Now, study Figure 1.2 to learn about what health is considered to be.

Figure 1 2: The concept of health

DEFINITION OF HEALTH PSYCHOLOGY

Health psychology is a branch of psychology that focuses on the understandingof how you can stay healthy, why you become ill and how you and yourenvironment respond when you get ill.

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A complete state of physical, mental, and social well-being and not merely

the absence of disease and infirmity.

1. Analyse your lifestyle. Which of your daily activities havepositive or negative effects on your physical fitness?

2. How would you change those negative activities so that you willstay healthy?

ACTIVITY 1.1

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Initially, Matarazzo (1980) defined health psychology as the comprehensivestudy of:

Recently, health psychologists have become involved in more important areasof health, for example, formulating health care policies and contributing tothe management of health care systems. Therefore, the definition of healthpsychology has incorporated these new roles as suggested by Brannon and Feist

(2000), who stated that health psychology is:

The above definition suggests that there must be some form of control. Control isa key concept in the psychology of health. It has important applications in the

fields of stress, coping and adaptation, health promotion, health education,rehabilitation and care in acute and chronic illness, disability and terminal illness.It also has important implications for the management of the relationship

between patients or clients and carers and health care professionals in all healthcare settings.

HISTORY OF HEALTH PSYCHOLOGY

To understand the history of health psychology you must first understandthe earlier concepts of mind and body, and then relate these with currentunderstanding.

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the specific educational, scientific, and professional contributions of thediscipline of psychology to the promotion and maintenance of health, theprevention and treatment of illness, and the identification of etiologic anddiagnostic correlates of health, illness and related dysfunction.

psychologys contributions to the enhancement of health, the prevention andtreatment of illness, the identification of health risk factors, the improvementof the health care system, and shaping of public opinion with regard tohealth

1. Define health in your own words.

2.

Define Health Psychology.

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1.3.1 Early Concepts of Mind and Body

Previous philosophers and researchers fluctuated in their views regarding the

relationship between mind and body.

Before modern times, manifestations of psychiatric disorders were believed to beassociated with supernatural phenomenon such as the belief that the body hascome into the possession of evil spirits.

Later, the Greeks believed that disturbances in our behaviour and emotionscould be due to an imbalance between elements in our body. Hippocrates(460370 BC) described the ancient Humoral Theory. He believed that certainhuman temperaments, i.e., moods, emotions and behaviours, were associated

with an imbalance of body fluids (called humors): blood, yellow bile, black bileand phlegm.

In humoral theory, individual diseases did not exist in the way that weunderstand them today. Diseases were not seen as forces or entities separatefrom the body, but instead were understood as states of bodily imbalance.Physicians trained in humoral theory relied not only on a knowledge of medicaltexts, but also on personal understanding of the patient; on the inspection of

blood, urine and other fluids produced by the body; and on the patientsdescription of his or her symptoms.

Extensive physical examinations were rare. Prognosis was a finely honed skill,and work published by physicians before the 20th century often containeddetailed observations of the stages and crisis periods in illness. Authors typicallyrefer to the eruption of lesions on the skin, the movement of fluids through the

body, and the problems caused by any blockages. Preventative treatment wasalso of central importance, and public health practices developed in the early19th century were based in part on basic humoral presuppositions especially onthe relationship between environment, individual lifestyle and health. Theseideas were often criticised, however, especially after mid-century.

Belief in the supernatural and religious influences were dominant in the MiddleAges. It was believed that a cure for an illness could be achieved by driving outevil through torturing the body.

During the Renaissance period, medicine placed more attention on technology,laboratory results and bodily factors. Through autopsies, humoral theory wasput to rest and cellular changes and pathology of the body became the basis ofthe diagnosis and treatment of diseases.

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1.3.2 Contemporary Psychology

Modern psychology began when neurologist Sigmund Freud (18561939) failed

to find the innervations that were responsible for hysterical phenomena. In orderto explain the phenomenon, he proposed a theory that specific unconsciousconflicts can produce physical disturbances that symbolise the repressedpsychological conflicts without specific physiological changes.

The relationship between body and mind was also explored throughphysiological studies. In 1928, Walter Cannon and Phillip Bard proposed theCannon Bard Theory which emphasised the importance of the autonomicnervous systemin the physiology of stress.

In the 1950s, Wolff further reinforced the association between stress and illnessby introducing a relationship between stress and adaptation in health anddisease states. Hans Selye introduced the General Adaptation Syndrome, whichemphasised the stages of stress and their association with hormonal,immunological and other physiological changes in our body.

Other researchers, namely Flanders Dunbar (1930s) and Franz Alexander (1940s),were more interested in the link between personality and certain illnesses, i.e.,they posited that people who have excessive needs for dependence and lovewere prone to developing ulcers. Dunbar and Alexander introduced the field of

Psychosomatic Medicine.

Two new interrelated disciplines emerged from psychosomatic medicine:behavioural medicineand behavioural health.

In 1977, Behavioural Medicinewas born out of psychosomatic medicine bySchwartz & Weiss. It was defined as:

... the field concerned with the development of behavioural scienceknowledge and techniques relevant to the understanding of physicalhealth and illness and the application of this knowledge and thesetechniques to prevention, diagnosis, treatment and rehabilitation.Psychosis and neurosis and substance abuse are included only so far asthey contribute to physical disorders as an endpoint.

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Behavioural Health focused more on the prevention of diseases in healthypeople rather than the treatment of sick people. This field covered researchand activities related to promoting a healthy lifestyle, e.g., a healthy diet, no

smoking, and regular exercise. Later , in 1978, this discipline becamerecognised as Health Psychology, Division 38 of the American PsychologicalAssociation (APA).

HEALTH PSYCHOLOGY VERSUS OTHERDISCIPLINES

There is no clear demarcation between health psychology, clinical psychology,behavioural medicine and psychiatry. However, health psychology focusesmore on medical diseases than mental disorders, when compared to clinicalpsychology and psychiatry. Often, the roles of professionals in the respectivedisciplines overlap. Figure 1.3 illustrates where health psychology stands inrelation to other related disciplines.

Figure 1 3: Health psychology and other related disciplinesSource: Albery and Munaf (2007)

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Write a short paragraph on the history of psychology.

SELF-CHECK 1.2

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IMPORTANCE OF HEALTH PSYCHOLOGY

Health psychology is important because of several factors, as discussed below:

(a) Changing Pattern of IllnessNowadays, illness patterns are changing. More non-communicablediseases, such as heart disease, cancer and diabetes, contribute to death anddisability compared to communicable diseases, such as tuberculosis and

pneumonia. Table 1.1 below shows the percentage of deaths worldwide in2008 by illness, according to the World Health Organization.

The main factors that contribute to these non-communicable diseases arelifestyle and social factors, both of which are modifiable.

Health psychologists who are experts in patterns of coping style,personality and stress management may contribute to the prevention andidentification of health risk factors, as well as to the improvement of thehealth care system to reduce the risk of such diseases.

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Fill in the blanks below:

I work with psychiatrists at a psychiatric clinic. I help those withschizophrenia, depression and others mental disorders. My disciplineis..................................................................................................

I help to promote a healthy lifestyle. I motivate those who are obese tolove themselves, to exercise and to get a balanced diet. My disciplineis................................................................

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Table 1.1: Percentage of Deaths Worldwide in 2008 (World Health Organization)

World

Deaths in

millions

of deaths

Ischaemic heart disease 7.25 12.8%Stroke and other cerebrovascular disease 6.15 10.8%Lower respiratory infections 3.46 6.1%Chronic obstructive pulmonary disease 3.28 5.8%Diarrhoeal diseases 2.46 4.3%HIV/AIDS 1.78 3.1%Trachea, bronchus, lung cancers 1.39 2.4%Tuberculosis 1.34 2.4%Diabetes mellitus 1.26 2.2%Road traffic accidents 1.21 2.

Source: http://www.who.int/mediacentre/factsheets/fs310/en/index.html

(b) Expanded Health Care ServicesPrevention is better than cure. Health care costs for the treatment ofdiseases are increasing. Therefore, preventive care for common diseases must

be the main emphasis in the management of any disease. Healthpsychologists who are experts in modifying peoples risky health behavioursare important professionals in implementing any health care system.

(c) Increased Medical Acceptance

In other countries, health psychologists are well accepted as part of themedical profession. In Malaysia, however, the contribution of healthpsychologists to mainstream medical care services is still limited.

(d) Advances in ResearchMore psychological research is needed to contribute to the comprehensivemanagement of medical diseases.

Research the contribution of health psychologists to the health caresystem in Malaysia. Discuss your findings during your tutorial.

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BASIC CONCEPTS IN HEALTHPSYCHOLOGY

The most important concept in health psychology is the biopsychosocial model.This model was introduced by G.L. Engel in 1977. This model shows theinterplay among psychological factors, biological factors and social factors in the

development of certain diseases. Figure 1.4 shows some aspects in the respectivebiopsychosocial factors that contribute to health and disease.

Figure 1.4: Biopsychosocial factors that contribute to health and diseaseSource: Brannon and Feist (2007)

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State the importance of health psychology.

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Read about Mr Ali in Figure 1.5 to understand better the bio-psychosocialconcept in health psychology.

Figure 1.5: Mr Ali and his problems

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Table 1.2 shows examples of the biopsychosocial factors that contribute to Mr Alisdisease. The table shows how there is an interplay among psychological factors,

biological factors and social factors in the development of certain diseases.

Table 1.2: Biopsychosocial Factors of Mr Ali's Disease

Psychology Biology Social

1. Poor stressmanagement

2. Poor impulse control;unable to control eating

1. Family history ofcardiovascular disease

2. Obesity

1. Financial crisis

2. Poor workingenvironment

Outcome:

Heart disease

You will learn more about the biopsychosocial model in relation to otherconcepts in health psychology in future topics.

1. Describe the importance of health psychology.

2. What is the role of a health psychologist?

SELF-CHECK 1.4

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Being healthy means you are in good physical condition, your mind ishealthy, you have good interaction with your environment and you canfunction appropriately.

Health psychology focuses more on the understanding of how you can stayhealthy, why you become ill and how you and your environment respondwhen you get ill.

Health psychology helps in the improvement of the health care system andthe shaping of public opinion with regard to health.

The relationship between mind and body has been described since ancienttimes. It was further elaborated by Sigmund Freud, Walter Cannon, PhillipBard, Hans Selye, Flanders Dunbar, Franz Alexander and other researchers.

Health psychology is important in present times because: there have beenchanges in the pattern of illness; there has been an expansion of health careservices; there have been advances in research; and there is now an increasedacceptance among medical professionals on the role of psychologists inmanaging various diseases.

The biopsychosocial model describes the interplay among psychologicalfactors, biological factors and social factors in the development of certaindiseases.

Behavioural medicine and behavioural health

Biopsychosocial model

Contemporary psychology

General Adaptation Syndrome

Health psychology

Humoral theory

Physiology of stress

Psychosomatic medicine

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Albery, I. P., & Munaf, M. (2007). Key concepts in health psychology. London:Sage Publications Ltd.

Brannon, L., & Feist, J. (2007). Health psychology An introduction to behaviorand health(6th ed.). Belmont, CA: Wadsworth Publishing.

Matarazzo, J. D. (1980). Behavioral health and behavioral medicine: Frontiers fora new health psychology. American Psychologist, 35(9), Sep 1980, 807817.doi: 10.1037/0003-066X.35.9.807

Percentage of Deaths Worldwide in 2008 by World Health Organization (2008).Retrieved fromhttp://www.who.int/mediacentre/factsheets/fs310/en/index.html.

Schwartz, G. E., & Weiss, S. M. (1977). Behavioural Medicine revisited: Anamended definition. Journal of behavioral medicine, 1(3), 249251,doi:10.1007/BF00846677

Taylor, S. E. (2006). Health psychology (6th ed.). Boston: Mc Graw Hill HigherEducation.

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