Assoc. Prof. Okan Cem Çırakoğlu

okanc@baskent.edu.tr

ODY318-Health Psychology

An Introduction to Health Psychology

Val Morrison and Paul Bennett

Chapter I

What is health?

By the end of this chapter, you should have an understanding of:

key perspectives on health, illness and disability, including the biomedical and biopsychosocial models

the influence of lifestage, culture and health status on health and illness concepts

a range of influences on the domains of health considered important

the role of psychology, and specifically the discipline of health psychology, in understanding health, illness and disability

how health is more than simply the absence of physical disease or disability

Learning Outcomes

Models of Health and Illness

Mind–body relationships

Disease attributed to evil spirits and punishment from the gods

Hippocrates (circa 460–377 BC) – Humoural theory

Descartes (1596–1650) – Dualism

Mechanistic view, underpins the biomedical model

Biomedical model

Diseases and symptoms have underlying pathological cause

Reductionist view

Biopsychosocial model

Disease and symptoms are explained by a combination of physical, cultural, psychological and social factors

Dualism vs. Monism

Dualism

the idea that the mind and body are separate entities (cf. Descartes)

Monoism

viewing them as one unit; one type of ‘stuff’

Psychology has played a significant role in altering both of these perspectives

due to an increased understanding of the bidirectional relationship between body and mind.

International Classification of Functioning, Disability and Health (ICF; WHO 2001)

Lay Theories of Health

Bauman (1961) asked ‘What does being healthy mean?’

The three main types of response were:

❑ a ‘general sense of well-being’

❑ identified with ‘the absence of symptoms of disease’

❑ seen in ‘the things that a person who is physically fit is able to do’.

She argued that these three types of response reveal health to be related to:

❑ feeling

❑ symptom orientation

❑ performance.

Social Representations of Health

The Health and Lifestyles survey (Cox et al. 1993)

The categories of health identified were as follows:

Health as not ill (i.e. no symptoms, no doctor visits, therefore I’m healthy)

Health as reserve (i.e. come from strong family; recover quickly from operation)

Health as behavior (i.e. usually applied to others rather than self; e.g. they are healthy because they look after themselves, exercise, etc.)

Social Representations of Health

Health as physical fitness and vitality (used more often by younger respondents, and often in reference to males)

Health as psychosocial wellbeing (health defined in terms of mental state; e.g. in harmony, feeling proud, or more specifically, enjoying others)

Health as function (idea of health as the ability to perform one’s duties; i.e. being able to do what you want when you want without being handicapped by ill health or physical limitation)

Definition of Health?

According to the World Health Organization . . .

State of complete physical, mental and social well-being and . . . not merely the absence of disease or infirmity (1947)

❑ does not address socio-economic and cultural influences on health, illness and health decisions;

❑ omits the major role of the ‘psyche’ in the experience of health and illness.

Cross-cultural Perspectives on Health

Cultures vary in their health belief systems

Holistic explanations

Westernized treatment divides mind, body and soul whereas non-Westerners integrate these ‘three elements of human nature’

Spiritual explanations

Uncommon in Western civilizations e.g. faith, God’s reward

❑ supernatural forces such as ‘hexes’ and ‘evil eye’

Collectivist vs. individualistic

Eastern communities locate health and illness in the social world vs. Westernized behavior driven by individual needs

Lifespan, Ageing and Beliefs aboutHealth and Illness

Growing older may be associated with decreased functioning, increased disability or dependence, however it is not only older people who live with chronic illness. There are developmental issues that health professionals should be aware of.

Developmental theories

The developmental process is a function of interaction among three factors:

Learning: a relatively permanent change in knowledge, skill or ability as a result of experience.

Experience: what we do, see, hear, feel, think.

Maturation: thought, behavior or physical growth, attributed to ageing and development rather than to experience.

Cognitive Development

Piaget (1930, 1970) proposed a staged structure to cognitive development which all individuals follow in sequence.

Sensorimotor (birth–2 years): understands the world through sensations and movement

Preoperational (2–7 years): symbolic thought develops, as does simple logic and language

Concrete operational (7–11 years): abstract thought and logic develops hugely, performs mental operations and manipulation

Formal operational (age 12 to adulthood): abstract thought, imagination and deductive reasoning develops

Development of an Illness Perception

Bibace and Walsh (1980)

Illness concepts gradually develop by asking questions.

Children aged 3–13 years were asked questions about health and illness as follows:

What is a cold? – knowledge

Were you ever sick? – experience

How does someone get a cold? – attributions

How does someone get better? – recovery

Themes of explanation can be attached to Piaget’s stages.

Illness Concept in Sensorimotor and Preoperational Stage Children

Under-7s generally explain illness on a ‘magical’ level – often based on association.

Incomprehension: child gives irrelevant answers or evades questions

e.g. ‘sun causes heart attacks’

Phenomenonism: illness is usually a sign that the child has at some time associated with the illness, with little cause and effect

e.g. ‘a cold is when you sniff a lot’

Contagion: illness is from a person or object that is close by; or can be attributed to an activity that occurred before illness

e.g. ‘you get measles from people’. If asked ‘how?’, ‘just by walking near them’

Illness Concept in Concrete Operational Stage Children

Explanations of illness at around 8–11 years are more concrete and based on a causal sequence:

Contamination: children learn illnesses can have multiple symptoms recognise germs and their own behaviour can cause illness e.g. ‘get a cold if you take your jacket off outside, it gets into yourbody’

Internalisation: illness is within the body, but the process by which symptoms occur can be partially understood

e.g. ‘cold caused from germs that I inhaled/swallowed’)

At this stage, children can differentiate between body organs and understand simple illness information. They also identify that treatment and/or personal actions improve health.

Illness Concept in Formal Operational Stage Adolescents

Illness concepts at this stage are abstract – explanations based on interactions between the person and their environment:

Physiological: A stage of physiological understanding is reached whereby illness can be defined in terms of specific bodily organsor functions. They begin to appreciate multiple physical causes

e.g. genes + pollution + behaviour

Psychophysiological: From 14+, many people understand body–mind interaction and accept the role of stress, worry, etc. in the exacerbation and cause of illness.

Many adults may not achieve this level of understanding and continue with cognitively simplistic explanations.

While Piaget did not describe further cognitive developments in adulthood, new perspectives develop from experience, and are applied with a view to achieving life goals.

Young adulthood: Less likely to adopt new health-risk behaviour and more likely to engage in protective behaviour for health reasons.

e.g. screening, exercise etc.

Middle age: Identified as a period of doubts, anxiety and change; some triggered by

uncertainty of role when children leave home i.e. ‘empty nest’ syndrome

awareness of physical changes e.g. greying hair, weight gain, stiff joints .

Adulthood 17/18+

Ageing and Health

The ageing population has burgeoned, and living longer.

The UN (2013) predict that those aged 65+ will double to 10% of the world population by 2025.

Implications for health and social care are clear given the epidemiology of illness:

❑ Increased prevalence of chronic disease

❑ Increased prevalence of disability and dependence

▪ 85% of the elderly may have a chronic condition (Woods 2008)

Ageing is not necessarily a negative experience:

Self-concept is relatively stable through ageing.

Successful ageing is possible and includes medical, psychological, socio-economic and broader social influences.

Bowling and Iliffe (2006)

Lay model of successful ageing (i.e. medical, psychological, social and socio-economic influences) strongest predictor of Quality of Life

5x more likely to rate QoL as ‘Good’

Holistic models of health are ‘better’

However, 98% of sample were white

Successful Ageing

Psychology

Psychology aims to describe, explain, predict, and where possible, intervene to control or modify behavioural and mental processes, from language, memory, attention and perception to emotions,social behaviour and health behaviour, to name just a few.

The world may be known through observation = empiricism we observe we define a problem we collect data we analyse data we develop a theory we test theory by return to data collection.

Health Psychology

Health psychology takes a biopsychosocial approach to health and illness. Its main goals (derived from Matarazzo’s definition, 1980) are to develop our understanding of biopsychosocial factors involved in:

the promotion and maintenance of health;

improving health-care systems and health policy;

the prevention and treatment of illness;

the causes of illness, e.g. vulnerability/risk factors.

Psychosomatic Medicine: previously psychoanalytical – now addresses mixed psychological, social and biological explanations of illnesses;

Behavioural Medicine: behavioural principles (e.g. operant conditioning) are employed with focus on rehab and treatment;

Medical Psychology: generally assigned to profession rather than discipline. Use mechanistic medical model to treat/cure for ‘normality’;

Medical Sociology: exemplifies close relationship between psychology and sociology, with health and illness considered in terms of social factors that may influence individuals;

Clinical Psychology: concerned with mental health and the diagnosis and treatment of mental health problems (e.g. phobias, anxiety, eating disorders etc.).

Contrasting Disciplines

Clinical health psychology merges clinical psychology’s focus on assessment and treatment with a broader biopsychosocial approach;

Public health psychology addresses issues such as immunisation, epidemics, and implications for health education and promotion;

Critical health psychology arose from criticism that health psychology was too individualistic in focus, too concerned with individual aspects at the expense of social;

Academic health psychology focuses on research, teaching and supervision conducted from academic base;

Professional health psychology action research to facilitate the growth of health groups and healthy communities.

Health Psychology Approaches