A Brief History of Health Psychology, Summaries of Health psychology

Download A Brief History of Health Psychology and more Summaries Health psychology in PDF only on Docsity! INTRODUCTION A Brief History of Health Psychology In the era of the hunter-gatherer, cave paintings and other relics yield evidence of an early human fascination with an imagined world of spirits and magic. A key element in such icons is a desire for survival aided by communication between body and spirit with the mind as mediator. The idea of body–mind–spirit integration can be traced to the earliest period of history, circa 10,000 BC. Shamanistic healing practices of a spiritual nature survive to the present day. Contemporary concepts of healing, health and illness are founded on these ancient systems. Early physicians, hypnotists and healers were intrigued by the mysterious ways in which the emotions affect bodily functioning. The hypnotists of the 18th and 19th centuries were aware of the power of imagination and sug- gestion over mental states, somatic perceptions and pain. The psycho- analysts developed theories about unconscious, emotional processes that apparently guide, not only dreams, but also behaviour and conscious experi- ence. The field of psychosomatic medicine studies mind–body relationships in different conditions of mental and physical health. Health psychology applies psychological knowledge and techniques to health, illness and health care. Like its parent discipline of psychology itself, health psychology has a short history but a long past. The term ‘health psychology’ entered the lexicon in the last quarter of the 20th century. After a gestation period in the 1970s, health psychology took its name in 1979 when the first book with the term ‘health psychology’ in the title was published (Stone et al., 1979). In the same year George Stone (1979), in ‘Patient compliance and the role of the expert’, argued that 'compliance' should be considered an attribute of the client–expert transaction rather than of the client alone.1 Understanding the essentially social nature of client–professional transactions became a formative principle in the development of a new ‘biopsychosocial’ model as an alternative to the biomedical model. The biopsychosocial model defines health and illness as: ‘the product of a combination of factors including biological characteristics (e.g. genetic predisposition), behavioural factors (e.g. lifestyle, stress, health beliefs), and social conditions (e.g. cultural influences, family relationships, social support)’ (American Psychological Association, 2001). This ‘model’2 is a foundation stone for the mainstream development of health psychology. The Division of Health Psychology was founded within the American Psychological Association in 1980. The European Health Psychology Society was established in 1984 and the Health Psychology Section of the British Psychological Society in 1986. The importance of psychological processes in the experience of health and illness is being increasingly recognised by professionals and lay people alike. Evidence for the role of behaviour in current trends of morbidity and mortality is accumulating apace. Epidemiological research shows that certain behaviours are strongly associated with morbidity and mortality (Marks, Murray, Evans and Willig, 2000). The 1980s and 1990s was a period of rapid growth for the field. Developments in clinical practice have also encom- passed psychological knowledge and expertise, and health psychologists are in increasing demand in clinical and medical settings. In the USA, the single largest area of placement of psychologists in recent years has been in medical centres. Psychologists have become vital members of multidisciplinary clinical and research teams in rehabilitation, cardiology, paediatrics, oncology, anaesthesiology, family practice, dentistry, and other medical fields. In reviewing the development of health psychology in the USA, Wallston (1993) stated: It is amazing to realise that formal recognition of the field of health psychology in the United States occurred less than 20 years ago. It is no longer correct to speak of health psychology as an ‘emerging’ speciality within American psychology; for the last dozen or so years, health psychology has flourished as one of the most vibrant specialties within the larger discipline of psychology. Not only is it recognised as a specialty in its own right, health psychology has had a profound impact upon clini- cal psychology, and has played a major (if not the major) role in developing and vitalising the interdisciplinary field called ‘behavioural medicine’. (Wallston, 1993: 215) The overlap with behavioural medicine in both theory and practice has been strong and, like behavioural medicine, health psychology is really an interdisciplinary field (Marks, 1996). Most of the leading causes of mortality have substantial behavioural components and these behavioural risk factors are the main focus of efforts in the area of health promotion and disease pre- vention, e.g. drug and alcohol use, unsafe sexual behaviour, smoking, diet, a sedentary lifestyle. Psychological methods and expertise are playing an increasing role in treatment and rehabilitation. Contrasting Approaches to Health Psychology Four parallel approaches to health psychology are evolving. The first is ‘clinical health psychology’ that is based on the biopsychosocial model and involves working within the health care system. It locates professional health psychology within hospitals and clinics and is similar in nature to (and partly overlapping with) clinical psychology. The environment for The Health Psychology Reader2 TABLE 1 (Continued) Characteristic Clinical health psychology Public health psychology Community health psychology Critical health psychology Context Patients in the health care Schools, work sites, the media Familes, communities and Social structures, economics, system, i.e. hospitals, clinics, populations within their social, government, and commerce health centres cultural and historical context Focus Physical illness and dysfunction Health promotion and disease Physical and mental health Power prevention promotion Target groups Patients with specific disorders Population groups who are most Healthy but vulnerable or exploited Varies according to the context: vulnerable to health problems persons and groups from the entire global population to the health of an individual Objective To enhance the effectiveness To improve the health of the entire Empowerment and social change Equality of opportunities and of treatments population: reducing morbidity, resources for health disability, and avoidable mortality. Orientation Health service delivery Communication and intervention Bottom-up, working with or Analysis, argument, critique alongside Skills Assessment, therapy, Statistical evaluation; knowledge of Participatory and facilitative; Theoretical analysis; critical consultancy and research health policy; epidemiological working with communities; thinking; social and political methods community development action; advocacy; leadership Discourse and ‘Evidence-based practice’; ‘Responsibility’; ‘Behaviour change’; ‘Freedom’; ‘Empowering’; ‘Power’; ‘Rights’; ‘Exploitation’; buzz words ‘Effectiveness’; ‘Outcomes’; Risk’; ‘Outcomes’; ‘Randomised ‘Giving voice to’; ‘Diversity’; ‘Oppression’; ‘Neo-Liberalism’; ‘Randomised controlled trials’ controlled trials’ ‘Community development’; ‘Justice’; ‘Dignity’; ‘Respect’ ‘Capacity building’; ‘Social capital’; ‘Sence of community’; ‘Inequalities’; ‘Coalitions’ Research Efficacy and effectiveness trials; Epidemiological methods; Participant action research; Critical analysis combined with methodology Quantitative and quasi- Large-scale trials; coalitions between researchers, any of the methods used in experimental methods Multivariate statistics; Evaluation practitioners and communities; the other three approaches multiple methodologies real possibility, the inequities, which are so evident in our streets and in our statistics, must be significantly reduced. Current trends, however, show a widening of the gaps, so there is a lot of work to be done at the policy and economic levels. The psychological aspects of health and illness must be considered in the context of the economic and social environment of people's everyday lives. Health Psychology is Still Developing Health psychology is dynamic field that is still developing. It is not a fixed, well-established activity with well-tried practices and formulas. All who are in the health psychology field can influence its nature and progress. There is room for new ideas, debate and dialogue. Hot topics for discussion are: theories about the nature of health and its determinants; method; and embodiment – how the material and biological body can be the location for meaning, value and intention. Individual behaviour is both socially and biologically determined. The social context of experience and behaviour, and the social and economic determinants of health, are seen as fundamental to a full understanding of the field. Economic and political changes have considerable, long-lasting influence on human well-being. Warfare and terrorism remain intermittent threats to human security. The gap between the ‘haves’ and the ‘have-nots’ widens, the Western population is ageing, and the impacts of learned helplessness, poverty and social isolation are becoming increasingly salient features of society. The health and psycho- logical impacts of global warming and energy addiction present many challenges for the 21st century. To quote Shelley Taylor: 'The only aspect of health psychology that is more exciting than its distinguished past and its impressive present, is its promising future’ (Taylor, 1986: 17).3 As currently defined, health psychology is the application of psychologi- cal theory, methods and research to health, physical illness and health care. Human well-being is a complex product of genetic, developmental and environmental influences. In accordance with the World Health Organisation (WHO) definition, health is seen as well-being in its broadest sense, not sim- ply the absence of illness. Expanding the WHO definition, well-being is the product of a complex interplay of biological, socio-cultural, psychological, economic and spiritual factors. The promotion and maintenance of health involves psychosocial processes at the interface between the individual, the health care system and society (Marks, Murray, Evans and Willig, 2000). Health psychology is concerned with the psychological aspects of the pro- motion, improvement and maintenance of health. The ecological context of these psychological aspects of health includes the many influential social systems within which human beings exist: families, workplaces, organisa- tions, communities, societies and cultures (Dahlgren and Whitehead, 1991; Marks, 1996; Marks, Murray, Evans and Willig, 2000). Any psychological activity, process, or intervention that enhances well-being is of interest to The Health Psychology Reader6 health psychology. Equally, any activity, process, or circumstance which has psychological components and which threatens well-being is of concern to health psychology. Interventions need to be designed in the light of the prevailing environmental conditions that contain the contextual cues for health-related behaviours. The mission of health psychology is to promote and maintain well-being through the application of psychological theory, methods and research, tak- ing into account the economic, political, social and cultural context. The vision of health psychology is to employ psychological knowledge, methods and skills towards the promotion and maintenance of well-being. The latter extends beyond hospitals and clinics – it includes health education and promotion among the healthy population as well as among those who are already sick. The application of psychological knowledge, methods and skills in the promotion and maintenance of well-being is a multi-faceted activity; it is not possible to define the field narrowly. There are many different settings and situations in which psychologists may have a role in promoting and main- taining human health. The psychologist often will be working with lay people, many of whom are patients’ relatives, acting as informal carers: ‘People are not just consumers of health care, they are the true primary care providers in the health care system’ (Sobell, 1995: 238). The psychologist will also work with communities, providing support and expertise to promote their agendas and goals and to help breakdown the barriers that are put up by more powerful factions to reduce their freedom and potential to flourish and grow. Notes 1 For a brief biography of George Stone, see Marks (1997a). 2 In Parts I and V, we will have reasons to question the biopsychosocial model. 3 For a brief biography of Shelley Taylor, see Marks (1997b). Introduction 7