
Penulis : Jane Ogden
Penerbit : Open University Press
Tahun terbit : 2007
Bahasa : Inggris
Tempat terbit : New York, USA
Jumlah halaman : 525 halaman
Format ebook : PDF
Chapter 1 : An Introduction to Health Psychology
The Background to Health Psychology
During the nineteenth century, modern medicine was established. ‘Man’ (the nineteenth-century term) was studied using dissection, physical investigations and medical examinations. Darwin’s thesis, The Origin of Species, was published in 1856 and described the theory of evolution. This revolutionary theory identified a place for man within nature and suggested that we were part of nature, that we developed from nature and that we were biological beings. This was in accord with the biomedical model of medicine, which studied man in the same way that other members of the natural world had been studied in earlier years. This model described human beings as having a biological identity in common with all other biological beings.
What is the Biomedical Model?
The biomedical model of medicine can be understood in terms of its answers to the following questions:
- What causes illness? According to the biomedical model of medicine, diseases either come from outside the body, invade the body and cause physical changes within the body, or originate as internal involuntary physical changes. Such diseases may be caused by several factors such as chemical imbalances, bacteria, viruses and genetic predisposition.
- Who is responsible for illness? Because illness is seen as arising from biological changes beyond their control, individuals are not seen as responsible for their illness. They are regarded as victims of some external force causing internal changes.
- How should illness be treated? The biomedical model regards treatment in terms of vaccination, surgery, chemotherapy and radiotherapy, all of which aim to change the physical state of the body.
- Who is responsible for treatment? The responsibility for treatment rests with the medical profession.
- What is the relationship between health and illness? Within the biomedical model, health and illness are seen as qualitatively different – you are either healthy or ill, there is no continuum between the two.
- What is the relationship between the mind and the body? According to the biomedical model of medicine, the mind and body function independently of each other. This is comparable to a traditional dualistic model of the mind–body split. From this perspective, the mind is incapable of influencing physical matter and the mind and body are defined as separate entities. The mind is seen as abstract and relating to feelings and thoughts, and the body is seen in terms of physical matter such as skin, muscles, bones, brain and organs. Changes in the physical matter are regarded as independent of changes in state of mind.
- What is the role of psychology in health and illness? Within traditional biomedicine, illness may have psychological consequences, but not psychological causes. For example, cancer may cause unhappiness but mood is not seen as related to either the onset or progression of the cancer.
The Twentieth Century
Throughout the twentieth century, there were challenges to some of the underlying assumptions of biomedicine. These developments included the emergence of psychosomatic medicine, behavioural health, behavioural medicine and, most recently, health psychology. These different areas of study illustrate an increasing role for psychology in health and a changing model of the relationship between the mind and body.
Psychosomatic Medicine
The earliest challenge to the biomedical model was psychosomatic medicine. This was developed at the beginning of the twentieth century in response to Freud’s analysis of the relationship between the mind and physical illness. At the turn of the century, Freud described a condition called ‘hysterical paralysis’, whereby patients presented with paralysed limbs with no obvious physical cause and in a pattern that did not reflect the organization of nerves. Freud argued that this condition was an indication of the individual’s state of mind and that repressed experiences and feelings were expressed in terms of a physical problem. This explanation indicated an interaction between mind and body and suggested that psychological factors may not only be consequences of illness but may contribute to its cause.
Behavioural Health
Behavioural health again challenged the biomedical assumptions of a separation of mind and body. Behavioural health was described as being concerned with the maintenance of health and prevention of illness in currently healthy individuals through the use of educational inputs to change behaviour and lifestyle. The role of behaviour in determining the individual’s health status indicates an integration of the mind and body.
Behavioural Medicine
A further discipline that challenged the biomedical model of health was behavioural medicine, which has been described by Schwartz and Weiss (1977) as being an amalgam of elements from the behavioural science disciplines (psychology, sociology, health education) and which focuses on health care, treatment and illness prevention. Behavioural medicine was also described by Pomerleau and Brady (1979) as consisting of methods derived from the experimental analysis of behaviour, such as behaviour therapy and behaviour modification, and involved in the evaluation, treatment and prevention of physical disease or physiological dysfunction (e.g. essential hypertension, addictive behaviours and obesity). It has also been emphasized that psychological problems such as neurosis and psychosis are not within behavioural medicine unless they contribute to the development of illness. Behavioural medicine therefore included psychology in the study of health and departed from traditional biomedical views of health by not only focusing on treatment, but also focusing on prevention and intervention. In addition, behavioural medicine challenged the traditional separation of the mind and the body.
Health Psychology
Health psychology is probably the most recent development in this process of including psychology in an understanding of health. It was described by Matarazzo as ‘the aggregate of the specific educational, scientific and professional contribution of the discipline of psychology to the promotion and maintenance of health, the promotion and treatment of illness and related dysfunction’ (Matarazzo 1980: 815). Health psychology again challenges the mind–body split by suggesting a role for the mind in both the cause and treatment of illness but differs from psychosomatic medicine, behavioural health and behavioural medicine in that research within health psychology is more specific to the discipline of psychology.
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