Reference:
Straub, R. O. (2014). Health Psychology: A Biopsychosocial Approach, 4th Edition.
[VitalSource Bookshelf Online]. Retrieved from
https://kaplan.vitalsource.com/#/books/9781464193880/
Chapter 1: Introducing Health Psychology
Health and Illness: Lessons from the Past
Ancient Views The Middle Ages and the Renaissance Post-Renaissance
RationalityDiscoveries of the Nineteenth Century The Twentieth Century
and the Dawn of a New Era
Biopsychosocial (Mind–Body) Perspective
The Biological Context The Psychological Context The Social
Context Diversity and Healthy Living: The Immigrant Paradox: SES and
the Health of ImmigrantsBiopsychosocial “Systems” Applying the
Biopsychosocial Model
Frequently Asked Questions about a Health Psychology Career
What Do Health Psychologists Do? Your Health Assets: College Does a
Mind and Body Good Where Do Health Psychologists Work? How Do I
Become a Health Psychologist?
Caroline Flynn stepped aboard the 32-ton steamer Mauretania on what must have
been an uncertain morning in the early 1880s. Bound for the United States, her
journey of hope began in Liverpool, England, in a desperate attempt to escape the
economic distress and religious persecution that she and her family suffered in
Ireland. The country’s troubles had begun decades earlier with “an Gorta Mór” (the
Great Hunger)—a famine caused by the potato fungus that destroyed the primary, and
often only, food of most Irish families.
Caroline’s journey was hardly unique. Between 1861 and 1926, four million Irish left
the country for similar reasons, and young people like Caroline were brought up for
“export” overseas. After a harrowing five- to six-week voyage across the Atlantic,
crowded with other emigrants into a steerage compartment that was rarely cleaned,
they endured the humiliating processing of immigrants at Ellis Island. Many of those
who were sick or without financial means or sponsors were forced to return to their
homeland.
As Caroline doggedly made her way in her adopted country, first north to upstate New
York and then west to Chicago, she found that things were better, but life was still
hard. Doctors were expensive (and few in number), and she always had to guard
against drinking impure water, eating contaminated foods, or becoming infected with
typhoid fever, diphtheria, or one of the many other diseases that were prevalent in
those days. Despite her vigilance, her survival (and later that of her husband and
newborn baby) remained uncertain. Life expectancy was less than 50 years, and one
of every six babies died before his or her first birthday. “It would keep you poor, just
burying your children,” wrote one Irishwoman to her family back home (Miller &
Miller, 2001). Equally troubling was the attitude of many native-born Americans, who
viewed the Irish as inferior, violent, and drunken. Most of the new immigrants toiled
as laborers in the lowest-paid and most dangerous occupations, and were banished to
ghettolike “Paddy” towns that sprang up on the outskirts of cities such as New York
and Chicago.
More than a century later, I smile as my mother recounts the saga of my greatgrandmother’s emigration to the United States. Her grandmother lived a long,
productive life and left a legacy of optimism and “indomitable Irishy” that fortified her
against the hardships in her life—and carried down through the generations. “How
different things are now,” I think as our phone call ends, “but how much of Caroline’s
spirit is still alive in my own children!”
Things are very different now. Advances in hygiene, public health measures, and
microbiology have virtually eradicated the infectious diseases that Caroline feared
most. Women born in the United States today enjoy a life expectancy of over 80 years,
and men often reach the age of 73. This gift of time has helped us realize that health is
much more than freedom from illness. More than ever before, we can get beyond
survival mode and work to attain lifelong vitality by modifying our diets, exercising
regularly, and remaining socially connected and emotionally centered.
My great-grandmother’s story makes clear that many factors interact in determining
health. This is a fundamental theme of health psychology, a subfield of psychology
that applies psychological principles and research to the enhancement of health and the
treatment and prevention of illness. Its concerns include social conditions (such as the
availability of health care and support from family and friends), biological factors (such
as family longevity and inherited vulnerabilities to certain diseases), and even
personality traits (such as optimism).
health psychology
The application of psychological principles and research to the enhancement of health
and the prevention and treatment of illness.
The word health comes to us from an old German word that is represented, in English,
by the words hale and whole, both of which refer to a state of “soundness of
body.” Linguists note that these words derive from the medieval battlefield, where loss
of haleness, or health, was usually the result of grave bodily injury. Today, we are more
likely to think of health as the absence of disease rather than as the absence of a
debilitating battlefield injury. Because this definition focuses only on the absence of a
negative state, however, it is incomplete. Although it is true that healthy people are free
of disease, complete health involves much more. A person may be free of disease but still
not enjoy a vigorous, satisfying life. Health involves physical as well as psychological
and social well-being.
health
A state of complete physical, mental, and social well-being.
The health of women is inextricably linked to their status in society. It
benefits from equality and suffers from discrimination.
—World Health Organization
We are fortunate to live in a time when most of the world’s citizens have the promise of
a longer and better life than their great-grandparents, with far less disability and disease
than ever before. However, these health benefits are not universally enjoyed. Consider:
The number of healthy years of life that can be expected by a child born today
differs substantially from country to country, ranging from 37.1 (Haiti) to 71.7 years
(Japan) for women and from 27.9 (Haiti) to 68.8 years (Japan) for men (Salomon
and others, 2012). Infections continue to have a profound impact in populations
deprived of social and economic resources (Semenza, 2010).
The number of new cases of cancer among minority populations in the United
States is projected to double in upcoming decades (U.S. Department of Health and
Human Services, 2011a).
Within the United States, states in the southeast region generally have higher death
rates than those in other regions of the country (Minino & Murphy, 2012).
Violence, drug- and alcohol-related deaths and injuries, accidents, and sexual perils
such as abuse and sexually transmitted infections often mark the transition from
adolescence to adulthood (OECD, 2012).
At every age, these and other health disparities abound. For instance, death
rates vary by ethnic group. Among American men and women, those of European
ancestry have a longer life expectancy than African-Americans, but both groups have
shorter life expectancies than people in Japan, Canada, Australia, the United
Kingdom, Italy, France, and many other countries (U.S. Census Bureau, 2012). It is
estimated that nearly 1 million deaths each year in this country (among all age
groups) are preventable (see Table 1.1).
Table 1.1: Preventable Injury and Death
o
Control of underage and excess use of alcohol could prevent 100,000 deaths from automobile
accidents and other alcohol-related injuries.
o
o
o
o
o
Elimination of public possession of firearms could prevent 35,000 deaths.
Elimination of all forms of tobacco use could prevent 400,000 deaths from cancer, stroke, and heart
disease.
Better nutrition and exercise programs could prevent 300,000 deaths from heart disease, diabetes,
cancer, and stroke.
A reduction in risky sexual behaviors could prevent 30,000 deaths from sexually transmitted
diseases.
Full access to immunizations for infectious diseases could prevent 100,000 deaths.
Source: U.S. Department of Health and Human Services. (2007). Healthy People 2010 midcourse
review. Retrieved January 10, 2010, from http://www.healthypeople.gov/Data/midcourse/.
health disparities
Preventable differences in the burden of disease, injury, violence, or opportunities to
achieve optimal health that are experienced by socially disadvantaged populations.
Although men are twice as likely as women to die of any cause, beginning in middle
age, women have higher disease and disability rates (U.S. Census Bureau, 2012).
Health care costs have risen sharply in the past 50 years. In 1960, health care costs
represented only 5.1 percent of the gross domestic product (GDP) of the United
States. Today, the United States spends $8233 per person (17.6 percent of GDP) on
health care. Although this amount is more than two-and-one-half times more than
most developed nations in the world, the United States has a lower average life
expectancy than that in other affluent countries, fewer physicians and hospital beds
per person, and was ranked by the World Health Organization only 37th out of 191
countries in terms of the overall performance of its health care system, as measured
by such factors as responsiveness, fairness of funding, and accessibility by all
individuals (OECD, 2011; WHO, 2000a).
Data related to health disparities can be found through the WHO
( http://www.who.int/research/en), which documents disparities across
and within countries. For the United States, the Kaiser Family Foundation
( www.kff.org ) provides monthly updates on health disparities and
maintains an interactive Web site ( www.statehealthfacts.org ) with data on
ethnic and racial differences on a state-by-state basis.
These statistics reveal some of the challenges in the quest for global wellness. Health
professionals are working to reduce the 30-year discrepancy in life expectancy between
developed and developing countries, to help adolescents make a safe, healthy transition
to adulthood, and to achieve a deeper understanding of the relationships among gender,
ethnicity, sociocultural status, and health.
In the United States, the Department of Health and Human Services report Healthy
People 2010focused on improving access to health services; eliminating health
disparities between women and men, as well as among various age and sociocultural
groups; and in general on substantially improving the health and quality of life and wellbeing for all Americans. It also noted that nearly 1 million deaths in this country each
year are preventable. Healthy People 2020 expands these goals into specific actions and
targets for reducing chronic diseases such as cancer and diabetes, improving health in
people of all ages, preventing injuries and violence, and taking steps in 32 other areas
(see Table 1.2). Specifically, the overarching goals are to:
attain high-quality, longer lives free of preventable disease, disability, injury, and
premature death.
achieve health equity, eliminate disparities, and improve the health of all groups.
create social and physical environments that promote good health for all.
promote quality of life, healthy development, and healthy behaviors across all life
stages.
Table 1.2: Select Topic Area Goals and Targets
of Healthy People 2020
Adolescent Health
Increase the proportion of adolescents who have had a wellness checkup in the past 12 months (target: 75.6
percent)
Reduce the proportion of adolescents who have been offered, sold, or given an illegal drug on school prope
(target: 20.4 percent)
Physical Activity
Increase the proportion of adults who engage in aerobic physical activity of at least moderate intensity for a
least 150 minutes/week, or 75 minutes/week of vigorous intensity, or an equivalent combination
Increase the proportion of the nation’s public and private schools that require daily physical education for a
students
Nutrition and Weight Status
Increase the proportion of schools that do not sell or offer calorically sweetened beverages to students (targe
21.3 percent)
Increase the proportion of adults who are at a healthy weight (target: 33.9 percent)
Injury and Violence Prevention
Reduce unintentional injury deaths (target: 36.0 deaths per 100,000 population)
Reduce motor vehicle crash-related deaths (target: 12.4 deaths per 100,000 population)
Sleep Health
Increase the proportion of adults who get sufficient sleep (target: 70.9 percent)
Reduce the rate of vehicular crashes per 100 million miles traveled that are due to drowsy driving (target: 2
vehicular crashes per 100 million miles traveled)
Source: http://healthypeople.gov/2020/topicsobjectives2020/pdfs/HP2020objectives.pdf.
To help the nation meet these goals, on March 23, 2010, President Barack Obama
signed the Patient Protection and Affordable Care Act (PPACA), the most
significant overhaul of the U.S. health care system in nearly 50 years. The primary goals
of the new law, which is being implemented incrementally and will be in full effect by
2015, are to decrease the number of people who do not have health insurance and to
lower the costs of health care. Other reforms are aimed at improving health care
outcomes and streamlining the delivery of health care. In addition, under PPACA,
insurers will be required to cover certain types of preventive care at no cost to the
consumer, including blood pressure and cholesterol tests, mammograms, colonoscopies,
and screenings for osteoporosis.
Patient Protection and Affordable Care Act
(PPACA)
A new federal law aimed at reducing the number of people in the United States who do
not have health insurance, as well as lowering the costs of health care.
This chapter introduces the field of health psychology, which plays an increasingly
important role in meeting the world’s health challenges. Consider a few of the more
specific questions that health psychologists seek to answer: How do your attitudes,
beliefs, self-confidence, and personality affect your physiology and your overall health?
Why are so many people turning to acupuncture, yoga, herbal supplements (plus other
forms of alternative medicine), as well as do-it-yourself preventive care? Do these
interventions really work? Why do so many people ignore unquestionably sound advice
for improving their health, such as quitting smoking, moderating food intake, and
exercising more? Why are certain health problems more likely to occur among people of
a particular age, gender, or ethnic group? Why is being poor, uneducated, or lonely a
potentially serious threat to your health? Conversely, why do those who are relatively
affluent, well educated, and socially active enjoy better health?
Health psychology is the science that seeks to answer these and many other questions
about how our wellness interacts with how we think, feel, and act. We begin by taking a
closer look at the concept of health and how it has changed over the course of history.
Next, we’ll examine the biopsychosocial perspective on health psychology, including
how it draws on and supports other health-related fields. Finally, we’ll take a look at the
kind of training needed to become a health psychologist and what you can do with that
training.
Health and Illness: Lessons from the Past
Although all human civilizations have been affected by disease, each one has understood
and treated it differently. At one time, people thought that disease was caused by
demons. At another, they saw it as a form of punishment for moral weakness. Today, we
wrestle with very different questions, such as, “Can disease be caused by an unhealthy
personality?” We will consider how views regarding health and illness have changed by
following a case study through the ages—the story of Mariana, who in 2013 was a 20year-old college sophomore. Mariana presents to her family doctor with a bad headache,
shortness of breath, sleeplessness, a racing heart, and a wild, frightened expression.
How will she be treated? Current understanding of these symptoms would probably lead
most health professionals to suggest that Mariana is suffering from anxiety. Her
treatment today might be a combination of talk therapy, relaxation techniques, and
possibly targeted drug therapy. But as we will see, her treatment through the ages would
have varied widely. (You may want to refer to Figure 1.1 throughout this section to get
a sense of the chronology of changing views toward health and illness.)
Figure 1.1: A Timeline of Historical and Cultural
Variations in Illness and Healing
From the ancient use of trephination to remove evil spirits to the current
use of noninvasive brain scans to diagnose disease, the treatment of health
problems has seen major advances over the centuries. A collection of
treatments across the ages is shown (from left to right): trephination (on an
ancient Peruvian skull); acupuncture from China; early surgery in
seventeenth-century Europe; and vaccination by the district vaccinator in
nineteenth-century London.
Credits (left to right): Trephinated skull engraving by English School (nineteenth
century) published 1878 in “Incidents of Travel and Exploration in the Land of the
Incas” by E. George Squier: private collection/Bridgeman Art Library; illustration
showing acupuncture: © Bettman/Corbis; “The Surgeon,” engraving by German School
(seventeenth century): private collection/Bridgeman Art Library; “Vaccination”
engraving, 1871: Hulton Archive/Stringer/Getty Images.
Ancient Views
Prehistoric Medicine
Our efforts at healing can be traced back 20,000 years. A cave painting in southern
France, for example, which is believed to be 17,000 years old, depicts an Ice Age shaman
wearing the animal mask of an ancient witch doctor. In religions based on a belief in
good and evil spirits, only a shaman (priest or medicine man) can influence these spirits.
For preindustrial men and women, confronted with the often-hostile forces of their
environment, survival was based on constant vigilance against these mysterious forces
of evil. When a person became sick, there was no obvious physical reason for it. Rather,
the stricken individual’s condition was misattributed to weakness in the face of a
stronger force, bewitchment, or possession by an evil spirit (Amundsen, 1996).
During this period of time, Mariana’s symptoms might have been treated with rituals of
sorcery, exorcism, or even a primitive form of surgery called trephination.
Archaeologists have unearthed prehistoric human skulls containing irregularly shaped
holes that were apparently drilled by early healers to allow disease-causing demons to
leave patients’ bodies. Historical records indicate that trephination was a widely
practiced form of treatment in Europe, Egypt, India, and Central and South America.
trephination
An ancient medical intervention in which a hole was drilled into the human skull,
presumably to allow “evil spirits” to escape.
About 4000 years ago, some peoples realized that hygiene also played a role in health
and disease, and they made attempts at improving public hygiene. The ancient
Egyptians, for example, engaged in cleansing rites intended to discourage illnesscausing worms from infesting the body. In Mesopotamia (a part of what is now Iraq),
soap was manufactured, bathing facilities designed, and public sewage treatment
systems constructed (Stone, Cohen, & Adler, 1979).
Greek and Roman Medicine
The most dramatic advances in public health and sanitation were made in Greece and
Rome during the sixth and fifth centuries B.C.E. In Rome, a great drainage system was
built to drain a swamp that later became the site of the Roman Forum. Over time, this
drainage system assumed the broader function of a modern sewage system. Public
bathrooms, for which there was a small admission charge, were commonplace in Rome
by the first century C.E.
… I will prevent disease whenever I can, for prevention is preferable to
cure.
I will remember that I remain a member of society, with special obligations
to all my fellow human beings, those sound of mind and body as well as the
infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live
and remembered with affection thereafter. May I always act so as to
preserve the finest traditions of my calling and may I long experience the
joy of healing those who seek my help.
—Written in 1964 by Louis Lasagna, Academic Dean of the School of
Medicine at Tufts University, this is the modern version of the Hippocratic
Oath used in many medical schools today.
The first aqueduct brought pure water into Rome as early as 312 B.C.E., and cleaning of
public roads was supervised by a group of appointed officials who also controlled the
food supply. This group passed regulations to ensure the freshness of meat and other
perishable foods, and they arranged for the storage of vast quantities of grain, for
example, in an effort to forestall famine.
In ancient Greece, the philosopher Hippocrates (460–377 B.C.E.) was establishing the
roots of Western medicine when he rebelled against the ancient focus on mysticism and
superstition. Hippocrates, who is often called the “father of modern medicine,” was the
first to argue that disease is a natural phenomenon and that the causes of disease (and
therefore their treatment and prevention) are knowable and worthy of serious study. In
this way, he built the earliest foundation for a scientific approach to healing.
Historically, physicians took the Hippocratic Oath, with which they swore to practice
medicine ethically. Over the centuries, the oath has been rewritten to suit the values of
various cultures that were influenced by Greek medicine. A version widely used in U.S.
medical schools today was written in 1964 by Dr. Louis Lasagna of Tufts University.
Hippocrates proposed the first rational explanation of why people get sick, and the
healers of this period in history may have been influenced by his ideas in addressing
Mariana’s problems. According to his humoral theory, a healthy body and mind
resulted from equilibrium among four bodily fluids called humors: blood, yellow bile,
black bile, and phlegm. To maintain a proper balance, a person had to follow a healthy
lifestyle that included exercise, sufficient rest, a good diet, and the avoidance of
excesses. When the humors were out of balance, however, both body and mind were
affected in predictable ways depending on which of the four humors was in excess.
Mariana, for example, might have been considered choleric, with an excess of yellow bile
and a fiery temperament. She might have been treated with bloodletting (opening a vein
to remove blood), liquid diets, enemas, and cooling baths.
humoral theory
A concept of health proposed by Hippocrates that considered wellness a state of perfect
equilibrium among four basic body fluids, called humors. Sickness was believed to be
the result of disturbances in the balance of humors.
Although humoral theory was discarded as advances were made in anatomy, physiology,
and microbiology, the notion of personality traits being linked with body fluids still
persists in the folk and alternative medicines of many cultures, including those of
traditional Eastern and Native American cultures. Moreover, as we’ll see in the next
chapter, we now know that many diseases involve an imbalance (of sorts) among the
brain’s neurotransmitters, so Hippocrates was not too far off.
Hippocrates made many other notable contributions to a scientific approach to
medicine. For example, to learn what personal habits contributed to gout, a disease
caused by disturbances in the body’s metabolism of uric acid, he conducted one of the
earliest public health surveys of gout sufferers’ habits, as well as of their temperatures,
heart rates, respiration, and other physical symptoms. Hippocrates was also interested
in patients’ emotions and thoughts regarding their health and treatment, and thus he
called attention to the psychological aspects of health and illness. “It is better to know
the patient who has the disease,” Hippocrates said, “than it is to know the disease which
the patient has” (quoted in Wesley, 2003).
The next great figure in the history of Western medicine was the physician Claudius
Galen (129–200 C.E.). Galen was born in Greece but spent many years in Rome
conducting dissection studies of animals and treating the severe injuries of Roman
gladiators. In this way, he learned much that was previously unknown about health and
disease. Galen wrote voluminously on anatomy, hygiene, and diet, building on the
Hippocratic foundation of rational explanation and the careful description of each
patient’s physical symptoms.
Galen also expanded the humoral theory of disease by developing an elaborate system of
pharmacology that physicians followed for almost 1500 years. His system was based on
the notion that each of the four bodily humors has its own elementary quality that
determined the character of specific diseases. Blood, for example, is hot and moist.
Galen believed that drugs, too, have elementary qualities; thus, a disease caused by an
excess of a hot and moist humor could be cured only with drugs that were cold and dry.
Although such views may seem archaic, Galen’s pharmacology was logical, based on
careful observation, and similar to the ancient systems of medicine that developed in
China, India, and other non-Western cultures. Many forms of alternative medicine
today use similar ideas.
Non-Western Medicine
At the same time that Western medicine was emerging, different traditions of healing
were developing in other cultures. For example, more than 2,000 years ago, the Chinese
developed an integrated system of healing, which we know today as traditional Oriental
medicine (TOM). TOM is founded on the principle that internal harmony is essential for
good health. Fundamental to this harmony is the concept of qi (sometimes spelled chi),
a vital energy or life force that ebbs and flows with changes in each person’s mental,
physical, and emotional well-being. Acupuncture, herbal therapy, tai chi, meditation,
and other interventions are said to restore health by correcting blockages and
imbalances in qi.
Ayurveda is the oldest-known medical system in the world, having originated in India
around the sixth century B.C.E., coinciding roughly with the lifetime of the Buddha. The
word ayurveda comes from the Sanskrit roots ayuh, which means “longevity,”
and veda, meaning “knowledge.” Widely practiced in India, ayurveda is based on the
belief that the human body represents the entire universe in a microcosm and that the
key to health is maintaining a balance between the microcosmic body and the
macrocosmic world. The key to this relationship is held in the balance of three bodily
humors, or doshas: vata, pitta, and kapha, or, collectively, the tridosha. We’ll explore
the history, traditions, and effectiveness of these and other non-Western forms of
medicine in Chapter 15.
The Middle Ages and the Renaissance
The fall of the Roman Empire in the fifth century C.E. ushered in the Middle Ages (476–
1450), an era between ancient and modern times characterized by a return to
supernatural explanations of health and disease in Europe. The church exerted a
powerful influence over all areas of life at this time. Religious interpretations colored
medieval scientists’ ideas about health and disease. In the eyes of the medieval Christian
church, humans were regarded as creatures with free will who were not subject to the
laws of nature. Because they had souls, neither humans nor animals were considered to
be appropriate objects of scientific scrutiny, and dissection of both was strictly
prohibited. Illness was viewed as God’s punishment for evildoing,
and epidemic diseases, such as the two great outbursts of plague (a bacterial disease
carried by rats and other rodents) that occurred during the Middle Ages, were believed
to be a sign of God’s wrath. Mariana’s “treatment” in this era surely would have involved
attempts to force evil spirits out of her body. There were few scientific advances in
European medicine during these thousand years.
epidemic
Literally, among the people; an epidemic disease is one that spreads rapidly among
many individuals in a community at the same time. A pandemic disease affects people
over a large geographical area.
In the late fifteenth century, a new age—the Renaissance—was born. Beginning with the
reemergence of scientific inquiry, this period saw the revitalization of anatomical study
and medical practice. The taboo on human dissection was lifted sufficiently that the
Flemish anatomist and artist Andreas Vesalius (1514–1564) was able to publish an
authoritative, seven-volume study of the internal organs, musculature, and skeletal
system of the human body. The son of a druggist, Vesalius was fascinated by nature,
especially the anatomy of humans and animals. In the pursuit of knowledge, no stray
dog, cat, or mouse was safe from his scalpel.
The Middle Ages began with an outbreak of plague that originated in Egypt
in 540 C.E. and quickly spread throughout the roman empire, killing as
many as 10,000 people a day. So great in number were the corpses that
gravediggers could not keep up. The solution was to load ships with the
dead, row them out to sea, and abandon them.
In medical school, Vesalius turned his dissection scalpel on human cadavers. What he
found proved some of the medical writings of Galen and earlier physicians to be clearly
inaccurate. How, he wondered, could an unquestionable authority such as Galen have
made so many errors in describing the body? Then he realized why: Galen had never
dissected a human body. Vesalius’s volumes became the cornerstones of a new scientific
medicine based on anatomy (Sigerist, 1958, 1971).
First Anatomical Drawings
By the sixteenth century, the taboo on human dissection had been lifted
long enough that the Flemish anatomist and artist Andreas Vesalius (1514–
1564) was able to publish a complete study of the internal organs,
musculature, and skeletal system of the human body.
Musculature of a man by Andreas Vesalius, 1543. Fratelli Fabbri, Milan,
Italy/Bridgeman Art Library.
One of the most influential Renaissance thinkers was the French philosopher and
mathematician René Descartes (1596–1650), whose first innovation was the concept of
the human body as a machine. He described all the basic reflexes of the body,
constructing elaborate mechanical models to demonstrate his principles. He believed
that disease occurred when the machine broke down, and the physician’s task was to
repair the machine.
Descartes is best known for his beliefs that the mind and body are autonomous
processes that interact minimally, and that each is subject to different laws of causality.
This viewpoint, which is called mind–body dualism (or Cartesian dualism), is based
on the doctrine that humans have two natures, mental and physical. Descartes and other
great thinkers of the Renaissance, in an effort to break with the mysticism and
superstitions of the past, vigorously rejected the notion that the mind influences the
body. Mariana’s condition and its connection to her emotional well-being were now
even less likely to be properly understood. Although this viewpoint ushered in a new age
of medical research based on confidence in science and rational thinking, it created a
lasting bias in Western medicine against the importance of psychological processes in
health. As we’ll see, this bias has been rapidly unraveling since the 1970s.
mind–body dualism
The philosophical viewpoint that mind and body are separate entities that do not
interact.
Post-Renaissance Rationality
Following the Renaissance, physicians were expected to focus exclusively on the
biological causes of disease. The ancient humoral theory of Hippocrates was finally
discarded in favor of this new anatomical theory of disease. Physicians at this time
would have considered internal causes for Mariana’s symptoms, such as heart or brain
malfunctions.
anatomical theory
The theory that the origins of specific diseases are found in the internal organs,
musculature, and skeletal system of the human body.
Science and medicine changed rapidly during the seventeenth and eighteenth centuries,
spurred on by numerous advances in technology. Perhaps the single most important
invention in medicine during this period was the microscope. Although a ground lens
had been used for magnification in ancient times, it was a Dutch cloth merchant (and
part-time scientist) named Anton van Leeuwenhoek (1632–1723) who fashioned the
first practical microscope. Using his microscope, Leeuwenhoek was the first to observe
blood cells and the structure of skeletal muscles.
Discoveries of the Nineteenth Century
Once individual cells became visible, the stage was set for the cellular theory of
disease—the idea that disease results when body cells malfunction or die. It was the
French scientist Louis Pasteur (1822–1895), however, who truly rocked the medical
world with a series of meticulous experiments showing that life can only come from
existing life. Until the nineteenth century, scholars believed in spontaneous
generation—the idea that living organisms can be formed from nonliving matter. For
example, maggots and flies were believed to emerge spontaneously from rotting meat.
To test his hypothesis, Pasteur filled two flasks with a porridgelike liquid, heating both
to the boiling point to kill any microorganisms. One of the flasks had a wide mouth into
which air could flow easily. The other flask was also open to air, but had a long curved
neck that kept any airborne microbes from falling into the liquid. To the amazement of
skeptics, no new growth appeared in the curved flask. However, in the flask with the
ordinary neck, microorganisms contaminated the liquid and multiplied rapidly. By
showing that a genuinely sterile solution remains lifeless, Pasteur set the stage for the
later development of aseptic (germ-free) surgical procedures. Even more important,
Pasteur’s successful challenge of a 2000-year-old belief is a powerful demonstration of
the importance of keeping an open mind in scientific inquiry.
cellular theory
Formulated in the nineteenth century, the theory that disease is the result of
abnormalities in body cells.
Pasteur’s discoveries helped shape the germ theory of disease—the idea that bacteria,
viruses, and other microorganisms that invade body cells cause them to malfunction.
The germ theory, which is basically a refinement of the cellular theory, forms the
theoretical foundation of modern medicine.
germ theory
The theory that disease is caused by viruses, bacteria, and other microorganisms that
invade body cells.
Louis Pasteur in His Laboratory
Pasteur’s meticulous work in isolating bacteria in the laboratory, then
showing that life can come only from existing life, paved the way for germfree surgical procedures.
© Bettman/Corbis
Following Pasteur, medical knowledge and procedures developed rapidly. In 1846,
William Morton (1819–1868), an American dentist, introduced the gas ether as an
anesthetic. This great advance made it possible to operate on patients, who experienced
no pain and thus remained completely relaxed. The German physicist Wilhelm
Roentgen (1845–1943) discovered x-rays 50 years later, and, for the first
time, physicians were able to observe internal organs in a living person directly. Before
the end of the century, researchers had identified the microorganisms that caused
malaria, pneumonia, diphtheria, syphilis, typhoid, and other diseases that my greatgrandmother’s generation feared. Armed with this information, medicine began to bring
under control diseases that had plagued the world since antiquity.
The Twentieth Century and the Dawn of a New Era
As the field of medicine continued to advance during the early part of the twentieth
century, it looked more and more to physiology and anatomy, rather than to the study of
thoughts and emotions, in its search for a deeper understanding of health and illness.
Thus was born the biomedical model of health, which maintains that illness always
has a biological cause. Under the impetus of the germ and cellular theories of disease,
this model first became widely accepted during the nineteenth century and continues to
represent the dominant view in medicine today.
biomedical model
The dominant view of twentieth-century medicine that maintains that illness always has
a physical cause.
The biomedical model has three distinguishing features. First, it assumes that disease is
the result of a pathogen—a virus, bacterium, or some other microorganism that
invades the body. The model makes no provision for psychological, social, or behavioral
variables in illness. In this sense, the biomedical model embraces reductionism, the
view that complex phenomena (such as health and disease) derive ultimately from a
single primary factor. Second, the biomedical model is based on the Cartesian doctrine
of mind–body dualism that, as we have seen, considers the mind and the body as
separate and autonomous entities that interact minimally. Finally, according to the
biomedical model, health is nothing more than the absence of disease. Accordingly,
those who work from this perspective focus on investigating the causes of physical
illnesses rather than on those factors that promote physical, psychological, and social
vitality. Physicians working strictly from the biomedical perspective would focus on the
physiological causes of Mariana’s headaches, racing heart, and shortness of breath,
rather than considering whether a psychological problem could be contributing to these
symptoms.
pathogen
A virus, bacterium, or some other microorganism that causes a particular disease.
Psychosomatic Medicine
The biomedical model advanced health care significantly through its focus on
pathogens. However, it was unable to explain disorders that had no observable physical
cause, such as those uncovered by Sigmund Freud (1856–1939), who was initially
trained as a physician. Freud’s patients exhibited symptoms such as loss of speech,
deafness, and even paralysis. Freud believed these maladies were caused by unconscious
emotional conflicts that had been “converted” into a physical form. Freud labeled such
illnesses conversion disorders, and the medical community was forced to accept a new
category of disease.
In the 1940s, Franz Alexander advanced the idea that an individual’s psychological
conflicts could cause specific diseases. When physicians could find no infectious agent
or other direct cause for rheumatoid arthritis, Alexander became intrigued by the
possibility that psychological factors might be involved. According to his nuclear
conflict model, each physical disease is the outcome of a fundamental, or nuclear,
psychological conflict (Alexander, 1950). For example, individuals with a “rheumatoid
personality,” who tended to repress anger and were unable to express emotion, were
believed to be prone to developing arthritis. Alexander helped
establish psychosomatic medicine, a reformist movement within medicine named
from the root words psyche, which means “mind,” and soma, which means “body.”
Psychosomatic medicine is concerned with the diagnosis and treatment of physical
diseases thought to be caused by faulty processes within the mind. This new field
flourished, and soon the journal Psychosomatic Medicine was publishing psychological
explanations of a range of health problems that included hypertension, migraine
headaches, ulcers, hyperthyroidism, and bronchial asthma. At this time, Mariana might
have been treated by Freud’s psychoanalysis—talk therapy that delves into one’s
childhood and attempts to uncover unresolved conflicts.
psychosomatic medicine
Anoutdated branch of medicine that focused on the diagnosis and treatment of physical
diseases caused by faulty psychological processes.
Psychosomatic medicine was intriguing and seemed to explain the unexplainable.
However, it had several weaknesses that ultimately caused it to fall out of favor. Most
significantly, psychosomatic medicine was grounded in Freudian theory. As Freud’s
emphasis on unconscious, irrational urges in personality formation lost popularity, the
field of psychosomatic medicine faltered. Psychosomatic medicine, like the biomedical
model, was also based on reductionism—in this case, the outmoded idea that a single
psychological problem or personality flaw is sufficient to trigger disease. We now know
that disease, like good health, is based on the combined interaction of multiple factors,
including heredity and environment, as well as the individual’s psychological makeup.
Although Freud’s theories and psychosomatic medicine were flawed, they laid the
groundwork for a renewed appreciation of the connections between medicine and
psychology. This was the start of the contemporary trend toward viewing illness and
health as multifactorial. That is, many diseases are caused by the interaction of several
factors, rather than by a single, invading bacterial or viral agent. Among these are host
factors (such as genetic vulnerability or resiliency), environmental factors (such as
exposure to pollutants and hazardous chemicals), behavioral factors (such as diet,
exercise, and smoking), and psychological factors (such as optimism and overall
“hardiness”).
Behavioral Medicine
During the first half of the twentieth century, the behaviorist movement dominated
American psychology. Behaviorists defined psychology as the scientific study of
observable behavior, and they emphasized the role of learning in the acquisition of most
human behavior.
By the early 1970s, behavioral medicine began to explore the role of learned
behaviors in health and disease. One of its early successes was the research of Neal
Miller (1909–2002), who used operant conditioning techniques to teach laboratory
animals (and later humans) to gain control over certain bodily functions. Miller
demonstrated, for example, that people could gain some control over their blood
pressure and resting heart rate when they were made aware of these physiological
states. Miller’s technique, called biofeedback, is discussed more fully in Chapter 4. By
this time in history, our anxiety sufferer, Mariana, would most likely have been
diagnosed correctly and treated in a way that brought her some relief from her
symptoms—perhaps including a combination of biofeedback and other relaxation
techniques.
behavioral medicine
An interdisciplinary field that integrates behavioral and biomedical science in
preventing, diagnosing, and treating illness.
Although the wellspring for behavioral medicine was the behaviorist movement in
psychology, a distinguishing feature of this field is its interdisciplinary nature. It draws
its membership from such diverse academic fields as anthropology, sociology, molecular
biology, genetics, biochemistry, and psychology, as well as the healing professions of
nursing, medicine, and dentistry. Behavioral medicine integrates these various fields
with the goal of improving the prevention, diagnosis, and treatment of disease. The
practice of behavioral medicine thus includes health psychology, along with
occupational therapy, rehabilitation medicine, and other applied therapies.
The Emergence of Health Psychology
In 1973, the American Psychological Association (APA) appointed a task force to explore
psychology’s role in the field of behavioral medicine, and in 1978, the APA created the
division of health psychology (Division 38). Four years later, the first volume of its
official journal, Health Psychology, was published. In this issue, Joseph Matarazzo, the
first president of the division, laid down the four goals of the new field:
To study scientifically the causes or origins of specific diseases, that is,
their etiology. Health psychologists are primarily interested in the psychological,
behavioral, and social origins of disease. They investigate why people engage
in health-compromising behaviors, such as smoking or unsafe sex.
etiology
The scientific study of the causes or origins of specific diseases.
To promote health. Health psychologists consider ways to get people to engage
in health-enhancing behaviors such as exercising regularly and eating nutritious
foods.
To prevent and treat illness. Health psychologists design programs to help people
stop smoking, lose weight, manage stress, and minimize other risk factors for poor
health. They also assist those who are already ill in their efforts to adjust to their
illnesses or comply with difficult treatment regimens.
To promote public health policy and the improvement of the health care system.
Health psychologists are very active in all facets of health education and consult
frequently with government leaders who formulate public policy in an effort to
improve the delivery of health care to all people.
As noted in Table 1.3, a number of twentieth-century trends helped shape the new field
of health psychology, pushing it toward the broader biopsychosocial perspective, which
is the focus of this text.
Table 1.3: Twentieth-Century Trends That Shaped
Health Psychology
Trend
Increased life expectancy
Rise of lifestyle disorders (for example,
cancer, stroke, and heart disease)
Rising health care costs
Rethinking the biomedical model
Result
Recognize the need to take better care of ourselves to promote vitali
through a longer life
Educate people to avoid the behaviors that contribute to these diseas
(for example, smoking and eating a high-fat diet)
Focus efforts on ways to prevent disease and maintain good health to
avoid these costs
Develop a more comprehensive model of health and disease—the
biopsychosocial approach
Biopsychosocial (Mind–Body) Perspective
As history tells us, looking at just one causative factor paints an incomplete picture of a
person’s health or illness. Health psychologists therefore work from a biopsychosocial
(mind–body) perspective. As depicted in Figure 1.2, this perspective recognizes
that biological, psychological, and sociocultural forces act together to determine an
individual’s health and vulnerability to disease; that is, health and disease must be
explained in terms of multiple contexts.
Figure 1.2: The Biopsychosocial Model of
Mariana’s Anxiety
According to the biopsychosocial perspective, all health behaviors are best
explained in terms of three contexts: biological processes, psychological
processes, and social influences. This diagram illustrates how these three
processes could influence anxiety, as experienced by Mariana in the case
study example (p. 7).
biopsychosocial (mind–body) perspective
The viewpoint that health and other behaviors are determined by the interaction of
biological mechanisms, psychological processes, and social influences.
The Biological Context
All behaviors, including states of health and illness, occur in a biological context. Every
thought, mood, and urge is a biological event made possible because of the characteristic
anatomical structure and biological function of a person’s body. Health psychology
draws attention to those aspects of our bodies that influence health and disease: our
genetic makeup and our nervous, immune, and endocrine systems (see Chapter 3).
Genes provide a guideline for our biology and predispose our behaviors—healthy and
unhealthy, normal and abnormal. For example, the tendency to abuse alcohol has long
been known to run in some families (see Chapter 9). One reason is that alcohol
dependency is at least partly genetic, although it does not seem to be linked to a single,
specific gene. Instead, some people may inherit a greater sensitivity to alcohol’s physical
effects, experiencing intoxication as pleasurable and the aftermath of a hangover as
minor. Such people may be more likely to drink, especially in certain psychological and
social contexts. The complete set of genetic instructions that make a living organism is
called its genome. Rapid advances in the new field of genomics (the study of genomes)
reflect the increasing scientific evidence supporting the benefits of using genetic tests
and family history to improve health. As evidence mounts, these benefits are being
incorporated as new target areas that will appear in Healthy People 2020.
genomics
The study of the structure, function, and mapping of the genetic material of organisms.
A key element of the biological context is our species’ evolutionary history, and
an evolutionary perspective guides the work of many health psychologists. Our
characteristic human traits and behaviors exist as they do because they helped our
distant ancestors survive long enough to reproduce and send their genes into the future.
For example, natural selection has favored the tendency of people to become hungry in
the presence of a mouthwatering aroma (see Chapter 8). This sensitivity to foodrelated cues makes evolutionary sense in that eating is necessary for survival—
particularly in the distant past when food supplies were unpredictable and it was
advantageous to have a healthy appetite when food was available.
At the same time, biology and behavior constantly interact. For example, some
individuals are more vulnerable to stress-related illnesses because they angrily react to
daily hassles and other environmental “triggers” (see Chapter 4). Among men, these
triggers are correlated with aggressive reaction related to increased amounts of the
hormone testosterone. This relationship, however, is reciprocal: Angry outbursts can
also lead to elevated testosterone levels. One of the tasks of health psychology is to
explain how (and why) this mutual influence between biology and behavior occurs.
It is also important to recognize that biology and behavior do not occur in a vacuum. At
first, the remarkable success of the Human Genome Project in mapping all the genes
that make up a person seemed to suggest that genes might determine everything; that
every aspect of you, including your health, will become whatever you are biologically
destined to be. We now know otherwise. It is true that genes influence all traits, both
psychological and physical. But even identical twins, who share identical genes,
do not have identical traits (Poulsen and others, 2007). Increasingly, we’re learning that
most important traits are epigenetic. Epigenetic effects occur throughout our lifetimes.
Some “epi-” influences impede our chances for optimal health (for example,
environmental toxins, child abuse, and poverty), and some improve them (for example,
nourishing food, safe places to grow up, and education). One example of this type of
gene–environment interaction comes from research on the MAOA gene, which codes for
an enzyme that affects key neurotransmitters in the brain. Boys who inherit one
variation of the gene, and girls who inherit a different variation of the same gene, are
more likely to engage in high-risk delinquent behavior as adolescents, but only if they
were exposed to the “epi-” effect of maltreatment as children (Aslund and others, 2011).
The variations in question are gene promoters, regions of DNA that regulate the
expression of that gene.
epigenetic
The effects of environmental forces on how genes are expressed.
As another example, consider DNA methylation, a biochemical process that occurs in
cells and is essential to the healthy functioning of nearly every body system. Occurring
billions of time each second, methylation helps regulate the expression of genes that
repair DNA, keep inflammation in check, and promote healthy blood vessels. A
breakdown in methylation may promote the development of cancer, diabetes,
cardiovascular disease, and even accelerate aging (Alashwal, Dosunmu, & Zawia, 2012).
The degree of methylation changes over the life span and is also influenced by “epi-”
effects such as diet, tobacco use, and exposure to environmental toxins (Davis & Uthus,
2004).
These examples of epigenetic research demonstrate that gene–environment effects are
always important. Some genes are expressed and affect our health, while some genes
are silenced and remain unnoticed from one generation to the next unless
circumstances, such as the quality of nurturing during childhood, change (Riddihough &
Zahn, 2010; Skipper, 2011).
Life-Course Perspective
Within the biological context, the life-course perspective in health psychology
focuses on important age-related aspects of health and illness. This perspective would
consider, for example, how a pregnant woman’s malnutrition, smoking, or use of
psychoactive drugs would affect her child’s lifelong development. Her child might be
born early and suffer from low birth weight (less than 2500 grams [5 pounds]). Low
birth weight is one of the most common, and most preventable, problems of prenatal
development. Consequences include smaller brain volume; slowed motor, social, and
language development; increased risk of cerebral palsy; heart disease and diabetes;
long-term learning difficulties; and even death (Jalil and others, 2008; van Soelen and
others, 2010).
life-course perspective
Theoretical perspective that focuses on age-related aspects of health and illness.
The roots of the word are revealing: epi means “around” or
“near.” Epigenetic, therefore, calls attention to environmental factors near
and around genes that affect their expression.
The life-course perspective also considers the leading causes of death in terms of the age
groups affected. In 2011, five major causes of death (heart disease, cancer, chronic lower
respiratory diseases, stroke, and accidents) accounted for nearly two-thirds of all deaths
in the United States (Centers for Disease Control and Prevention, 2013). However, the
profile of leading causes of death varies by age group. The chronic diseases that are the
leading causes of death in the overall population are more likely to affect middle-aged
and elderly adults. Young people between the ages of 1 and 24 years old are much more
likely to die from external causes that include accidents, homicide, and suicide, followed
by cancer and heart disease (see Figure 1.3).
Figure 1.3: The Leading Causes of Death in the
United States by Age Group
The five leading causes of death in young people include external causes
(accidents, homicide, and suicide), followed by cancer and heart disease.
This pattern of external causes accounting for more deaths than chronic
conditions changes as people get older. In older age groups, chronic
conditions account for more deaths than do external causes. For example,
accidents account for more than one-third of all deaths among persons aged
1–24 years. Accidental deaths are rarer in older age groups and do not even
rank as one of the five leading causes of death in people 65 years and older.
Source: Minino, A.M., and Murphy, S.L. (2012). Death in the United States,
2010. NCHS data brief, no. 99. Hyattsville, MD: National Center for Health Statistics.
The Psychological Context
The central message of health psychology is, of course, that health and illness are subject
to psychological influences. For example, a key factor in how well a person copes with a
stressful life experience is how the event is appraised or interpreted (see Chapter 5).
Events that are appraised as overwhelming, pervasive, and beyond our control take a
much greater toll on us physically and psychologically than do events that are appraised
as minor challenges that are temporary and surmountable. Indeed, some evidence
suggests that, whether a stressful event is actually experienced or merely imagined, the
body’s stress response is nearly the same. Health psychologists think that some people
may be chronically depressed and more susceptible to certain health problems because
they replay stressful events over and over again in their minds, which may be
functionally equivalent to repeatedly encountering the actual event. The new field
of positive psychology has given rise to many studies of the importance of subjective
well-being—our feelings of happiness and sense of satisfaction with life (see Table
1.4). Throughout this book, we will examine the health implications of thinking,
perception, motivation, emotion, learning, attention, memory, and other topics of
central importance to psychology.
Table 1.4: Testing Yourself: Subjective Well-Being
The WHO-5 Well-Being Index (WHO-5) is a self-report mood questionnaire developed
by the World Health Organization’s Collaborating Center in Mental Health.
For each statement, please indicate which is closest to how you have been feeling over
the last two weeks. For example, if you have felt cheerful and in good spirits more than
half of the time during the last two weeks, put a tick in the box with the number 3 in the
upper-right corner.
Over the last two weeks
I have felt cheerful and in good
spirits
1.
2.I have felt calm and relaxed
All of the Most of
time
the time
More then half Less then half
of the time
of the time
Some of
the time
5
4
3
2
1
5
4
3
2
1
At n
time
0
Over the last two weeks
All of the Most of
time
the time
3.I have felt active and vigorous
4.I woke up feeling fresh and rested
My daily life has been filled with
things that interest me
5.
More then half Less then half
of the time
of the time
Some of
the time
At n
time
5
4
3
2
1
0
5
4
3
2
1
0
5
4
3
2
1
0
The raw score is calculated by totaling the figures of the five answers. The raw score
ranges from 0 to 25, 0 representing worst possible and 25 representing best possible
quality of life. A score below 13 indicates poor subjective well-being and may be an
indication for additional testing for depression.
Source: Bech, P. (2004). Measuring the dimensions of psychological general well-being by the WHO5. Quality of Life Newsletter, vol. 32, 15–16.
subjective well-being
The cognitive and emotional evaluations of a person’s life.
Psychological factors also play an important role in the treatment of chronic conditions.
The effectiveness of all health care interventions—including medication and surgery, as
well as acupuncture and other alternative treatments—is powerfully influenced by a
patient’s attitude. A patient who believes a drug or other treatment will only cause
miserable side effects may experience considerable tension, which can actually worsen
his or her physical response to the treatment. This reaction can set up a vicious cycle in
which escalating anxiety before treatment is followed by progressively worse physical
reactions as the treatment regimen proceeds. On the other hand, a patient who is
confident that a treatment will be effective may actually experience a greater therapeutic
response to that treatment.
Psychological interventions can help patients learn to manage their tension, thereby
lessening negative reactions to treatment. Patients who are more relaxed are usually
better able, and more motivated, to follow their doctors’ instructions. Psychological
interventions can also assist patients in managing the everyday stresses of life, which
seem to exert a cumulative effect on the immune system. Negative life events such as
bereavement, divorce, job loss, or relocation have been linked to decreased immune
functioning and increased susceptibility to illness. By teaching patients more effective
ways of managing unavoidable stress, health psychologists may help patients’ immune
systems combat disease.
The Social Context
Turn-of-the-century Irish immigrants like my great-grandmother surmounted poverty
and prejudice in the United States by establishing Irish-American associations that
strongly reflected an ethic of family and communal support. “Each for himself, but all
for one another,” wrote recent immigrant Patrick O’Callaghan to his sister back home,
as he described this system of patronage. In placing health behavior in its social context,
health psychologists consider the ways in which we think about, influence, and relate to
one another and to our environments. Your gender, for example, entails a particular,
socially prescribed role that represents your sense of being a woman or a man. In
addition, you are a member of a particular family, community, and nation; you also have
a certain racial, cultural, and ethnic identity, and you live within a specific
socioeconomic class. You are influenced by the same historical and social factors as
others in your birth cohort—a group of people born within a few years of each other.
For example, those who lived 100 years ago were more likely to die from diseases that
we in developed countries today consider preventable, such as tuberculosis and
diphtheria (Table 1.5), and infant mortality in the United States has dropped
significantly (Figure 1.4). Each of these elements of your unique social context affects
your experiences and influences your beliefs and behaviors—including those related to
health.
Table 1.5: Leading Causes of Death in the United
States, 1900 and 2010
1900
Pneumonia
Tuberculosis
Diarrhea and enteritis
Heart disease
Liver disease
Accidents
Cancer
Senility
Diphtheria
Percent
11.8
11.3
8.3
5.2
5.2
4.2
3.7
2.9
2.3
2010*
Percent of All Deaths
Heart disease
24.2
Cancer
23.3
Chronic lower respiratory diseases
5.6
Cerebrovascular diseases (stroke)
5.2
Accidents
4.8
Alzheimer’s disease
3.4
Diabetes mellitus
2.8
Kidney disease
2.0
Influenza and pneumonia
2.0
Intentional self-harm (suicide)
1.5
Sources: Murphy, S.L., Xu, J.Q., and Kochanek, K.D. (2012). Deaths: Preliminary data for 2010. National Vital
Statistics Reports; 60(4). Table B. Hyattsville, MD: National Center for Health Statistics.
*
Note that the leading causes of death in 2010 were not new diseases; they were present
in earlier times, but fewer people died from them, or they were called something else.
Figure 1.4: Infant Mortality in the United States
Less than a century ago, 15 percent of babies born in the United States died
before their first birthday. For those who survived, life expectancy was only
slightly more than 50 years. With improved health care, today more than 90
percent of newborn babies survive to at least 1 year of age.
Sources: Historical Statistics of the United States: Colonial Times to 1970, by U.S.
Bureau of the Census, 1975, Washington, DC: U.S. Government Printing Office, p. 60;
Infant mortality rates by race—States, The 2010 Statistical Abstract, by U.S. Census
Bureau, Washington, DC: U.S. Government Printing Office, Table 113.
birth cohort
A group of people who, because they were born at about the same time, experience
similar historical and social conditions.
Consider the social context in which a chronic disease such as cancer occurs. A spouse,
significant other, or close friend provides an important source of social support for
many cancer patients. Women and men who feel socially connected to a network of
caring friends are less likely to die of all types of cancer than their socially isolated
counterparts (see Chapter 11). Feeling supported by others may serve as a buffer that
mitigates the output of stress hormones and keeps the body’s immune defenses strong
during traumatic situations. It may also promote better health habits, regular checkups,
and early screening of worrisome symptoms—all of which may improve a cancer victim’s
odds of survival.
Sociocultural Perspective
Within the social context, the sociocultural perspective considers how social and
cultural factors contribute to health and disease. When psychologists use the
term culture, they refer to the enduring behaviors, values, and customs that a group of
people have developed over the years and transmitted from one generation to the next.
Within a culture, there may be two or more ethnic groups—large groups of people who
tend to have similar values and experiences because they share certain characteristics.
sociocultural perspective
Theviewpoint that it is impossible to understand a person fully without understanding
his or her culture and ethnic identity.
In multiethnic cultures such as those of the United States and most large nations, wide
disparities still exist between the life expectancy and health status of ethnic minority
groups and the majority population. These disparities were even greater among previous
cohorts, such as the ethnic groups of my great-grandmother and others who emigrated
to America. Some of these differences undoubtedly reflect variation in socioeconomic
status (SES), which is a measure of several variables, including income, education, and
occupation. For example, the highest rates of chronic disease occur among people who
are at the lowest SES levels (AHRQ, 2012). Evidence also suggests that bias, prejudice,
and stereotyping on the part of health care providers may be factors. Minorities tend to
receive lower-quality health care than whites do, even when insurance status, income,
age, and severity of conditions are comparable (AHRQ, 2012).
Sociocultural forces also play an important role in the variation in health-related beliefs
and behaviors. For example, traditional Native American health care practices are
holistic and do not distinguish separate models for mental and physical illnesses. As
another example, Christian Scientists traditionally reject the use of medicine in their
belief that sick people can be cured only through prayer. And Judaic law prescribes that
God gives health, and it is the responsibility of each individual to protect it.
In general, health psychologists working from the sociocultural perspective have found
wide discrepancies not only among ethnic groups, but also within these groups. Latinos,
for example, are far from homogeneous. The three major nationality groups—Mexicans,
Puerto Ricans, and Cubans—differ in education, income, overall health, and risk of
disease and death (Angel, Angel, & Hill, 2008; Bagley and others, 1995). Socioeconomic,
religious, and other cultural patterns also may explain why variations in health are
apparent not just among ethnic groups, but also from region to region, state to state,
and even from one neighborhood to another. For example, out of every 1,000 live births,
the number of infants who die before reaching their first birthday is much greater in the
District of Columbia (13.1 percent), Mississippi (10.0 percent), and Louisiana (9.2
percent) than in Washington (4.8 percent), Vermont (5.1 percent), and Utah (5.1
percent) (U.S. Census Bureau, 2011). In terms of your overall health, the way you age
seems to depend on where you live.
Gender Perspective
Also within the social context, the gender perspective in health psychology focuses on
the study of gender-specific health behaviors, problems, and barriers to health care.
With the exceptions of reproductive-system problems and undernourishment, men are
more vulnerable than women to nearly every other health problem. Although biology
certainly plays a part in gender differences in health, masculinity norms have also been
implicated (Gough, 2013). Compared to women, men are more likely to:
make unhealthy food choices,
be overweight,
exceed guidelines for alcohol consumption and engage in binge drinking,
ignore illness symptoms and avoid seeing doctors,
engage in risky competitive sports where there is a higher rate of injury, and
be at greater risk for nearly all the major diseases that affect both sexes.
gender perspective
A focus on the study of gender-specific health behaviors, problems, and barriers to
health care.
Diversity and Healthy Living: The Immigrant
Paradox: SES and the Health of Immigrants
A dramatic example of research stemming from the sociocultural perspective concerns
the surprising health of Latinos in the United States considering their generally lower
incomes and education levels. In general, low SES correlates with poorer health
outcomes. This is true for low birth weight, the rate of which increases worldwide as
income falls. Immigrants to the United States, especially those from Spanish-speaking
countries, have an average lower SES than native-born Americans. Logically, then,
researchers would expect babies born to immigrants to weigh less than those born to
native-born women. But, paradoxically, babies born to U.S. immigrants are healthier in
every way, including birth weight, than babies of the same ethnicity whose mothers, like
their babies, were born in the United States. This surprising finding, which was first
documented among Mexican-Americans and is also true for U.S. immigrants from other
Spanish-speaking countries, from the Caribbean, and from parts of Eastern Europe,
continues after birth. Throughout childhood, children born to low-SES immigrants seem
to do better in health and cognition than native-born children of the same ethnicity and
income (García Coll & Marks, 2012). Remarkably, the immigrant paradox (also
called the Hispanic paradox or Latino paradox) is found throughout the life span.
Although Latinos in the United States generally have lower SES, are less likely to have
health insurance, use health care less often, and receive less in the way of highlevel care
when they are sick, they appear to have lower rates of heart disease, cancer, and stroke—
the biggest killers of Americans.
immigrant paradox
The finding that, although low socioeconomic status usually predicts poor health, this is
not true for Hispanics and other ethnic groups in the United States.
Carry this out a generation or two, however, and things change. The children and
grandchildren of immigrants typically surpass their elders in income and education, but
as SES increases, so does the prevalence of virtually every illness and chronic condition,
including obesity, diabetes, cardiovascular disease, and cancer (Garcia Coll & Marks,
2012). By the time an immigrant family has been in the United States for two
generations, the “playing field” has been leveled: The grandchildren of immigrants die at
the same rate as those of native-born Americans (Barger & Gallo, 2008).
Even within the life span of a single person, the immigrant paradox can be observed.
Adults who immigrated to the United States within the past year are one-tenth as likely
to be obese as are their counterparts who arrived as children and who have lived in this
country for 15 years or more (Roshania and others, 2008). Similar disparities exist for
diabetes, cardiovascular disease, and many other chronic conditions.
One possible explanation for the immigrant paradox, called the healthy migrant effect,
is that people who choose to leave their native country are healthier to begin with,
despite being poor. Although it may be true that some people do not emigrate because
they are too sick to make what is often a hazardous journey, this effect is not sufficient to
explain the immigrant health advantage (Garcia Coll & Marks, 2012).
The idea that masculinity is bad for men’s health is a strong theme in health psychology.
The effect is cumulative, and by age 80, women outnumber men 2 to 1 (U.S. Census
Bureau, 2011)
Sociocultural Bias in Diagnosis
Physicians were told that these supposed “heart patients” were identical in
occupation, symptoms, and every other respect except age, race, and
gender. Although catheterization was the appropriate treatment for the
described symptoms, the physicians were much more likely to recommend
it for the younger, white, male patients than for the older, female, or black
patients.
Source: Schulman, K.A. and others. (1999). The effect of race and sex on physician’s
recommendations for cardiac catherization. New England Journal of Medicine, 340,
618–625.
As another example of research guided by the gender perspective, consider that the
medical profession has a long history of treating men and women differently. For
example, research studies have shown that women treated for heart disease are more
likely to be misdiagnosed (Chiaramonte & Friend, 2006); they are less likely than men
to receive counseling about the heart-healthy benefits of exercise, nutrition, and weight
reduction (Stewart and others, 2004) or to receive and use prescription drugs for the
treatment of their heart disease (Vittinghoff and others, 2003). In a classic study, 700
physicians were asked to prescribe treatment for eight heart patients with identical
symptoms (Schulman and others, 1999). The “patients” were actors who differed only in
gender, race, and reported age (55 or 70). Although diagnosis is a judgment call, most
cardiac specialists would agree that diagnostic catheterization is the appropriate
treatment for the symptoms described by each hypothetical patient. However, the actual
recommendations revealed a small, but nevertheless significant, antifemale and antiAfrican-American bias. For the younger, white, and male patients, catheterization was
recommended 90, 91, and 91 percent of the time, respectively; for the older, female, and
African-American patients, 86, 85, and 85 percent of the time, respectively.
Problems such as these, and the underrepresentation of women as participants in
medical research trials, have led to the criticism of gender bias in health research and
care. In response, the National Institutes of Health (NIH) issued detailed guidelines on
the inclusion of women and minority groups in medical research (USDHHS, 2001). In
addition, in 1991 the NIH launched the Women’s Health Initiative (WHI), a long-term
study of more than 161,000 postmenopausal women focusing on the determinants and
prevention of disability and death in older women. Among the targets of investigation in
this sweeping study were osteoporosis, breast cancer, and coronary heart disease. The
clinical trials that formed the basis of the WHI tested the effects of hormone therapy,
diet modification, and calcium and vitamin D supplements on heart disease, bone
fractures, and breast cancer (WHI, 2010).
Despite the significance of such sociocultural and gender influences, remember that it
would be a mistake to focus exclusively on this, or any one context, in isolation. Health
behavior is not an automatic consequence of a given social, cultural, or gender context.
For example, although as a group cancer patients who are married tend to survive
longer than unmarried persons, marriages that are unhappy and destructive offer no
benefit in this regard and may even be linked to poorer health outcomes.
Biopsychosocial “Systems”
As these examples indicate, the biopsychosocial perspective emphasizes the mutual
influences among the biological, psychological, and social contexts of health. It is also
based on an ecological-systems approach (Bronfenbrenner and Morris, 2006).
Applied to health, this approach is based on the idea that our well-being—and all of
nature—is best understood as a hierarchy of systems in which each system is
simultaneously composed of smaller subsystems and part of larger, more encompassing
systems (Kazak, Bosch, & Klonoff, 2012) (Figure 1.5).
Figure 1.5: Ecological-Systems Approach and
Health
The systems potentially influencing Mariana’s headache, shortness of
breath, sleeplessness, and racing heart (review the case study example, p. 7)
include her body’s internal biological systems (immune, endocrine,
cardiovascular, and nervous), as well as her family, neighborhood, culture,
and other external systems of which she is part.
ecological-systems approach
The viewpoint that nature is best understood as a hierarchy of systems, in which each
system is simultaneously composed of smaller subsystems and larger, interrelated
systems.
One way to understand the relationship among systems is to envision a target with a
bull’s eye at the center and concentric rings radiating out from it. In this model, the
individual is at the center. Now consider each of us as a system made up of interacting
systems such as the endocrine system, the cardiovascular system, the nervous system,
and the immune system. (Also keep in mind that, within each of our biological systems,
there are smaller subsystems consisting of tissues, nerve fibers, fluids, cells, and genetic
material.) If you move out from the individual at the center and into the radiating outer
rings, you can see larger systems that interact with us—and these rings include our
families, our schools and workplaces, our neighborhoods, our communities, our
societies, and our cultures.
Applied to health, the model emphasizes a crucial point: A system at any given level is
affected by and affects systems at other levels. For example, a weakened immune system
affects specific organs in a person’s body, which affect the person’s overall biological
health, which in turn might affect the person’s relationships with his or her family and
friends. Conceptualizing health and disease according to a systems approach allows us
to understand the whole person more fully. Recognizing the importance of this
approach, a growing number of health psychologists are investigating biopsychosocial
health as a specific outcome measure in their research (Ferris, Kline, & Bourdage, 2012).
Applying the Biopsychosocial Model
To get a better feeling for the usefulness of biopsychosocial explanations of healthy
behaviors, consider the example of alcohol abuse, which is a maladaptive drinking
pattern in which at least one of the following occurs: recurrent drinking despite its
interference with role obligations; continued drinking despite legal, social, or
interpersonal problems related to its use; and recurrent drinking in situations in which
intoxication is dangerous. Like most disordered behavior, alcohol abuse is best
explained in terms of several mechanisms that include both genetic and environmental
components (Ball, 2008) (Figure 1.6). Research studies of families, identical and
fraternal twins, and adopted children clearly demonstrate that people (especially men)
who have a biological relative who was alcohol dependent are significantly more likely to
abuse alcohol themselves (NIAAA, 2010). In fact, for males, alcoholism in a first-degree
relative is the single best predictor of alcoholism (Plomin and others, 2001). In addition,
people who inherit a gene variant that results in a deficiency of a key enzyme for
metabolizing alcohol are more sensitive to alcohol’s effects and far less likely to become
problem drinkers (Zakhari, 2006).
Figure 1.6: A Biopsychosocial Model of Alcohol
Abuse
Alcohol abuse is best understood as occurring in three contexts: biological,
psychological, and social.
On the psychological side, although researchers no longer attempt to identify a single
“alcoholic personality,” they do focus on specific personality traits and behaviors that
are linked with alcohol dependence and abuse. One such trait is poor self-regulation,
characterized by an inability to exercise control over drinking (Hustad, Carey, Carey, &
Maisto, 2009). Another is negative emotionality, marked by irritability and agitation.
Along with several others, these traits comprise the alcohol dependency syndrome that
is the basis for a diagnosis of alcohol abuse (Li, Hewitt, & Grant, 2007).
On the social side, alcohol abuse sometimes stems from a history of drinking to cope
with life events or overwhelming social demands. Peer pressure, difficult home and
work environments, and tension reduction also may contribute to problem drinking.
And more generally, as many college students know, certain social contexts promote
heavy drinking. Research studies have shown that college students who prefer large
social contexts involving both men and women tend to be heavier drinkers than those
who prefer smaller mixed-sex contexts. In addition, men who often drink in same-sex
groups (whether large or small) report more frequent drunkenness than men who drink
more often in small mixed-sex groups. This suggests that college men who drink heavily
may seek out social contexts in which this behavior will be tolerated (LaBrie, Hummer,
& Pedersen, 2007). Fortunately, researchers have also found that heavy college drinking
does not necessarily predict similar post-college drinking behavior. Students tend to
stop heavy drinking sooner than nonstudents—maturing out of hazardous alcohol use
before it becomes a long-term problem (NIAAA, 2006; White, Labouvie, &
Papadaratsakis, 2005).
Frequently Asked Questions about a Health
Psychology Career
We have seen how views regarding the nature of illness and health have changed over
the course of history, examined trends that helped shape the new field of health
psychology, and discussed the various theoretical perspectives from which health
psychologists work. But you may still have questions about the profession of health
psychology. Here are answers to some of the most frequently asked questions.
What Do Health Psychologists Do?
Like all psychologists, health psychologists may serve as teachers, research scientists,
and/or clinicians. As teachers, health psychologists train students in health-related
fields such as psychology, physical therapy, and medicine. As research scientists, they
identify the psychological processes that contribute to health and illness, investigate
issues concerning why people do not engage in healthful practices, and evaluate the
effectiveness of specific therapeutic interventions.
Health psychologists are on the cutting edge of research, testing the biopsychosocial
model in numerous areas, including Alzheimer’s disease, HIV/AIDS, adherence with
medical treatment regimens, and immune functioning and various disease processes.
Because the biopsychosocial model was first developed to explain health problems, until
recently the majority of this research has focused on diseases and health-compromising
behaviors. Historically, if you weren’t a patient, you were considered healthy. However,
as part of the positive psychology movement, an increasing amount of research centers
on positive health, the scientific study of health assets that produce longer life and
optimal human functioning (APA, 2010). The premise of this movement is simple but
critical: The absence of disease and distress is not the same thing as health and
happiness. The scope of this research—covering assets as diverse as optimism and
happiness, psychological hardiness, and the traits of people who live to a ripe old age—
shows clearly that the biopsychosocial model guides much of it (see “Your Health
Assets”).
positive health
The scientific study of health assets, which are factors that produce longer life, reduce
illness, and increase overall well-being.
Clinical health psychologists, who generally focus on health-promoting interventions,
are licensed for independent practice in areas such as clinical and counseling
psychology. As clinicians, they use the full range of diagnostic assessment, education,
and therapeutic techniques in psychology to promote health and assist the physically ill.
Assessment approaches frequently include measures of cognitive functioning,
psychophysiological assessment, demographic surveys, and lifestyle or personality
assessment. Interventions may include stress management, relaxation therapies,
biofeedback, education about the role of psychological processes in disease, and
cognitive-behavioral interventions. Interventions are not limited to those who are
already suffering from a health problem. Healthy or at-risk individuals may be taught
preventive healthy behaviors.
Your Health Assets: College Does a Mind and
Body Good
Depending on what your day has been like, it may be difficult for you to believe that
attending college is most likely good for your health. To be sure, college can add
additional sources of possible stress. Your hectic schedule may include squeezing in an
online course between jobs or after putting children to bed at night, leaving you in a
sleep-deprived state, with little time for exercising and maintaining a healthy diet. Some
group settings on campus may also promote high-risk activities such as binge drinking,
violence, and dangerous sexual behaviors. Despite these potential barriers to a healthy
lifestyle, women and men who have attended college are healthier than those who have
not. Worldwide, college students report fewer symptoms of poor health and lower levels
of stress than do non-students (Grzywacz, Almeida, Neupert, & Ettner, 2004). Those
who graduate from college have lower death rates from all causes, including accidents,
infectious diseases, and chronic illness, and live about 10 years longer than those
without a high school diploma (National Center for Health Statistics, 2012).
What factors might explain why higher education is a valuable health asset? One is the
impact of college on cognition. According to one classic study (Perry, 1999), thinking
advances through nine levels of increasing complexity over a typical four-year college
experience. A first-year student may think in simple, dualistic terms (yes/no,
right/wrong) on many issues. Over the next three years of college, thinking typically
becomes broader and increasingly recognizes the validity of multiple perspectives on
issues. Intelligent, educated people thus are more likely to develop higher health
literacy and become better informed consumers of information, doing their own
research and becoming more knowledgeable and empowered when it comes to their
health.
health literacy
The ability to understand health information and use it to make good decisions about
one’s health.
A second factor in the college-health relationship is higher income. College students,
especially those who graduate, generally find better jobs and have greater average
incomes than those who do not (Batty and others, 2008). This gives them greater access
to health care and the sometime costly choices of a healthy lifestyle that include
nutritious food, flexible work and leisure time, and safe places to exercise. According to
U.S. census data, averaged over a lifetime, a college degree adds about $20,000 per year
to a worker’s salary.
A third factor is healthier lifestyle. Higher education is associated with better health
habits, including avoiding tobacco, eating nutritious food, and exercising regularly. This
may partly explain why among U.S. adults, the rate of obesity is 9 percent for those with
a college degree, compared to 30 percent for those without (National Center for Health
Statistics, 2012).
Throughout the world, the leaders of many nations have accepted the idea that
increasing the number of students enrolled in college is an effective way to promote
health and increase productivity. This has resulted in massification, the idea that
higher education benefits everyone (that is, the masses) (Altbach, 2010). As a college
student, you have an opportunity to acquire many assets that may be reflected in a long,
healthy life—including higher income potential, greater health literacy, a social context
in which you are surrounded by like-minded, health-conscious friends, and good
lifestyle habits.
massification
The transformation of a product or service that was once only available to the wealthy
such that it becomes accessible to everyone. Applied to education and health, it is the
idea that college can benefit everyone.
Where Do Health Psychologists Work?
Traditionally, most psychologists accepted teaching or research positions at universities
and four-year colleges. Employment opportunities for health psychologists with applied
or research skills also include working in government agencies that conduct research,
such as the National Institutes of Health and the Centers for Disease Control and
Prevention (CDC).
In medical settings, health psychologists teach health care providers, conduct research,
become involved in health care policy development, and provide a variety of other
services. They help patients cope with illness and the anxiety associated with surgery
and other medical interventions, as well as intervene to promote patients’ adherence to
complicated medical regimens. In this capacity, clinical health psychologists often work
on interdisciplinary hospital teams. As part of a new model of integrated care, these
teams improve medical treatment outcomes, lower costs, and offer a successful model
for future health care systems (Novotney, 2010a).
In addition, medical residency programs in the United States now have a clear mandate
to improve physician training in areas such as sensitivity and responsiveness to patients’
culture, age, gender, and disabilities. Increasingly, health psychologists are helping
physicians become better listeners and communicators. As we’ll see, this mandate stems
from mounting evidence that this type of care results in better health outcomes and
helps control health care costs (Novotney, 2010a).
Health psychologists may also be found working in health maintenance organizations
(HMOs), medical schools, pain and rehabilitation clinics, and private practice (Figure
1.7). An increasing number of health psychologists also may be found in the corporate
world, where they advise employers and workers on a variety of health-related issues.
They also establish on-the-job interventions to help employees lose weight, quit
smoking, and learn more adaptive ways of managing stress.
Figure 1.7: Where Do Health Psychologists Work?
Besides colleges, universities, and hospitals, health psychologists work in a
variety of venues, including HMOs, medical schools, pain and rehabilitation
clinics, and independent practices. An increasing number of health
psychologists can be found in the workplace, where they advise employers
and workers on a variety of health-related issues.
Source: 2009 Doctoral Psychology Workforce Fast Facts. Washington, DC: American
Psychological Association.
How Do I Become a Health Psychologist?
Preparing for a career in health psychology usually requires an advanced degree in any
of a number of different educational programs. Some students enroll in medical or
nursing school and eventually become nurses or doctors. Others train for one of the
allied health professions, such as nutrition, physical therapy, social work, occupational
therapy, or public health. An increasing number of interested undergraduates continue
on to graduate school in psychology and acquire research, teaching, and intervention
skills. Those who ultimately hope to provide direct services to patients typically take
their training in clinical or counseling psychology programs.
Many students who wish to pursue a career in health psychology begin with general
psychology training at the undergraduate level. Because of health psychology’s
biopsychosocial orientation, students are also encouraged to take courses in anatomy
and physiology, abnormal and social psychology, learning processes and behavior
therapies, community psychology, and public health.
Most health psychologists eventually obtain a doctoral degree (Ph.D. or Psy.D.) in
psychology. To earn a Ph.D. in psychology, students complete a four- to six-year
program, at the end of which they conduct an original research project. Psy.D. programs
generally provide slightly more clinical experience and clinical courses, but less research
training and experience, than Ph.D. programs.
Graduate training in health psychology is generally based on a curriculum that covers
the three basic domains of the biopsychosocial model. Training in the biological domain
includes courses in neuropsychology, anatomy, physiology, and psychopharmacology.
Training in the psychological domain includes courses in each of the major subfields
(biological, developmental, personality, and so on) and theoretical perspectives (socialcultural, cognitive, behavior, neuroscience, and so on). And training in the social
domain includes courses on group processes and ways in which the various groups
(family, ethnic, and so on) influence their members’ health.
Following graduate training, many health psychologists complete two or more years of
specialized training in the form of an internship in a hospital, clinic, or other medical
setting. Some advocates have suggested that such training should culminate in board
certification of health psychologists as primary health care providers themselves
(Tovian, 2004, 2010).
Graduate training in the social domain includes courses on group processes
and ways in which the various groups to which people belong influence
their health.
GlobalStock/iStockphoto.com
Weigh In on Health
Respond to each question below based on what you learned in the chapter. (Tip: Use
the items in “Summing Up” to take into account related biological, psychological, and
social concerns.)
1. Considering how views of health have changed over time, what would be a good
description of health for an individual today? How do gender, culture, and the
practice of health influence your description?
2. How does the overall health of your school population benefit when different
contexts, systems, models, and theories about health are taken into consideration?
3. Your friend Tran is thinking about pursuing a career in health psychology. What
general advice would you give him, and how would you suggest he choose a specific
career in the field?
Summing Up
1. Health is a state of complete physical, mental, and social well-being. The goals of
health psychology are to promote health; prevent and treat illness; investigate the
role of biological, behavioral, and social factors in disease; and evaluate and improve
the formulation of health policy and the delivery of health care to all people.
2. Although many of the world’s citizens have the promise of a longer and better life
than their ancestors, these health benefits are not universally enjoyed. Health
disparities such as ethnic and socioeconomic group differences in the rates of disease
occur in every nation.
Health and Illness: Lessons from the Past
3. In the earliest-known cultures, illness was believed to result from mystical forces
and evil spirits that invaded the body. Hippocrates, Galen, and other Greek scholars
developed the first rational approach to the study of health and disease. Non-Western
forms of healing, including TOM and ayurveda, developed simultaneously.
4. In Europe during the Middle Ages, scientific studies of the body (especially
dissection) were forbidden, and ideas about health and disease took on religious
overtones. Illness was viewed as punishment for evildoing, and treatment frequently
involved what amounted to physical torture.
5. French philosopher René Descartes advanced his theory of mind–body dualism—
the belief that the mind and body are autonomous processes, each subject to different
laws of causality. During the Renaissance, Descartes’ influence ushered in an era of
medical research based on the scientific study of the body. This research gave rise to
the anatomical, cellular, and germ theories of disease.
6. The dominant view in modern medicine is the biomedical model, which assumes
that disease is the result of a virus, bacterium, or some other pathogen invading the
body. Because it makes no provision for psychological, social, or behavioral factors in
illness, the model embraces both reductionism and mind–body dualism.
7. Freud and Franz Alexander promoted the idea that specific diseases could be
caused by unconscious conflicts. These views were expanded into the field of
psychosomatic medicine, which is concerned with the treatment and diagnosis of
disorders caused by faulty processes within the mind. Psychosomatic medicine fell
out of favor because it was grounded in psychoanalytic theory and predicated on the
outmoded idea that a single problem is sufficient to trigger disease.
8. Behavioral medicine was an outgrowth of the behaviorist movement in American
psychology. Today, the field is an interdisciplinary subspecialty of medicine
concerned with the integration of behavioral and biomedical information to the
prevention, diagnosis, and treatment of physical and psychological disorders.
Biopsychosocial (Mind–Body) Perspective
9. Health psychologists approach the study of health and illness from several
overlapping perspectives. The life-course perspective in health psychology focuses
attention on how aspects of health and illness vary with age, as well as how birth
cohort experiences (such as shifts in public health policy) influence health.
10. The sociocultural perspective calls attention to how social and cultural factors,
such as ethnic variations in dietary practice and beliefs about the causes of illness,
affect health.
11. The gender perspective calls attention to male–female differences in the risk of
specific diseases and conditions, as well as in various health-enhancing and healthcompromising behaviors.
12. The biopsychosocial perspective in effect combines these perspectives,
recognizing that biological, psychological, and social forces act together to determine
an individual’s health and vulnerability to disease.
13. Biology and behavior do not occur in a vacuum. The new field of epigenetics
focuses environmental factors near and around genes that affect their expression.
14. A key element of the biological context is our species’ evolutionary history, and an
evolutionary perspective guides the work of many health psychologists
15. According to the ecological-systems model, health is best understood as a
hierarchy of systems in which each system is simultaneously composed of smaller
subsystems and part of larger, more encompassing systems.
Frequently Asked Questions about a Health
Psychology Career
16. Health psychologists are engaged in three primary activities: teaching, research,
and clinical intervention. Health psychologists work in a variety of settings, including
hospitals, universities and medical schools, health maintenance organizations,
rehabilitation clinics, private practice, and, increasingly, the workplace.
17. A growing body of research centers in health psychology focuses on positive
health, the scientific study of health assets that produce longer life and optimal
human functioning.
18. Preparing for a career in health psychology usually requires a doctoral degree.
Some students enter health psychology from the fields of medicine, nursing, or one of
the allied health professions. An increasing number enroll in graduate programs in
health psychology.
Chapter 2: Research in Health Psychology
Critical Thinking and the Evidence Base
The Dangers of “Unscientific” Thinking
Health Psychology Methods
Descriptive Studies Interpreting Data: Association Versus
Causation Experimental StudiesQuasi-Experiments Developmental
Studies
Epidemiological Research: Tracking Disease
Objectives in Epidemiological Research Diversity and Healthy
Living: Hypertension in African-Americans: An Epidemiological
“Whodunit” Interpreting Data: Tables and GraphsResearch Methods in
Epidemiology Inferring Causality Interpreting Data: Measuring Risk
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