Alongside the changing definition of health there was growing disarray surrounding the dominant model of health in western medicine.
The roots of the biomedical model,” which is still the dominant model in the teaching practice of medicine today,” (Friedman) theoretically can be traced to the seventeenth century and ‘mind-body dualism’ which proposes, “that all disease or physical disorders can be explained by disturbances in physiological processes, which result from injury, biochemical imbalances, bacterial or viral infection – disease is an affliction of the body and is separate from the psychological and social processes of the mind” (Sarafino 1994)
The biomedical model has been criticised on several levels, for it focuses entirely on the physical aspects of health and illness and it ignores and fails to develop a model of practice that fully incorporates the important aspects of psychological and social components. Curtis (2000) shares this opinion and views the ‘biomedical model’ as firstly, being Reductionistic in approach and not having a ‘holistic’ view taking into consideration the whole person in treatment. Secondly that the biomedical model assumes physical causes for disorders, when many of the modern disorders that afflict us today such as heart disease, and cancer, are multi-factorial and have many potential causes that all interact together e.g. genetic, diet and behaviour, and all play a role in disease susceptibility.
Bishop (1994) states, “the medical model has been successful but not at accounting for the phenomena of health and illness.” This is true, traditional medicine through its medical practices and discoveries has been successful in prolonging life and alleviating suffering, through medical and technological advances for surgery, dentistry and treatment of infectious diseases, there are however diseases and conditions of which medical treatment was not able to make a substantial curative impact, such as psychiatric disorders, learning disabilities and most relevantly diseases were behaviour, attitudes and life -styles play an important role. Curtis (2000) States, “as the patterns of illness change over time so to has the need for new models of health”. A view also shared by Sarafino (1994) “A new area of medical problems requires a whole new approach to health care”.
What was growing from this dissatisfaction with biomedical health care, and why its been heavily criticised since the 1970’s was the general consensus among health professionals, that what was need was a philosophy of practice that adequately encompassed biological, social and psychological aspects of health and illness. Sheridan (1992) states, “This challenged to the biomedical model opened the door for psychologists to apply their knowledge, research and clinical skills to health related areas.” This and the indication that behaviours, attitudes and life style events can influence health has weakened the dominance of the biomedical mode and has led to the development of the ‘biopsyhosocial model’. It is not limited by the mind-body dualistic thinking but see the environment impacting on and being impacted upon the patient. It involves the interplay of biological, psychological and social aspects of a person’s life. Marks (2000) states that, “the various aspects of health and illness can be organised in a hierarchy from the biosphere and society down through the individuals level of experience and behaviour to the cellular and subatomic level”. All these levels interact and need to be considered if we are to understand health and illness.
Another considering factor as suggested by Eysenck (1998) for the development and phenomenal growth of Health psychology was soaring health costs during the 1970’s, health expenditures in western countries were quickly growing out of control, as a consequences of these of theses budgetary problems many countries began to explore possibilities that, ‘disease prevention was better than cure”. An understanding of the origins of health psychology should help us more closely relate the role that it plays within the health care system today.
The American Psychological Association approved the division of Health psychology in 1979 and then it was later given status within the British Psychological Association. Matarazzo (1994) states, “ this reflects the increasing need and value of applying insights in psychology to health and health care out comes.” It is defined as, “a sub-field of psychology devoted to the understanding of psychological influences on health and illness. It also considers the responses to these states, as well as the psychological origins and impacts of health policy and health interventions”. (Curtis 2000)
It addresses two issues, firstly the relationship between psychological processes and behaviour, secondly the relationship between health and illness. It has been defined in more detail by Matarazzo (1980), “health psychology is the aggregate of the specific educational, scientific and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of the etiologic and diagnostic correlation’s of health and illness and related disfuchions and the analysis and improvement of the health care system and health policy”.
The goals of heath psychology cover several broad areas; the promotion and maintenance of health, by understanding individual differences in behaviour and lifestyle this has been extended extensively by the use of social cognition models. Prevention and treatment of illness, by application of healthy habits and psychological principles to cope better with illness, regain health or function as fully as possible. Improving the health care system for users and providers plus the formulation of health care policy.
Sheridan (1992) informs us that health psychology at a primary level is to promote the well being of individuals, communities and populations, at theoretical level it is concerned with understanding the relationship between mind and body as theses effect the overall sate of an individuals well being and at a practical level, it is concerned with the intervening in the interface between the individual, health care system and society.
Health psychology research is based on two epistemologies of knowledge for trying to understand behaviour in relation to health, the natural science approach which searches for a single true account of reality and the human science approach which explores human behaviour with the object of discovering underlying meaning or understanding. Its methodologies are determined by the use of qualitative and quantitative research methods.
So what do health psychologists do? Bishop (1994) describes three broad categories of involvement, research based on a broad array of issues, application of research, by applying and using behavioural techniques to both the prevention and treatment of disease, and education and training through the teaching of health professionals. There work is based on the biopsychosocial model of health and they are concerned with the medical, psychological, social, community and spiritual content of health care, they work in a multidisciplinary environment in a variety of settings, with individuals, couples, families, groups and communities, through the public private and voluntary sectors.
In conclusion, in order to determine what is ‘health psychology’ we looked at the changing definitions of health and the most influential definition of health offered by WHO which is central to the work of health professionals and health psychologists. Explanations were presented to account for the origins of health psychology, such as the dramatic shift in the causation of mortality rates in western countries from communicable diseases to chronic illness. These are associated with risk factors related to unhealthy behaviour and life-styles, so if they are behavioural in nature then they are preventable and interventions can be found. Psychology as the science of behaviour and behaviour change can apply its applications to health, to gain an understanding of health behaviours and develop behavioural change models. This developed along side a period of economic crises within the health care system when cost were spiralling out of control as a result of these budgetary problems countries began to explore possibilities of disease prevention. There was a growing dissatisfaction with the biomedical model of health care, for a number of reasons, the individual is not a passive victim of illness and the whole person must be treated not just the physical symptoms. Health psychology argues that illness has no one specific cause of ill health or disease, rather it is multivariable, it integrates the psychological, the social and the biomedical aspects of health and this is why there work is based on the biopsychosocial model of health and illness which developed as a result of the weakening of the biomedical model. We then considered more closely definitions of health psychology and briefly defined its role within the health care system. Thus “ health psychology is a sub-division of psychology concerned with the interrelationship between behaviour and cognitive processes and health and illness”, it focuses more on health and health maintenance than on disease and disease prevention.
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