INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages

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Health Psychology PSY408

LESSON 02

INTRODUCTION TO HEALTH PSYCHOLOGY

Changing Patterns of Illness Today and In The Past

People in the United States and other developed, industrialized nations live longer, on the average, than they

did in the past, and they suffer from a different pattern of illness. During the 17th, 18th, and 19th centuries,

people in North America suffered and died chiefly from two types of illness: dietary and infectious.

Dietary diseases result from malnutrition--for example, beriberi is caused by a lack of vitamin t31 and is

characterized by anemia, paralysis, and wasting away.

Infectious diseases are acute illnesses caused by harmful matter or microorganisms, such as bacteria or

viruses, in the body. In most of the world today, infectious diseases continue to be the main causes of death

(WHO. l999c).

A good example of the way illness patterns have changed in developed nations comes from the history of

diseases in the United States. From the early colonial days in America through the 18th century, colonists

experienced periodic epidemics of many infectious diseases, especially smallpox, diphtheria, yellow fever,

measles, and influenza. It was not unusual for hundreds, and sometimes thousands. of people to die in a

single epidemic. Children were particularly hard hit. Two other infectious diseases. malaria and dysentery,

were widespread and presented an even greater threat. Although these two diseases generally did not kill

people directly, they weakened their victims and reduced the ability to resist other fatal diseases. Most, if not

all, of these diseases did not exist in North America before the European settlers arrived--the settlers

brought the infections with them--and the death toll among Native Americans was extremely high. This

high death rate occurred for two reasons. First, the native population had never been exposed to these new

microorganisms, and thus lacked the natural immunity that our bodies develop after lengthy exposure to

most diseases (Grob, 1983). Second. Native Americans' immune functions were probably limited by a low

degree of genetic variation among these people (Black, 1992).

In 19th century infectious diseases were still the greatest threat to the health of Americans, The illnesses of

the colonial era continued to claim many lives, but new diseases began to appear. The most significant of

these diseases was tuberculosis, or "consumption as it was often called. In 1842, for example consumption

was listed as the cause for 22% of all deaths in the state of Massachusetts (Grob, 1983). But by the end of

the 19th century deaths from infectious diseases had decreased sharply. For instance, the death rate from

tuberculosis declined by about 60% in a 25'year period around the turn of the century.

Did this decrease result mostly from advances in medical treatment? Although medical advances helped to

some degree, the decrease occurred long before effective vaccines and medications were introduced. This

was the case for most of the major diseases we've discussed, including tuberculosis, diphtheria, measles, and

influenza.

It appears that the decline resulted chiefly from preventive measures such as improved personal hygiene,

greater resistance to diseases (owing to better nutrition), and public health innovations, such as building

water purification and sewage treatment facilities. Fewer deaths occurred from diseases because fewer

people contracted them.

The 20th century has seen great changes in the patterns of illness afflicting people, particularly in developed

nations where advances in preventive measures and medical care have reduced the death rate from life-

threatening infectious diseases (WHO, 1999c). At the same time, the average life expectancy of people has

increased dramatically. At the turn of the century in the United States, the life expectancy of babies at birth

was about 48 years (USDHHS. 1987); today it is 76 years (USBC, 1999).

Health Psychology PSY408

Babies who survived their first year in 1900 could be expected to live to about 56 years of age. Surviving

that first year added seven years to their expected total lie span. Moreover, people in 1900 who had reached

the age of 20 years could expect to live to almost 63 years of age. Today the death rate for American

children is much lower, and only a small difference exists in the expected total life span for newborns and

20-year-olds.

Death is still inevitable, of course, but people die at later ages now and from different causes. The main

health problems and causes of death in developed countries today are chronic diseases--that is,

degenerative illnesses that develop or persist over a long period of time. About two-thirds of all deaths in

developed nations are caused by three chronic diseases: heart disease, cancer, and stroke (WHO, l999c).

These diseases are not new, but they were responsible for a much smaller proportion of deaths before the

20th century. Why? One reason is that people's lives are different today. For example, the growth of

industrialization increased people's stress and exposure to harmful chemicals. In addition, more people

today survive to old age, and chronic diseases are more likely to afflict the elderly than younger individuals.

Thus, another reason for the current prominence of chronic diseases is that more people are living to the

age when they are at high risk for contracting them.

Are the main causes of death in childhood and adolescence different from those in adulthood? Yes. In the

United States, for example, the leading cause of death in children and adolescents, by far, is not an illness,

but accidental Injury (USBC. 1999). Nearly 40% of child and adolescent deaths result from accidents,

frequently involving automobiles. In childhood, the next two most frequent causes of death are cancer and

congenital abnormalities; in adolescence, they are homicide and suicide {USBC, 1999). Clearly the role of

disease in death differs greatly at different points in the life span.

Viewpoints from History:

Physiology, Disease Processes and the Mind

Is illness a purely physical condition? Does a person's mind play a role in becoming ill and getting well?

People have wondered about these questions for thousands of years, and the answers they have arrived at

have changed over time.

Early Cultures

Although we do not know for certain, it appears that the best educated people thousands of years ago

believed physical and mental illness were caused by mystical forces, such as evil spirits (Stone. 1979). Why

do we think this? Researchers found ancient skulls in several areas of the world with coin-size circular holes

in them that could not have been battle wounds. These holes were probably made with sharp stone tools in

a procedure called trephination. This procedure was done presumably for superstitious reasons--for instance,

to allow illness-causing demons to leave the head. Unfortunately, we can only speculate about the reasons

for these holes because there are no written records from those times.

Ancient Greece and Rome

The philosophers of ancient Greece produced the earliest written ideas about physiology, disease processes,

and the mind between 500 and 300 B.C. Hippocrates, often called the Father of Medicine, proposed a

humoral theory to explain why people get sick. According to this theory, the body contains four fluids called

humors (in biology, the term humor refers to any plant or animal fluid). When the mixture of these humors is

harmonious or balanced, we are in a state of health. Disease occurs when the mixture is faulty (Stone, 1979).

Hippocrates recommended eating a good diet and avoiding excesses to help achieve humoral balance.

Greek philosophers, especially Plato, were among the first to propose that the mind and the body are

separate entities. This view is reflected in the humoral theory: people get sick because of an imbalance in

body fluids. The mind was considered to have little or no relationship to the body and its state of health.

This remained the dominant view of writers and philosophers for more than a thousand years.

Health Psychology PSY408

Many people today still speak about the body and the mind as if they were separate. The body refers to our

physical being, including our skin, muscles, bones, heart, and brain. The mind refers to an abstract process

that includes our thoughts, perceptions, and feelings. Although we can distinguish between the mind and

the body conceptually, an important Issue is whether they also function independently. The question of

their relationship is called the mind/body problem.

Galen was a famous and highly respected physician and writer of the 2nd century A.D. who was born in

Greece and practiced in Rome. Although he believed generally in the humoral theory and the mind/body

split, he made many innovations. For example, he dissected animals of many species (but probably never a

human), and made important discoveries about the brain, circulatory system. pd kidneys' (Stone. 1979. p. 4).

From this work, he became aware that illnesses can be localized, with pathology in specific parts of the

body, and that different diseases have different effects. Galen's ideas became widely accepted.

The Middle Ages

After the collapse of the Roman Empire In the 5th century A.D., much of the Western world was in

disarray. The advancement of knowledge and culture slowed sharply in Europe and remained stunted

during the Middle Ages, which lasted almost a thousand years. Galen's views dominated Ideas about

physiology and disease processes for most of this time.

The influence of the Church in slowing the development of medical knowledge during the Middle Ages was

enormous. According to historians, in the eyes of the Church the human being was regarded as a creature

with a soul, possessed of a free will which set him apart from ordinary natural laws, subject only to his own

willfulness and perhaps the will of God. Such a creature, being free-willed, could not be an object of

scientific investigation. Even the body of man was regarded as sacrosanct, and dissection was dangerous for

the dissector. These strictures against observation hindered the development of anatomy and medicine for

centuries.

The prohibition against dissection extended to animals as well, since they were thought to have souls, too.

People's ideas about the cause of illness took on pronounced religious overtones, and the belief in demons

became strong again. Sickness was seen as God's punishment for doing evil things. As a result, the Church

came to control the practice of medicine, and priests became increasingly involved in treating the III, often

by torturing the body to drive out evil spirits.

It was riot until the 13th century that new ideas about the mind/body problem began to emerge. The Italian

philosopher St. Thomas Aquinas rejected the view that the mind and body are separate. He saw them as an

interrelated unit that forms the whole person. Although his position did not have as great an impact as

others had had, it renewed interest in the issue and influenced later philosophers.

-The Renaissance and After

The word renaissance means rebirth--a fitting name for the 14th and 15th centuries. During this period in

history, Europe saw a rebirth of inquiry, culture, and politics. Scholars became more human-centered" than

God-centered" in their search for truth and believed that truth can be seen In many ways, from many

individual perspectives"(Leahy, 1987. p. 80). These ideas set the stage for important changes in philosophy

once the scientific revolution began after 1600.

The 17th-century French philosopher and mathematician Rene Descartes probably had the greatest

influence on scientific thought of any philosopher in history. Like the Creeks, he regarded the mind and

body as separate entities, but he introduced three important innovations.

First, he conceived of the body as a machine and described the mechanics of how action and sensation

occurred. Second, he proposed that the mind and body, although separate, could communicate through the

pineal gland, an organ in the brain. Third, he believed that animals have no soul and that the soul in humans

Health Psychology PSY408

leaves the body at death. This belief meant that dissection could be an acceptable method of study --a

point the Church was now ready to concede.

In the 18th and 19th centuries, know-ledge in science and medicine grew quickly, helped greatly by the

development of the microscope and the use of dissection in autopsies. Once scientists learned the basics of

how the body functioned and discovered that microorganisms cause certain diseases, they were able to

reject the humoral theory of illness and propose new theories. The field of surgery flourished after

antiseptic techniques and anesthesia were introduced in the mid-I 9th century (Stone, 1979). Before that

time, hospitals were notorious places, more likely to spread diseases than cure them (Easterbrook, 1987. p.

42) Overtime, the reputation of physicians and hospitals began to improve, and people's trust in the ability

of doctors to heal increased.

These advances, coupled with the continuing belief that the mind and body are separate, laid the foundation

for a new approach, or model, for conceptualizing health and illness. This approach--called the biomedical

model--proposes that all diseases or physical disorders can be explained by disturbances in physiological

processes, which result from injury, biochemical imbalances, bacterial or viral infection, and the like. The

biomedical model assumes that disease is an affliction of the body and is separate from the psychological

and social processes of the mind. This viewpoint became widely accepted during the 19th and 20th

centuries and still represents the dominant view in medicine today.

The biomedical model has been very useful. Using it as a guide, researchers have made enormous

achievements. They conquered many infectious diseases, such as polio and measles, through the

development of vaccines. They also developed antibiotic, which made it possible to cure illnesses caused by

bacterial infection, Despite these great advances, the biomedical model needs improvement. Let's see why.

The biomedical model does not take the person's psychological and social factors in view. Have you ever

noticed how some people are always sick--they get illnesses more frequently than most people do and get

well more slowly? These differences between people can result from biomedical sources, such as variations

in physiological processes and exposure to harmful microorganisms.

But psychological and social factors also play a role. And we just can not ignore such factors while dealing

with the health of a person. And this leads us to our next point of discussion: what is the role of psychology

in health?

Psychology`s Involvement in Health

Although chronic diseases have many causes, no one seriously disputes the evidence that individual

behavior and lifestyle are strongly implicated in their development. Because most chronic diseases stem at

least partly from individual behavior, psychology--the science of behavior--has become involved in health

care.

A large part of psychology's involvement in health care is a commitment to keep people healthy rather than

waiting to treat them after they become ill. Psychology shares this role with medicine and other health care

disciplines, but unlike medicine (which tends to study specific diseases), psychology contributes certain

broad principles of behavior that cut across specific diseases and specific issues of health. Among

psychology's contributions to health care are techniques for changing behaviors that have been implicated

in chronic diseases. In addition to changing unhealthy behaviors, psychologists have also used their skills to

relieve pain and reduce stress, improve compliance with medical advice, and help patients and family

members live with chronic illnesses.

In summary, the role of psychologists in medical settings has expanded beyond traditional mental health

problems to include procedures and programs to help people stop smoking, eat a healthy diet, exercise,

adhere to medical advice, reduce stress, control pain, live with chronic disease, and avoid unintentional

injuries.

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