INTRODUCTION TO HEALTH PSYCHOLOGY:Psychosomatic Medicine

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Health Psychology PSY408

LESSON 03

INTRODUCTION TO HEALTH PSYCHOLOGY

How the Role of Psychology Emerged

The idea that medicine and psychology are somehow connected has a long history, dating back at least to

ancient Greece. It became somewhat more formalized early in the 20th century in the work of Sigmund

Freud, who was trained as a physician. He noticed that some patients showed Symptoms of physical illness

without any organic disorder. Using principles from his psychoanalytic theory, Freud proposed that these

symptoms were converted from unconscious emotional conflicts. He called this condition conversion hysteria.

Psychosomatic Medicine

The term psychosomatic does not mean a person's symptoms are imaginary; it means that the mind and body

are both involved. Until the 1960s or so, research in psychosomatic medicine focused on psychoanalytic

interpretations for specific, real health problems including ulcers, high blood pressure, asthma, migraine

headaches, and rheumatoid arthritis.

Freud's methods relied on clinical experience and intuitive hunches that were largely unverified by

laboratory research. The research base for psychosomatic medicine began with Walter Cannon's

observation in 1932 that physiological changes accompany emotion.

Cannon's research demonstrated that emotion can cause physiological changes that might be related to the

development of physical disease; that is, emotion can cause changes, which in turn, may cause disease. From

this finding, Flanders Dunbar (1943) developed the notion that habitual responses, which people exhibit as

part of their personalities, are related to specific diseases. In other words, Dunbar hypothesized a

relationship between personality type and disease. A little later, Franz Alexander (1950), a one-time follower

of Freud, began to see emotional conflicts as a precursor to certain diseases.

Unfortunately, these views led others to begin seeing specific illnesses as "psychosomatic." These illnesses

included such disorders as peptic ulcer, rheumatoid arthritis, hypertension, asthma, hyperthyroidism, and

ulcerative colitis. Many lay people began to look at these psychosomatic disorders as not being "real" but

merely "all in the head."

Coupled with this oversimplified belief were the modern medical advances that led many in the health care

field to neglect the mind--body continuum and to concentrate on powerful remedies for specific diseases.

These remedies included penicillin, antibiotics, insulin, and vaccines (Fritz, 2000). With such effective

medical procedures available, many physicians and other health care providers began to lose sight of the

psychological and social concomitants of disease.

The Emergence of Behavioral Medicine

From the remnants of the old psychosomatic medicine emerged two new and interrelated disciplines--

behavioral medicine and health psychology.

A 1977 conference at Yale University led to the definition of a new field, behavioral medicine, defined as

"the interdisciplinary field concerned with the development and integration of behavioral and biomedical

science knowledge and techniques relevant to health and illness and the application of this knowledge and

these techniques to prevention, diagnosis, treatment and rehabilitation".

This definition indicates that behavioral medicine is designed to integrate medicine and the various

behavioral sciences, especially psychology. The goals of behavioral medicine are similar to those in other

areas of health care: improved prevention, diagnosis, treatment, and rehabilitation. Behavioral medicine,

Health Psychology PSY408

then, attempts to use psychology and the behavioral sciences in conjunction with medicine to promote

health and treat disease.

The Emergence of Health Psychology

At about the same time that behavioral medicine was given life, a new discipline called behavioral health

began to emerge. Behavioral health emphasizes the enhancement of health and the prevention of disease in

healthy people rather than the diagnosis and treatment of disorders in sick people. Behavioral health

includes such concerns as injury prevention, cigarette smoking, alcohol use, diet, and exercise.

Behavioral health has not continued to develop as a strong, formal discipline, and its goals have largely been

incorporated by a new field called health psychology, the branch of psychology that concerns individual

behaviors and lifestyles affecting a person's physical health.

Health psychology includes psychology's contributions to the enhancement of health, the prevention and

treatment of disease, the identification of health risk factors, the improvement of the health care system,

and the shaping of public opinion with regard to health.

More specifically, it involves the application of psychological principles to such physical health areas as

lowering high blood pressure, controlling cholesterol, managing stress, alleviating pain, stopping smoking,

and moderating other risky behaviors, as well as encouraging regular exercise, medical and dental checkups,

and safer behaviors.

In addition, health psychology helps identify conditions that affect health, diagnose and treat certain chronic

diseases, and modify the behavioral factors involved in physiological and psychological rehabilitation. As

such, health psychology interacts with both biology and sociology to produce health- and disease-related

outcomes. Note that neither psychology nor sociology contribute directly to outcomes; only biological

factors contribute directly to physical health and disease.

A Brief History of Health Psychology

As an identifiable area, health psychology received its first important impetus in 1973, when the Board of

Scientific Affairs of the American Psychological Association (APA) appointed a task force to study the

potential for psychology's role in health research. Three years later, this task force (APA, 1976) reported

that few psychologists were involved in health research and that research conducted by psychologists in the

area of health was not often reported in the psychology journals. However, the report envisioned a future in

which health psychology might help to enhance health and prevent disease. In 1978, the American

Psychological Association established Division 38, Health Psychology, as "a scientific, educational, and

professional organization for psychologists interested in (or working in) areas at one or another of the

interfaces of medicine and psychology" (Matarazzo, 1994, p. 31).

Four years later, in 1982, the journal Health Psychology began publication as the official journal of Division

38. Currently, health psychology is not only a well-established division within the American Psychological

Association but is also recognized by the American Psychological Society, another powerful professional

organization, one that emphasizes research over clinical practice.

Health Psychology's Position within Psychology

In 2001, the APA membership voted to change its bylaws and to include the term "health" in its mission

statement. This statement now reads: "The objects of the American Psychological Association shall be to

advance psychology as a science and profession and as a means of promoting health and human welfare.

Health Psychology PSY408

Health psychologists are first and foremost psychologists, with the same basic training as any other

psychologists. This training core was determined by the landmark Boulder Conference of 1949, which

established psychology as both a scientific discipline and a practicing profession. From that time, every

doctoral program within a department of psychology has offered nearly the same core of generic course

work for psychologists.

Along with the core courses required of all psychologists, health psychologists take courses in such fields as

biostatistics, epidemiology, physiology, biochemistry, and cardiology. Like other psychologists, health

psychologists rely on and contribute to the basic core of psychological research and then apply this

knowledge to a particular field of specialization.

In other words, health psychologists are psychologists first and specialists in health second. According to

Matarazzo (1987b), "psychology" is the noun that identifies the subject matter; and "health" is the adjective

that describes the client, problem, or setting to which psychology is applied. Like other fields of psychology

health psychology applies the principles of generic psychology to a particular area.

Health psychology does not exist as a profession separate from generic psychology; rather it applies both

research knowledge and clinical experience to the science and profession of generic psychology, Health

psychology has clearly emerged as a unique profession, having met six criteria for a separate profession.

First, it has founded its own national and international associations;

Second, it has established a number of its own journals in addition to health Psychology;

Third, it has received acknowledgment from professionals in other fields of psychology that its subject

matter, methods, and applications are different from theirs;

Fourth, health psychology has set up postdoctoral training specific to health psychology and distinct from

other fields of psychology;

Fifth, it has received recognition from the American Board of Professional Psychology; and

Sixth, it has been recognized by the American Psychological Association Commission on the Recognition of

Specialties and Proficiencies in Professional Psychology.

In addition, health psychology is becoming recognized within medical schools, schools of public health,

universities, and hospitals. Health psychology strives to enhance health, prevent and treat disease, identify

risk factors, improve the health care system, and shape public opinion regarding health issues.

Areas of Special Focus of health psychology:

Health psychology is concerned with all aspects of health and illness across the life span of individuals.

Health psychologists focus on health promotion and maintenance, which includes such issues as how to get

children to develop good health habits, how to promote regular exercise, and how to design a media

campaign to get people to improve their diets.

Health psychologists also study the psychological aspects of the prevention and treatment of illness. A

health psychologist might teach people in a high-stress occupation how to manage stress effectively so that

it will not adversely affect their health. A health psychologist might work with people who are already ill to

help them adjust more successfully to their illness or to learn to follow their treatment regimen.

Health Psychology PSY408

Health psychologists also focus on the etiology and correlations of health, illness and dysfunction. Etiology

refers to the origins or causes of illness, and health psychologists are especially interested in behavioral and

social factors that contribute to health or illness and dysfunction. Such factors can include health habits

such as alcohol consumption, smoking, exercise, the wearing of seat belts, and ways of coping with stress.

Finally, health psychologists analyze and attempt to improve the health care system and the formulation of

health policy. They study the impact of health institutions and health professionals on people's behavior and

develop recommendations for improving health care.

Putting it all together, health psychology represents the educational, scientific, and professional

contributions of psychology to the promotion and maintenance of health, the prevention and treatment of

illness, the identification of the causes and correlates of health, illness, and related dysfunction, the

improvement of health care system, and health policy formation.

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