INTRODUCTION TO HEALTH PSYCHOLOGY:Health and Wellness Defined

INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages >>

Health Psychology PSY408

LESSON 01

INTRODUCTION TO HEALTH PSYCHOLOGY

Prologue

"Wide load" the boys shouted as they pressed themselves against the walls of the hallway at school. They

were `making room for a very overweight girl named Sara to pass through. Lunch time in the cafeteria was

even more degrading for Sara because when she sat down to eat; her schoolmates would stop eating, stare at

her every move, and make pig noises. "Kids can be cruel." her parents would say to console her. One of

Sara's aunts told her that she inherited a glandular problem, and you can't do anything about it." and

another aunt said, "You'll lose weight easily in a couple of years when you start getting interested in boys."

Is either aunt right?

Sara's parents are concerned about her weight because they know that overweight people often have social

problems and face special health risks, particularly for high blood pressure and heart disease. But her

parents are not sure why she is so heavy or how to help her. Although her father is a bit overweight, her

mother is very heavy; was heavy as a child, and did not lose weight when she became interested in boys.

This could support the idea of an inherited cause of her being overweight. On the other hand, they know

Sara eats a lot of fattening foods and gets very little exercise, a combination that often causes weight gains.

As part of their effort to change these two behaviors, they encouraged her to join a recreation program,

where she will be Involved in many physical activities.

This story about Sara illustrates important issues related to health. For instance, being overweight is

associated with the development of specific health problems and may affect the individual's social relations.

Also, weight problems can result from a person's inheritance and his or her behavior.

What is Health?

What is health? How do you know when you are healthy? To answer these questions, let's first consider

what illness is. We define a disease as a characteristic grouping of physical signs and symptoms; it is given a

specific name and can often be traced to a specific causal agent. Illness, however, is a broader term that

involves people's beliefs about the state of their physical well-being and the resulting behaviors they engage

in.

Illness beliefs may be the result of a specific disease or just the way we feel when we say we are ill (even

when there is no evidence of a disease).

Illness is important because it is what motivates people to seek out a physician. A disease is what the

physician recognizes as a specific disorder based on known signs and symptoms. Therefore, a physician is

likely to define health as the absence of disease, while the average person might define health more broadly;

as the absence of any ill feelings.

In both of these definitions, however, health is described in terms of what it is not--as the absence of

disease or illness.

We commonly think about health in terms of an absence of

(1) Objective signs that the body is not functioning properly, such as measured high blood pressure, or

(2) Subjective symptoms of disease or injury, such as pain or nausea.

Dictionaries define health in this way, too. But there is a problem with this definition of health. Let's see

why.

Consider Sara, the overweight girl in the opening story. You've surely heard people say. "It's not healthy to

be overweight," Is Sara healthy? What about someone who feels fine but whose lungs are being damaged

from smoking cigarettes or whose arteries are becoming clogged from eating foods which are high in

Health Psychology PSY408

saturated fats? These are all signs of improper body functioning. Are people with these signs healthy? We

probably would say they are not "sick"--they are just less healthy than they would be without the

unhealthful conditions.

This means health and sickness are not entirely separate concepts--they overlap. There are degrees of

wellness and of illness. Medical sociologist Aaron Antonovsky (1979, 1987) has suggested that we consider

these concepts as ends of a continuum, noting that "We are all terminal cases. And we all are, so long as

there is a breath of life in us, in some measure healthy". He also proposed that we revise our focus, giving

more attention to what enables people to stay well than to what causes people to become ill.

The Illness-wellness Continuum

In this way, health refers to a positive state of physical, mental, and social wellbeing--not simply the

absence of injury or disease--that varies over time along a continuum. At the wellness end of the

continuum, health is the dominant state. At the other end of the continuum, the dominant state is illness or

injury, in which destructive processes produce characteristic signs, symptoms, or disabilities.

Health and Wellness Defined

In 1947, the World Health Organization (WHO) defined health as "the state of complete mental, physical,

and social well-being, not merely the absence of disease" (WHO, 1947). WHO's definition was the first

globally accepted conceptualization of health and stood the test of time for more than a decade.

Although multifaceted, this definition of health was flawed, according to members of a new movement

called holistic health. The holistic health movement came into being in the 1960s as an attempt to expand

the view of health that WHO had spread.

One of the early pioneers in the field, Halbert Dunn (1962), believed that WHO'S vision of health

characterized it as a static state. Rather than call health a state of well-being, Dunn preferred to view it as a

continuum. Developing and maintaining a high level of health means moving toward high-level functioning

along a continuum that starts with low-level wellbeing and ends with optimal functioning. Health is a

conscious and deliberate approach to life and being, rather than something to be abdicated to doctors and

the healthcare system. Optimal health is a result of your decisions and behavior.

In addition, Dunn recast the notion of wellbeing to revolve around how well a person functions. That is, he

viewed functioning as evidence of well-being. Although people will have setbacks in their quest for optimal

functioning, the direction in which their lives are moving becomes an important criterion for evaluating

their wellbeing. In this movement, daily habits and behaviors, as well as overall lifestyle, assume primary

importance.

Originally, the scope of well-being was limited to three dimensions: physical, social, and mental. Adherents

of holistic health argued that the mental dimension has two components--the intellectual (rational thought

processes) and the emotional (feelings and emotions). Each of these domains deals with a different aspect

of psychological well-being. An additional dimension, the spiritual, was added because it was thought that

Health Psychology PSY408

humans could not function optimally in a spiritual vacuum. Therefore, the holistic definition of health has

five dimensions: physical, social, emotional, intellectual, and spiritual.

In the 1970s and 1980s, the definition of health was expanded once again by the wellness movement

(Ardell, 1985). Wellness is an approach to health that focuses on balancing the many aspects or dimensions

(physical, social, spiritual, emotional, intellectual, and environmental/occupational) of a person's life by

increasing the adoption of health-enhancing conditions and behaviors rather than by attempting to

minimize conditions of illness (AAHE, 2001).

A key element of the wellness model is striving for balance. When all of the six dimensions are at high levels

and in balance, we have optimal health and well-being. When the dimensions are out of balance or one is

severely lacking, we have lower levels of health and well-being.

Another important part of wellness is the process of becoming healthier. The journey (becoming the best

one can be) is more important than the ending. The process of wellness involves becoming increasingly

more aware of health and making healthy choices.

The Six Dimensions of Wellness

Physical

The first dimension, physical well-being, is reflected in how well the body performs its intended functions.

Absence of disease--although an important influence--is not the sole criterion for health. The physical

domain is influenced by your genetic inheritance, nutritional status, fitness level, body composition, and

immune status, to name just a few factors.

Intellectual

Intellectual well-being is the ability to process information effectively. It involves the capability to use

information in a rational way to solve problems and grow. This dimension includes issues such as creativity,

spontaneity, and openness to new ways of viewing situations. To maintain a high level of intellectual well-

being, you must seek knowledge and learn from your experiences. Ideally, your college experiences will have

added to your intellectual well-being (Figure 1.4).

Emotional

Emotional well-being means being in touch with your feelings, having the ability to express them, and being

able to control them when necessary. Optimal functioning involves the understanding that emotions are the

mirror of the soul. Emotions help us get in touch with what is important in our lives. Our emotions make

us feel alive and provide us with a richness of experience that is uniquely human.

Social

Social well-being involves being connected to others through various types of relationships. Individuals who

function optimally in this domain are able to form friendships, have intimate relationships, give and receive

love and affection, and accept others unconditionally. They are able to give of themselves and share in the

Joys and sorrows of being part of a community. This community includes both formal and informal

networks. Formal networks include organizations such as churches, professional organizations, fraternities,

sororities, and campus groups requiring official membership, dues, and standards. Informal networks, such

as an intramural sports team, do not have rigid rules for membership. In a sense, your social networks are a

major part of your environment.

Spiritual

Spirituality is a belief in or relationship with some higher power, creative force, divine being, or infinite

source of energy (Fowle; 1986). This belief is manifested in a sense of interconnectedness, a feeling that

somehow, some way, we are all in this together. For people whose spirituality is religion- based, it is

ecumenical in scope. It is part of but transcends individual religions. Those whose spirituality is religion-

Health Psychology PSY408

based believe in a supreme being or higher supernatural force and subscribe to a formalized code of

conduct. For individuals whose spirituality is secular, it is universal or even extraterrestrial. In a secular

sense, spirituality could manifest itself through connection to something greater than oneself. Whether it is

being part of a community, working to save the environment, helping to feed the needy, or being

committed to world peace, the underlying feeling is a perception of life as having meaning beyond the self

(Richards & Bergin, 1997).

Spirituality is a two-dimensional concept. The first dimension relates to one's relationship with the

transcendent (a connection with a higher being or power). The second dimension is connected to one's

relationship with the self, others, and the environment. A continual interrelationship links the two

dimensions. Feeling connected with a higher power or being gives us faith and hope and helps us believe we

can do things to make life meaningful. Believing in oneself and feeling connected with others and one's

community empowers us to act. Those with a high level of spiritual health behave in an interconnected way

(Harris et al., 1999). They take part in church and/or community activities. They help others. They get

involved in causes and groups that are proactive, whether it involves cleaning up a vacant lot or a beach

with an environmental group or visiting the sick and infirm who arc hospital bound. It is in the "doing" that

some of the greatest benefits of spirituality are derived (Harris et al., 1999; Richards & Bergin, 1997).

Environmental

Environmental well-being involves high-level functioning on two levels. The most immediate environment,

the micro-environment, consists of your school, home, neighborhood, and work site. The people with

whom you interact in those places link the environment to the social aspects of your health. This

environment greatly affects your overall health and personal safety by influencing whether you are at risk for

and fear issues such as theft, crime, and violence. The quality of air and water, noise pollution, crowding,

and other issues that affect your stress level are also included.

Your social support system is also part of this environment. The macro-environment, the level of wellbeing

at a larger level--state, country, and the world at large--also affects wellness. The wars in Iraq and

Afghanistan, the terrorist attacks of September 11, 2001, and other issues such as violence, international

disputes, racism, sexism, heterosexism, and ageism--all influence us daily to some extent. When this book's

authors were in college, the Vietnam War was going on. College-age men started each day by reading the

newspaper to see which draft numbers were being called up (all draft-eligible men were issued draft

numbers) and if any of their friends were killed or missing in action. Decisions that our political leaders

make, such as engaging in wars or determining where we store radioactive wastes, affect the way we think

and live our lives. Our ability to stay focused and whole is constantly challenged by the media, which bring

the entire world and its problems into our living rooms each night. We need to learn to think globally, act

locally, and be happy despite the myriad of problems in the world.

Occupational/Vocational

Occupational/vocational well-being involves issues related to job wiliness. It encompasses everything from

the safety of your particular work site to the nature of your career. Work-site well-being includes both

physical (e.g., air, water, physical plant, machinery) and social (e.g., relationships with coworkers,

management, health and wellness facilities and activities) factors. Your personal wellness is affected by the

health of your work site. Employers and work sites vary tremendously in relation to health. Some strive for

optimal levels, encouraging employees to take advantage of a myriad of health-enhancing programs and

services. Others merely meet the minimum acceptable standards for health and safety set by the

government.

Besides the specific health of the workplace, different jobs pose varying threats to individuals' wellbeing as a

result of the nature of the work. Some jobs, such as police and military service, are risky because of possible

exposure to hostile combatants. Other occupations, such as those of firefighters, emergency medical service

workers, coal miners, arid oil rig operators, are risky because they place employees in dangerous

environments. Still other occupations are characterized by high stress due to deadlines, competition, or

other factors.

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