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INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages

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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).
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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.
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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
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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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Table of Contents:
  1. INTRODUCTION TO HEALTH PSYCHOLOGY:Health and Wellness Defined
  2. INTRODUCTION TO HEALTH PSYCHOLOGY:Early Cultures, The Middle Ages
  3. INTRODUCTION TO HEALTH PSYCHOLOGY:Psychosomatic Medicine
  4. INTRODUCTION TO HEALTH PSYCHOLOGY:The Background to Biomedical Model
  5. INTRODUCTION TO HEALTH PSYCHOLOGY:THE LIFE-SPAN PERSPECTIVE
  6. HEALTH RELATED CAREERS:Nurses and Physician Assistants, Physical Therapists
  7. THE FUNCTION OF NERVOUS SYSTEM:Prologue, The Central Nervous System
  8. THE FUNCTION OF NERVOUS SYSTEM AND ENDOCRINE GLANDS:Other Glands
  9. DIGESTIVE AND RENAL SYSTEMS:THE DIGESTIVE SYSTEM, Digesting Food
  10. THE RESPIRATORY SYSTEM:The Heart and Blood Vessels, Blood Pressure
  11. BLOOD COMPOSITION:Formed Elements, Plasma, THE IMMUNE SYSTEM
  12. SOLDIERS OF THE IMMUNE SYSTEM:Less-Than-Optimal Defenses
  13. THE PHENOMENON OF STRESS:Experiencing Stress in our Lives, Primary Appraisal
  14. FACTORS THAT LEAD TO STRESSFUL APPRAISALS:Dimensions of Stress
  15. PSYCHOSOCIAL ASPECTS OF STRESS:Cognition and Stress, Emotions and Stress
  16. SOURCES OF STRESS:Sources in the Family, An Addition to the Family
  17. MEASURING STRESS:Environmental Stress, Physiological Arousal
  18. PSYCHOSOCIAL FACTORS THAT CAN MODIFY THE IMPACT OF STRESS ON HEALTH
  19. HOW STRESS AFFECTS HEALTH:Stress, Behavior and Illness, Psychoneuroimmunology
  20. COPING WITH STRESS:Prologue, Functions of Coping, Distancing
  21. REDUCING THE POTENTIAL FOR STRESS:Enhancing Social Support
  22. STRESS MANAGEMENT:Medication, Behavioral and Cognitive Methods
  23. THE PHENOMENON OF PAIN ITS NATURE AND TYPES:Perceiving Pain
  24. THE PHYSIOLOGY OF PAIN PERCEPTION:Phantom Limb Pain, Learning and Pain
  25. ASSESSING PAIN:Self-Report Methods, Behavioral Assessment Approaches
  26. DEALING WITH PAIN:Acute Clinical Pain, Chronic Clinical Pain
  27. ADJUSTING TO CHRONIC ILLNESSES:Shock, Encounter, Retreat
  28. THE COPING PROCESS IN PATIENTS OF CHRONIC ILLNESS:Asthma
  29. IMPACT OF DIFFERENT CHRONIC CONDITIONS:Psychosocial Factors in Epilepsy