What Health Psychology Is and Where It Came From

25 min

Doctors and cigarettes

In 1950 the British researchers Richard Doll and Austin Bradford Hill published a study comparing patients with lung cancer with similar patients who had other illnesses. Almost all the lung-cancer patients had smoked. Their later study of British doctors confirmed that the more a person smoked, the higher the risk of dying of lung cancer.

The finding changed how medicine thought about disease. One of the world's biggest killers was caused not by a germ alone but by a behaviour. And behaviour (why people start smoking, why they find it hard to stop, how they can be helped) is a question for psychology. Health psychology grew out of discoveries like this one.

Definition

Health psychology: the branch of psychology that studies how biological, psychological and social factors influence health and illness, and applies this knowledge to promote health, prevent and treat illness, and improve health care. Joseph Matarazzo (1980) defined it as psychology's contribution "to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health, illness and related dysfunction", and to improving the health care system and health policy.

Etiology (also spelled aetiology): the causes of a disease.

Mind–body dualism: the view that the mind and the body are separate things that work independently.

1. What health psychologists do

Aim	Example question
Promote and maintain health	How can young people be helped to stay physically active?
Prevent illness	Why do some families use mosquito nets every night and others not?
Understand psychological causes and effects of illness	How does long-term stress affect the immune system?
Improve treatment and recovery	Why do many patients stop taking their medicine, and how can they be helped?
Improve health care and policy	How should health workers explain a diagnosis so that patients understand and remember it?

Health psychology works closely with clinical psychology (diagnosing and treating mental health conditions), behavioural medicine (an interdisciplinary field joining behavioural science and medicine), medical sociology and public health.

2. A brief history

Ancient ideas. The Greek physician Hippocrates (about 460–370 BCE) taught that health depends on a balance of four bodily "humours" and on lifestyle, diet and environment. The Roman-era physician Galen (2nd century CE) linked the humours to temperament. The theory was wrong about the body, but it treated mind, body and environment as connected.
Separation of mind and body. The French philosopher René Descartes (1600s) argued that mind and body are separate. This dualism allowed doctors to study the body as a machine, which helped anatomy and surgery develop, but it pushed the mind out of medicine.
The biomedical model. In the 1800s, Louis Pasteur and Robert Koch showed that specific germs cause specific diseases. Vaccines and, later, antibiotics followed, and medicine came to see disease as a purely biological fault.
The mind returns. In the early 1900s Sigmund Freud described physical symptoms with psychological causes, and in the 1930s and 1940s psychosomatic medicine studied how emotions affect illnesses. From the 1950s, research on smoking, diet and heart disease showed that the main killers in rich countries were linked to behaviour.
The new field. In 1977 George Engel proposed the biopsychosocial model (Lesson 3). In 1978 the American Psychological Association created its Division of Health Psychology (Division 38), and its journal Health Psychology began in 1982. In 1986 the World Health Organization's Ottawa Charter for Health Promotion called for building healthy public policy, supportive environments, community action and personal skills, not only health services.

3. Health psychology in Rwanda

Health psychology's ideas are visible in Rwanda's health system. The Rwanda Biomedical Centre (RBC) has a Mental Health Division whose work includes support during the commemoration of the 1994 Genocide against the Tutsi and follow-up of trauma cases, alongside specialised services at Ndera Neuropsychiatric Hospital. Programmes against non-communicable diseases (NCDs) such as diabetes and heart disease aim to change behaviours like tobacco use, harmful alcohol use, unhealthy diet and physical inactivity, which the WHO names as the main behavioural risk factors for NCDs.

At the Rwanda Biomedical Centre in September 2017, facilitators of a training course on non-communicable diseases go over the curriculum with participants, public health professionals who run NCD prevention programmes. Photo: CDC Global, CC BY 2.0, via Wikimedia Commons.

Warning

Don't confuse health psychology with clinical psychology. Clinical psychologists mainly assess and treat mental health conditions. Health psychologists focus on how psychological and social factors affect physical health and health behaviour, such as smoking, adherence to treatment or coping with a chronic illness. The fields overlap, but their main questions differ.

Tip

History in three acts: (1) mind and body together (Hippocrates, Galen); (2) mind and body apart (Descartes, germ theory, biomedical model); (3) mind and body together again (psychosomatic medicine, Engel, health psychology).

Important

Discuss. The biomedical model brought vaccines and antibiotics that have saved millions of lives. Why, then, did psychologists and doctors decide in the 1970s that it was not enough?

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Practice

Define health psychology and mind–body dualism.
State four aims of health psychology, with an example question for each.
Explain why Doll and Hill's smoking research was important for the rise of health psychology.
Explain how Descartes's dualism both helped and harmed medicine.
Arrange in order: germ theory; Ottawa Charter; humoral theory; biopsychosocial model; psychosomatic medicine.
Distinguish between health psychology and clinical psychology.
Assess the claim that the history of health psychology is a "return to old ideas".

Show answersHide answers

Health psychology: the study of how biological, psychological and social factors influence health and illness, applied to promote health, prevent and treat illness and improve health care. Mind–body dualism: the view that mind and body are separate and work independently.
Promote health (keeping youth active); prevent illness (mosquito net use); understand psychological causes (stress and immunity); improve treatment (adherence); improve health care (explaining diagnoses). Any four.
It showed that a leading cause of death was a behaviour, not only a germ, so understanding and changing behaviour became central to health.
Helped: the body could be studied as a machine, which advanced anatomy, surgery and the germ-theory medicine that followed. Harmed: psychological and social causes of illness were pushed out of medicine.
Humoral theory; germ theory; psychosomatic medicine; biopsychosocial model; Ottawa Charter.
Clinical psychology mainly assesses and treats mental health conditions; health psychology focuses on psychological and social factors in physical health, illness and health behaviour.
For: ancient medicine linked mind, body and environment, as the biopsychosocial model does. Against: modern health psychology rests on scientific evidence (epidemiology, experiments, measurement), not on humours, and it uses the achievements of biomedicine rather than rejecting them. Judgement: a return to an old insight, but with new methods and evidence.

Sources and credits

Works described: Doll, R. and Hill, A. B. (1950), "Smoking and carcinoma of the lung", British Medical Journal 2; Matarazzo, J. D. (1980), "Behavioral health and behavioral medicine: frontiers for a new health psychology", American Psychologist 35; Engel, G. L. (1977), "The need for a new medical model: a challenge for biomedicine", Science 196; Ottawa Charter for Health Promotion, WHO (1986).
Rwanda: Locate our services: mental health, Rwanda Biomedical Centre; Noncommunicable diseases, WHO fact sheet.
Photo: Noncommunicable Disease Training in Rwanda, CDC Global, Wikimedia Commons, CC BY 2.0.

Written by Ganzaa: the text, the timeline (Figure 1), the table and the exercises.

1Doctors and cigarettes

21. What health psychologists do

32. A brief history

43. Health psychology in Rwanda

Doctors and cigarettes

1. What health psychologists do

2. A brief history

3. Health psychology in Rwanda