Psychology and health
Health psychology is one of the fastest-growing areas of psychology throughout the world, and with good reason. With the increase in chronic, degenerative illnesses and behaviour-related illnesses such as cancer, HIV/AIDS and substance abuse, it has become clear that it is no longer sufficient to think of health and illness only in terms of the functioning and malfunctioning of the body. There has been an increasing awareness of how psychological, social and cultural factors are linked with biochemistry and physiology. Health psychology attempts to understand how the mind—body relationship influences why people become ill, how they respond to treatment and how they stay well. Health psychologists are concerned with the prevention and treatment of illness and disability, the promotion and maintenance of good health, ways of coping and adapting to illness and disability, and improvements in the delivery of health care.
Scientific evidence from behavioural medicine has shown that there is a strong connection between mental and physical health. Thoughts, feelings and behaviours are now known to have a major impact on health. For example, people who are depressed are more likely to develop heart disease. Conversely, it is also known that physical health influences mental health and well-being. People with persistent pain have, for instance, been shown to be four times more likely to have an anxiety or depressive disorder than those without pain.
Mental and physical health influence each other in two fundamental ways: through the biochemical and physiological systems such as the endocrine and immune systems and/or through health behaviour. When people are anxious or depressed, their endocrine and immune systems may be compromised, thus increasing their susceptibility to physical illness. As is discussed in Chapter 21, stress is related to the development of the common cold. Furthermore, as demonstrated in Chapter 23, certain micronutrients, such as iodine, are essential to healthy cognitive development, with a person’s nutritional intake also being influenced by psychological and societal factors. Moreover, as also illustrated in Chapter 23, a disease process or parasitic infection can often impact on cognitive functioning.
Health behaviour, which refers to activities such as diet, exercise and sexual practices, also plays an important role in shaping a person’s health status. Health behaviour is an important influence on non-communicable diseases or health problems such as cardiovascular disease, cancers, injury, and substance abuse, but also plays an important role in the spread and control of infectious diseases, such as HIV/AIDS, TB and parasitic infections.
Health behaviour has been found to be related to a number of psychosocial influences. A person’s attitudes, beliefs and mental well-being have been found to play a major role in determining his/her health behaviour, be it engaging in high-risk behaviour, health-seeking behaviour, or adhering to treatment. It has been found, for instance, that young people with depression are more likely to engage in high-risk behaviour compared to those with no depressive disorder. In addition, health behaviour is influenced by interpersonal factors such as role modelling the behaviour of parents and peers, as well as by environmental and societal influences such as poverty and sociocultural norms. These relationships are explored in greater detail in Chapter 21.
Health psychology has contributed to the understanding of a wide variety of health conditions and behaviours. In this part, we also focus on issues that are of particular concern in sub-Saharan Africa: nutrition and under-nutrition, substance abuse, HIV/AIDS, TB and parasitic infections such as malaria and bilharzia.
Given that the field of health psychology is very broad, it is not possible in the scope of a text such as this to cover all aspects of the field. The chapters focusing on particular health issues are therefore designed to introduce different aspects of how the principles of health psychology can be applied.
Chapter 21 discusses risk behaviour and shows that there is a reciprocal relationship between the individual, interpersonal, community and societal levels of influence. This chapter also discusses stress, which has important implications for human functioning, and this chapter also records the practical things that can be employed to reduce stress.
Chapter 22 introduces substance abuse as an area in which psychologists can play an important role in the prevention of health problems. Preventing disorders and promoting health at individual and broader social levels are core activities of health psychologists, and the field of substance abuse is one in which psychologists have been very active.
In treating or managing the mental health of individuals with psychiatric illnesses, medication is often indicated as part of the psychological intervention process. Chapter 22 also provides an overview of psychopharmacological interventions, describing the use of psychoactive drugs to treat the symptoms of psychiatric illness. The mechanisms of action of psychoactive drugs, their classification, uses and effects are described in a relatively non-technical way.
Chapter 23 emphasises the impact that physical health can have on mental and social development. The important role that certain micronutrients and a healthy diet play in cognitive and psychosocial development is emphasised. The chapter also shows how psychological factors can affect nutritional status — as in the case of eating disorders such as anorexia nervosa.
Chapter 23 also deals with HIV/AIDS, TB and parasitic infections, and demonstrates how, when we consider these complex conditions, we need to think about them simultaneously at a range of levels. It emphasises the role psychology can play in prevention, treatment and control, and also considers some of the psychological and social consequences of the spread of these conditions. While there are many infectious diseases, HIV/AIDS, TB and parasitic infections collectively contribute in a huge way to the death rate in the developing world.
Health and illness are produced by the interaction of biological, psychological and social factors. Therefore medical and psychological strategies need to be accompanied by interventions at the community and societal levels, and these must address both cultural and socio-economic barriers to health. Poverty and sociocultural norms fuel many of the health problems covered by these chapters. Without addressing these issues as well, behavioural change interventions will be severely compromised and, at times, fruitless exercises.
Students are encouraged, when thinking about how psychology can be helpful in the health field, to think beyond the boundaries of this part of the book. The insights of Part 6 (Social psychology) and Part 8 (Mental health) should prove especially useful.