What are the changing perspectives on health?

According to Stone (1979) there are a number of questions that cannot be answered in concrete terms. For example, we can ask ourselves how we maintain, protect and recover health when there is no clear definition and way to measure it. Most people will not realize that health can have a totally different meaning to other people, cultures and social classes.

What is meant by mind-body relationships?

Researchers discovered that some skulls from the stone age had holes in them. The holes originated from a skull drilling process, that was performed to release evil spirits that caused diseases. Illness was sometimes interpreted as a punishment from the gods, according to ancient Hebrew texts.

The ancient Greeks saw body and mind as a whole, but did not attribute illness to spiritual matters. Hippocrates was one of the first who talked about a balance between the four bodily fluids, also called humours (mucus, blood, yellow bile and black bile). Each humour has a different trait. In addition, the humours are also linked to the seasons and the four conditions dry, wet, cold and warm. Mucus is connected to winter (cold and wet). Large amounts of mucus were linked to a calm temperament. Blood is connected to spring (wet and warm). Large amounts of blood were linked to an optimistic personality. Large amounts of yellow bile are associated with an angry temperament and belong to the summer (hot and dry). Finally, black bile is related to sadness and autumn (cold and dry). If the juices are in balance, a person is healthy. Hippocrates also recognized the link between diet and health and he recognized that physical factors can influence the mind.

Galen, another influential Greek, talked about the physical basis of disease around 300 years after Hippocrates. The bodily fluids would not only affect our character, but would also be responsible for certain diseases. The mind plays no role in the development of a disease. The occurrence of a disease is also called etiology.

In the Middle Ages, health was primarily seen as a function of spirituality. Illness was assumed to be God's punishment for misconduct or caused by evil spirits who had taken possession of someone, like people used to think before. Individuals had little or no control over their health.

In the 14th and 15th century, the Renaissance period, much attention was paid to individual thinking and doing. The scientific revolution around 1600 caused a lot of developments in physical medicine. Statements for illness had an organic and physiological perspective, psychological explanations were not present.

At the beginning of the 17th century, Descartes came up with dualism. According to Descartes, body and mind are separated, but interaction between the two was possible.

The role of doctors was to protect and heal the material body, and spiritual scholars were to protect the non-material mind.

Dualists, such as Descartes, saw the body as a machine. This mechanism implies that behavior can be reduced to the physical functioning of the body. This approach is the basis for the biomedical model, which assumes that disease symptoms are caused by a pathology and can be remedied with medical treatment. The biomedical model is sometimes also described as reductionism. Body, mind and human behavior can be reduced to the level of cells, neural activity and biochemical activity. No attention is paid to the fact that people are different and can react differently to the same diseases. Dissection and autopsy were accepted by the church, resulting in an enormous growth in medical insight.

Biopsychosocial model of illness 

The biopsychosocial model of illness  is more similar to what we currently find most plausible in regular healthcare. This model is based on the assumption that there is some sort of matter that you can approach in two ways. One type of matter can be approached in a subjective and objective manner. Someone who is sick has symptoms associated with that illness, but responds to it in an individual, unique way. The biopsychosocial model therefore takes physical, social, psychological and cultural aspects into account when illness or symptoms are explained.

Since the bi-directional relationship (two-way relationship) between body and mind gains more understanding, the tension between monists and dualists has decreased. Psychology and Freud have contributed to this. Monists believe that there is one kind of matter, so body and mind are of the same matter. In contrast, dualists claim that the body is physical but the mind is not. They believe that the mind and the body are seperated. 

In his time (first half of the 20th century) Freud spoke of consciously or unconsciously instead of body or mind. According to him, unconscious conflicts caused physical problems, we now would call this psychosomatic. Health is more than just the absence of illness, individual behavior also plays a role in health and illness.

Behavior, death and disease

Not only have our views on disease changed a lot over the centuries. The knowledge about physical functioning and any possible treatments is very extensive. In the 20th century, life expectancy has risen sharply in Western countries. Explanations for this are treatments with medicines, vaccinations, developments in education and in agriculture.

Infectious diseases are becoming less common. Instead, diseases such as cancer, heart, lung and liver diseases have become more common. This development mainly occurs in developed countries. Behavior such as smoking, extreme alcohol consumption, poor diet and a sedentary lifestyle are associated with the diseases just mentioned. Cancer deaths account for approximately two-thirds of our behavior. In addition, because humans nowadays prevent or survive the diseases that we previously died of, which means that humans now reach ages where the cancer incidence is higher. Incidence is the number of new cases of an illness per unit of time. This is often confused with prevalence, which indicates how many people suffer from a particular disease at a given time.

A striking development in recent decades is that people from Western cultures are increasingly considering traditional medicine and that people from traditional or developing countries are learning more and more about modern medicine.

What are the individual, cultural and lifespan perspectives on health?

Lay theories of health

If you want to offer individuals optimal health care, it is important to know what they mean by health and what their health behaviors are. These definitions differ per culture, gender and age category. Young people and people who are not sick often describe health as observing health behavior, while elderly and sick people describe health as the absence of symptoms and illness. Health can also be defined as the abilities of a physically fit person.

Social representations of health

How people assess their own health also depends on who, what and where they are. Someone who often eats unhealthy will consider this less serious if they have many people in their environment who eat unhealthy more often. But there are more perspectives for viewing health:

• Health as not ill: no symptoms, no visits to the doctor.
• Health as reserve: someone comes from a healthy family and often recovers quickly. The person will sooner think that he can handle unhealthy behavior.
• Health as behavior: usually when it comes to others. The neighbor is very healthy, because we see him running every morning.
• Health as physical fitness and vitality: this definition is often used by young people, especially men. Men see the concept of health more as the feeling of being fit, while women define health more as full of energy.
• Health as psychosocial well-being: someone who feels good is probably also healthy.
• Health as function: health is increasingly described as being able to work and being able to do what you want to do.

People who have to indicate whether they consider themselves healthy often compare themselves with others. When people are in good health, there are more young people than older people who compare themselves to people of their own age. Young people are generally in good health. When people are in less good health, there are more older people than young people who compare themselves to their peers. Older people more often have poor health. People try to get the best out of their evaluations. Health is therefore a relative term.

World Health Organization definition of health

The World Health Organization (WHO) describes health as a state of physical, mental and social well-being and the absence of disease. What is missing in these definitions are the socio-economic and cultural influences on health. The definition also does not make clear what the role of the psyche is, but it plays an important role in the experience of health and disease.

Cross-cultural perspectives of health

Opinions about health can differ per culture. A good example is the approach to alcohol addiction. In some cultures, alcohol addiction is seen as a legal and moral problem. Addicts are seen as victims of a substance. In other cultures, alcohol consumption is seen more as a sign of personal weakness. It also differs per culture if someone's health is their own concern or is dealt with collectively. In many African regions, it is common for the residents of a village to be concerned about the health of all villagers. Everyone has their own task and therefore contributes to collective health. In Eastern cultures, there is often a holistic approach in addition to the collectivist approach. They are concerned with the whole being, the well-being of their environment, instead of the visible or physical part. In the West you often see an individualistic approach. People must ensure that they become or remain healthy. How someone behaves in this case is also largely determined by their personal needs.

Lifespan, ageing and beliefs about health and illness

It goes without saying that a toddler has little knowledge about health and healthy behavior. People usually acquire this knowledge automatically as they develop. There are various theories about this.

Developmental theories

The development process is a function of the interaction between three factors:

1. Learning: a relatively permanent change of knowledge, skill or ability as a result of experience.
2. Experience: what we do, see, hear, feel and think.
3. Maturation: thoughts, behavior or physical growth, attributed to the genetically determined order of aging and not to experiences.

Erik Erikson (1959 and 1989) described eight development phases that have to do with the development of an image and a character with regard to health. These eight phases can be roughly divided into the following four points.

• Cognitive and intellectual functioning.
• Language and communication skills.
• The understanding of illness.
• Healthcare and maintenance behaviour.

When you want to treat someone's health, it is important to know what developments a person has lived through so that you also know what kind of behavior you can expect from someone.

Piaget developed a framework around the cognitive development of people. He also developed a structure of different phases, which he thought everyone would go through in the same order. However, not everyone comes to the final phase in their development.

• From birth to 2 years: sensorimotor: the child understands the world through sensations and movement. It has no symbolic thoughts yet. It moves from reflective to voluntary action.
• From 2 to 7 years old: pre-operational: the child develops symbolic thoughts and becomes ego-centered = self-centered, the child sees things only from his own perspective
• From 7 to 11 years: concrete operational: abstract thoughts and logic develop enormously, the child can perform mental operations and manipulate objects.
• From 12 years: formal operational: abstract thoughts and fantasy develop just like deductive reasoning. Not everyone can reach this level.

Sensorimotor and pre-operational stage

The language skills of the child are still very limited during the first two phases. It is difficult for the child to indicate whether it is in pain, for example, and it does not yet understand all the explanations about healthy behavior. The experience is very self-centered. That is, it cries when it hurts itself and does not understand and recognize the signals of others.

Children under the age of 7 often declare illness magical. Their statements are based on associations:

• Lack of understanding (incomprehension): the child gives irrelevant answers.
• Phenomenalism: disease is usually a signal or sound that the child sometimes experiences and associates with this disease. However, it does not yet understand cause-effect relationships. For most children under the age of 7, for example, a cold is no more than coughing and sniveling
• Contagion: illness usually comes from a close person or object that does not necessarily have to touch the child, or it results from activities that occurred just before being sick. For example: you became ill because you walked alongside someone who was sick for a long time.

Concrete operational stage

In the concrete operational stage, children learn to think logically about objects and events. They increase in their understanding of the causal relationships between behavior and disease. For example, they learn why they should wear a jacket when it rains or when it is cold. It is good if children try to gain some personal control over their illness and treatment.

Children over the age of seven understand that diseases are accompanied by symptoms and that diseases are caused by bacteria in certain behaviors (contamination).

They understand that disease is in the body, but they only understand half the symptoms exactly. They understand that behavior or treatment plays a role (internalization).

Adolescence and the formal operational thought

Adolescence is skipped in some cultures. Children grow up without going through an intermediate phase. Many Western cultures are familiar with adolescence. In this phase, an individual is preparing for independence. A lot of harmful behavior starts in this phase. The image of health that many adolescents have, is based on interaction with the environment.

From the age of 11, someone is able to see illness as the functioning of physical functions or organs. They also see that there are often multiple causes, such as physical causes, genes and behavior (physiological).

From around the age of 14, in late adolescence, someone understands that mind and body work together and that stress can, for example, cause illness (psychophysiological). Many adults do not reach this stage of understanding.

If someone is older than 18, he or she is called an adult. The period from 18 to 40 is called early adulthood and is characterized by the fact that new things are happening, such as graduation, getting married, having a child and losing a parent. The behavior with regard to health has for the most part already been learned and people start to behave defensively and have themselves examined structurally.

Aging is no longer a negative process by definition. Middle age, from 40 to 60 years, is often defined as a period of uncertainty, especially for men between 37 and 41. It is often difficult for women if they have always been housewives and their children leave home. They may become uncertain about their role, which was before taking care of the children.

The stage theories do not receive universal support. Relatively fixed phases lose sight of influences such as experience and knowledge. Children around the age of 5 already have multidimensional concepts about health, which are more complex than a change from concrete to abstract thinking presented in stage theories.

Aging and health

The study of patterns of disease in various populations and the association with other factors (epidemiology) is quite important. Given that the incidence of illnesses increase as people live longer, it has important implications for health and social care.

The self-concept is fairly stable during aging. It is often thought that aging is a negative process, so a change in self-concept is inevitable. Aging creates new challenges, but they should not be seen as a problem.

Successful ageing

Bowling and Iliffe (2006) describe five progressive models of successful aging:

1. Biomedical model: based on physical and psychiatric functioning.
2. Broader biomedical model: as above model but also includes social involvement and activity
3. Social functioning model: based on the nature and frequency of social functioning and networks.
4. Psychological resources model: based on personal characteristics of optimism and self-efficacy and a sense of purpose, coping and problem solving, and self-worth.
5. Lay model: based on the variables above plus socio-economic variables income and perceived social capital.

What is health psychology?

Modern psychology wants to describe, explain and predict. This requires scientific research. Data is collected through observation, or empiricism. Research starts with a theory, which can be vague or inaccurate in the beginning.

What connects psychology to health?

Psychological approaches can help explain why some people respond to diseases in a certain way, while others react in a different way. Health psychology integrates cognitive, developmental and social theories and explanations to get a better picture of health and healthcare.

The most important topics of health psychology are:

• Promote and maintain health.
• Improving healthcare systems and health policy.
• Prevention and treatment of illness.
• Causes of illness, as well as risk factors.

Health psychology and other fields

Health psychology is in contact with other branches, such as health economics, medicine, medical sociology and therapeutic disciplines. Health psychology itself is also described as the biopsychosocial model and therefore relates to biological, psychological and social factors.

• Psychosomatic medicine: psychosomatic refers to the fact that mind and body are both involved in illness. Today it is mainly concerned with combined psychological, social and biological / physiological explanations of illness.
• Behavioral medicine: This is an interdisciplinary field with behavioral science including psychology, sociology and health education, in relation to medicine and medical conditions. Principles of classical and operant conditioning play a role in this.
• Medical psychology: medical psychologists use a holistic model (UK). In other parts of Europe, medical psychologists are people who have completed a psychology course and a master's degree in health psychology. Medical psychology is therefore more about a profession than a discipline.
• Medical sociology: Health and illness are considered in terms of social factors that can affect individuals. Individuals are considered within families and cultures.
• Clinical psychology: clinical psychology is concerned with mental health and the diagnosis and treatment of mental health problems.
• Health Psychology: health Psychology adopts a biopsychosocial model for illness and health. Sometimes they are also concerned with public health.