Health, Disease and Mind: Research Findings

The word health is derived from Old High German and Anglo-Saxon words meaning whole, hale and holy. Galen, the early Greek Physician, followed the Hippocratic tradition in believing that hygieia (health) and euxia (soundness) occur when there is a balance between the hot, cold, dry and wet components of the body. The four bodily fluids were believed to be blood, phlegm, yellow bile and black bile that were hot and wet, cold and wet, hot and dry and cold and dry respectively. Diseases were thought to be caused by external pathogens that disturbed the balance of the body's four elements. Galen believed that the body's constitution, temperament or state could be put out of equilibrium by excessive heat, cold, dryness or wetness. Such imbalances might be caused by fatigue, insomnia, distress, anxiety, or by the residues of food resulting from the wrong quantity or quality.

In Nineteenth Century, Rudolf Virchow, a German Pathologist, found microscopic organisms that disrupt normal operation of the body and cause disease. This resulted in the bout of Germ theory. The Germ Theory, along with Descartes' dualistic interactionism dominated Medicine and Physiology for 300 years. Both provided an important foundation for the Bio-Medical Model of illness. Hitherto, this model dominated medicine. The Bio-Medical Model has four characteristics.

1. Dualistic: Physical and psycho-social process are separate, and disease is not influenced by the latter.

2. Mechanistic: The body is like a machine. Disease occurs when the normal operation of the body-machine is disrupted by a foreign agent.

3. Deductionistic: Ignores the complexity of factors-some psychological and some physical-that are involved in the health of the whole person by focusing solely on one disease or physical system.

4. Disease oriented: Health is defined as the absence of disease and efforts rarely go beyond the elimination of the disease.

The Germ Theory and Bio-Medical Model led to the development of specific aggressive physical treatments, for diseases, such as;
a) Medication that destroy pathogens or ease pain and suffering were discovered in nature or created synthetically.
b) Vaccines to protect against viral diseases were discovered. (Eg. Polio)
c) Medical technology to diagnose disease was advanced (Eg: x-ray)
d) New surgical procedures (antiseptics and anesthetics) to reduce complication and save lives were discovered.

These resulted in greatest health advancement in human history. Many diseases like Hepatitis B, Influenza, Malaria, Mumps, Measles, Pneumonia, Rabies, Tetanus, Tuberculosis etc. which are found to be the results of pathogenic attack began to get treated. The three Ds of Bio-Medical Model is Diagnosis, Disease and Drugs

However, Bio-Medical Model has been challenged by two recent trends.
1) Changing patterns of illness
2) Escalating cost of health care.
The changing pattern of illness is the result of several factors.
1) The decline of contagious diseases, due partly to success of Bio-Medical Model.
2) The decline in the rate of infant mortality.
The increase in the non-contagious diseases is largely the result of people living longer and engaging in health compromising behaviour.

Psychiatrist George Engel (1977) was the first to propose a Bio-Psycho-Social Model of illness. He said that health and illness are a consequence of physical, psychological, and cultural variables. The three Ps of Bio-Psycho-Social Model - People, Prevention, Psychology - can be contrasted with the three Ds of Bio-Medical Model. By stating that a model of disease must take the patient into account, Engel repudiated the Bio-Medical Model and Dualism. Bio-Psycho-Social model stands for the idea; people are "individual mind-body complexes ceaselessly interacting with the social and physical environment in which they are embodied".
Bio-Psycho-Social Model is actually a return to holism, which existed at the time of Hippocrates - the Father of Medicine. According to Bio-Psycho-Social Model, health and illness are states of being that result from multiple factors and have multiple effects. These multiple factors include biological and physiological processes, pathogens and chemical imbalances, as well as psychosocial processes, personality and behaviour. The mind and body are not separate independent entities. They are two aspects of the whole person.

The relation between Medicine and Psychology can be traced back at least to the period of ancient Greece. This relationship is more formalized by the works of Sigmund Freud in Twentieth Century. He noticed that some patients showed symptoms of physical illness without any organic disorders. He attributed these illnesses to unconscious mental conflicts and called the disorder conversion hysteria. He believed that mental conflicts were being converted into physical symptoms.

Today, conversion hysteria is among a category of psychological disorders called somatoform. Under dualistic tradition, physicians have been involved only when there is a verifiable organic pathology. Somatoform disorders was regarded as a domain of psychiatrists or psychologists.
The ancient Greek Holists, Hippocrates among them, believed that mind and body should not be separated and studied independently. In Twentieth Century, Freud's psychiatric contemporaries showed interest in researches combining psyche (mind) and soma (body), which came to be known as psycho-somatic medicine. The term psychosomatic does not mean a person's symptoms are imaginary. It means that mind and body are both involved. Until 1960s or so, research in psychosomatic medicine focused on psycho-analytic interpretation for specific, real health problems including ulcer, high blood pressure, asthma, migraine headaches, and rheumatoid arthritis. After 1960s, it focused on new approaches. Currently, it is a broader field concerned with the inter-relationships among psychological and social factors, biological and physiological functions and the development and course of illness.

Two new fields emerged in 1970s to study the role of Psychology in illness. One is Behavioural Medicine and the second one, Health Psychology.

The field of Behavioural Medicine was launched in association with the National Academy of Sciences. This field has two defining characteristics.

1. Its membership is inter-disciplinary, including Psychology, Sociology and various areas of Medicine.

2. It grew out of the perspective of behaviourism, which proposed that people's behaviour results from learning (conditioning).

Conditioning methods has shown a good deal of success as therapeutic approaches in helping people modify problem behaviours such as over eating and emotions such as anxiety and fear.
Behaviourism served as an important foundation for Health Psychology - a field that is principally within the discipline of Psychology. In APA, the division of Health Psychology was introduced in 1978. The Journal "Health Psychology" began publication four years later.

Matarazzo, the First President of the division in APA, outlined four goals of Health Psychology.

1. To promote and maintain health: Psychologists study such topics as why people do and don't smoke cigarettes, use safety belts in cars, drink alcohol and eat particular diets. Health Psychologists can help in the design of school health education programmes and media campaigns to encourage healthful lifestyles and behaviour.

2. To prevent and treat illness: Psychological principles have been applied effectively in preventing illness, such as in reducing high blood pressure and therefore, the risk of heart disease and stroke. For those people who become seriously ill, psychologists with clinical training can help them adjust to their current condition, rehabilitation programme and future prospects, such as reduced work or sexual activity.

3. To identify the causes and diagnostic correlates of health, illness and related dysfunction: Psychologists study the causes of disease. Psychologists also study physiological and perceptual processes which affect people's experience of physical symptoms.

4. To analyze and improve health care systems and health policy: Psychologists contribute toward this goal by studying how characteristics or functions of hospitals, nursing homes, medical personnel and medical costs affect patients. The resulting knowledge enables them to make recommendations of improvement, suggesting ways to help physicians and nurses become more sensitive and responsive to the needs of patients and to make the system more accessible to individuals who fail to seek treatment.

According to Matarazzo (1982), Health Psychology is the aggregate of the specific educational, scientific, and professional contribution of the discipline of psychology 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 the analysis and improvement of the health care system and health policy formation. Matarazzo's definition has been adopted by the American Psychological Association (APA), the British Psychological Society and other organizations. It serves as Health Psychology's official definition.