We explore the nature of psychological theories and their relevance to health care. We outline the different schools of thoughts in psychology and methods of inquiry. We seek to distinguish between psychology as an academic discipline and popular notions of psychology. In order to show psychology can be applied to health and health care, we introduce a family scenario whose characters will appear throughout the book. We draw on this to illustrate how different schools of psychological thought can provide different interpretations of a common situation.
Finally, we identify health care professionals whose practice is mainly concerned with the application of psychology. It is important to note that psychology has evolved from western philosophy, science and research and may therefore be viewed as specific to western cultures. This work is contextual. It contains material that is drawn largely from secondary sources and is to be found in most undergraduate psychology textbooks.
Definition of Psychology:
Psychology is the study of human behavior, thought processes and emotions.
Why it is important? :
It can contribute to our understanding of us and our relationships with other people, if it is applied in an informed way.
What psychology should take in account? :
Psychology must take account of the context of people’s lives. Certain sets of beliefs and behaviors are risk factors for illness; therefore some knowledge of public health agenda for change is essential. Those we care for come from a variety of different social and cultural backgrounds that value certain beliefs and behaviors above others. These may place some people at greater or lesser risk of illness than others; therefore some knowledge of sociology is essential. In order to understand the link between psychological and physiological processes, some knowledge of the biomedical sciences is also essential. The psychology of health cannot be viewed in isolation from these other disciplines.
Figure (1): illustrate interaction of psychology & other disciplines.
Different Perspectives in psychology:
Functioning as a person involves coping with social and psychological aspects of everyday life as well as having fully functioning body systems, but divisions between health related disciplines have made holistic care difficult. Descartes, a French philosopher in the seventeenth century, proposed that body and mind could be understood independently of each other. This is referred to as mind – body dualism.
In medical science, this has legitimized the study of body systems without focusing on the whole person. In psychology, the predominance of the study of the mind meant that the individual was often studied in isolation from their social context and social groupings.
The development of psychology:
Before the twentieth century, the study of the mind was primarily the preserve of philosophers. This changed at the turn of the twentieth century with the emergence of psychology as a scientific discipline. Initially, the main methods of studying the mind were based on introspection and scientific experimentation. Introspection originated in philosophy and involves the analysis of one’s own thoughts. Freud recognized the need for a more scientific approach and set about developing a more systematic method of studying the minds of others, which he termed psychoanalysis.
Other researchers opted for laboratory – style experimentation to study behavior change. This was termed behavioral psychology or behaviorism. Behaviorism involved the study of behavior change under carefully controlled conditions. The "subjects" of these experiments were predominantly rats and pigeons rather than humans, but it was assumed that the principles of learning observed in these experiments would apply equally to human beings.
Another scientific approach to psychology was the study of human memory, which becomes part of cognitive psychology. Early experiments focused on the quantity of information that humans could remember under different conditions. Although based on human subjects, the experiments involved recalling nonsense syllables that were free of meaning. It is evident that psychoanalysis captured the interest and imagination of those wanting to learn more about the nature of human mind and its impact on human behavior. Critics have since cast doubt on the scientific basis of psychoanalysis, but it has been very influential in a number of important areas, including the development of human relationships and coping with stress. While behaviorism and early memory research were criticized for the lack of real- world value (ecological validity).
In the second half of the twentieth century, the scientific approach to psychology was appraised as problematic by Carl Rogers and fellow psychologists. Science is based on the assumption that people can be treated as objects of study and research findings generalized to the population under study. He argued that it was inappropriate to regard people as objects of study, or to assume that an individual’s response was predictable.
Humanistic psychologists favoured an approach drawn from philosophy called "Existential phenomenology". Phenomenology is not concerned with the development of universal laws or theories, but with understanding personal or subjective experience. It formed the basis of humanistic psychology which has proved very influential within the caring professions. Another field of psychology to emerge during the twentieth century was social psychology. Social psychologists recognized the need to interpret behavior in its social context. They set about conducting simulated and "real – world" experiments that challenged many assumptions about how people think and behave in different types of social situation.
The most prominent branch of academic psychology is now cognitive science. This is concerned with a scientific understanding of the human mind. It uses up – to – date technologies and links psychologists with those working in other disciplines such as artificial intelligence and neuroscience. One of the most influential aspects of cognitive science in the psychology of health is the development of a new discipline called psychoneuroimmunology. This seeks to understand the relationship between psychological factors and physiological responses that can affect health and illness. Another new area of psychology of particular interest to the professions is narrative psychology, which focuses on both the content and coherence of autobiographical memories.
Schools of Thought in psychology:
There are five main schools of thought in psychology in which academic psychologists normally work and on which health psychology is based.
- Cognitive science (referred to as cognitive psychology): the study of cognition (mental processes) including memory, perception, information processing, psychophysiology and psychoneuroimmunology.
- Behavioral psychology (based on behaviorism): the study of learning by observing the direct effects of external environmental stimuli on behavior and behavior change.
- Psychodynamic psychology (developed from psychoanalysis): the study of the influence of childhood experiences on current psychological and emotional states.
- Humanistic psychology: the subjective study of human experience.
- Social psychology: the study of human behavior in social settings.
(1): Cognitive Science:
Cognitive psychology is concerned with thought processes. It was traditionally based on experimental studies of memory, perception and more recently, information processing. Until 1990s, cognitive theories were largely based on assumptions about how information might be transmitted and stored in the brain. More recently, the introduction of brain imaging techniques has enabled psychologists and neuroscientists to map this against brain function. As a result, cognitive psychology has been incorporated into cognitive science, which is now the dominant field of academic psychology.
In the field of mental health, cognitive- based therapies have emerged as important techniques to help change the way that psychologically distressed or behaviorally disturbed individuals interpret and respond to problem situations. In the field of treatment, Aaron Beck is best known for his theory of depression and the development of cognitive therapy as a treatment for depression.
(2): Behavioral Psychology:
Behavioral Psychology refers to the study of behavioral learning. It is based on the assumptions that behavior change is a direct response to changes in external stimuli and indicates that learning has taken place. Ivan Pavlov was the first to report a simple form of associative learning which he termed classical conditioning. John Watson, often referred to as the father of behaviorism, went on to suggest that learning was the basic foundation of all human activity. He proposed that psychologists should concentrate only on observable behavior. They should not concern themselves with mental processes since (at that time) these could not be directly observed.
Behaviorism grew to greater prominence during the 1940s to 1970s with the work of B.F. Skinner on operant conditioning, which studied the effect of external stimuli on voluntary responses such as obtaining food. This led to the development of theories that predict a direct relationship between behavior and its consequences.
Declined in Behavioral Psychology:
Behavioral psychology declined in popularity for a number of reasons.
- Most of the research involved the use of animals, which became increasingly unacceptable to the general public.
- Researchers working in other areas of psychology questioned the applicability of animal experiments to human psychology, arguing that human mental processes are qualitatively different from those in other animal species.
- The assumption that human behavior is determined by external forces (determinism) was challenged for philosophical and political reasons, since it seemed to contradict the notion of "free will".
- Finally, research in this field reached a point where it was possible to interpret learning in terms of underlying predictions or beliefs.
- Effective behavior therapies have been developed for the treatment of fears and phobias, anxiety disorders and the management of unwanted or challenging behaviors. Cognitive behavioral therapy has emerged as one of the most successful treatments of choice for non- psychotic disorders.
(3): Psychodynamic Psychology:
Psychoanalysis was founded by Sigmund Freud as a "scientific" way of understanding complex psychological problems. It was developed as a method of inquiry, a theory of mind and a mode of treatment. Freud was a medical doctor who studied neurological problems, later moving on to treat physical illnesses that were believed to be manifestations of psychological problems. The correct term for this is psychogenic illness (physical illness that has a psychological cause), as distinct from a psychosomatic disorder, which is a physical illness that has a psychological component (or vice versa).
Psychoanalysis has had a tremendous influence on the ways in which people think and talk about motivations unconscious processes. People commonly use Freudian terms and concepts, such as denial and repression, in everyday conversation, as through these are matters of fact rather than theoretical concepts. Similarly, the ego is also treated as something real. Freud’s ideas have been influential in psychiatry, clinical psychology and counseling.
Many aspects of psychoanalytical theory have not been amenable to experimental testing and have been difficult to prove or disprove. Psychoanalytical explanations are usually offered post hoc (after the event), and some would argue that psychoanalytic theory is therefore unable to fulfill what they see as the prime purpose of a theory, to predict outcomes. This has led to attack from members of the scientific community who regard psychoanalysis as a pseudoscience.
This gave rise to a number of important developmental and cognitive theories, including Erikson’s theory of life stage development, theories of attachment, separation and loss, and coping theory. It also led to the development of psychodynamic psychotherapy.
Psychodynamic psychotherapy evolved from psychoanalysis under the influence of Melanie Klein and others. It emphasizes processes of development and change and retains the proposition that most emotional problems are caused by unresolved difficulties in relationships encountered in childhood. However, most psychodynamic therapists reject the notion of the sexual urge as the prime cause of repressed thoughts. They base their therapy on helping clients to retrieve and resolve difficult or traumatic memories, many of which are related to difficulties in the caregiver-child attachment relationship. Psychodynamic counseling is current one of the most popular approaches in western societies to the treatment of anxiety and depression.
(4): Humanistic Psychology:
Humanistic Psychology has its origins in existential phenomenology in which causal explanations are of relatively little interest. Humanistic Psychologists do not deny the existence of an objective external reality, but are concerned with individual perceptions and interpretations which are influenced by social and cultural meanings and past experiences. They acknowledge that individual perceptions may change over time and vary in different social and cultural changes. Psychologists who accept his philosophical view reject the scientific method as an appropriate method of investigation. They would argue that there is no single truth, no single right way of doing things, and no one size fits all treatment for emotional problems.
The main focus of humanistic psychology is on the individual’s sense of self. Carl Rogers is the most commonly associated with his aspect of humanistic psychology. He trained as a psychoanalyst and worked with people who had emotional problems, but eventually rejected psychoanalysis. He noted that people who came to him with psychological problems exhibited a natural tendency towards growth and maturity that enabled them to overcome many of their own problems. Therefore, he encouraged people to explore their self – understanding. Rogers introduced the concept of self – actualization which he refused to refer to an innate tendency that drives all individuals to achieve their full potential within the limits of environmental or situational constraints.
An important theoretical contribution to humanistic psychology came from Abraham Maslow in the 1950s. Maslow observed human needs in different settings and used these to construct a "hierarchy of needs (see the figure).
Self actualization includes accepting self and others for what they are; the ability to tolerate uncertainty; creativity; the use of problem- centered rather than self centered approaches to deal with issues ; and strong moral and ethical standards. Rogers used his clinical observation to develop Rogerian counseling which is a client – centered therapy.
At the beginning of the twenty- first century, Rogerian counseling appears to have lost ground in popularity to psychodynamic counseling. Nevertheless, humanistic principles remain central to the notion of the therapeutic relationship, which is built on the notion of accepting people for what or who they are in a non – judgmental way.
(5): Social Psychology:
Much of social psychology lies in a grey area between psychology, sociology and anthropology. Social psychologists seek to explain how humans behave in certain social contexts and predict social influences on human thought and behavior. In the field of health and social care, social psychology has done much to enhance our understanding of the interactions between health professionals and patients. It has also contributed much to our understanding of the ways in which individuals make sense of illness and disability, and how those with altered minds or bodies are perceived by others.
Psychological Facts versus Psychological Theory:
In spite of recent advances in brain technology, it is rarely possible to study the human mind directly. We can never "know" what someone is really thinking. Therefore, psychology, as with all social sciences, is not a body of "facts", but a body of theories that changes over time in the light of new information, new research methods, new technologies and new ways of thinking about things.
Psychological theory, as with all scientific theory, must be treated with caution. Theories predict only what is likely to happen. Quantitative research tests predictions at the level of statistical probability. This tells us only what is likely to occur in the population that has been studied, not what will happen to a single individual. People vary in their responses, so no theory or research evidence can ever tell us precisely what will apply to an individual person or patient. Therefore, when applying theory to practice, it is always necessary to IF – THEN logic. For example "if this theory is correct, then the following course of action is likely to be appropriate…." Or "if X theory is applied, then this patient may be at risk of ….."
Pop Psychology and Pseudoscience:
It is important to discriminate between psychology as a serious academic discipline and "pop psychology". Much of what we think of as psychology has no scientific foundation and is therefore myth. An example is the commonly held belief that when patients complain about a symptom for which there is no confirmable medical diagnosis, it must be "all in the mind". This assumption is unsafe unless or until a detailed assessment of the individual and their situation has been conducted. A pseudoscience is one that has a body of knowledge or theory that cannot be tested or has never been tested. For example, some psychologists tend to regard psychoanalysis as a pseudoscience.