Lecture 1
Brief history
The mind-body relationship
o During prehistory
Mind and body intertwined
Diseases arise when evil spirits enter the body
Treatment consisted primarily of attempts to exorcise these spirits
o Ancient Greeks: humoral theory of illness
Diseases resulted when the four humors, or circulating fluids of the body,
were out of balance
Treatment: to restore balance between the humors
Four humors
Blood – passionate temperament
Black bile – sadness
Yellow bile – angry disposition
Phlegm – laid-back approach to life
o Middle ages
Disease regarded as God’s punishment
Treatment: driving out evil forces by torturing the body. Later, it was replaced
by prayer and doing good
o Renaissance to present day
Enhanced scientific knowledge and assessment
Practice is dependent on laboratory findings and reported or observed bodily
factors
Diagnosis and treatment are based on organic and cellular pathology
The result: biomedical model emerged
The biomedical model
o All illness can be explained through aberrant somatic bodily processes
o Health is seen as biochemical or physical in nature
o Assumes that psychological and social processes are largely irrelevant to the disease
process
o Ill-suited to understanding illness
Reduces illness to low-level processes
Fails to recognize social and psychological processes as powerful influences –
assumes a mind-body dualism
Emphasizes illness rather than focusing on behaviors that enhance health
Cannot address puzzles that face practitioners
Conversion hysteria
o The biomedical viewpoint started to change with the rise of modern psychology
o Specific unconscious conflicts produce physical disturbances symbolizing repressed
psychological conflicts
o Conceptualized by Sigmund Freud
o Gave rise to the field of psychosomatic medicine
Psychosomatic medicine
o Idea that specific illnesses are produced by people’s internal conflicts
o Dunbar and Alexander linked patterns of personality to specific illnesses
Ulcer-prone personality: someone with excessive needs for dependency and
love
Secretion of acid in the stomach eroding the lining of the stomach
Conflict produces anxiety which takes a physiological toll
o Criticism: conflict or personality type is not sufficient to produce illness
, Biopsychosocial model
o Health and illness are consequences of the interplay of biological, psychological and
social factors
o Advantages
Maintains that the macrolevel and microlevel processes continually interact
to influence health and illness
Emphasizes both health and illness
o Also received criticism
Social aspect not well captured in research
To be studied over time, explore complex interaction systems
Biomedical vs biopsychosocial
Clinical implications of the biopsychosocial model
o Understanding the interacting role of biological, psychological, and social factors
informs diagnosis
o Emphasis on the relationship between patient and their practitioner, which improves
Patient’s use of services
Efficacy of treatment
Rapidity with which illness is resolved
Epidemiology
Different disciplines
Mental problems and physical illness
o What is the relationship between mental problems and illness/disease?
o Which major fields contribute to our knowledge on mental problems and/or
illness/disease and what is the role of these fields in a medical setting?
Psychology and medicine
, Psychology is different from medicine
o Mono-causal explanation of disease in medicine
o Emphasis on biological pathways
o Clear distinction between body and mind
o Disease vs illness
Disease is something an organ has, illness is something a man has
Disease is something that needs to be cured. Illness is something that needs
to be managed.
They are not mutually exclusive, and often occur together
Psychiatry
o Focus on mental health problems
o Treatment of abnormal emotions and behavior
o Largely driven by DSM classification
o Psychiatrist is physician
o Use of psychotropic drugs to treat mental conditions
Clinical psychology
o Diagnostics of mental problems
o Provision of psychotherapeutic treatment
Health psychology
o Part of psychology that mainly concerns prevention of disease and promotion of
health
o Promotion of certain health behaviors in order to prevent illness
o Health-compromising behaviors
o Health-enhancing behaviors
Medical psychology
o Focus on patients in medical situations and their psychological problems
o Psychologists work in hospitals or rehabilitation center
o Patient categories in a medical setting
Adult patients with chronic diseases
Patients with functional complaints who present somatic complaints, in the
absence of a clear medical cause
Adult patients with brain damage, who need neuropsychological assessment
and treatment
Children up to 18 years of age, with a variety of diseases and symptoms
Adult psychiatric patients with primary psychiatric conditions
o Medical psychology in hospitals
In 2022, there are about 71 hospitals
Patients can only consult a medical specialist after being referred by the GP
However, the GP can not refer patients to a medical psychologist in
the hospital directly
The following disciplines are working in departments of medical psychology
Psychologists
Health psychologists
Clinical psychologists
And psychological assistants, psychological workers, secretaries and
trainees
o Tasks of a psychologist in a medical setting
Direct interaction with the patient
Assessment of the patient and his complaints by interviewing,
observation and testing
Psychological treatment, which generally is short-term intervention
, Indirect patient related tasks
Team coaching, consultation of other professionals
Participating in staff committees
Management tasks
Training of master students and post-graduate students
In general, research is not a structural task
Recognition of symptoms
Individual differences
o Hypochondriacs believe that normal bodily symptoms are indicators of illness
o Neurotic people often exaggerate their symptoms
Attentional differences
o People who are focused on themselves are quicker to notice symptoms
o People with more distractions and who attend less to themselves experience fewer
symptoms
Situational factors
o Boring situations make people more attentive to symptoms
o Medical students’ disease: students believe they are ill with the same illness about
which they are studying
Stress
o Stress-related physiological changes are interpreted as symptoms of illness
Mood and emotions
o Affects perceptions of symptoms and perceived vulnerability to illness
Interpretation of symptoms
o Prior experience
Common disorders are regarded as less serious than rare disorders
o Expectations
Unexpected symptoms are ignored, and expected symptoms are amplified
o Seriousness of the symptoms
Treatment is sought only when the symptoms affects a highly valued organ
and/or limits mobility
Common sense model of illness (Leventhal)
o People hold implicit commonsense beliefs about their symptoms and illnesses
o Result in organized illness representations
o Includes basic information about an illness
Identity = name
Causes = factors that led to illness
Consequences = symptoms, treatment, and implication of QoL
Timeline = length of time illness is expected to last
Control or cure = belief that illness can be managed or cured
Coherence = how well these beliefs represent the disorder
o Models of illness
Acute illness
Believed to be caused by viral or bacterial agents
Short in duration, with no long-term consequences
Chronic illness
Believed to be caused by multiple factors
Long in duration, with severe consequences
Cyclic illness
Alternating period of either no symptoms or many symptoms
Brief history
The mind-body relationship
o During prehistory
Mind and body intertwined
Diseases arise when evil spirits enter the body
Treatment consisted primarily of attempts to exorcise these spirits
o Ancient Greeks: humoral theory of illness
Diseases resulted when the four humors, or circulating fluids of the body,
were out of balance
Treatment: to restore balance between the humors
Four humors
Blood – passionate temperament
Black bile – sadness
Yellow bile – angry disposition
Phlegm – laid-back approach to life
o Middle ages
Disease regarded as God’s punishment
Treatment: driving out evil forces by torturing the body. Later, it was replaced
by prayer and doing good
o Renaissance to present day
Enhanced scientific knowledge and assessment
Practice is dependent on laboratory findings and reported or observed bodily
factors
Diagnosis and treatment are based on organic and cellular pathology
The result: biomedical model emerged
The biomedical model
o All illness can be explained through aberrant somatic bodily processes
o Health is seen as biochemical or physical in nature
o Assumes that psychological and social processes are largely irrelevant to the disease
process
o Ill-suited to understanding illness
Reduces illness to low-level processes
Fails to recognize social and psychological processes as powerful influences –
assumes a mind-body dualism
Emphasizes illness rather than focusing on behaviors that enhance health
Cannot address puzzles that face practitioners
Conversion hysteria
o The biomedical viewpoint started to change with the rise of modern psychology
o Specific unconscious conflicts produce physical disturbances symbolizing repressed
psychological conflicts
o Conceptualized by Sigmund Freud
o Gave rise to the field of psychosomatic medicine
Psychosomatic medicine
o Idea that specific illnesses are produced by people’s internal conflicts
o Dunbar and Alexander linked patterns of personality to specific illnesses
Ulcer-prone personality: someone with excessive needs for dependency and
love
Secretion of acid in the stomach eroding the lining of the stomach
Conflict produces anxiety which takes a physiological toll
o Criticism: conflict or personality type is not sufficient to produce illness
, Biopsychosocial model
o Health and illness are consequences of the interplay of biological, psychological and
social factors
o Advantages
Maintains that the macrolevel and microlevel processes continually interact
to influence health and illness
Emphasizes both health and illness
o Also received criticism
Social aspect not well captured in research
To be studied over time, explore complex interaction systems
Biomedical vs biopsychosocial
Clinical implications of the biopsychosocial model
o Understanding the interacting role of biological, psychological, and social factors
informs diagnosis
o Emphasis on the relationship between patient and their practitioner, which improves
Patient’s use of services
Efficacy of treatment
Rapidity with which illness is resolved
Epidemiology
Different disciplines
Mental problems and physical illness
o What is the relationship between mental problems and illness/disease?
o Which major fields contribute to our knowledge on mental problems and/or
illness/disease and what is the role of these fields in a medical setting?
Psychology and medicine
, Psychology is different from medicine
o Mono-causal explanation of disease in medicine
o Emphasis on biological pathways
o Clear distinction between body and mind
o Disease vs illness
Disease is something an organ has, illness is something a man has
Disease is something that needs to be cured. Illness is something that needs
to be managed.
They are not mutually exclusive, and often occur together
Psychiatry
o Focus on mental health problems
o Treatment of abnormal emotions and behavior
o Largely driven by DSM classification
o Psychiatrist is physician
o Use of psychotropic drugs to treat mental conditions
Clinical psychology
o Diagnostics of mental problems
o Provision of psychotherapeutic treatment
Health psychology
o Part of psychology that mainly concerns prevention of disease and promotion of
health
o Promotion of certain health behaviors in order to prevent illness
o Health-compromising behaviors
o Health-enhancing behaviors
Medical psychology
o Focus on patients in medical situations and their psychological problems
o Psychologists work in hospitals or rehabilitation center
o Patient categories in a medical setting
Adult patients with chronic diseases
Patients with functional complaints who present somatic complaints, in the
absence of a clear medical cause
Adult patients with brain damage, who need neuropsychological assessment
and treatment
Children up to 18 years of age, with a variety of diseases and symptoms
Adult psychiatric patients with primary psychiatric conditions
o Medical psychology in hospitals
In 2022, there are about 71 hospitals
Patients can only consult a medical specialist after being referred by the GP
However, the GP can not refer patients to a medical psychologist in
the hospital directly
The following disciplines are working in departments of medical psychology
Psychologists
Health psychologists
Clinical psychologists
And psychological assistants, psychological workers, secretaries and
trainees
o Tasks of a psychologist in a medical setting
Direct interaction with the patient
Assessment of the patient and his complaints by interviewing,
observation and testing
Psychological treatment, which generally is short-term intervention
, Indirect patient related tasks
Team coaching, consultation of other professionals
Participating in staff committees
Management tasks
Training of master students and post-graduate students
In general, research is not a structural task
Recognition of symptoms
Individual differences
o Hypochondriacs believe that normal bodily symptoms are indicators of illness
o Neurotic people often exaggerate their symptoms
Attentional differences
o People who are focused on themselves are quicker to notice symptoms
o People with more distractions and who attend less to themselves experience fewer
symptoms
Situational factors
o Boring situations make people more attentive to symptoms
o Medical students’ disease: students believe they are ill with the same illness about
which they are studying
Stress
o Stress-related physiological changes are interpreted as symptoms of illness
Mood and emotions
o Affects perceptions of symptoms and perceived vulnerability to illness
Interpretation of symptoms
o Prior experience
Common disorders are regarded as less serious than rare disorders
o Expectations
Unexpected symptoms are ignored, and expected symptoms are amplified
o Seriousness of the symptoms
Treatment is sought only when the symptoms affects a highly valued organ
and/or limits mobility
Common sense model of illness (Leventhal)
o People hold implicit commonsense beliefs about their symptoms and illnesses
o Result in organized illness representations
o Includes basic information about an illness
Identity = name
Causes = factors that led to illness
Consequences = symptoms, treatment, and implication of QoL
Timeline = length of time illness is expected to last
Control or cure = belief that illness can be managed or cured
Coherence = how well these beliefs represent the disorder
o Models of illness
Acute illness
Believed to be caused by viral or bacterial agents
Short in duration, with no long-term consequences
Chronic illness
Believed to be caused by multiple factors
Long in duration, with severe consequences
Cyclic illness
Alternating period of either no symptoms or many symptoms
