D&H3: Psychology and Health lecture notes
Lecture 1: How to define health?
Goals first lecture:
1. You can distinguish common definitions of (mental) health and apply them within
healthcare
2. You can describe and explain relationships between these definitions of health and
are able to explain the integrative model (3C-model)
3. You can use this integrative model as a heuristic for generating and analyzing
questions for the case you will describe in your paper
Defining health
- At a psychological level: the experience of something is going wrong (the negative
definition)
- What is going wrong?
o I do not know what happens to me: I cannot explain it by normal attribution
Internal attribution: vertical: something inside my body or my mind
External attribution: horizontal: others are the cause of what happens
to me
o I do not experience any control over my pain/body/feelings/behavior
- Health as the absence of discomfort? Discomfort =
o Illness (subjective feeling)
o Sickness (social role)
o Disease (the biological kernel/substratum)
- In this definition you can have a disease without being ill, you can also have a disease
without the social role of someone being ill
Medical model: health as the absence of disease
- The body/mind as origin/cause of illness
- The logic of the medical model:
o Physical origin: medicine is mainly concerned with the physical body
o Doctors see patients when something is going wrong, medicine is about
explaining illness
o The role of doctors: relating the visible outside
(complaints) to the invisible inside (disease)
o Distinction between complaint, symptom,
syndrome, substratum (sheet medical model)
o A specific combination of complaints refers to a
specific set of symptoms (syndrome) which
indicates the existence of a disease =
substratum (kernel)
The medical model
- Medical science
o The science of the etiology, pathogenesis, natural course, treatment, and
prognosis of diseases
, o Etiology and pathogenesis: complex interaction of external events and genetic
constitution
o Natural course: what happens if nothing will change
o Prognosis: what will be the final state, with and without treatment
- Medicine is build on the logic of infectious diseases
o The archetype: the appendicitis (pain in lower right abdomen, etc. it is cured
by removal of the appendix)
o Later it has been elaborated towards the knowledge of other diseases
- The distinction between cause and kernel
o Cause: responsible for the onset and development of the illness. A virus or a
bacteria
o Kernel (substratum): what gives reason to your complaints and symptoms
(the cause of what you are feeling)
The elaboration toward mental illness: hypotheses
- The medical model: look inside and you will understand
- The hypothesis: in order to understand mental disorder, you have to look inside
(substratum)
o (some) complaints should be interpreted as symptoms
o Symptoms manifest themselves in specific constellations (syndromes)
o Syndromes are discrete and distinctive entities (the DSM-hypothesis)
o Syndromes refer to underlying kernels – substrata
o These kernels are the internal part of the disease, and as such the cause of
your suffering
o But not the cause of your disease
- The strict medical model: the kernel is physical (we are our brain)
- The liberal medical model: the kernel could be mental (whatever it means)
- Mental health as the absence of a mental disorder
Case: Mrs. van den berg
Mrs. Van den Berg has been referred to a psychologist by her GP:
- 48-year-old woman with depressive complaints for three months
- Third time she visted her GP with these type of complaints (6 years ago, 2 years ago)
- Mother also suffered from depressive complaints and had made an end of her life
- Has had a partner for 10 years but no children
- One brother at distance
- Sadness, loss of appetite, anhedonia, sleeping problems, ruminating, stinging pain in
her neck, continuous headache, upset – feeling stressed, irritable, continuously
angry, feelings of hate and disgust
- Lost 4 kg in the past 2-3 months
- Works as a secretary (management assistant)
- 3 months ago: she had a quarrel with her boss
- At the same time her partner had an affair with her colleague
- Rather shy and introvert (just a small social circle around her)
- Calls herself perfectionistic and she has a fear for failure
- Rather negative self-image
- Likes to read books, has no other hobbies
, - Does not take much time for sports
Case of Mrs. van den Berg continued
- First idea: Mrs. van den Berg is suffering from a depression. She is ill
- Major depressive disorder: at least 5 of the following symptoms have been present
during the same 2-week period and represent a change from previous functioning:
o Depressed mood ⊠
o Markedly diminished interest or pleasure ⊠
o Significant weight loss or weight gain
o Insomnia or hypersomnia ⊠
o Psychomotor agitation or retardation
o Fatigue or loss of energy⊠
o Feelings of worthlessness or excessive or inappropriate guilt⊠
o Diminished ability to think or concentrate⊠
o Recurrent thought of death
- What should we do? Treat her depression with CBT or medication (guidelines)
Social models
- What if the illness is not located somewhere in the individual?
- The distinction between being ill and being the holder of the symptoms
o A child suffering from all kinds of complaints, but looking more closely reveals
that the parents have serious relation problems? Who is ill?
o Not the individual but the social environment (community) is ill
- Different social models
o Contextual model: society as norm
o Systemic model: society as a system
o Sick society model: society as cause
Social model I: the deviance (the contextual model)
- Oldest model of health, but often forgotten (see Larson)
- Health = being normal (not deviant from the general population). A sociological
definition
- The oldest title for clinical psychology: abnormal psychology: (psychology of deviant
behavior)
- Psychologists do not like this definition very much
o Negative taste: the more you conform yourself to the social norm the
healthier you are (we know better)
- However: this definition has very attracting features
o A descriptive model: it takes for granted that a certain number of behaviors
are labelled as deviant
o A critical viewpoint: many of the problems we face have a sociological nature
Deviance: a statistical approach
Cultures can differ for how tolerate they are for ‘abnormal’
behavior and what they call ‘abnormal’. Context differs, so their
number and type of behavior of abnormal differ
, Deviance
- Social norms determine what kind of behavior is considered to be healthy (or not)
- Social norms (culture):
o What we accept as being normal
o A norm changes over time, and social norms are important to understand
what we see as being normal
Social model II: system approach
- The sick individual is just the holder of symptoms, the weakest link of a system
- Origin: David Laing: the divided self
o Contradictory demands: the schizophrenogenic mother
o The schizophrenic reaction as the only solution within the interaction with his
mother
- Communication theory: message has content and relational aspect
o Paradoxical message: be spontaneous
o Hidden message: honesty is the best policy
o Contradictory message: sweetheart I hate you so much
- System approach: you have unhealthy relationships instead of unhealthy individuals
- The individual who holds the symptoms is just the expression of what is going wrong
in the system
Social model III: the sick society
- Society as cause of sickness (the disease remains situated within the individual)
o Community approach: society as a determinant of health (level of education,
social class, poverty, gender, organisation of work, etc.)
o Covid, climate
o The stressful society demands too much
- The sick society (the disease is situated in society)
o A continuing body of literature suggests that our society is developing in a
pathological direction – through the culture of narcissism, identity failure
(Paul Verhaeghe) or borderline (Dirk de Wachter)
o Interesting discussions. Was life 100 years ago better? Strong opinions
o Each society creates its own illness. If an ill person is transferred to another
society, this person will become better
Case Mrs. van den Berg within the social model
With the medical model you focused more the anxiety- and depressive complaints, but
within the social model you would focus more on the quarrels with her boss and boyfriend
And the unhealthy demands from work
The wellness model (the humanistic – positive psychology model)
- Health as the absence of disease or ‘abnormality’ suggests that the top of health
achievement is absence of disease or absence of deviance
- But is health just the absence of deviance or illness?
- World war II: absence of war is not identical to peace
- WHO 1949: health: ‘a state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity’
Lecture 1: How to define health?
Goals first lecture:
1. You can distinguish common definitions of (mental) health and apply them within
healthcare
2. You can describe and explain relationships between these definitions of health and
are able to explain the integrative model (3C-model)
3. You can use this integrative model as a heuristic for generating and analyzing
questions for the case you will describe in your paper
Defining health
- At a psychological level: the experience of something is going wrong (the negative
definition)
- What is going wrong?
o I do not know what happens to me: I cannot explain it by normal attribution
Internal attribution: vertical: something inside my body or my mind
External attribution: horizontal: others are the cause of what happens
to me
o I do not experience any control over my pain/body/feelings/behavior
- Health as the absence of discomfort? Discomfort =
o Illness (subjective feeling)
o Sickness (social role)
o Disease (the biological kernel/substratum)
- In this definition you can have a disease without being ill, you can also have a disease
without the social role of someone being ill
Medical model: health as the absence of disease
- The body/mind as origin/cause of illness
- The logic of the medical model:
o Physical origin: medicine is mainly concerned with the physical body
o Doctors see patients when something is going wrong, medicine is about
explaining illness
o The role of doctors: relating the visible outside
(complaints) to the invisible inside (disease)
o Distinction between complaint, symptom,
syndrome, substratum (sheet medical model)
o A specific combination of complaints refers to a
specific set of symptoms (syndrome) which
indicates the existence of a disease =
substratum (kernel)
The medical model
- Medical science
o The science of the etiology, pathogenesis, natural course, treatment, and
prognosis of diseases
, o Etiology and pathogenesis: complex interaction of external events and genetic
constitution
o Natural course: what happens if nothing will change
o Prognosis: what will be the final state, with and without treatment
- Medicine is build on the logic of infectious diseases
o The archetype: the appendicitis (pain in lower right abdomen, etc. it is cured
by removal of the appendix)
o Later it has been elaborated towards the knowledge of other diseases
- The distinction between cause and kernel
o Cause: responsible for the onset and development of the illness. A virus or a
bacteria
o Kernel (substratum): what gives reason to your complaints and symptoms
(the cause of what you are feeling)
The elaboration toward mental illness: hypotheses
- The medical model: look inside and you will understand
- The hypothesis: in order to understand mental disorder, you have to look inside
(substratum)
o (some) complaints should be interpreted as symptoms
o Symptoms manifest themselves in specific constellations (syndromes)
o Syndromes are discrete and distinctive entities (the DSM-hypothesis)
o Syndromes refer to underlying kernels – substrata
o These kernels are the internal part of the disease, and as such the cause of
your suffering
o But not the cause of your disease
- The strict medical model: the kernel is physical (we are our brain)
- The liberal medical model: the kernel could be mental (whatever it means)
- Mental health as the absence of a mental disorder
Case: Mrs. van den berg
Mrs. Van den Berg has been referred to a psychologist by her GP:
- 48-year-old woman with depressive complaints for three months
- Third time she visted her GP with these type of complaints (6 years ago, 2 years ago)
- Mother also suffered from depressive complaints and had made an end of her life
- Has had a partner for 10 years but no children
- One brother at distance
- Sadness, loss of appetite, anhedonia, sleeping problems, ruminating, stinging pain in
her neck, continuous headache, upset – feeling stressed, irritable, continuously
angry, feelings of hate and disgust
- Lost 4 kg in the past 2-3 months
- Works as a secretary (management assistant)
- 3 months ago: she had a quarrel with her boss
- At the same time her partner had an affair with her colleague
- Rather shy and introvert (just a small social circle around her)
- Calls herself perfectionistic and she has a fear for failure
- Rather negative self-image
- Likes to read books, has no other hobbies
, - Does not take much time for sports
Case of Mrs. van den Berg continued
- First idea: Mrs. van den Berg is suffering from a depression. She is ill
- Major depressive disorder: at least 5 of the following symptoms have been present
during the same 2-week period and represent a change from previous functioning:
o Depressed mood ⊠
o Markedly diminished interest or pleasure ⊠
o Significant weight loss or weight gain
o Insomnia or hypersomnia ⊠
o Psychomotor agitation or retardation
o Fatigue or loss of energy⊠
o Feelings of worthlessness or excessive or inappropriate guilt⊠
o Diminished ability to think or concentrate⊠
o Recurrent thought of death
- What should we do? Treat her depression with CBT or medication (guidelines)
Social models
- What if the illness is not located somewhere in the individual?
- The distinction between being ill and being the holder of the symptoms
o A child suffering from all kinds of complaints, but looking more closely reveals
that the parents have serious relation problems? Who is ill?
o Not the individual but the social environment (community) is ill
- Different social models
o Contextual model: society as norm
o Systemic model: society as a system
o Sick society model: society as cause
Social model I: the deviance (the contextual model)
- Oldest model of health, but often forgotten (see Larson)
- Health = being normal (not deviant from the general population). A sociological
definition
- The oldest title for clinical psychology: abnormal psychology: (psychology of deviant
behavior)
- Psychologists do not like this definition very much
o Negative taste: the more you conform yourself to the social norm the
healthier you are (we know better)
- However: this definition has very attracting features
o A descriptive model: it takes for granted that a certain number of behaviors
are labelled as deviant
o A critical viewpoint: many of the problems we face have a sociological nature
Deviance: a statistical approach
Cultures can differ for how tolerate they are for ‘abnormal’
behavior and what they call ‘abnormal’. Context differs, so their
number and type of behavior of abnormal differ
, Deviance
- Social norms determine what kind of behavior is considered to be healthy (or not)
- Social norms (culture):
o What we accept as being normal
o A norm changes over time, and social norms are important to understand
what we see as being normal
Social model II: system approach
- The sick individual is just the holder of symptoms, the weakest link of a system
- Origin: David Laing: the divided self
o Contradictory demands: the schizophrenogenic mother
o The schizophrenic reaction as the only solution within the interaction with his
mother
- Communication theory: message has content and relational aspect
o Paradoxical message: be spontaneous
o Hidden message: honesty is the best policy
o Contradictory message: sweetheart I hate you so much
- System approach: you have unhealthy relationships instead of unhealthy individuals
- The individual who holds the symptoms is just the expression of what is going wrong
in the system
Social model III: the sick society
- Society as cause of sickness (the disease remains situated within the individual)
o Community approach: society as a determinant of health (level of education,
social class, poverty, gender, organisation of work, etc.)
o Covid, climate
o The stressful society demands too much
- The sick society (the disease is situated in society)
o A continuing body of literature suggests that our society is developing in a
pathological direction – through the culture of narcissism, identity failure
(Paul Verhaeghe) or borderline (Dirk de Wachter)
o Interesting discussions. Was life 100 years ago better? Strong opinions
o Each society creates its own illness. If an ill person is transferred to another
society, this person will become better
Case Mrs. van den Berg within the social model
With the medical model you focused more the anxiety- and depressive complaints, but
within the social model you would focus more on the quarrels with her boss and boyfriend
And the unhealthy demands from work
The wellness model (the humanistic – positive psychology model)
- Health as the absence of disease or ‘abnormality’ suggests that the top of health
achievement is absence of disease or absence of deviance
- But is health just the absence of deviance or illness?
- World war II: absence of war is not identical to peace
- WHO 1949: health: ‘a state of complete physical, mental, and social well-being and
not merely the absence of disease or infirmity’
