A psicologia da saúde: aspectos teóricos e campo de atuação

• The chapter explores theoretical and methodological models in health psychology and Urie Bronfenbrenner's ecological development concept, focusing on the field of practice.

Learning Objectives

• Characterize health psychology based on its field of practice.
• Define Urie Bronfenbrenner's model as an alternative to the health-disease process.
• Explain the main trends in studies, debates, and practice in health psychology.

Introduction to Health Psychology

• Psychology is an ancient field, existing even when psychic processes were considered as the soul, spirit, and world of ideas.
• Its psychological character relates to human thought, feelings, and philosophical beliefs.
• Psychology evolved into a vast, obscure, diversified, and divergent field.
• Modern scholars trace psychology's scientific origin to Wilhelm Wundt's Institute of Psychology in Leipzig, Germany, in 1879.
• Various schools of thought, theories, and methodologies emerged to explain phenomena, from experimental psychology and cognitive psychology to psychoanalysis, psycholinguistics, educational psychology, and health psychology.

Health Psychology Origins

• Health psychology cannot be discussed without revisiting the 15th-century ideology focused on valuing and understanding the human being.
• Sartre named the ideology Humanism, aiming to comprehend man's existence.
• Humanism revived the sophist philosophy from Classical Antiquity, which stated that "man is the measure of all things."
• Humanism sought to educate man through self-knowledge and understanding of civilization.
• The meaning of Humanism evolved over time, with Christian Humanism in the Middle Ages and Aristotelian realism during the Renaissance.
• Discoveries by figures like Copernicus and Galileo transformed human thinking.
• Modern Era philosophy was based on Descartes (human as the owner of knowledge), Rousseau (each human is indivisible from the whole), and Kant (human as an autonomous being).
• the contemporary brought the valuation of humanity and its capacity for autonomy.
• The humanist movement influenced psychology, leading to humanistic psychology and the integration of its knowledge into health psychology.

Humanistic Psychology in the 20th Century

• Rising from the social movement valuing human life, culminating in the Universal Declaration of Human Rights and the UN in 1948.
• It legally solidified Humanism, viewing humans as autonomous and self-aware.
• Maslow, Allport, Murphy, and Rogers pioneered humanizing knowledge about humans, health, and well-being, and also criticized biological determinism.
• Humanistic psychology saw development as evolving from interpersonal relationships.
• Maslow emphasized re-humanizing science, Murphy focused on human bio-social issues, Allport viewed humans as active organisms with core motives, and Rogers defined three levels of intervention: education, organizational work, and psychotherapy.
• Roger's psychotherapy centered on the client, not the analyst, deemphasizing psychoanalytic transfer.
• Humanistic psychology was introduced in Brazil in 1970, based on translations of Carl Rogers's studies.
• The approach influenced the creation of Carl Rogers' person-centered approach in Brazil, influencing practice in applied psychology.

The Expansion of Health Psychology in Brazil

• Humanist ideals gained traction following anti-asylum movements, compelling psychologists to rethink their roles.
• Applied psychology emerged in health, creating a diverse field due to conflicting theoretical approaches.
• Psychologists broadened their scope beyond mental health institutions, directing attention to specialists in human behavior and health.
• Mental health also opened its doors, reducing the social exclusion of patients.
• Health psychology is defined as a field for psychologists to understand and act on the relationship between behavior and health, as well as to develop coping strategies.
• It emerged with a task force in the American Psychological Association (APA) in 1970.
• In 1978, Division 38: Health Psychology was created to encourage integrating biomedical information with psychological knowledge.

Contributions to Defining Health Psychology

• Its scope aligns with the psychologist's field of practice.
• De Marco (2003) considered health psychology as psychologist-led activities in the health field.
• Trindade and Teixeira (1998, 2002) emphasized health psychology as a science and profession.
• It includes physical and mental health, exceeds medical knowledge, considers social, cultural, environmental, economic, and gender aspects influencing health.
• Psychologists must focus on health promotion, maintenance, and disease prevention, improving well-being and quality of life.
• Psychologists should expand practices beyond mental health institutions to general health institutions, research centers, and align with a broader health concept.
• Matarazzo (1990) defines health psychology as educational, scientific, and professional contributions promoting health, preventing and treating diseases.
• It identifies health-related etiologies and diagnoses, analyzing diseases/dysfunctions in healthcare systems and for health policy development.
• A health psychology approach should consider biopsychosocial, economic, cultural, and ecosystemic dimensions to improve quality of life.
• Health psychologists operate in primary, secondary, and tertiary care health facilities, addressing patient and family needs in interdisciplinary ways.
• Health psychologists engage in research and academic training, specializing in their area or related health fields.

Expansion of health psychology since 1970

• Health psychology saw a rise through theoretical and methodological frameworks.
• Social medicine and other schools aimed to break from the hegemonic mechanistic model of health, while pointing to differences in theory and practice.
• Social medicine arose as a form of population control to link medicine, state, and capitalism, becoming integrated with occupational medicine.
• Michel Foucault (1988) notes the development of techniques and knowledge, applying technology to control the ways individuals live, linking medical knowledge to social aspects.
• Social psychology divided into multiple approaches, including epidemiology, health surveillance, and collective health, contributing to psychological practices in health.
• Key research paths influencing health models and approaches included social, behavioral, phenomenological existential, and psychoanalysis psychology.
• Emerging from these fields, the areas tend to show new movement within medical and psychology.
• Since the 1970's, four theoretical-methodological models were identified in health psychology: behavioral medicine, psychosomatic medicine, medical psychology, and hospital psychology.
• The methods used are traced from the origins of sociology, the philosophy of anthropology, the medicine of psychiatry, and more.

Key Considerations in Health Psychology

• The work of psychologists in health is complex with a variety of applications and approaches, influenced, in part, by brazilian practice.
• Practice depends influence on the characteristics like the community, region and the respective institution.

Bronfenbrenner's Ecological Systems Theory

• It is used frequently to study individuals within families, societies, and the elderly.
• It considers that people are broadly influenced by a network of environments, which affect human growth and well-being.

Urie Bronfenbrenner's Ecosystemic Model

• Urie Bronfenbrenner, an American psychologist born in Russia, dedicated himself to human development studies.
• Best known for the ecological and systemic theory studied the person within the contexts of their life, through interactive processes.
• Senna and Dessen (2012) explain the model as described in works of 1979, and later refined in 1999.
• Human development requires perception, motor skills, cognition based with relational patterns across differing contexts and multiple environments.

Bronfenbrenner's Premise

• It calls for researching in natural settings, disapproving studies taken "out of context" to focus on the multiple contexts the person lives in.
• Developmental and family studies use the Bronfenbrenner model.
• The model focuses on how a child is exposed to learning environments.
• They develop relating to their environment, meaning the progress of children is possible when they are involved.
• This is an approach that studies the subject in common settings to understand actual reality.
• Numerous authors use it to distinguish what layers surround an environment on different scales, such as the micro, meso, exo, and macro systems.

Ecological Environments

• These structured structures help interpret the environments that have impact on a person.
• The structures interact with one another as a game of stacked dolls, and influence development as a whole.

The Structures are Defined as Follows

Micro

• Individuals experience patterns of activities roles, and interpersonal status in a given environment.
• Characteristics include physical and material (BRONFENBRENNER, 1996)
• These cover the features of the individual such as gender, weight, height, health and other institutions that they interact with closely like family, school, and church.

Meso

• This relates to the interrelations of two or more environments to form or enlarge through those affiliations.
• Institutions include those interact directly with the subject as well as their affiliation.
• For example, this includes the parents in relation to the institution of the church which influence the child as they structure themselves.

Exo

• This holds the major institutions outside of an average family pattern, relating to subject, family, and institutions.
• Unlike the mesosystem, the individual does not take part in processes, but events can always affect it.
• For example, surrounding services such as neighborhoods, jobs, health, and media can all influence this tier.

Macro

• This presents culture relevant to a subject, as attitudes and ideology.
• Connections are determined for each subject who come from different cultures.

Bioecological Characteristics

• After 1998, Bronfenbrenner referred to ecological as bioecological, reemphasizing the biopsychological characteristics of the human undergoing development for design.
• Essential to understand development is identifying process (P), person, context (C), and time (T) with dynamic integration.
• In those characteristics, reciprocated interactions between objects, symbols, or other people are engaged in the process.
• The interactions vary by ability, moment, and surrounding, as well as inducing dysfunctions to progress.

Proximal Processes

• Proposed through the model in the means of interactions between the atmosphere and processes long lasting in time, to produce the early means of human growth.
• The bioecological model of human progress are demonstrated through the four inter-related dimensions assigned: PPCT - process, person, situation, and time.
• They are defined in this way (MARTINS, SZYMANSKI, 2004):

Person

• These consist of consistencies and alterations in the existence of a human through the course of living.
• Emphasis rests in the features of the person evolving, such as motivation, activity, and core beliefs.
• All are influenced by interaction in terms of which environments one can enter or what they experience through the type of person it is.
• Social values or values relating can foster a break or promote ones psychological condition.
• The actions one takes can be traced through disposition, knowledge, and skills.
• Dispositions activate proximal workings, skills help to assist in those operations, and demand can either lead to discourage in social settings.

Process

• References tiers of differing levels to represent the day to day activities of any person moving through growth.
• Development socially and intellectually requires an active part in engaging with a progressive engagement with symbology.

Context

• The world the person sits within that is active with progress.
• All the environments entail a full understanding of how those closest can be intimate with that of the progressing mind.
• Levels are measured through those in proximity or by scales such as macro or meso, exo, or micro.

Time

• Can be translated to historic progressions along with shifts through events that one suffers in their development.
• These moments in time across the life can change direction for a population depending on the society.
• Shorter familial periods can be more influential at pivotal moments.

Health and Health Psychology

• These help provide understanding for those who do public health and psych with this model in use for their research, policies, and in management.
• This stems from recognizing what facets human need to better their life as housing, transport, and access to culture.
• In contrast to a model based on relationships that create environmental levels that influence the stances, actions, and approaches from those individuals in life.

Theoretical and Methodological Models

• Psychology is built on models, so here are a few schools of thought with insight on the current applications, from current research.
• While Social Medicide first served as society control, it had since evolved and opened doors in the sector in order to define new approaches to the arena alongside other majors in order to generate modern psychology.
• Early modern medicine was composed of bureaucrats, generally doctors, who oversaw the management of those connected to this sector within a certain rationale.
• Not long after, another came to england to serve as a mixture in between welfare and medicine, dealing workers on wages.
• From there had been a third school of thought led by healthcare workers in france that impacted healthcare in brazil.
• Foucault (1988) summarized what urban medical goals entailed into 3 key principles: to assess unhealthy urban spots, to command of clean water quality, and to dominate the frequency sources to support basic survival.
• Starting with the 70, there were several events in social medicine as healthcare as a group, the application of statistics and looking out for people's care that served fundamental guidelines.

Medicine, psychiatry, and psychology

• By the 70s, other schools of thought derived from previously mentioned medicine, psychiatry, and other forms of psychology and became integrated under the field of public health.
• Actions of a medical nature were: psychosomatic approach, healthcare actions, functional medicine, and health from a facility view.
• The hospital view of brazillian public health may be encompassed by that of public health.
• the following table contrasts the distinctions between treatment received at each institution as stated.

Comparative Findings of Patient Care in Brazil

• In the framework of traditional medicine, care provided is attention during secondary and tertiary care, performed inside the location itself, no qualifications are obligated for physicians and it's interdisciplinary.
• Healthcare facilities, care levels span across all 3 tiers of protection primary, secondary and tertiary, spanning outside for local service or NGOs etc. requires some certification in certain nations and is inclusive of many services in the same framework.

Psychosomatic Approach

• Emerges as a way for doctors to understand the mental sources for physical disorders through studying them using an analytic technique.
• While first appearing hard to work out in all factors, the study gives means as where dimension and where the underlying logic of inner clashes as traced under a mental lens.
• In these roles doctors and analysts may share the determinants for conditions that display corporeal signs.
• Treatment comes via patient care under medical circumstances.

Foundation of Psychosomatic Chicago School

• The medical branch regards detection and aid to physical disorders stemmed from deficient mentality.
• Nowadays Psychosomatic study is broad and has many clashing points with common ideas.
• In Brazil, psychosomatic science is researched and applied from divergent standpoints that do not reflect original theories.
• The branch is guided by the theory of mental evaluation along freudian ideas.
• When Freud was studying, certain tangible symptoms in persons did not correlate with impacted organ physiology and gave origin to pschoanalysis.
• Understanding through mental interpretation and corporeal translation allowed analysts to uncover the repelling elements inside those patients.

French psychosomatic school founded by Pierre Marty

• This school believed that Paris created an institute to that end in 1972, applying ideas from psychoanalysis.
• Dr. Marty saw tangible pathology to source from the lack of mental expression, out of weakened representations and sensations.
• Criticism came from what Alexanders views by saying its not the mental side thats causes ailment, the inverse occurs as well.

Contributions of Doctors Capitão and Carvalho

• McDougall and the rest aided adults as in youth who were not able to put their thoughts into words and act through mind driven signals from pain.
• In every way said people support a certain ideal by telling the human with a mind thats weak needs symbolic depictions of those around them for comprehension.

Medicine influences public health

• Psychosomatic influence changed perspectives in multiple new avenues within public health.
• More is contained in the book "modern Psychosomatic medicine".

Medical Psychology

• Started through hungarian psychoanalyst Balint, also concerning patient medical workers interactions. Schneider 1971, mentalist care takes more concern in the relations in public health than client ailments.
• According to the book "Today and yesterday", medical psycho shifts concentrate in treatment and practices.
• Analysis also says that it builds knowledge from mankind, as understanding fully.
• Balints analytic method helped those previously thought to have regressed, difficult clients and unable to work through adult discourse.
• According to Brandt, Some applied the idea as groups.
• Group activities, are reasoned with in counter measures relating to the therapist.

Balint's psychoanalytic work

• The basis from work with illness comes with the relating factors created through specialist-client within all aspects.

Behavioral approach

• Science using modification to alter how to look after, treat, and return a patient.
• They have recognized how health problems coincide with harmful activity and mental and physical practices can treat humans, cognition and mental reactions.
• While other processes work on other factors, mental reactions and cognitive approach are seen to work in an indirect way.