Health Psychology and Human Diversity Introduction PDF

Health Psychology and Human Diversity Introduction to the unit Will be presented by : Dr. Kareem Nasir Hussain Al-Esawi F.I.C.M.S, C.A.BM. M.R.C.PSYCH Consultant psychiatrist  This unit aims to introduce you to psychological theories and research t...

Health Psychology and Human Diversity Introduction to the unit Will be presented by : Dr. Kareem Nasir Hussain Al-Esawi F.I.C.M.S, C.A.BM. M.R.C.PSYCH Consultant psychiatrist  This unit aims to introduce you to psychological theories and research that will be relevant to your practice as a doctor. Unit designed to meet the requirements of the GMC (Tomorrow’s Doctors 2009)  Unit content Psychology, health & illness Biopsychosocial model, stress, pain; changing health behaviour; coping with illness; psychological therapy; adherence to treatment; dying Diversity Stereotypical thinking; aspects of diversity e.g. disability, sexuality, ageing; reflective practice  Teaching on the unit Teaching methods include: Lectures, many with visiting speakers for clinical focus, or to cover specialist topics Small group sessions DVDs Independent study & reflection Blackboard (lecture slides, readings, self-directed study discussion board) Different locations You need to check the timetable in Unit Book Assessment Assessment based on Learning Outcomes for the unit and for individual sessions Formative mid-unit exam, with model answers Revision session ONLINE What is expected from you Show respect for speakers and fellow students Be on time (ready to start, not just arriving) Be quiet in lectures Participate in discussions and group sessions Offer constructive comments and suggestions Seek help appropriately Diversity in student background Some topics may be particularly sensitive for you. Be aware of what is coming up and contact the module leader before the relevant session if you have any concerns.  Psychology and medicine Biopsychosocial model Objectives To enable you to: Describe how biological, psychological and social factors can contribute to health and illness, and to health related behaviour ‫سلو‬ ‫ك‬  Psychology is the science of how people think, feel and behave. What is health psychology? – contribution of the discipline ‫ان ﺿ ب ا ط‬ of psychology to: the promotion ‫ﺗﻌ ﺰ ﻳﺰ‬ and maintenance of health; the prevention and treatment of illness; the identification of psychological factors influencing health and illness; and the analysis and improvement of the health care system and health policy formation. ‫ا ل س ي اس ة‬  The biomedical model Traditionally medicine not interested in psychological or social factors Biomedical model dominant in Western medicine Illness understood in terms of biological and physiological processes treatment involves physical intervention (drugs, surgery) "The body is treated like a machine that is fixed by removing or replacing the ailing part or destroying the foreign body that is causing the problem” McClelland (1985) – But is this too narrow a picture? How important are psychological and social factors in health?  Ali 50 year old financial manager Divorced, 3 teenage children Recovering from a heart attack What factors might have contributed to Ali’s heart attack? Other than medication, what else might his doctor recommend? The biopsychosocial model (Engel,1977)  Value of psychology to medicine Patients as people (complex and messy!) Causal influence of thoughts, feelings, motivation and behaviour on health and illness diagnosis treatment (and adherence) Doctors have a role in changing health behaviour (e.g. smoking ‫ وﻗف‬cessation) Doctors see people with mental health problems Important to understand feelings and emotions e.g. reactions to diagnosis and coping with illness Diversity and stereotypy  Learning outcomes ‫ا &عر ف ي ة‬ Describe how normal human cognitive functions can lead to stereotypical thinking Begin to reflect upon and challenge your own stereotypes around disability  Why do medical students need to study diversity? ‫اﻟﺘﻧو ع‬ To prepare themselves for being able to meet GMC requirements ‫اﻟوعي‬ To increase their knowledge and awareness of the diversity of their patients To increase their awareness of stereotypes and how to challenge them  Why is Human Diversity relevant? Different groups of people have different health problems have different lifestyles (that impact on health) want different types of health services hold different health beliefs ‫ا'ع ت ق دات‬ engage in different health behaviours have different health needs  Duties of Good Medical Practice You must treat patients fairly and with respect whatever their life choices and beliefs. This includes your views about a patient’s age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.  As a doctor you will need to be aware of how your own values, beliefs and stereotypes ‫ت أﺛﻴﺮ‬ about different groups may impact on your treatment of patients and interactions with colleagues ‫اﻟﺰ م (ء‬ ‫اﺳ ﺖ حس ن‬ ‫ﺗوﻗﻊ ﻟﯾس‬%‫ ﻣن ا‬ not be expected to agree with patients or approve of them in order to provide good health care, but you will need to understand them and respect their rights This session offers you time to reflect on issues that may be sensitive for you and to consider how you might address them during your training  Stereotypes generalisations we make about specific social groups, and members of those groups ‘rules of thumb’ – broadly correct but can be erroneous  ‫أس ا‬ The basis of stereotypes ‫س‬ How we store memories and organise knowledge cognitive model of psychology ‫ﺗم ث ي ل‬ Knowledge is stored as mental representations, organised in schemata, groups of related information e.g. restaurant schema, fruit schema Function: ‫اﻟﺘﻧﺑؤ ﺑﮫﺎ ﻳﻣ ﻛ ن‬ save ‘processing power’; environment is more predictable; allows anticipation; avoids ‘information overload’ ‫ت حﺳﺐا‬ Think of an apple….  Schemata Members of group share some characteristics But ‘shortcut’ ‐ overlooks diversity  Stereotypes social schemata (about people, roles, relationships) ideas about ‘typical’ older person, politicians etc ‫ت اﻛ ﻴ د‬ prone to an emphasis on negative traits, and are resistant to change  In-group / out-group attributions ‫اﻟﮫ و ﻳﺔ‬ ‫اﻟذات اﺣﺘﺮام‬ Groups are a source of self identity & self‐esteem ‫ﻓﺮز‬Assign people to categories to help understand social environment Social identification Social comparison builds self esteem ‫ﺳ ﻣ ﺎت‬ People are more likely to focus on negative attributes of people from other social groups, and on positive attributes of people in their own social groups Negative bias in many stereotypes can lead to prejudice ‫ان ﺣﻲا ز‬ ‫ﻣ ﺴ ﺒﻖ‬ ‫ر أي‬/ ‫ت ع ﺻﺐ‬  Social cognition ‫اد ر ا‬ ‫ك‬ ‫ﻣ ط اب ق ة‬ Compliance, conformity and group behaviour Behaviour is influenced by social and cognitive processes we may not be aware of All human beings are susceptible so we need to know about them and be vigilant  Summary Everyone has stereotypes, not just ‘bad people’, it is how we use them that is important! We refer to stereotypes unconsciously Provide helpful shortcuts ‫ﻧﻐ ﻔل‬ But discount individual differences And can lead to prejudice Getting to know members of other groups helps challenge negative stereotypes Reflective practice can also help Understanding behaviour in old age - the psychology of ageing  Understanding behaviour in old age - The psychology of ageing Background - demographic context ( Geropsychology ) Psychological issues ‫ذك ا‬ Intellect ‫ء‬ and aging Personality and ageing Social context Ageing: Important contextual issues  The context - population ageing ‫ﻗ ﻴد اﻟﺣ ﻴﺎه ﻋ ﻠﻰ‬ 1 2 3 4 5 6 7 8 0 0 0 0 0 0 0 0 The context - population ageing Source - United Nations 1998, New York  Ageist stereotypes of old peoples’ behaviour ‫ﻣ ﻊ اﺻ ﺮ ه‬ Very prevalent in contemporary culture e.g. “Intellectual deterioration is the norm…” ‫ي ت م اش و‬ “Old people are unable to innovate ‫ن‬ and adapt to change…” ‫ا ن تظا ر ا 'ر ض و كذ ا‬ “Old age is a period of personal stagnation…” “Old people tend to be rigid, cantankerous and introverted…” But are these valid ideas ? Intellect and ageing  Intellect and ageing Cross-sectional studies emphasised a gradual linear decline in IQ throughout adult life, accelerating after age 70  Intellect and ageing Methodological issues in studying intellectual function over the human lifespan Differences between ages - comparing groups of different ages cross- sectionally Changes over time within individuals Cohort effects e.g. numeracy/arithmetical skills Validity of measures  Intellect and ageing More valid longitudinal studies paint a less pessimistic picture Shaie and Willis - Seattle study (35+ years follow up) 5 ‘skill areas’ considered Verbal meaning ‫ﻣ ﻌ ﺎﻧ ﻲ ﻛ ﻠﻣ ﺎت‬ Verbal fluency ‫ﺳ ﺔ‬# ‫س‬،‫ﻓﺻ ﺎﺣ ﺔ‬ Inductive reasoning ‫ا (ﺳ ﺘد (ل ا (ﺳ ﺘﻘ ﺮ اﺋﻲ‬ Numeracy ‫ا (ر قا‬ ‫م‬ Spatial orientation ‫كا ن‬.‫ ت ع ر ف ع ل ى ا‬، ‫ﻣ ﻊ ر ف ة‬ Decline does not occur in all areas at same rate  Intellect and ageing The most age-sensitive component of intelligence seems to be processing speed ‘Crystallised vs ‘fluid’ intelligence Highly learnt skills and general knowledge vs problem solving without prior training or exposure ‘Terminal drop’ ?  Intellect and ageing - memory It gets worse with age doesn’t it? Different aspects of memory function may behave differently Effects of disease... Dementia Alzheimer’s disease Ag e  Intellect and ageing - summary Bad news: Some aspects of cognitive function do, in general, decline with age Good news: Some aspects of intellect are very stable over time Some individuals change very little The impact of social and personality factors on behaviour in old age  Personality and ageing: a complex relationship Does getting old change your personality ? Or does a gradual throughout-life development in personality eventually correspond to the social construct of ‘an old person’? Developmental models and trait models  The developmental model of personality ageing Derives from psychoanalytical theory Freud et al had a fairly negative view of later life The most influential ideas were those of Erikson with his ‘life- stages’ and associated conflicts ‫ﺻ ﺮاع‬ Young adult life - Intimacy vs. isolation Mid-adult life - Generation vs. stagnation ‫ر كو‬ ‫د‬ Old-age - Integrity vs. despair ‫ﺗ ك ام ل‬ ‫اﻟﻲ أ س‬  The Trait model of personality ageing (Those who adapted) ‫مو رو ثه ﺻ ﻔ ﺎ ت‬ Personality is described in terms of constituent traits Cross-sectional studies suggest a differential distribution of traits at different ages ‫اﻟﺗﺄﻛﯾد‬ Longitudinal studies however, emphasise the stability of traits within an individual over time  Social adjustment and ‘successful’ ageing Disengagement model Disengagement from from social involvement as an adaptive mechanism Activity model Successful ageing requires maximal engagement in all areas of life  The social context of ageing - families in old age Major family role adjustments e.g. ‘Empty nest’ phenomenon Grandparenthood Changing patterns of family contact The importance of friendships  The social context of ageing - Work and retirement Historical perspective ‫ﺗﺎرﻳﺦ ﻳمت ل ك‬ Loss of manifest and latent rewards of paid work ‫مﻧﺟ ﺰ اﺗﻪ‬ Unemployment vs. retirement ‫ ي ﻋ م ل ﻛﺎن‬0 ‫ او ﻛ ﺎ ن‬، ‫ي ﻋ م ل‬ Most people do adjust successfully  The social context of ageing - death and bereavement ‫ﻓ ﻘ د ان‬ Reluctance to acknowledge mortality in Western culture may make this aspect of ageing ‘difficult’ and lead to social rejection Bereavement in old age - is it different or just more common?  Conclusions Most stereotypical views of behaviour in old age are inaccurate ‫ﻣ ﻠﺣ و ظ ﺔ‬ Older people as a group are notable by their diversity - generalisations are even more unhelpful than at other stages of life Later life is not a period of stagnation, but a time ‫ متوقﻋﺔ‬change during of great and often unanticipated ‫ﻏ ﻴﺮ‬ which people have to adapt rapidly to enforced ‫ﻓ ﺮ ض ق ي ود‬ limitations In youth the days are short and the years are long. In old age the years are short and day's long. Pope Paul VI