Health Psychology: Biopsychosocial Interactions PDF Ninth Edition

 k k k k  k HEALTH PSYCHOLOGY Biopsychosocial Interactions Ninth Edition k k k  k k k k  k HEALTH PSYCHOLOG...

 k k k k  k HEALTH PSYCHOLOGY Biopsychosocial Interactions Ninth Edition k k k  k k k k  k HEALTH PSYCHOLOGY Biopsychosocial Interactions Ninth Edition Edward P. Sarafino The College of New Jersey Timothy W. Smith k University of Utah k k  k VP AND EDITORIAL DIRECTOR George Hoffman EDITORIAL DIRECTOR Veronica Visentin EDITORIAL ASSISTANT Ethan Lipson EDITORIAL MANAGER Gladys Soto CONTENT MANAGEMENT DIRECTOR Lisa Wojcik CONTENT MANAGER Nichole Urban SENIOR CONTENT SPECIALIST Nicole Repasky PRODUCTION EDITOR Rajeshkumar Nallusamy PHOTO RESEARCHER Billy Ray COVER PHOTO CREDIT c Mark Wragg/Getty Images, Inc. This book was set in 9.5/11.5 NovareseStd-Book by SPi Global, printed and bound by Lightning Source Inc. Founded in 1807, John Wiley & Sons, Inc. has been a valued source of knowledge and understanding for more than 200 years, helping people around the world meet their needs and fulfill their aspirations. 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Upon completion of the review period, please return the evaluation copy to Wiley. Return instructions and a free of charge return shipping label are available at: www.wiley.com/go/returnlabel. If you have chosen to adopt this textbook for use in your course, please accept this book as your complimentary desk copy. Outside of the United States, please contact your local sales representative. ISBN 978-1-119-29948-6 (PBK) ISBN 978-1-119-29944-8 (EVALC) Library of Congress Cataloging in Publication Data: Names: Sarafino, Edward P., 1940- author. | Smith, Timothy W., author. Title: Health psychology : biopsychosocial interactions / Edward P. Sarafino, Timothy W. Smith. Description: Ninth edition. | Hoboken, NJ : John Wiley & Sons Inc., | Includes bibliographical references and index. Identifiers: LCCN 2016039196| ISBN 9781119299486 (pbk.) | ISBN 9781119299462 (epub) Subjects: LCSH: Clinical health psychology. Classification: LCC R726.7.S27 2017 | DDC 616.89—dc23 LC record available at https://lccn.loc.gov/2016039196 The inside back cover will contain printing identification and country of origin if omitted from this page. In addition, if the ISBN on the back cover differs from the ISBN on this page, the one on the back cover is correct. k  k E.P.S. In memory of my mother and father. They gave me life, loved and nurtured me, and helped me be healthy. T.W.S. For Paula, Wyatt, and Elliott. k k k  k ABOUT THE AUTHORS Edward P. Sarafino received his PhD from the University in cardiovascular disease. He is a Fellow in Division of Colorado and began his affiliation with the Department 38 (Health Psychology) of the American Psychological of Psychology at The College of New Jersey more Association and in the Society of Behavioral Medicine. than three decades ago. He is now Professor Emeritus He has served as President of Division 38, and the there. His scholarship has combined areas of health, Academy of Behavioral Medicine Research. He has also developmental, and behavioral psychology, particularly served as a member of the Behavioral Medicine Study with regard to the study of asthma. In addition to having Section of the National Institutes of Health, and as published dozens of research articles and chapters, he an Associate Editor or on the editorial boards of a is the author of eight books. He is a Fellow of Division variety of journals, including the Journal of Consulting and 38 (Health Psychology) of the American Psychological Clinical Psychology, Health Psychology, Annals of Behavioral Association, served as an officer (Secretary) of that Medicine, and the American Psychologist. His research has division, and has been a member of several committees been supported by the National Institute on Aging and of Division 38 and of the Society of Behavioral Medicine. the National Heart, Lung, and Blood Institute of NIH, When he is not working, he enjoys being with family and and has been recognized in awards from Division 38, friends, traveling, hiking and other outdoor activities, and the American Psychosomatic Society, and the Society of going to cultural events, especially music and visual arts. Behavioral Medicine. He has supervised the graduate studies of over twenty-five PhD students in clinical and health psychology, including two past recipients of the American Psychological Association’s award for early career contributions to health psychology. He k k enjoys skiing, backpacking, mountain biking, exercise, and spending time with family and friends. Timothy W. Smith received his PhD from the University of Kansas. After both a pre-doctoral internship in clinical psychology and a post-doctoral fellowship in behavioral medicine at the Brown University Medical School, he joined the faculty of the Department of Psychology at the University of Utah, where he has TO CONTACT THE AUTHORS remained for nearly thirty years. He has published over two hundred articles and chapters, and three books, We would be pleased to receive comments and sugges- most in personality and social psychology, clinical tions about this book from students and instructors so psychology, and health psychology and behavioral that we may consider those ideas for future editions. You medicine, particularly in the area of psychosocial issues may contact us at sarafi[email protected]. vi k  k PREFACE “The first wealth is health,” wrote the poet/philosopher the last 10 years, and hundreds are new, published since Ralph Waldo Emerson in the 19th century. Although the prior edition of this book went to press. people have probably always valued good health, they are becoming increasingly health conscious. This heightened consciousness generally reflects two beliefs: that we can NEW TO THIS EDITION do things to protect our health and that being sick is unpleasant. As Emerson put it, “Sickness is poor-spirited, The new edition retains the overall organization and the and cannot serve anyone.” Serious health problems pedagogy that students and instructors have praised in can be quite distressing to a patient and his or her the last edition. It also retains the modular structure of family and friends. These beliefs underlie psychologists’ Chapter 2, The Body’s Physical Systems, which allows interests in helping people behave in ways that promote instructors to choose to cover all of the systems at once (assign wellness, adjust to health problems that develop, and the whole chapter) or distribute them to other chapters. participate effectively in treatment and rehabilitation For students using the distributed approach, appropriate programs. subsequent chapters have salient notices that tell stu- The goal for each edition of this text has been dents when to read a specific module that is relevant to to create a teaching instrument that draws from the the current material. For example, a notice to read Mod- research and theory of many disciplines to describe how ule 4 (The Respiratory System) appears early in Chapter 7 psychology and health are interconnected. The resulting at the start of the discussion of smoking tobacco, and a book is a comprehensive text that is appropriate for notice with the Key Terms list for that chapter reminds several courses, especially those entitled either Health the students to study Module 4. In addition, we have k k Psychology or Behavioral Medicine. Two objectives were retained the interactive animations of physiological systems central regarding the likely audience in these courses. in the Student Companion Website and notes in the First, although we aimed to make the content appropriate book that prompt students to use them. Each animation for upper-division students, we wrote in a straightfor- takes 5 to 10 minutes to review and is accessed at http:// ward style to make the material accessible to most www.wiley.com/college/sarafino. sophomores. The content assumes that the student has Two features of the book were enhanced across already completed an introductory psychology course. chapters in the new edition. The most obvious enhance- Second, we tried to make the material relevant and inter- ments are to: esting to students from diverse disciplines—particularly Cross-cultural data. To give students a broader pic- psychology, of course, but also fields such as sociology, ture of health psychology, we have found the latest medicine, allied health, and health and physical educa- available data on health and lifestyles and presented tion. Training in health psychology has developed rapidly them concisely, typically in tables, for 14 countries: and can play an important role in helping students from Australia, Brazil, Canada, China, Germany, India, Italy, many disciplines understand the interplay of biological, the Netherlands, Singapore, South Africa, Sweden, psychological, and social factors in people’s health. Turkey, the United Kingdom, and the United States. The field of health psychology is enormously For example, Table 6.7 gives data on infant mortal- exciting, partly because of its relevance to the lives of ity and preterm births in these countries. Two fac- those who study it and individuals the students know tors guided the choice of nations. First, we wanted to or will work with in the future. The field is also exciting include countries with large and small populations because it is so new, and researchers from many dif- that represent a variety of geographical areas and ferent disciplines are finding fascinating and important diverse cultures. Second, a very large number of stu- relationships between psychology and health every day. dents use this book outside the United States, and we Keeping up to date in each area of such a complex field wanted to include data for their nations, when avail- presents quite a challenge, which begins with culling able, to make the book more relevant for them. from thousands of new abstracts, articles, and books to Illustrations. We updated data in several figures prepare for the current revision. Most of the more than and developed new ones to clarify physio- 3,000 references this edition cites were published within logical processes and to present interesting vii k  k viii Preface and important data. Figures 1-2, 6-4, 7-1, 9-2, ORGANIZATION 13-3, 14-3, 14-4, and 15-1 are examples. Every chapter has been updated, and we substan- This text examines the major topics and problem areas in tially revised or expanded the coverage of the following health psychology by using an overall organization that topics: progresses in main focus across chapters from primary, How stress affects health to secondary, to tertiary prevention and care. As the table of contents shows, the book is divided into 15 chapters Health risks from adverse childhood experiences in the following seven parts: Religiosity, positive emotions, and health Stages of change and motivational inter- Part I. Chapter 1 presents the history and focus of viewing in health promotion health psychology and introduces the major concepts and research methods used in the field. Chapter 2 Processes in and prevention and treat- describes the physical systems of the body in an ment of tobacco and alcohol use engaging manner a reviewer called “a pleasant sur- Weight control and exercise prise.” This chapter is divided into six modules that Health care systems in the United instructors can assign in two ways—all together or dis- States and around the world tributed to later chapters—depending on how they like to organize the course. Instructors who cover the Pain conditions and treatment modules all together want to present the body sys- Chronic illnesses, treatments, and tems as an integrated and basic topic that underlies psychosocial interventions all later topics. They also want students to have a Technological approaches for health promotion single place to refer to if needed, such as when read- ing about the neural transmission of pain signals in Chapter 11. Instructors who distribute the modules want to introduce important physiological principles THEMES as they become relevant. Either approach works well. k Part II. Chapters 3, 4, and 5 discuss stress, its relation k A commonly stated goal in psychology is to understand to illness, and methods for coping with and reducing the “whole person.” To approach this goal, this book it. Some modules on body systems in Chapter 2 adopts the biopsychosocial model as the basic explanatory connect directly to discussions in Chapters 3 and 4, theme. We have tried to convey a sense that the com- such as the sections entitled “Biological Aspects of ponents of this model interrelate in a dynamic and Stress,” “Physiological Arousal,” “Stress, Physiology, and Illness,” and “Psychoneuroimmunology.” This continuous fashion, consistent with the concept of sys- connection is one reason why stress is covered early tems. The psychological research cited reflects an eclectic in the book. A reviewer recognized a second reason and orientation and supports a variety of behavioral, phys- wrote: “The issue of stress permeates all of the other iological, cognitive, and social–personality viewpoints. topics, and it would be useful to have the students read In addition, gender and sociocultural differences in health and about this first.” Chapter 5 includes information on related behaviors are addressed at many points in the psychosocial methods in helping people cope better. book. In these ways, this book presents a balanced view Part III. The third part of the book examines issues of health psychology that is squarely in the mainstream involved in enhancing health and preventing illness. of current thinking in the field. Chapters 6, 7, and 8 discuss how health-related behav- One additional theme makes this book unique. We iors develop and are maintained, can affect health, and have integrated a focus on life-span development in health can be changed via psychosocial and public health and illness throughout the book, and each chapter efforts. Chapter 7 gives special attention to the topics contains information dealing with development. For of tobacco, alcohol, and drug use, and Chapter 8 dis- example, the book discusses how health and health- cusses nutrition, weight control, exercise, and safety. related behavior change with age and describes health The role of stress in health behaviors and decision care issues and examples that pertain to pediatric and making is considered in these chapters. The book up elderly patients. Sometimes this information is organized to this point focuses mainly on primary prevention. as a separate unit, as with the sections “Development Part IV. In Chapter 9, the main focus shifts to sec- and Health-Related Behavior,” “When the Hospitalized ondary prevention by describing the kinds of health Patient Is a Child,” “Assessing Pain in Children,” and services that are available and considering why peo- “Alzheimer’s Disease.” ple use, do not use, and delay using these services. k  k Preface ix This chapter also examines patients’ relationships to LEARNING AIDS practitioners and problems in adhering to medical regimens. Chapter 10 discusses the hospital setting This book contains many pedagogical features. Each and personnel, how people react to being hospital- chapter begins with a contents list, giving students an ized and cope with stressful medical procedures, and the role psychologists play in helping patients cope overview of the progression of major topics and concepts. with their illnesses and medical treatments. Then a prologue introduces the chapter with (1) a lively and engaging vignette that is relevant to the chapter material Part V. Chapters 11 and 12 explore the physical and and (2) an overview of the basic ideas to be covered. psychological nature of pain, ways to assess patients’ The body of each chapter includes many figures, tables, discomfort, the psychosocial impact of pain, and and photographs to clarify concepts or research findings. methods for managing and controlling pain. For example, special figures were created to show how Part VI. The two chapters in this part of the book the immune system functions and how gate-control emphasize tertiary prevention. They examine differ- theory explains pain perception. Important terms are ent chronic health problems, their impact on patients boldfaced, and italics are used liberally for other terms and their families, and medical and psychosocial treat- and for emphasis. ment approaches. The chapters separate illnesses Throughout the book, three types of boxed material on the basis of mortality rates. Chapter 13 focuses are presented to fit with the surrounding content. They on health conditions, such as diabetes and arthri- tis, that have either very low or moderate rates of are identified in the text with the corresponding icons: mortality and may lead to other health problems or Highlight. This type of box focuses on high-interest disability. In contrast, Chapter 14 examines four high- and in-depth topics. Some of these topics are: careers mortality illnesses—heart disease, stroke, cancer, and relating to health and psychology, health behaviors AIDS—and people’s reactions to losing a loved one. to protect against breast cancer, the effects of sec- Part VII. Chapter 15 discusses goals and issues ondhand smoke, acute pain in burn patients, and for the future of health psychology. the complex medical regimens for diabetes. Assess Yourself. This boxed feature has students k k actively examine their own health-related charac- OPTIONAL ORGANIZATION teristics, such as their lifestyles, typical daily has- sles, ways of coping with stress, knowledge about Because some instructors might like some flexibility in the transmission of HIV, beliefs about alcohol the organization of chapters, Chapters 10 through 14 were use, and symptoms of health problems. written with this possibility in mind. Chapter 10, Part V, Clinical Methods and Issues. The third type of boxed and Part VI are written as three independent units that material focuses on methods and issues in application may be covered in any order. Two examples of alternate efforts in clinical health psychology, medicine, public sequences that would work nicely after Chapter 9 are: health, and rehabilitation. We examine, for instance, (1) Part V, Part VI, and then Chapter 10; and (2) Part VI, cognitive and behavioral methods that can help people Chapter 10, and then Part V. reduce stress, stop smoking, and eat healthfully; biofeedback and relaxation techniques for treating asthma and some forms of paralysis; and procedures LANGUAGE AND STYLE to prepare children for being hospitalized. Each chapter ends with a substantial summary and The field of health psychology involves complex issues a list of key terms. All these terms are redefined in the and technical information that require extra efforts to glossary at the back of the book. make the material readable and clear without sacrificing content. To accomplish this, we have limited the use of jargon in this book and have sought to write in a ONLINE SUPPLEMENTS concrete and engaging fashion. The gradual progression of concepts, choice of words, and structure of each Instructors who are using this text can access a sentence were all designed to help students master Companion Website at www.wiley.com after registering and retain the material. When introducing new terms, and obtaining a password. It contains: we define them immediately. Many examples and case studies are included to clarify concepts and to bring them An instructor’s manual with information to help to life. instructors organize and present the subject k  k x Preface matter effectively and enrich the classroom cited. There would be no health psychology without experience through activities and discussion. their work. We also received a great deal of direct help A test bank. and encouragement from a number of people whose Powerpoint slides with figures and tables from the contributions we gratefully acknowledge. text are available for download. Across editions, the textbook review process gen- erated many helpful suggestions that have made this a Access to Psychology Select, a custom-publishing pro- better book than it would have been otherwise. Review- gram that provides a database of materials from which ers of the book deserve our heartfelt thanks for their you can create your own custom course-pack of read- ings, journal articles, and research articles. ideas and favorable comments regarding plans for the book and the major parts of the manuscript they read. The book’s Companion Website also includes fea- The new edition has benefited greatly from the review tures specifically for students, such as chapter quizzes and process and excellent perspectives of the following over a dozen interactive animations that show how physio- colleagues: logical systems work, describe the effects of homeostatic Because each new edition retains many of the imbalances on them, and present case studies of peo- features of earlier editions of the book, we continue ple with health problems and their diagnostic signs and to be indebted to the reviewers for those editions. Their symptoms. names and affiliations (when the reviews were done) are given on the book’s companion website. Very personal thanks go to the closest people in our ACKNOWLEDGMENTS lives—family, friends, and colleagues—for encouraging and supporting our efforts to complete this book and for Writing this book and revising it have been enormous tolerating our preoccupation. tasks. We are indebted first of all to the thousands of researchers whose important and creative work we have Edward P. Sarafino and Timothy W. Smith k k k  k TO THE STUDENT “I wish I could help my father stop smoking,” a health have made special efforts to write in a straightforward, psychology student said at the start of the semester. clear, and engaging fashion. Maybe she did help—he quit by the end of the course. This example points out two things that will probably make health psychology interesting to you: (1) the FEATURES OF THE BOOK material is personally relevant and (2) many of the things you learn can actually be applied in your everyday life. To help you master the material and remember it longer, Studying health psychology will also help you answer the book includes the following learning aids: important questions you may have considered about Chapter Contents and Prologue. Each chapter health and psychology in the past. Does the mind affect begins with a contents list that outlines the major our health—and if so, how? What effect does stress topics in the order in which they are covered. The have on health and recovery from illness? What can prologue then introduces the chapter with a vignette be done to help people lead more healthful lives than that is relevant to the material ahead and gives an they do? Why don’t patients follow their doctors’ advice, overview of the basic ideas you will read about. and what can health care workers do to help? What Illustrations. The many figures, tables, and special needs do children have as patients, and how can photographs in each chapter are designed parents and health care workers address these needs? to clarify concepts and research findings How can families, friends, and health care workers help and help them stick in your mind. patients adjust to disabling or life-threatening health problems? Boxed material. Three types of boxed mate- k rial are included in the chapters. Each type of k As these questions indicate, knowledge of health box has a special icon that is used in “Go to psychology can be relevant both now and later when you...” instructions, prompting you to read the enter your future career. This is so whether you are studying appropriate box at the right point in the text. to be a psychologist, medical social worker, nurse or physician, physical or occupational therapist, public Summary and Key Terms. Each chapter closes health worker, or health educator. You will learn in this with two features: (1) the summary, which presents the most important ideas covered, and (2) the key course that the relationship between the person’s health terms—a list of the most important terms in the and psychology involves a “two-way street”—each affects chapter, arranged in order of their appearance. the other. Psychological factors go hand in hand with medical approaches in preventing and treating illness Glossary. The glossary at the back of the book gives and in helping patients adjust to the health problems definitions of important terms and concepts, along with they develop. pronunciation keys for the most difficult words. It will be useful when you are studying or reading and are not sure of the exact meaning or pronunciation of a term. THE BOOK AND WEBSITE THE WEBSITE This book was designed for you, the reader. First and foremost, it provides a thorough and up-to-date To enhance your learning experience, you can access presentation of the major issues, theories, concepts, and this book’s Companion Website at www.wiley.com/college/ research in health psychology. Throughout the book, sarafino. This website contains links to websites of illness- the major point of view is “biopsychosocial”—that is, related organizations and: that health and illness influence and result from the interplay of biological, psychological, and social aspects Chapter quizzes, which contain multiple-choice items, of people’s lives. Because integrating these aspects separated by chapter. For each item, the approximate involves complex concepts and technical material, we page number of the textbook where the topic was xi k  k xii To the Student discussed is given. For Chapter 2, the items are it useful to read the summary first, even though it separated also by modules, enabling easy use contains terms they may not yet understand. Then read for students who are covering the entire chapter the prologue. As you begin each new section of the at once or are distributing the modules to other chapter, look at its title and turn it into a question. Thus, chapters. The software provides feedback, telling the heading early in Chapter 1, “An Illness/Wellness you how well you performed for each chapter Continuum,” might become “What is an illness/wellness and module and which items you missed. continuum?” Doing this helps you focus on your reading. Interactive animations that will (1) help you learn how After reading the section, reflect on what you have just each physiological system of the body operates and read. Can you answer the question you asked when you (2) describe case studies of people with serious health reworded the title? problems. Announcements of the animations are When you have finished the body of the chapter, given in the text with the relevant material, telling review what you have read by reading the summary and you that they are available and how to access them. trying to define the items in the list of key terms. If When you use the website, click on Health Psychol- there is something you do not understand, look it up ogy Animations and Interactions and then on the in the chapter or glossary. Last, reread the chapter at title of the animation you want to review. The ani- least once, concentrating on the important concepts or mations provide instructions—voice and written ideas. You may find it helpful to underline or highlight (which has the icon )—and a bar at the bottom selected material now that you have a good idea of of the screen to control the progress and sound. Each animation takes 5 to 10 minutes to do. what is important. If your exam will consist of “objective” questions, such as multiple choice, using this approach intensively should be effective. If your exam will have STUDY HINTS essay items, you will probably find it helpful to develop a list of likely questions and write an outline or a complete answer for each one. There are many ways you can use the features of this book We hope that you enjoy this book, that you learn a to learn and study well, and you may want to experiment great deal from it, and that you will share our enthusiasm k to find the best way for you. We will describe one method k and fascination for health psychology by the time you that works well for many students. finish the course. Survey the chapter first. Read the contents list and browse through the chapter, examining the figures, tables, and photographs. Some students also find Edward P. Sarafino and Timothy W. Smith k  k BRIEF CONTENTS PART I An Introduction: Basic Issues and PART IV Becoming Ill and Getting Medical Processes 1 Treatment 232 Chapter 1 An Overview of Psychology and Chapter 9 Using Health Services 232 Health 1 Chapter 10 In the Hospital: The Setting, Procedures, and Chapter 2 The Body’s Physical Systems 30 Effects on Patients 260 PART II Stress, Illness, and Coping 57 PART V Physical Symptoms: Pain and Discomfort 288 Chapter 3 Stress—Its Meaning, Impact, and Sources 57 Chapter 11 The Nature and Symptoms of Pain 288 Chapter 4 Stress, Biopsychosocial Factors, and Chapter 12 Managing and Controlling Clinical Pain 314 Illness 82 PART VI Chronic and Life-Threatening Health Chapter 5 Coping With and Reducing Stress 112 Problems 336 PART III Lifestyles to Enhance Health and Prevent Illness 135 Chapter 13 Serious and Disabling Chronic Illnesses: Causes, Management, and Coping 336 Chapter 6 Health-Related Behavior and Health Chapter 14 Heart Disease, Stroke, Cancer, and AIDS: Promotion 135 Causes, Management, and Coping 365 k k Chapter 7 Substance Use and Abuse 167 PART VII Looking to the Future 394 Chapter 8 Nutrition, Weight Control and Diet, Exercise, and Safety 200 Chapter 15 What’s Ahead for Health Psychology? 394 xiii k  k CONTENTS PART I An Introduction: Basic Issues and Other Glands 39 Processes 1 Highlight: Our Physiological Individuality 40 Module 3: The Digestive System 41 Food’s Journey through Digestive Organs 41 Using Nutrients in Metabolism 43 Chapter 1 An Overview of Psychology and Health 1 Assess Yourself: How Many Calories Do You Burn What is Health? 2 While Resting? 44 An Illness/Wellness Continuum 2 Module 4: The Respiratory System 44 Illness Today and in the Past 2 The Respiratory Tract 44 Viewpoints from History: Physiology, Disease Respiratory Function and Disorders 45 Processes, and the Mind 5 Module 5: The Cardiovascular System 46 Early Cultures 5 The Heart and Blood Vessels 47 Ancient Greece and Rome 5 Blood Pressure 48 The Middle Ages 6 Blood Composition 49 The Renaissance and After 6 Cardiovascular Disorders 50 Seeing a Need: Psychology’s Role in Health 7 Module 6: The Immune System 50 Problems in the Health Care System 7 Antigens 51 ‘‘The Person’’ in Health and Illness 8 The Organs of the Immune System 51 Assess Yourself: What’s Your Lifestyle Like? 8 Soldiers of the Immune System 52 How the Role of Psychology Emerged 10 Defending the Body with an Immune Response 53 Health Psychology: The Profession 12 Highlight: When Immune Functions Are Absent 54 k k Clinical Methods and Issues: Behaviorism’s Legacy: Less-Than-Optimal Defenses 55 Progress in Health Psychology’s Goals 12 Current Perspectives on Health and Illness 13 PART II Stress, Illness, and Coping 57 The Biopsychosocial Perspective 13 Life-Span and Gender Perspectives 16 Related Scientific Fields: Foundations and Connections for Health Psychology 17 Chapter 3 Stress—Its Meaning, Impact, and Related Fields 17 Sources 57 Highlight: Related Nonpsychology Careers 18 Experiencing Stress in Our Lives 58 Health and Psychology across Cultures 20 What Is Stress? 58 Research Methods 21 Appraising Events as Stressful 59 Experiments 21 Clinical Methods and Issues: Posttraumatic Stress Disorder Correlational Studies 23 (PTSD) 61 Quasi-Experimental Studies 24 Dimensions of Stress 61 Genetics Research 26 Biopsychosocial Aspects of Stress 62 Which Research Method Is Best? 28 Biological Aspects of Stress 62 Psychosocial Aspects of Stress 65 Chapter 2 The Body’s Physical Systems 30 Sources of Stress throughout Life 67 Module 1: The Nervous System 31 Sources within the Person 67 How the Nervous System Works 31 Sources in the Family 68 The Central Nervous System 33 Sources in the Community and Society 71 Clinical Methods and Issues: Biofeedback Treatment Highlight: Gender Differences in Caregiving? 71 for Paralysis 36 Highlight: Does Environmental Stress Affect Reactivity The Peripheral Nervous System 36 to New Stressors? 74 Module 2: The Endocrine System 38 Measuring Stress 74 The Endocrine and Nervous Systems Working Together 38 Physiological Arousal 74 Adrenal Glands 39 Life Events 75 xiv k  k Contents xv Daily Hassles 77 Clinical Methods and Issues: The Case of ‘‘Bear’’ 127 Chronic Stressors in Specific Domains 78 Clinical Methods and Issues: Treating Insomnia 129 Can Stress Be Good for You? 78 Massage, Meditation, and Hypnosis 129 Assess Yourself: Hassles in Your Life 78 Highlight: Can Interventions Curb Adverse Childhood Experiences? 131 Chapter 4 Stress, Biopsychosocial Factors, and Using Stress Management to Reduce Coronary Illness 82 Risk 131 Psychosocial Modifiers of Stress 83 Modifying Type A Behavior 131 Social Support 83 Treating Hypertension 132 Assess Yourself: How Much Emotional Support Do You Get? 85 A Sense of Personal Control 89 PART III Lifestyles to Enhance Health and Prevent Clinical Methods and Issues: Social Support, Therapy, Illness 135 and Cognitive Processes 89 Personality Factors in Stress 93 Type A Behavior and Beyond 95 Chapter 6 Health-Related Behavior and Health How Stress Affects Health 98 Promotion 135 Stress, Behavior, and Illness 98 Health and Behavior 136 Stress, Physiology, and Illness 99 Lifestyles, Risk Factors, and Health 136 Psychoneuroimmunology 101 Highlight: Which Health Behaviors Are Beneficial Highlight: Stress and Wound Healing 104 against Breast Cancer? 138 Psychophysiological Disorders 104 Interdisciplinary Perspectives on Preventing Illness 139 Digestive System Diseases 104 Problems in Promoting Wellness 140 Asthma 105 What Determines People’s Health-Related Recurrent Headache 105 Behavior? 142 k Other Disorders 106 General Factors in Health-Related Behavior 142 k Stress and Cardiovascular Disorders 106 The Role of Beliefs and Intentions 144 Hypertension 106 The Role of Less Rational Processes 149 Coronary Heart Disease 108 Developmental, Gender, and Sociocultural Factors Highlight: Does Acculturation Increase Blood in Health 150 Pressure? 109 Development and Health 150 Stress and Cancer 109 Gender and Health 153 Sociocultural Factors and Health 153 Chapter 5 Coping with and Reducing Stress 112 Programs for Health Promotion 155 Coping with Stress 113 Methods for Promoting Health 155 What Is Coping? 113 Clinical Methods and Issues: Dialogues to Help People Functions and Methods of Coping 113 Stop Smoking 157 Assess Yourself: Your Focuses in Coping 114 Promoting Health in Schools and Religious Reducing the Potential for Stress 118 Organizations 159 Enhancing Social Support 118 Worksite and Community-Based Wellness Programs 160 Highlight: Do Religiousness and Spirituality Reduce Electronic Interventions for Health Promotion 160 Stress and Enhance Health? 119 Prevention with Specific Targets: Focusing on AIDS 161 Managing Interpersonal Problems 120 Assess Yourself: Your Knowledge about HIV/AIDS 162 Highlight: The Amish Way of Social Support in Bereavement 120 Chapter 7 Substance Use and Abuse 167 Improving One’s Personal Control 121 Organizing One’s World Better 121 Substance Abuse 168 Exercising: Links to Stress and Health 121 Addiction and Dependence 168 Preparing for Stressful Events 122 Processes Leading to Dependence 168 Reducing Stress Reactions: Stress Management 123 Smoking Tobacco 170 Medication 123 Who Smokes, and How Much? 171 Behavioral and Cognitive Methods 123 Why People Smoke 172 k  k xvi Contents Highlight: Do Curiosity and Susceptibility ‘‘Kill the Accidents 228 Cat’’? 173 Environmental Hazards 229 Smoking and Health 175 Highlight: Does Someone Else’s Smoking Affect Your PART IV Becoming Ill and Getting Medical Health? 177 Treatment 232 Alcohol Use and Abuse 178 Who Drinks, and How Much? 179 Assess Yourself: What’s True about Chapter 9 Using Health Services 232 Drinking? 179 Why People Use and Abuse Alcohol 181 Types of Health Services 233 Assess Yourself: Do You Abuse Alcohol? 182 Specialized Functions of Practitioners 233 Drinking and Health 183 Office-Based and Inpatient Treatment 233 Highlight: Drinking—Games People Play 183 The American Health Care System 234 Drug Use and Abuse 184 Health Care Systems in Other Countries 235 Perceiving and Interpreting Symptoms 236 Highlight: Types and Effects of Drugs 185 Perceiving Symptoms 236 Who Uses Drugs, and Why? 185 Drug Use and Health 187 Highlight: Symptoms by Suggestion? 238 Reducing Substance Use and Abuse 187 Interpreting and Responding to Symptoms 238 Preventing Substance Use 187 Using and Misusing Health Services 240 Quitting a Substance without Therapy 189 Who Uses Health Services? 240 Treatment Methods to Stop Substance Use Why People Use, Don’t Use, and Delay Using Health and Abuse 192 Services 241 Highlight: Where Should Treatment Occur, and What Using Complementary and Alternative Medicine 244 Should Be the Goals and Criteria for Success? 193 Highlight: A New Meaning for ‘‘Diehard’’ Sports Clinical Methods and Issues: Behavioral Methods for Fan 244 Treating Substance Abuse 195 Problematic Health Service Usage 245 k Dealing with the Relapse Problem 196 k The Patient–Practitioner Relationship 246 Patient Preferences for Participation in Medical Care 246 Chapter 8 Nutrition, Weight Control and Diet, The Practitioner’s Behavior and Style 247 Exercise, and Safety 200 Highlight: Fighting for Your Life 247 Nutrition 201 The Patient’s Behavior and Style 249 Components of Food 201 Assess Yourself: Do You Know the Meanings of Medical What People Eat 202 Terms? 249 Nutrition and Health 204 Compliance: Adhering to Medical Advice 250 Weight Control and Diet 207 Extent of the Nonadherence Problem 251 Desirable and Undesirable Weights 207 Why Patients Do and Do Not Adhere to Medical Becoming Overly Fat 209 Advice 252 Highlight: Do ‘‘Fat-Bugs’’ Lead to Overweight? 211 Patient–Practitioner Interactions 254 Dieting and Treatments to Lose Weight 214 Increasing Patient Adherence 255 Highlight: Which ‘‘Carbs’’ to Avoid 215 Clinical Methods and Issues: Simple Methods to Promote Adherence 257 Clinical Methods and Issues: Problem-Solving Training Focusing on Prevention 258 to Control Weight 217 Anorexia and Bulimia 219 Assess Yourself: Your Weight Control Patterns 220 Chapter 10 In the Hospital: The Setting, Procedures, Exercise 222 and Effects on Patients 260 The Health Effects of Physical Activity 222 The Hospital—Its History, Setting, and Procedures 261 Highlight: Types and Amounts of Healthful How the Hospital Evolved 261 Exercise 223 The Organization and Functioning of Hospitals 262 Who Gets Enough Exercise, Who Does Not—and Assess Yourself: Who’s Who in Physician Care 263 Why? 225 Roles, Goals, and Communication 263 Reasons for Not Exercising 225 The Impact of the ‘‘Bottom Line’’ 264 Promoting Exercise Behavior 226 Being Hospitalized 265 Safety 228 Relations with the Hospital Staff 266 k  k Contents xvii Sick-Role Behavior in the Hospital 267 Chapter 12 Managing and Controlling Clinical Emotional Adjustment in the Hospital 268 Pain 314 Coping Processes in Hospital Patients 269 Clinical Pain 315 Preparing Patients for Stressful Medical Procedures 270 Acute Clinical Pain 315 Highlight: Lamaze Training as a Method of Chronic Clinical Pain 315 Psychological Preparation for a Medical Medical Treatments for Pain 316 Procedure 273 Surgical Methods for Treating Pain 317 When the Hospitalized Patient Is a Child 274 Chemical Methods for Treating Pain 317 Clinical Methods and Issues: Preparing Children for Highlight: Types of Pain-Relieving Chemicals 318 Impending Hospitalization 276 Behavioral and Cognitive Methods for Treating How Health Psychologists Assist Hospitalized Pain 320 Patients 277 The Operant Approach 320 Initial Steps in Helping 278 Fear Reduction, Relaxation, and Biofeedback 321 Tests for Psychological Assessment of Medical Cognitive Methods 324 Patients 278 Clinical Methods and Issues: Guiding a Client to Pain Promoting Patients’ Health and Adjustment 279 Redefinition 326 When the Illness is Terminal 280 Hypnosis and Interpersonal Therapy 327 The Patient’s Age 280 Assess Yourself: Would Behavioral or Cognitive Methods Psychosocial Adjustments to Terminal Illness 281 Help Your Pain? 328 Assess Yourself: Your Living Will Choices 283 Hypnosis as a Treatment for Pain 328 Medical and Psychological Care of Dying Patients 284 Interpersonal Therapy for Pain 329 A Place to Die—Hospital, Home, or Hospice? 284 Stimulation and Physical Therapies for Pain 330 Clinical Methods and Issues: Saying Good-bye 285 Stimulation Therapies 330 Physical Therapy 331 PART V Physical Symptoms: Pain and Pain Clinics 332 Discomfort 288 Multidisciplinary Programs 332 k Highlight: Physical Activity and Back Pain 333 k Evaluating the Success of Pain Clinics 334 Chapter 11 The Nature and Symptoms of Pain 288 PART VI Chronic and Life-Threatening Health What is Pain? 289 Problems 336 The Qualities and Dimensions of Pain 289 Perceiving Pain 291 Highlight: Acute Pain in Burn Patients 292 Theories of Pain 295 Chapter 13 Serious and Disabling Chronic Illnesses: Early Theories of Pain 295 Causes, Management, and Coping 336 Highlight: Inducing Pain in Laboratory Research 295 Adjusting to a Chronic Illness 337 The Gate-Control Theory of Pain 297 Initial Reactions to Having a Chronic Condition 337 Biopsychosocial Aspects of Pain 298 Influences on Coping with a Health Crisis 337 Neurochemical Transmission and Inhibition of Pain 299 The Coping Process 340 Personal and Social Experiences and Pain 300 Impacts of Different Chronic Conditions 341 Highlight: Placebos and Pain 301 Asthma 342 Emotions, Coping Processes, and Pain 303 Epilepsy 344 Clinical Methods and Issues: Assessing Difficulty Coping Highlight: What to Do for a Seizure 344 with Pain 304 Nervous System Injuries 345 Assessing People’s Pain 305 Diabetes 348 Self-Report Methods 305 Assess Yourself: Do You Have Diabetes? 349 Assess Yourself: Describing Your Pain 308 Highlight: Self-Managing Diabetes 351 Behavioral Assessment Approaches 309 Arthritis 353 Psychophysiological Measures 310 Alzheimer’s Disease 356 Pain in Children 310 Psychosocial Interventions for People with Chronic Pain and Children’s Sensory and Cognitive Conditions 358 Development 311 Educational, Social Support, and Behavioral Methods 359 Assessing Pain in Children 311 Relaxation and Biofeedback 360 k  k xviii Contents Clinical Methods and Issues: Treating Asthma with Physical and Psychosocial Impact 391 Biofeedback and Relaxation 361 Psychosocial Interventions for Bereavement 392 Cognitive Methods 361 Reaching a Positive Adaptation 392 Interpersonal and Family Therapy 362 Collaborative or Integrated Care Approaches 362 PART VII Looking to the Future 394 Chapter 14 Heart Disease, Stroke, Cancer, and AIDS: Causes, Management, and Coping 365 Chapter 15 What’s Ahead for Health Psychology? 394 Coping with and Adapting to High-Mortality Illness 366 Goals for Health Psychology 395 Adapting While the Prospects Seem Good 366 Enhancing Illness Prevention and Treatment 395 Adapting in a Recurrence or Relapse 367 Improving Efforts for Helping Patients Cope 396 Heart Disease 368 Identifying Evidence-Based Interventions and Cost–Benefit Who Is at Risk of Heart Disease, and Why? 368 Ratios 396 Highlight: Anatomy of a Heart Attack 369 Expanding Psychologists’ Roles in Medical Settings 397 Assess Yourself: Are You at Risk for Heart Disease? 370 Careers and Training in Health Psychology 398 Medical Treatment and Rehabilitation of Cardiac Clinical Methods and Issues: Psychologists in the Primary Patients 371 Care Team 399 The Psychosocial Impact of Heart Disease 372 Career Opportunities 399 Psychosocial Interventions for Heart Disease 374 Training Programs 399 Stroke 375 Issues and Controversies for the Future 400 Causes, Effects, and Rehabilitation of Stroke 375 Environment, Health, and Psychology 400 Psychosocial Aspects of Stroke 377 Quality of Life 400 Clinical Methods and Issues: Stroke Rehabilitation Ethical Decisions in Medical Care 401 for Visual Neglect 377 Future Focuses in Health Psychology 402 Cancer 378 Life-Span Health and Illness 402 k The Prevalence and Types of Cancer 378 Assess Yourself: Some Ethical Dilemmas: What Do You k The Sites, Effects, and Causes of Cancer 379 Think? 403 Diagnosing and Treating Cancer 380 Sociocultural Factors in Health 404 The Psychosocial Impact of Cancer 383 Gender Differences and Women’s Health Issues 405 Psychosocial Interventions for Cancer 385 Factors Affecting Health Psychology’s Future 405 Childhood Cancer 386 Highlight: Can Psychosocial Interventions Improve Glossary 407 Cancer Survival? 386 AIDS 387 References 413 Risk Factors, Effects, and Treatment of AIDS 387 The Psychosocial Impact of AIDS 388 Author Index 517 Psychosocial Interventions for AIDS 390 The Survivors: And Life Goes On 391 Subject Index 535 k  k PART I AN INTRODUCTION: BASIC ISSUES AND PROCESSES 1 AN OVERVIEW OF PSYCHOLOGY AND HEALTH What Is Health? Genetics Research An Illness/Wellness Continuum Which Research Method Is Best? k Illness Today and in the Past k Viewpoints from History: Physiology, Disease Processes, and the Mind PROLOGUE Early Cultures Ancient Greece and Rome “I suppose I should feel lucky, but mostly I just feel really The Middle Ages lousy,” Alec said from his bed in the intensive care unit The Renaissance and After the day after open heart surgery. “We’re all lucky, but things in our lives need to change,” replied Nancy, his Seeing a Need: Psychology’s Role in Health worried and exhausted wife, grateful that she still had a Problems in the Health Care System husband and their two college-age girls still had a father. “The Person” in Health and Illness It was a close call. How the Role of Psychology Emerged In the prior few weeks, Alec had noticed he was more Health Psychology: The Profession tired than usual, became short of breath during exertion, and had odd sensations that felt like indigestion. He first Current Perspectives on Health and Illness thought that his demanding job managing an electronics The Biopsychosocial Perspective store was getting to him, making for long days, too Life-Span and Gender Perspectives little sleep, and too much fast food at the mall where Related Scientific Fields: Foundations and he worked. He decided his symptoms were temporary; Connections for Health Psychology “I just need a vacation,” he thought. But at home two Related Fields days ago, Nancy noticed he was perspiring excessively Health and Psychology across Cultures and complaining of nausea and pain in his left shoulder, so she insisted that he go to the hospital. Alec was lucky. Research Methods Thanks to his wife, he got treatment before his heart Experiments suffered much damage. He would be in the hospital for a Correlational Studies few more days, and then sent home to a life changed in Quasi-Experimental Studies ways he was only beginning to grasp. 1 k  k 2 Part I / An Introduction: Basic Issues and Processes Nancy was right about their lives changing. To AN ILLNESS/WELLNESS CONTINUUM avoid further heart trouble in the future, Alec would Consider Alec, in the opening story. Before he noticed have to adhere faithfully to a medical regimen that included several daily medicines and some major growing fatigue and other vague symptoms, was he lifestyle changes. He would need to watch his diet, healthy? Even though he had no outward signs of the get regular exercise for the first time in many years, serious illness he was about to suffer, his diet was and reduce the stress he felt at work. Nancy knew that poor, and he got far too little exercise. In fact, his heart Alec’s father had died of a heart attack at a young age, disease had begun many years before, progressing with and hoped that these changes would help limit any no obvious signs or symptoms. What about someone susceptibility to heart disease Alec may have inherited. who feels fine but whose lungs are being damaged from She also knew she would have to help him stick with his smoking cigarettes? These are all signs of improper body lifestyle changes, but felt they were essential for Alec and functioning. Are people with these signs healthy? We could also be good for her and for their girls if they made probably would say they are not “sick”—they are just them as well. less healthy than they would be without the unhealthful This story about Alec and his family illustrates conditions. important issues related to health. For instance, our This means health and sickness are not entirely dietary and activity habits can contribute to serious separate concepts—they overlap. There are degrees illnesses. Current medical care can save lives, but people of wellness and of illness. Medical sociologist Aaron undergo complex decisions about whether or not they Antonovsky (1979, 1987) has suggested that we consider need care and whether to follow medical advice when these concepts as ends of a continuum, noting that “We they get it. Making the correct decisions can be a are all terminal cases. And we all are, so long as there is a matter of life and death. Also, people’s everyday stress breath of life in us, in some measure healthy” (1987, p. 3). can influence their health, and developing a health He also proposed that we revise our focus, giving more problem can become a major source of stress. Health attention to what enables people to stay well than to problems affect the patients and their families, and their what causes people to become ill. Figure 1-1 presents a interrelationships can promote the health of all of them. diagram of an illness/wellness continuum, with death at k In this book, we will examine the relationships between one end and optimal wellness at the other. k health and many biological, psychological, and social We will use the term health to mean a positive factors in people’s lives. state of physical, mental, and social well-being—not This chapter introduces a relatively new and exciting simply the absence of injury or disease—that varies field of study called health psychology. We look at its scope, over time along a continuum. At the wellness end of the its history, its research methods, and how it draws on and continuum, health is the dominant state. At the other end supports other sciences. As we study these topics, you of the continuum, the dominant state is illness or injury, will begin to see how health psychologists would answer in which destructive processes produce characteristic such questions as: Does the mind affect our health? What signs, symptoms, or disabilities. role does the cultural background of individuals play in their health? Does the age of a person affect how he or she deals with issues of health and illness? But first, let’s ILLNESS TODAY AND IN THE PAST begin with a definition of health. People in the United States and other developed, industrialized nations live longer, on the average, than they did in the past, and they suffer from a different WHAT IS HEALTH? pattern of illnesses. During the 17th, 18th, and 19th centuries, people in North America suffered and died You know what health is, don’t you? How would you chiefly from two types of illness: dietary and infectious define it? You would probably mention something about (Grob, 1983). Dietary diseases result from malnutrition—for health being a state of feeling well and not being sick. example, beriberi is caused by a lack of vitamin B1 We commonly think about health in terms of an absence and is characterized by anemia, paralysis, and wasting of (1) objective signs that the body is not functioning away. Infectious diseases are acute illnesses caused properly, such as measured high blood pressure, or by harmful matter or microorganisms, such as bacteria (2) subjective symptoms of disease or injury, such as pain or viruses, in the body. In much of the world today, or nausea (Kazarian & Evans, 2001; MedlinePlus, 2015). infectious diseases continue to be a main cause of death. Dictionaries define health in this way, too. But there is a Specifically, in lower income or developing countries, problem with this definition of health. Let’s see why. lower respiratory infections such as pneumonia and k  k Chapter 1 / An Overview of Psychology and Health 3 INCREASING WELLNESS Major disability Symptoms and Worse-than- Average Healthful signs Very healthful Optimal Death from illness minor disability average signs signs and lifestyle signs and lifestyle Wellness INCREASING ILLNESS Neutral Health Status Figure 1-1 An illness/wellness continuum to represent people’s differing health statuses. Starting at the center (neutral level) of the diagram, a person’s health status is shown as progressively worse to the left and progressively healthful as it moves to the right. The segments in the central band describe dominant features that usually characterize different health statuses, based on the person’s physical condition—that is, his or her signs (such as blood pressure), symptoms, and disability—and lifestyle, such as his or her amount of regular exercise, cholesterol consumption, and cigarette smoking. Medical treatment typically begins at a health status to the left of the neutral level and intensifies as the physical condition worsens. Medical treatment can bring the person’s health status back to the mid-range of the continuum, but healthful lifestyles can help, too. Increasing wellness beyond the mid-range can be achieved through lifestyle improvements. (Based on information in Antonovsky, 1987; Bradley, 1993; Ryan & Travis, 1981.) tuberculosis, diarrheal diseases, and HIV/AIDS are the Children were particularly hard hit. Two other infectious leading causes of death (WHO, 2014). diseases, malaria and dysentery, were widespread and A good example of the way illness patterns have presented an even greater threat. Although these two changed in developed nations comes from the history diseases generally did not kill people directly, they weak- k of diseases in the United States. From the early colonial ened their victims and reduced their ability to resist k days in America through the 18th century, colonists expe- other fatal diseases. Most, if not all, of these diseases rienced periodic epidemics of many infectious diseases, did not exist in North America before the European set- especially smallpox, diphtheria, yellow fever, measles, tlers arrived—the settlers brought the infections with and influenza. It was not unusual for hundreds, and some- them—and the death toll among Native Americans sky- times thousands, of people to die in a single epidemic. rocketed. This high death rate occurred for two reasons. Epidemics of deadly infectious dis- Bettman/Corbis Images eases have occurred throughout the world. Before the 20th century, there were no effective methods for preven- tion or treatment of the plague, for instance, which is the disease illus- trated in this engraving. k  k 4 Part I / An Introduction: Basic Issues and Processes First, the native population had never been exposed to 90 these new microorganisms, and thus lacked the nat- ural immunity that our bodies develop after lengthy exposure to most diseases (Grob, 1983). Second, Native 80 Americans’ immune functions were probably limited by At 65 years a low degree of genetic variation among these people Expected total life span in years (Black, 1992). In the 19th century, infectious diseases were still the 70 greatest threat to the health of Americans. The illnesses At 20 years of the colonial era continued to claim many lives, but new diseases began to appear. The most significant of At 1 year these diseases was tuberculosis, or “consumption” as it 60 was often called. In 1842, for example, consumption was listed as the cause for 22% of all deaths in the state of At birth Massachusetts (Grob, 1983). But by the end of the 19th 50 century, deaths from infectious diseases had decreased sharply. For instance, the death rate from tuberculosis declined by about 60% in a 25-year period around the turn of the century. 0 1901 1960 1984 2010 Did this decrease result mostly from advances in Year medical treatment? Although medical advances helped Figure 1-2 Expected total life span at various years since to some degree, the decrease occurred before effec- 1900 for people in the United States who were born in the tive vaccines and medications were introduced. This specified year or had reached 1 year, 20 years, or 65 years was the case for most of the major diseases we’ve dis- of age. (Data from USDHHS, 1987, p. 2, for years 1900–1902, cussed, including tuberculosis, diphtheria, measles, and 1959–1961, and 1984; NCHS, 2013, Table 7, for 2010.) influenza (Grob, 1983; Leventhal, Prohaska, & Hirschman, k k 1985). It appears that the decline resulted chiefly from preventive measures such as improved personal hygiene, total life span for newborns and 20-year-olds. Developed greater resistance to diseases (owing to better nutrition), countries around the world experienced similar histories. and public health innovations, such as building water Death is still inevitable, of course, but people purification and sewage treatment facilities. Many people die at later ages now and from different causes. had become concerned about their health and began to The main health problems and causes of death in heed the advice of health reformers like William Alcott, developed countries today are chronic diseases—that an advocate of moderation in diet and sexual behav- is, degenerative illnesses, such as heart disease, cancer, ior (Leventhal, Prohaska, & Hirschman, 1985). Fewer and stroke—that develop or persist over a long period deaths occurred from diseases because fewer people of time. And worldwide, chronic illnesses account for contracted them. more than half of all deaths (WHO, 2014). These diseases The 20th century witnessed great changes in the are not new, but they were responsible for a much patterns of illness afflicting people. The death rate smaller proportion of deaths before the 20th century. from life-threatening infectious diseases declined, and Why? One reason is that people’s lives are different people’s average life expectancy increased dramatically. today. For example, more people today survive to old For example, at the turn of the century in the United age, and chronic diseases are more likely to afflict older States, the life expectancy of babies at birth was about than younger individuals. Thus, a major reason for the 48 years (USDHHS, 1987); today it is nearly 79 years current prominence of chronic diseases is that more (NCHS, 2013). Figure 1-2 shows this change and an people are living to the age when they are at high important reason for it: the death rate among children risk for contracting them. In addition, the growth of was very high many years ago. Babies who survived their industrialization increased people’s stress and exposure first year in 1900 could be expected to live to about to harmful chemicals. Trends show that chronic diseases 56 years of age, adding 7 years to their expected total are increasing rapidly in low income or developing life span. Moreover, people in 1900 who had reached the nations of the world: in the next few decades, deaths age of 20 years could expect to live to almost 63 years of due to infectious diseases other than HIV/AIDS are age. Today, the death rate for American children is much expected to decrease, and deaths from cardiovascular lower, and only a small difference exists in the expected disease; tobacco-related chronic disease; and chronic k  k Chapter 1 / An Overview of Psychology and Health 5 diseases related to obesity, such as diabetes, are likely to rise (Mathers & Loncar, 2006). John Verano, National Museum of Natural History; courtesy Smithsonian Institution Are the main causes of death in childhood and adolescence different from those in adulthood? Yes. In the United States, for example, the leading cause of death in children and adolescents, by far, is not an illness, but accidental injury (NCHS, 2013). In the age range from 1 to 24 years, about 40% of deaths result from accidents, frequently involving automobiles. In this age group, the next three most frequent causes of death are suicide, cancer, and cardiovascular diseases, all of which are far more common among 15- to 24-year-olds than for younger ages. Clearly, the role of disease in death differs greatly at different points in the life span. VIEWPOINTS FROM HISTORY: PHYSIOLOGY, DISEASE PROCESSES, AND THE MIND Is illness a purely physical condition? Does a person’s mind play a role in becoming ill and getting well? People have wondered about these questions for thousands of years, and the answers they have arrived at have changed over time. A skull with holes probably produced by trephination. This k person probably survived several of these procedures. k EARLY CULTURES in a state of health. Disease occurs when the mixture is Although we do not know for certain, it appears that the faulty (Friedman & Adler, 2011; Stone, 1979). Hippocrates best educated people thousands of years ago believed recommended eating a good diet and avoiding excesses physical and mental illness were caused by mystical to help achieve humoral balance. forces, such as evil spirits (Benyamini, 2011). Why do we Greek philosophers, especially Plato, were among think this? Researchers found ancient skulls in several the first to propose that the mind and the body are areas of the world with coin-size circular holes in them separate entities (Marx & Hillix, 1963; Schneider & that could not have been battle wounds. These holes were Tarshis, 1975). The mind was considered to have probably made with sharp stone tools in a procedure little or no relationship to the body and its state of called trephination. This procedure was done presumably health. This remained the dominant view of writers and for superstitious reasons—for instance, to allow illness- philosophers for more than a thousand years. Today, causing demons to leave the head. Because there are no the body and mind are separate concepts: The body written records from those times, we can only speculate refers to our physical being, including our skin, muscles, about the reasons for the holes. bones, heart, and brain; the mind refers to an abstract process that includes our thoughts, perceptions, and feelings. Although we can separate the mind and body ANCIENT GREECE AND ROME conceptually, an important issue is whether they function The philosophers of ancient Greece produced the earliest independently. The question of their relationship is written ideas about physiology, disease processes, and called the mind/body problem. the mind between 500 and 300 B.C. Hippocrates, often Galen was a famous and highly respected physi- called “the Father of Medicine,” proposed a humoral theory cian and writer of the 2nd century A.D. who was born of illness. According to this theory, the body contains in Greece and practiced in Rome. Although he believed four fluids called humors (in biology, the term humor generally in the humoral theory and the mind/body split, refers to any plant or animal fluid). When the mixture he made many innovations (Friedman & Adler, 2011). of these humors is harmonious or balanced, we are For example, he “dissected animals of many species k  k 6 Part I / An Introduction: Basic Issues and Processes (but probably never a human), and made important politics. Scholars became more “human-centered” than discoveries about the brain, circulatory system, and kid- “God-centered” in their search for truth and “believed that neys” (Stone, 1979, p. 4). From this work, he became truth can be seen in many ways, from many individual aware that illnesses can be localized, with pathol- perspectives” (Leahey, 1987, p. 80). These ideas set the ogy in specific parts of the body, and that different stage for important changes in philosophy once the diseases have different effects. Galen’s ideas became scientific revolution began after 1600. widely accepted.