Notes On Psychology PDF

1 NOTES ON PSYCHOLOGY: RAD 242 AN OVERVIEW OF PSYCHOLOGY Psychology is a broad field that encompasses the study of human thought, behavior, development, personality, emotion, motivation, and more. Gaining a richer and deeper understanding of psychology can help people achieve insights into their...

1 NOTES ON PSYCHOLOGY: RAD 242 AN OVERVIEW OF PSYCHOLOGY Psychology is a broad field that encompasses the study of human thought, behavior, development, personality, emotion, motivation, and more. Gaining a richer and deeper understanding of psychology can help people achieve insights into their own actions as well as a better understanding of others. What Is Psychology? Psychology is the study of the mind and behavior. Research in psychology seeks to understand and explain how people think, act, and feel. Psychologists strive to learn more about the many factors that can impact thought and behavior, ranging from biological influences to social pressures. Applications for psychology include mental health treatment, performance enhancement, self-help, ergonomics, and many other areas affecting health and daily life. It is difficult to capture everything that psychology encompasses in just a brief definition, but topics such as development, personality, thoughts, feelings, emotions, motivations, and social behaviors represent just a portion of what psychology seeks to understand, predict, and explain. Top 4 Things to Know About Psychology 1. Psychology Is Both an Applied and Theoretical Discipline Psychology is both an applied and academic field that studies the human mind and behavior. Research in psychology seeks to understand and explain how we think, act, and feel. Research psychologists contribute to our understanding of why people behave as they do as well as different factors that can impact the human mind and behavior. As most people already realize, a large part of psychology is devoted to the diagnosis and treatment of mental health issues, but that's just the tip of the iceberg when it comes to applications for psychology. In addition to mental health, psychology can be applied to a variety of issues that impact health and daily life including well-being, ergonomics, motivation, productivity, and much more.  2 2. There Are Many Different Specialty Areas in Psychology Psychology is a broad and diverse field. Some different subfields and specialty areas have emerged. The following are some of the major areas of research and application within psychology:  Abnormal psychology: is the study of abnormal behavior and psychopathology. This specialty area is focused on research and treatment of a variety of mental disorders and is linked to psychotherapy and clinical psychology.  Biological psychology: also known as biopsychology, studies how biological processes influence the mind and behavior. This area is closely linked to neuroscience and utilizes tools such as MRI and PET scans to look at brain injury or brain abnormalities.  Clinical psychology: is focused on the assessment, diagnosis, and treatment of mental disorders. It is also considered the single largest area of employment within psychology.  Cognitive psychology: is the study of human thought processes and cognitions. Cognitive psychologists study topics such as attention, memory, perception, decision-making, problem-solving, and language acquisition.  Comparative psychology: is the branch of psychology concerned with the study of animal behavior. This type of research can lead to a deeper and broader understanding of human psychology.  Developmental psychology: is an area that looks at human growth and development over the lifespan. Theories often focus on the development of cognitive abilities, morality, social functioning, identity, and other life areas.  Forensic psychology: is an applied field focused on using psychological research and principles in the legal and criminal justice system.  Industrial-organisational psychology: is a field that uses psychological research to enhance work performance, and select employees.  Personality psychology: focuses on understanding how personality develops as well as the patterns of thoughts, behaviors, and characteristics that make each individual unique.  Social psychology: focuses on understanding group behavior as well as how social influences shape individual behavior. Topics studied by social psychologists include attitudes, prejudice, conformity, and aggression. 3. Psychologists Utilize Scientific Methods  3 Psychologists use objective scientific methods to understand, explain, and predict human behavior. Psychological studies are highly structured, beginning with a hypothesis that is then empirically tested. As psychology moved away from its philosophical roots, psychologists began to employ more and more scientific methods to study human behavior. Contemporary researchers use a variety of scientific techniques including experiments, correlational studies, and longitudinal research. 4. There Are Many Different Applications for Psychology The most obvious application for psychology is in the field of mental health where psychologists use principles, research, and clinical findings to help clients manage and overcome symptoms of mental distress and psychological illness. There are also many other ways that psychology is used to help people live better, healthier lives. Psychological research can have an impact on public policy, can be used to design public health initiatives, and can guide approaches to education and child development programs. The Major Branches of Psychology How do psychologists think about and study the human mind and behavior? Psychology is such a huge topic and conveying the depth and breadth of the subject can be difficult. As a result, a number of unique and distinctive branches of psychology have emerged to deal with specific subtopics within the study of the mind, brain, and behavior. Each branch or field looks at questions and problems from a different perspective. While each has its own focus on psychological problems or concerns, all areas share a common goal of studying and explaining human thought and behavior. Psychology can be roughly divided into two major areas: 1. Research, which seeks to increase our knowledge base 2. Practice, through which our knowledge is applied to solving problems in the real world  4 Because human behavior is so varied, the number of subfields in psychology is also constantly growing and evolving. Some of these subfields have been firmly established as areas of interest, and many colleges and universities offer courses and degree programs in these topics. Each field of psychology represents a specific area of study focused on a particular topic. Oftentimes, psychologists specialize in one of these areas as a career. The following are just some of the major branches of psychology. For many of these specialty areas, working in that specific area requires additional graduate study in that particular field. a. Abnormal Psychology: is the area that looks at psychopathology and abnormal behavior. Mental health professionals help assess, diagnose, and treat a wide variety of psychological disorders including anxiety and depression. Counselors, clinical psychologists, and psychotherapists often work directly in this field. b. Behavioral Psychology: also known as behaviorism, is a theory of learning based on the idea that all behaviors are acquired through conditioning. While this branch of psychology dominated the field during the first part of the twentieth century, it became less prominent during the 1950s. However, behavioral techniques remain a mainstay in therapy, education, and many other areas. People often utilize behavioral strategies such as classical conditioning (a kind of learning in which a person or animal comes to associate two kinds of stimuli, one that naturally prompts a given behavior and one that does not. In simple terms two stimuli are linked together to produce a new learned response in a person or animal) and operant conditioning (a method of learning that occurs through rewards and punishments for behaviour) to teach or modify behaviors. For example, a teacher might use a system of rewards in order to teach students to behave during class. When students are good, they receive gold stars which can then be turned in for some sort of special privilege. Put in another way, classical conditioning is when a conditioned response is paired with a neutral stimulus e.g. Pavlov’s dogs trained to salivate at the  5 sound of metronome (a musical instrument that produces audible sound at regular intervals) or school bells in boarding secondary schools like eating bell with its expected response. Operant conditioning involves encouraging or discouraging a specific behaviour using reinforcement e.g. training dogs to sit by giving them a treat when they do (cf positive and negative reinforcement e.g food as positive) c. Biopsychology: is a branch of psychology that is focused on how the brain, neurons, and nervous system influence thoughts, feelings, and behaviors. This field draws on many different disciplines including basic psychology, experimental psychology, biology, physiology, cognitive psychology, and neuroscience. People who work in this field often study how brain injuries and brain diseases impact human behavior. Biopsychology is also sometimes referred to as physiological psychology, behavioral neuroscience, or psychobiology. d. Clinical Psychology: is the branch of psychology concerned with the assessment and treatment of mental illness, abnormal behavior, and psychiatric disorders. Clinicians often work in private practices, but many also work in community centers or at universities and colleges. Others work in hospital settings or mental health clinics as part of a collaborative team that may include physicians, psychiatrists, and other mental health professionals. e. Cognitive Psychology: is the branch of psychology that focuses on internal mental states. This area of psychology has continued to grow since it emerged in the 1960s. This area of psychology is centered on the science of how people think, learn, and remember. Psychologists who work in this field often study things such as perception, motivation, emotion, language, learning, memory, attention, decision-making, and problem-solving. Cognitive psychologists often use an information- processing model to describe how the mind works, suggesting that the brain stores and processes information much like a computer. f. Comparative Psychology: is the branch of psychology concerned with the study of animal behavior. The study of animal behavior can lead to a deeper and broader understanding of human psychology. This area has its roots in the work  6 of researchers such as Charles Darwin and Georges Romanes and has grown into a highly multidisciplinary subject. Psychologists often contribute to this field, as do biologists, anthropologists, ecologists, geneticists, and many others. g. Counseling Psychology: is one of the largest individual subfields within psychology. It is centered on treating clients experiencing mental distress and a wide variety of psychological symptoms. The Society of Counseling Psychology describes the field as an area that can improve interpersonal functioning throughout life by improving social and emotional health as well as addressing concerns about health, work, family, marriage, and more. h. Cross-Cultural Psychology: is a branch of psychology that looks at how cultural factors influence human behavior. The International Association of Cross-Cultural Psychology (IACCP) was established in 1972, and this branch of psychology has continued to grow and develop since that time. Today, increasing numbers of psychologists investigate how behavior differs among various cultures throughout the world. i. Developmental Psychology: focuses on how people change and grow throughout the entire lifespan. The scientific study of human development seeks to understand and explain how and why people change throughout life. Developmental psychologists often study things such as physical growth, intellectual development, emotional changes, social growth, and perceptual changes that occur over the course of the lifespan. These psychologists generally specialize in an area such as infant, child, adolescent, or geriatric development, while others may study the effects of developmental delays. This field covers a huge range of topics including everything from prenatal development to Alzheimer's disease. j. Educational Psychology: is the branch of psychology concerned with schools, teaching psychology, educational issues and student concerns. Educational psychologists often study how students learn or work directly with students, parents, teachers, and administrators to improve student outcomes. They might study how different variables influence individual student outcomes. They also study topics such as learning disabilities, giftedness, the instructional process, and individual differences.  7 k. Experimental Psychology: is the branch of psychology that utilizes scientific methods to research the brain and behavior. Many of these techniques are also used by other areas in psychology to conduct research on everything from childhood development to social issues. Experimental psychologists work in a wide variety of settings including colleges, universities, research centers, government and private businesses. Experimental psychologists utilize the scientific method to study a whole range of human behaviors and psychological phenomena. This branch of psychology is often viewed as a distinct subfield within psychology, but experimental techniques and methods are actually used extensively throughout every subfield of psychology. Some of the methods used in experimental psychology include experiments, correlational studies, case studies and naturalistic observation. l. Forensic Psychology: is a specialty area that deals with issues related to psychology and the law. Those who work in this field of psychology apply psychological principles to legal issues. This may involve studying criminal behavior and treatments or working directly in the court system. Forensic psychologists perform a wide variety of duties, including providing testimony in court cases, assessing children in suspected child abuse cases, preparing children to give testimony and evaluating the mental competence of criminal suspects. This branch of psychology is defined as the intersection of psychology and the law, but forensic psychologists can perform many roles so this definition can vary. In many cases, people working within forensic psychology are not necessarily "forensic psychologists." These individuals might be clinical psychologists, school psychologists, neurologists or counselors who lend their psychological expertise to provide testimony, analysis or recommendations in legal or criminal cases. m. Health Psychology: is a specialty area that focuses on how biology, psychology, behavior and social factors influence health and illness. Other terms including medical psychology and behavioral medicine are sometimes used interchangeably with the term health psychology. The field of health psychology is focused on promoting health as well as the prevention and treatment of disease and illness. Health psychologists are interested in improving health across a wide  8 variety of domains. These professionals not only promote healthy behaviors, they also work on the prevention and treatment of illness and disease. Health psychologists often deal with health-related issues such as weight management, smoking cessation, stress management, and nutrition. They might also research how people cope with illnesses and help patients look for new, more effective coping strategies. Some professionals in this field help design prevention and public awareness programs, while others work within the government to improve health care policies. n. Industrial-Organizational Psychology: is a branch that applies psychological principles to research on workplace issues such as productivity and behavior. This field of psychology, often referred to as I/O psychology, works to improve productivity and efficiency in the workplace while also maximizing the well- being of employees. Research in I-O psychology is known as applied research because it seeks to solve real-world problems. I-O psychologists study topics such as worker attitudes, employee behaviors, organizational processes, and leadership. Some psychologists in this field work in areas such as human factors, ergonomics, and human-computer interaction. Human factors psychology is an interdisciplinary field that focuses on topics such as human error, product design, ergonomics, human capability, and human-computer interaction. People who work in human factors are focused on improving how people interact with products and machines both in and out of the workplace. They might help design products intended to minimize injury or create workplaces that promote greater accuracy and improved safety. o. Personality Psychology: is the branch of psychology that focuses on the study of the thought patterns, feelings, and behaviors that make each individual unique. Classic theories of personality include Freud's psychoanalytic theory of personality and Erikson’s theory of psychological development. Personality psychologists might study how different factors such as genetics, parenting, and social experiences influence how personality develops and changes. p. School Psychology: is a field that involves working in schools to help kids deal with academic, emotional, and social issues. School psychologists also  9 collaborate with teachers, students, and parents to help create a healthy learning environment. Most school psychologists work in elementary and secondary schools, but others work in private clinics, hospitals, state agencies, and universities. Some go into private practice and serve as consultants, especially those with a doctoral degree in school psychology. q. Social Psychology: seeks to explain and understand social behavior and looks at diverse topics including group behavior, social interactions, leadership, nonverbal communication, and social influences on decision-making. This field of psychology is focused on the study of topics such as group behavior, social perception, nonverbal behavior, conformity, aggression, and prejudice. Social influences on behavior are a major interest in social psychology, but social psychologists are also focused on how people perceive and interact with others. r. Sports Psychology: is the study of how psychology influences sports, athletic performance, exercise and physical activity. Some sports psychologists work with professional athletes and coaches to improve performance and increase motivation. Other professionals utilize exercise and sports to enhance people’s lives and well-being throughout the entire lifespan. WHY PSYCHOLOGY IS IMPORTANT IN HEALTH CARE Psychology can contribute to our understanding of ourselves, and our relationships with other people. Health care workers spend most of their working lives interacting with other people. It enhances their therapeutic work, promote the health and well- being of their patient or clients, preserve their personal sense of well-being and enable them work more effectively with colleagues in intra- and inter-professional teams. Psychology must take account of the context of people’s lives. Certain sets of beliefs and behaviours are risk factors for illness. Therefore some knowledge of public health and public health agenda for change is essential. Those we care for come from a  10 variety of different social and cultural backgrounds that value certain beliefs and behaviours above others. These may place some people at greater or lesser risk of illness than others; therefore some knowledge of sociology is essential. In order to understand the link between psychological and physiological processes, some knowledge of the biomedical sciences is also essential. The psychology of health cannot be viewed in isolation from these other disciplines. There are many ways in which psychological theory and research can contribute to improvements in health and social care: 1. Appreciate how people’s comprehension and needs vary, so that we can try to ensure that the individualised care we provide is both appropriate and optimal. 2. Gaining a better understanding of communication processes so that we can identify ways of improving the therapeutic relationship and work more effectively in inter-professional and inter-agency contexts. 3. Identifying factors that affect how people cope with such situations as acute and chronic illness, pain and loss, and the demands of everyday life, so that we can help them to cope better and reduce the risk of stress-related illness. 4. Informing us about factors that influence whether or not people are likely to engage in certain health-related behaviours like smoking, dietary change and exercise, so that we can help them to change or modify their lifestyles in order to enhance their long-term health and well-being. How Psychology Came to Be What It Is Today Early psychology evolved out of both philosophy and biology. Discussions of these two subjects date as far back as the early Greek thinkers, including Aristotle and Socrates. The word "psychology" itself is derived from the Greek word psyche, literally meaning "life" or "breath." Derived meanings of the word include "soul" or "self." The emergence of psychology as a separate and independent field of study truly came about when Wilhem Wundt established the first experimental psychology lab in Leipzig, Germany in 1879.  11 Wundt's work was focused on describing the structures that compose the mind. This perspective relied heavily on the analysis of sensations and feelings through the use of introspection, an extremely subjective process. Wundt believed that properly trained individuals would be able to identify accurately the mental processes that accompanied feelings, sensations, and thoughts. Throughout psychology's history, various schools of thought have formed to explain the human mind and behavior. In some cases, certain schools of thought rose to dominate the field of psychology for a period of time. While these schools of thought are sometimes perceived as competing forces, each perspective has contributed to our understanding of psychology. Schools of Thought in Psychology The following are some of the major schools of thought in psychology.  Wundt and Titchener's structuralism was the earliest school of thought, but others soon began to emerge.  The early psychologist and philosopher William James became associated with a school of thought known as functionalism, which focused its attention on the purpose of human consciousness and behavior.  Soon, these initial schools of thought gave way to several dominant and influential approaches to psychology. Sigmund Freud's psychoanalysis centered on the how the unconscious mind impacted human behavior.  The behavioural school of thought turned away from looking at internal influences on behavior and sought to make psychology the study of observable behaviors.  Later, the humanistic approach centered on the importance of personal growth and self-actualization.  By the 1960s and 1970s, the cognitive revolution spurred the investigation of internal mental processes such as thinking, decision-making, language development, and memory. Following from above, it is important to note that there are five main schools of thought in psychology in which academic psychologists normally work and on which health psychology is based. People working in the field of health or social care may draw on any or all of this, but it is helpful to understand the assumptions and  12 principles that underpin them. They are:  Cognitive science (also referred to as cognitive psychology): The study of cognition (mental processes) including memory, perception, attention span, information processing, learning, psychophysiology, and psychoneuroimmunology.  Behavioural psychology (based on behaviourism): the study of learning by observing the direct effects of external environmental stimuli on behaviour and behaviour change. It is based on a theory that suggests that environment shapes human behaviour.  Psychodynamic psychology (developed from psychoanalysis): the study of the influence of childhood experiences on current psychological and emotional states. It is based on the assumption that all behaviour has an underlying cause especially the subconscious mind. Everyone has experiences in their lives and childhoods that affect their day to day lives choices and behaviours.  Humanistic psychology: the subjective study of human experience. It supports the belief that humans, as individuals are unique beings and should be recognized and treated as such.  Social psychology: the study of behaviour of humans in their social and cultural settings. It is the study of the manner in which the personality, attitudes, motivations, and behaviour of the individual influence and are influenced by social groups Psychologists working in these different fields of psychology often agree that people tend to respond in predictable ways in certain clearly defined situations. What they usually disagree about is the theoretical explanation and interpretation of these observations. Professionals involved in the prevention, management and treatment of psychological problems The number of psychologists working in health and social care and other fields has increased considerably over the last few decades. Their tasks focus on preventing, assessing, treating and/or helping individuals to manage emotional, behavioural and cognitive problems using psychological theory and research. They also work alongside or provide consultancy, to other health professionals. Some examples are:  13  Clinical Psychologist: aims to reduce psychological distress and enhance and promote psychological well-being. They work with people with physical or mental health problems which might include anxiety and depression, serious and enduring mental illness, adjustment to physical illness, neurological disorders, addictive behaviours, childhood behaviour disorders, personal and family relationships. They work with people throughout the life span, including those with severe learning difficulties.  Health psychologist: applies psychological research and methods to the prevention and management of disease, the promotion and maintenance of health, the identification of psychological factors that contribute to physical illness, and the formulation of health policy.  Counselling psychologist: applies psychology to working collaboratively with people across a diverse range of human problems. This includes helping people manage difficult life events such as bereavement, past and present relationships, and working with mental health issues and disorders. BEHAVIOURAL SCIENCE While taking ward rounds a doctor examines Mr R aged fifty-five years on bed no. 5, and Mr S aged forty-eight years on bed no. 6, with both patients having similar symptoms and diagnosed with carcinoma of lungs. From physical point of view the doctor prescribed medicines based on his knowledge of human anatomy, physiology, and learning of pharmacology. However he finds that both patients were reacting to the illness and responding to the medical treatment differently. This can only be explained by behavioural science. Mr S is restless, gets irritated easily, is always complaining of other staff working in the ward. On the other hand Mr R is accommodating and is grateful for whatsoever care is given to him. They are not only patients of bed no. 5 and bed no. 6, but are two human beings with their unique personalities, abilities to cope with stress and varied family responsibilities. These differences in behaviour are due to their own different personalities and reactions to illness. It is not sufficient to have knowledge about the biological and organic aspects of the disease only, it is important to understand the person having the disease and his psychosocial background. Definition Behavioural Sciences is defined as the branch of science, which can help one in  14 understanding his patients as unique individuals. This term has been used to denote the study of human behaviour both of the individual and of groups of people, small or large. It emphasises on individual behaviour and on the application of such basic knowledge to medical and allied disciplines. Thus behavioural sciences have become part of the undergraduate medical and health sciences education all over the world. Behavioural Sciences draws upon various disciplines and sciences related to the study of human behaviour like: psychology, sociology, anthropology, economics and statistics (Fig. 1.1). Psychology is the study of human individual behaviour. Sociology is more about social and group behaviours. Anthropology deals with culture and natural history of mankind of different races and their development. Economics has to do with the distribution of scarce resources within a society. The statistics helps in testing hypotheses and measurement. Fig. 1.1: Subject content in behavioural sciences Need for Behavioural Sciences An understanding of human behaviour is desirable in most branches of clinical practice; it is especially important in medicine, psychiatry, community medicine, pediatrics and geriatrics. There are ample examples to illustrate the need for the disciplines of behavioural sciences (which mainly consists of psychology and sociology) to provide a systematic academic foundation in the preclinical period for these clinical subjects.  15 They can have a significant effect on the outlook and attitudes of medical and allied health students, both through their subject matter (human behaviour and social processes) and through their central premise that the problems they deal with are susceptible to scientific investigation and explanation. In medical and healthcare practice the main concern of the healthcare worker is individual patient. Often one encounters differences in response to pain, illness, hospitalisation, and other stresses; the influence of personality and social class on illness. Patient’s personalities and relationships may be important factors in the disease process and in medical care. There is also need to communicate effectively with patients, their relatives, and co-workers (inter and intra-professionally). There is also experience of resistance to attitude and behaviour change in the context of preventive medicine— these are a few examples of everyday problems of medical care, which require the doctor and healthcare worker to form judgement and make decisions based on an understanding of human behaviour and institutions. Furthermore, psychological knowledge can be valuable in developing the effectiveness of the student’s and doctor’s own cognitive processes. Clinical practice involves complex routines of observations, discrimination, and interpretation, acquiring and retaining factual information, of problem-solving and decision-making. There is an extensive body of psychological knowledge concerning these processes and the variables which influence them (e.g. the effects of fatigue, attitudes, and expectancy on accuracy of perception and recall); and it is believed that students can profit from awareness of these problems and of the principles underlying them. Culture as Determinant of Health Culture is shared learned behaviour that is transmitted from one generation to another for purposes of human adjustment, adaptation, and growth. Culture has both external and internal referents. External referents include roles and institutions. Internal referents include attitudes, values, beliefs, expectations, and consciousness. Culture is something that mediates and shapes virtually all aspects of human behaviour. It is the way in which human beings define and experience reality. It includes their sense of morality and personhood. These dimensions of human behaviour are not inborn but rather are shaped by the socialisation process. An ethno cultural group’s language and its religion, economic, political, and social systems are institutional reflections of culture and help to shape the internal referents as part of a reciprocal or  16 interdependent system. As children are reared, they are conditioned directly and indirectly to think, feel, and act in certain ways. These ways constitute their reality. Their language helps to shape reality and is also in turn shaped by it. Culture is a critical determinant of human behaviour, to the extent that ifculture varies, human behaviour must also vary. It can be observed that the differences in the appearance, food, dress, and rituals of people that grow up in different cultural settings also produce differences in the way they think and define reality. The individual is the representative product of biological, psychological, social and cultural determinants. Figure 1.2 presents this conceptualisation of human behaviour. The illness behaviour is also influenced by the cultural determinants, e.g. in many cultures males are not likely to cry or express pain or suffering, during an illness. If you are not aware of these determinants, then probably your assessment of that patient’s pain and suffering will be biased. Fig. 1.2: Determinants of behaviour Scope of Behavioural Sciences Training in the behavioural sciences is essential for the appropriate education of physicians as major health problems of today can lead to premature death or disability. Cardiovascular disease, substance abuse, AIDS, cancer, and adolescent pregnancy are directly caused by risk- taking behaviour and can be prevented by people only by modifying their lifestyle and behaviour. Many diseases require major modifications of lifestyle to ensure benefits of therapy. The primary purpose of teaching behavioural science in medical schools is to prepare physicians to understand the role of social and psychological factors in the aetiology and course of disease. The knowledge can be applied to reduce the burden of disease by changing the patient’s behaviour. Some other causes of illness stem from sociocultural forces, such as poverty, low socioeconomic status,  17 and industrialisation. These factors are very common in developing countries, though they lie beyond the realm of the individual doctor-patient relationship; yet understanding these factors can help physicians plan appropriate medical services and preventive efforts. The scope of behavioural sciences is envisaged in the following areas of medicine: i. The Doctor-Patient Relationship: The clinical knowledge base now includes a large amount of research on doctor-patient relationships which has been demonstrated to be important to patient care outcomes. It includes information about the understanding of intimacy-relations of trust and power between doctors and patients, and how interpersonal influence works in doctor-patient transactions. Effective interviewing techniques are among the most essential skills that all physicians need to learn. Many studies have demonstrated that physicians who fail to obtain accurate information may misdiagnose or recommend inappropriate therapies. ii. Social Class and Health Behaviour: Social class is broadly associated with almost every indicator of morbidity, disability and mortality. Understanding specific risks and vulnerabilities associated with social status provides physicians opportunities for more effective communication and therapy, and for preventive initiatives. Several investigators have demonstrated that disadvantaged social environments increase the risk of serious health problems especially in children and adolescents. One of the examples is the low birth weight child when reared in disadvantaged environment, has an increased prevalence of acute and chronic illness for as long as eleven years after birth. Physicians often underestimate the extent to which the patients of lower socioeconomic status desire information. Such patients are often less expressive and less questioning than the better educated patients and physicians commonly give them less treatment relevant information. iii. Human Development: Life Cycle, Health and Illness: Physicians need to understand how life experiences at one stage of development influence later behaviour, susceptibility to illness, and use of medical services. Previous life experiences also modify physiologic and immunologic responses. Longitudinal studies of life span in humans have illuminated the cause-and effect relationships of early nutrition to later heart disease and the effect of early life stress on later immunologic response.  18 iv. Psychophysical Relations: This is one of the most rapidly advancing fields in the mind-body relationship. Parents with a child who is dying from leukaemia have markedly different cortisol and T-lymphocyte responses, depending on whether they can grieve openly or not. Those who cannot grieve have greater elevation of cortisol and more illness in the year after the death of a child than those who can. Children who are taught self-imaging (i.e. self- hypnosis) respond with greater secretory Immunoglobulin A (IgA – an antibody blood protein that is part of the immune system) in their pharynges than those who are not, and self-imaging has been shown to be as effective in treatment of migraine headaches in children as standard pharmacologic treatments. There are marked individual differences in cortisol and neuroimmunologic response to stress from early life. Physicians need to recognise the mind-body relationship, which has been extensively documented. Physical disease cause behavioural changes. Psychological stresses cause physical changes. v. Health and Illness Behaviour: Differences in behaviour account for much of the variation in the health of different populations. These include not only personal health behaviours such as smoking, diet, substance abuse and exercise but also exposure to environmental risks and interpersonal, work- related and community-related stresses. Risks to health are often inadvertent consequences of personal choices and routine activities. Understanding these risks and developing strategic approaches for intervention enhance physician’s opportunities to assist their patients in leading healthier lives. Controlling many extremely serious risks to health and to life itself such as HIV infection depends exclusively on successful modification of behaviour and exposure to risk. vi. The Impact of Social Support: Many studies show that the presence of social support, the quality of social networks, and the degree of participation in them have substantial effects on coping health status, and longevity. vii. The Importance of Self Efficacy: Self efficacy reflects confidence in the ability to exert control over one’s own motivation, behavior and social environment. A large literature now attests to the importance of self efficacy in supporting social adaptation and health. The deterioration of frail elderly persons who move to new environments is often linked to their sense of loss of control. Experiments carried out in nursing homes show that increasing the  19 elderly person’s sense of control results in enhancement of health. Similar finding have been reported on patients with chronic pain, that experience of pain is less in patients who think controlling power is with the person himself. While there is still much to be learned, several areas of research converge in demonstrating the importance of a person’s sense of control over his or her immediate environment. viii. The Hole of Self-Attention on Symptom Amplification: Numerous lines of investigation show how focussed attention on physical states amplifies the intensity of experience and concern about health status. Understanding of this work has relevance for pain management and for understanding symptom prevention and response. ix. The Illness-Disability Perception: Disability caused by the illness depends on a range of factors that intervene between the occurrence of illness and disability. These factors include personal variables such as attitudes and motivation; aspects of the social context, such as opportunities for participation, stigma, and physical accessibility; and the health workers’ management of the initial condition over its longitudinal course. The understanding of these factors is crucial in the appropriate care of persons with physical impairments, the elderly, and individuals with chronic disease. x. Adult Sexuality, Loss, Grief, Mourning, Aging, and Death: These issues are concerned primarily with the interaction of psychologic and sociologic aspects of individual behaviour and need few specific examples to demonstrate their importance. Behavioural science seeks to understand the social organisation of the communities in which patients live, the institutions involved in the provision of medical care, and their influence on health. Selye described the general adaptation syndrome and developed the general concept of stress and the neuroendocrine mechanisms involved, particularly the role of catecholamines and the steroids. Since that time, steady progress has been made toward working out step-by-step the biological mechanisms involved, whereby stress can lead to cardiovascular changes that cause heart attacks and stroke or have profound effects on the immune system for example, we still have a long way to go in learning the details of these mechanisms, but we know enough already to begin to see how behaviours such as smoking and high fat/high calorie diets, for example, affect these same mechanisms and exacerbate them and how exercise can ameliorate them. We also  20 know that behavioural change leading to prenatal care, good nutrition, and immunisation will make the difference in improving our infant mortality rates. Furthermore, violence, teenage high-risk behaviours, and suicide are major cause of mortality and morbidity. Finally, we know that adherence to medication, especially in the adult and the elderly, remains a major problem in managing chronic diseases. SENSORY PROCESSES AND PERCEPTION Ranjeet, a young man comes to the clinic with severe anxiety, He is a music teacher in a private school, is blind due to congenital defect, and is married but does not have children. His wife has normal vision, but is not educated. The anxiety was precipitated after a neighbour suddenly passed away following cardiac arrest, an incident that caused concern and fear in Ranjeet’s mind, He wondered how he can handle such a situation if the need be considering that he was blind,. Any sensory defect can have negative psychological impact on the individual’s personality and adjustment. The sensory organs—vision, hearing, smell, touch and taste are highly complex systems and they do not make a straightforward response to each stimulus encountered. The knowledge comes to each one of us through our senses. We know about the world around us from what we learn directly about it, using our bodily sensations. We can understand the external world only from what our senses can detect of it. Therefore, sensation becomes the primary source of all human knowledge. In human being unlike simple organism, sensation is only a small part of much more complicated information processing systems.  A stimulus is any form of energy to which we can respond (light waves, sound waves, and pressure on the skin).  A sense is a particular physiological pathway for responding to a specific kind of energy.  Sensation is the feeling we have in response to information that comes in through our sensory organs.  Perception is the way our brain organises these feelings to make sense out of them. This involves recognition of objects that comes from a combination of sensations and the memory of previous sensory experiences.  21 SENSATION Sensations contain both a ‘quantity’ element (size, hardness, coldness), and a ‘quality’ element (attractive, bad or dangerous). For example if you get burnt from a hot pressure cooker, you may think of all pressure cookers as being dangerous equipment. The physical property of heat may therefore, take on the psychological property of dangerousness. Thus the physical and physiological events are collectively called ‘sensation’. That is the way in which the body responds to energy impinging upon it from the environment. PERCEPTION Sensation refers to the process of receiving information, whereas to perceive means to interpret and understand. Perceiving is not seeing, believing. Perception refers to what is immediately experienced by a person. Sensory events are translated into patterns of activity in the sensory channels and the central nervous system. Some of what we perceive is very closely linked to these activity patterns. Perception is the process of knowing the world outside you, by forming some mental representation. Perception is a complex process, extending far beyond the mere registering of light, sound, and other impulses from the external world. This external information must be internally coded and transformed before anyone can know what is really out there. Often your beliefs and expectations about some external stimulus prove to be more important in determining your behaviour than the physical characteristics of that external object. Perception is like solving a complicated puzzle. You must take bits and pieces of information that are present in the external world and fit them together somehow to form a comprehensive internal picture. It may at first appear that every object in the external world makes direct contact with the brain via the sense organs: the eyes, ears, skin, and so on. But this view of perception is much too simple. There is no direct one-to-one relationship between the image formed by your eye and your perception of that image. The situation is indeed even more complex, since many physical arrangements in the external world can produce exactly the same image upon the eye. For example, it follows from elementary principles of geometry that a small triangle near you will produce the same image in the eye as that of a large triangle further away. Since any single external cue is likely to prove insufficient to narrow down the possibilities about the external world, we are forced to rely upon various combinations of cues. Although each cue by itself may be unreliable, if we consider enough cues together, we can often come up with an accurate mental picture of the external situation. However, for much of what we perceive, the sensory patterns merely provide the ‘raw data’ for experience. The sensory information is transformed elaborated and combined with memories to create what we actually experience or perceive.  22 Perceptual Processes We do not perceive world as loud sounds, bright lights or patches of colours. We perceive the world around us as objects like, book, glass, and plants. We hear doorbell, footsteps and songs. That means the sensory inputs at the focus of our attention have form and meaning. Perceptual processes which provide meaning to what we see or hear are classified as: form, visual depth, constancy, movement perception, plasticity and individual differences. We shall very briefly examine these processes. A. Form Perception: The sensory inputs we receive come into our awareness as shapes, pattern and form. The basic element needed for visual form perception is the presence of contour. A contour isan area within the visual array where there is an abrupt change in luminance. The normal optic array is filled with contour information and an area completely enclosed by a contour is usually seen as distinct and separate form. Another fundamental process in form perception is the recognition of a figure on a ground. We see objects as standing against a background. The words on this book are figures against the background of the page. We must be able to differentiate between the figure and these backgrounds, from which they are emerging. But in a reversible figure ground stimulus; perception of figures is a psychological act of interpretations and not necessarily, directly predictable from the stimulus array. Reversible figure ground relationship illustrates the multistability of perceptual organisation, i.e. some stimulus inputs can be organised differently in perception. Organisation in perception partially explains our perception of complex patterns as unitary forms or objects. We see objects as objects only because grouping process operate in perception. Some laws of organisation are: 1. Law of proximity—items close together in space or time tend to be perceived as belonging together. 2. Similarity—similar objects tend to be grouped together. 3. Symmetry—there is a tendency to organise things to make a balanced or symmetrical figure that includes all the parts. 4. Continuation—there is a tendency to perceive a time that starts in one way as continuing in the same way. 5. Common fate—elements, which are perceived as moving together from an organised group. 6. Law of closure—refers to perceptual process sees, which organize the perceived world by filling gaps in stimulation.  23 B. Depth Perception: Artists, philosophers, and psychologists have long been challenged by the everyday fact of 3D seeing. The problem is set by the very structure of eye, which forms an optical image on a 2- dimensional surface, the retina. We make use of information, or cues in the sensory input to generate the 3D perception. The depth cues, were first studied by artist Leonardo da Vinci (1452- 1519) to keep artists portray depth and distance on a flat canvas. We use monocular and binocular cues to create such effect.  Monocular cues: These operate when only one eye is looking. The artist to give us depth experience from a flat painting generally uses these. The depth perception is created by-Linear perspective (the distances operating the images), clearness, interposition (one object obstructs view of another), shadows, gradients of texture (change without abrupt transition) and movement.  Binocular cues: Many of the cues for depth perception require only one eye. Individuals with vision in one eye have adequate depth perception in most conditions. When we observe with two- eye vision, at the world we add binocular cues to the depth perception to the monocular cues since the two eyes receive slightly different view of the world thereby producing binocular cues.  Nonvisual cues of depth and distance: There are two possible cues to the perception of depth namely convergence and accommodation. The conception was that subject adjusted this accommodation and convergence until he had a sharp and single image of the object. C. Visual Pattern Perception: When we consider all the processes that underlie the recognition of complex, everyday pattern, we find they can be classified in two ways: 1. Data-driven processing: This begins with the arrival of sensory information reaching the receptors (data). This input is said to drive a series of analyses, beginning with registration of luminance differences in image, colours, lines, angles, etc. This analysis proceeds from retina up through various levels of visual pathways, until it reaches higher centres of brain. 2. Cconceptually-driven processing: This uses higher level conceptual processes including memories of past experiences; general organisational strategies; knowledge of world and expectations based upon surrounding context or situation. Both types of analyses can be occurring simultaneously, or they may occur one after the other. Constancy of perception: Our perceptual experiences are not isolated; they build a world of identifiable things. This world as we perceive is a stable world. An object that has been  24 constituted perceptually as a permanent and stable thing is perceived as such regardless of the illumination on it; the position from which it is viewed; or the distance at which it appears. This stability of environment as we experience is termed as ‘perceptual constancy’. Size constancy: This refers to the fact that as an object is moved further away, we tend to correct it for distance and still see it as more or less normal in size. When we see an object at a distance, we might judge its size in one of the 3 ways: 1. Perspective size: According to the geometry of perspective, i.e. size inversely proportional to distance. This size would correspond to size of image on retina. 2. Object size: If object constancy is perfect we might judge an object by its known size. 3. Compromise between perspective size and object size: It might compromise and see the objects smaller at a distance, but not as much smaller as geometry of perspective indicates. Size constancy develops largely as the result of experience. Similarly, the tendency to see an object, as of standard shape regardless of the viewing angle is shape constancy. The tendency to see an object as of normal colour regardless of light and shadow is called ‘colour constancy’ and brightness respectively. Finally, the fact that objects retain their same positions, even as we move about is known as ‘location constancy’. Although the word constancy is an exaggeration, it however dramatises our relatively stable perception of objects. D. Movement Perception: When we perceive movement, we sense action in space taking place over time. We usually explain the perception of movement according to the stimulation of successive parts of sensory surface. Adaptive behaviour requires that we perceive movement accurately; otherwise one would land up in the hospital following an accident. Perceived motion also occurs without any energymovement acrossthe receptorsurface or without a successive pattern of stimulation, and is called apparent motion. In contrast to this there is real motion, the perception of the actual physical movement of the objects. Apparent motion: It is movement perceived in the absence of physical movement of an image across the retina. This is caused by the following factors: a. Autokinetic effect—if we stare at a single spot of light in a completely dark room, after a few seconds light will appear to move in an erratic manner. This apparent movement of stationary light is called Autokinetic effect. b. Stroboscopic motion—This illusion of motion is created, when separated stimuli, not in motion are presented in succession. This motion is used in making of cartoon films. Each frame of a film is slightly different from the preceding one, but when frames are presented rapidly enough, the picture blends into a smooth motion. A simple form of stroboscopic motion is called “Phi- Phenomenon”, according to this, in a dark room if these are four lights and one of these four lights blinks on and off, followed shortly by another, there is an illusion of a single light moving from  25 first position to the second. When all four lights flash on and off in a rapid sequence, it appears that single light is travelling in a circle, but the perceived size of the circle is smaller; than would be the case if lights were actually rotating. Real motion: The perception of real motion depends upon relations between objects within the visual field. Whenever there is movement, the brain has to decide what is moving and what is stationary with respect to some frame of reference.Wegenerally tend to assume that large objects are stationary and, smaller objects are moving. “Induced movement” is experienced when we look at the moon through a thin cover of moving clouds. In a clear sky, the moon appears to be stationary. When framed by moving clouds the moon will appear to race across the sky, while clouds appear stationary. Plasticity: Visual deprivation or plasticity is restriction of the visual output. This is generally caused during the development stage in early infancy. Individuals born with congenital cataract face this type of problem. Individual differences: Individuals differ in the ways they process sensory inputs to give rise to what they experience. Two individuals watching sunset in the western coast beach may have very different perceptions of the sunset. One may report it was breath taking or pure magic, whereas the other may report a red circle gradually descending. These differences in the perception are the result of the following factors. Perceptual learning: Eleanor Gibson (1969) has defined perceptual learning as “increase in the ability to extract information from the environment as a result of experience or practice with the stimulation coming from it”. This learning influences behaviours and experiences; and also determines the focus of attention. There are many examples to show that learning can mould perception. The one common example that we commonly encounter is the competence of individuals trained in various professions, as compared to untrained individuals. Skills in any variety are result of perceptual learning, which is achieved only through practice. Another very relevant example of perceptual learning is that blind persons learn to extract information from the environment, which generally the sighted people cannot do, e.g. very sensitive discrimination of auditory sounds. Related with learning one often wonders whether the perception is inborn or is influenced by the environmental factor. Those who advocate nature’s role, say that brain organisation is determined by genetic codes and is so innate. The perception that depends upon this organisation is thus also innate. They say that sensory deprivation or special sensory experience during critical period results in a loss of brain connections that were genetically determined, because they needed environmental input, or nurture, for their maintenance. On the other hand, supporters of environment, argue that while genetic codes may provide a rough blueprint, nurture interacts with the genetic outline during critical periods to direct growth and cause the proper brain connections to be made, so according to them alterations in the environment during critical period actually change  26 the way the brain grows and the connections are made. Perceptual set: We frequently perceive an event or object because we were mentally prepared for a particular object or event to arise. Set refers to the idea that we are ready to receive certain kinds of sensory input. Such set or expectancies vary university, you will be able to recollect that you were able to spot the result in the newspaper in no time whereas your friends who were not expecting did not even look at this news. Perceptual sets are related to the actual physical environment of the stimulus itself or to the internal factors, such as emotion or motivation. Motives and needs: Several experiments have been conducted to study the effect of need and motive on perception. We attend to and organise sensory inputs in ways that match our needs. When you are hungry or thirsty, you are likely to pay more attention to places that would satisfy your need. Illusions: Visual illusions are a dramatic example of how perceptual cues can be assembled incorrectly. Many illusions do not support the traditional view of perception that we infer from what we see. An illusion is any figure that gives rise to a bizarre interpretation of reality. The illusions demonstrate that what we perceive often depends on processes that go far beyond the ‘raw data’ of sensory input. Illusions show that perception results from transformation, elaboration and combination of sensory inputs. Specific instances in which the apparent curvature or length of a perceived line are not predictable from the curvature or length of its stimulus pattern, have been called the “Geometrical illusions”. But this does not mean that they occur only with regular lines and patterns; they can also be demonstrated with quite irregular drawings and with real objects in normal environment. The illusions are important because they may provide clues for our understanding of processes of shape perception. We shall examine some illusions that have a direct basis in our perception of ordinary objects and scenes. In these cases it may be that our senses have become so used to interpreting a particular stimulus in a given way that they cannot readily be dispensed with the ‘stereo type’. The famous Muller-Lyer illusion (Fig. 2.1) shows that people usually perceive the vertical lines of different lengths. In reality both the vertical lines are equal in length. This illusion arises because of the architectural perspective implied in these two arrangements of lines. Fig. 2.1: Which of the lines is longer? The Muller-Lyer illusion  27 Fig. 2.2: Measure the space between the two sets of arrowheads at their point However, Figure 2.2 shows, even when the vertical lines are removed from the figure the illusion still persists; the inward pointing arrowheads still seem to be further separated at the point than are those in the outward pointing version. The reason for this illusion is that even in normal circumstances we do not utilise all the available information when we perceive objects. Fig. 2.3: Which of the straight lines is longer Same illusion is evoked even when arrows are replaced by circles (Fig. 2.3). In this presence of the circles now generate the illusion of one line being longer than the other. Fig. 2.4: Converging railroad  28 Lines that converge suggest an appearance of distance. The common example of this is a stretch of long road or railroad tracks that remain parallelandequally wideastheydisappear into the distance (Fig. 2.4). The Ponzo illusion also occurs due to the converging lines suggest depth (Fig. 2.5). Illusions make clear that the context in which a given stimulus appears will determine how it is perceived.  29 Fig. 2.5: Ponzo illusion Figure 2.6 demonstrates the importance of context in determining perception that we cannot ignore. In spite of our knowing that we do not perceive accurately, still we are unable to prevent the false interpretation arising out of these figures. These illusions show that our perception is independent of our conscious will. Information reaching us in normal circumstances may frequently contain inaccuracies imposed by these unconscious processes even though we are unaware of it happening. At times the illusions can have serious effects. The Poggendorf Illusion can cause serious tragedy like, crashing aeroplanes, or misguiding the surgeons while operating. This is the simple illusion, which occurs when there are two parallel lines and a third line intersects them (Fig. 2.7). Fig. 2.6: Perceive these circles. The context of the circles that surround the centre circles influences our perception Fig. 2.7: The Poggendorf illusion It can be seen that the diagonal lines do not appear to intersect, though in reality they are extensions of the same line. The Poggendorf illusion can be explained by a combination of physical and cognitive factors. These factors are called structural effects and processing strategies. The structural effect depends upon the biological and optical construction of the eye. The processing strategy depends upon the cognitive decisions that are shaped by learning, experience and motivation. Perception as Developmental Process Like any other psychological processes, perception is also different in children as compared to the adults and is thus a developmental process.  30 Moreover, throughout the life span of an individual some changes occur in the perceptual processes. Basic perceptual functions in children may continue to mature during first year due to the actual normal functioning of the visual system. At behavioural level, we can find some responses in newborns to the direction, distance or movement of stimuli. Infants are capable of directing their age movements toward targets. Neonates tend to make convergent and divergent eye movements. Even repetitive eye movement sequence in the presence of a moving pattern called optikinetic nystagmus, is seen. But visual acuity of neonates is quite poor. Infants can discriminate between patterns. Fontz (1963) found that infants younger than one month, reported a looking preference for stimuli containing facial features; but could not differentiate between normal and a scrambled face. This suggests they are discriminating patterns on basis of simple elements rather than on the basis of total stimulus organisation. However, by 4 months, there is definite preference for unscrambled face; indicating they can identify human face. Process of habituation can be seen from the very first days of life. So, the newborn child does have a reasonable set of perceptual capacities, quite soon after the birth. One of the most informative ways to monitor changes in perceptual discrimination, recognition and information processing is to observe the way in which child selects information from external stimuli. By monitoring eye movement patterns in children we can determine the manner in which they are viewing and hence constructing. As child becomes older there is gradual movement toward a consideration of more global aspects of a pattern and its elements. Older children are more efficient at extracting details. But there is one form of pattern discrimination error, which is characteristic of young children. This involves mirror reversals (common around 3 year and gradually decrease, until child is about 10 or 11 years). Letter reversals, in children suggest that a child is relatively insensitive to orientation of a stimulus. Perceptual change in adults involve basic sensory function especially like dark adaptation which tend to diminish with age, response to more complex visual problems becomes better, or more accurate with age. As we grow older, there seems to be gradual decrease in efficiency of sensory structures. This is, however accompanied by gradual improvement in our abilities to perform complex, perceptual integrations and discriminations. E. Extrasensory Perception (ESP): You would have heard that some persons have reported correctly about their previous birth, or can predict about some event which is about to occur in very near future, like some accident is to take place or such a person sitting 500kms would be doing a particular task. These extraordinary types of perceptions require no sense organ stimulation whatsoever. Though, ESP is a controversial issue, yet some research has been carried out even in India. ESP stimulates also called as parapsychological phenomenon is of two main kinds— 1. ESP a. Telepathy or thought transference from one person to another. b. Clairvoyance or, perception of objects or events not influencing the senses (e.g. telling the details of the contents sealed in an envelope. 2. Psychokinesis (PK) or mentally manipulating objects without touching them. There is skepticism about ESP, one of the chief reasons being that no method has been formed for reliably demonstrating the phenomena. Also, the results do not vary systematically with the introduction of different experimental manipulation. But still, it is desirable to keep an open mind about issues that permit empirical demonstration, as some ESP phenomena do. F. Social Perception: We meet someone for the first time and talk with or observe him or her for a few minutes. Even in this short space of time we make judgements about a number of characteristics. Social perception is concerned with our interpretation of behaviour in social settings and generally refers to  31 how we perceive others, favourably or unfavourably. Social perception is of great relevance to medical profession. How the patient perceives the physician determines his trust for physician’s healing power. Similarly physician’s perception of the patient, his illness, agony and pain influences physician’s involvement and efficacy of treatment. In the present era of consumer protection social perception of both the physician and the patient has gained even more importance. We form opinion of other persons by means of initial impression formed, the reasons for prejudice and discrimination, and also the development of liking and relationships with specific individuals through interpersonal attraction. Attribution As we do not have access to the personal thoughts, motives, or feelings of others, we make inferences about the traits based on the behaviour we observe. If we infer that something about the person is primarily responsible for the behaviour our inference is called “dispositional attribution.” But if we include that some external force is, primarily responsible for the behaviour, it is called “situational attribution”. Basic tendency to ascribe causes to events is believed to be an inherent part of how people process information in both their social and physical world. A particular behaviour is considered to be caused by environmental forces plus personal forces, which is further divided into motivation and ability. Motivation involves both an intention to do something and an exertion of efforts to accomplish it. There is also relation between personal force of ability and environmental forces such as task difficulty. Together, these qualities form the perception of ‘can’ if the personal force of ability outweighs environmental force, then individual can do action. Behaviour is seen as involving choices and intended effects on the part of the individual. A perceiver is said to take into account not only what other person does but also what the person might have done. What a persondoesisa chosen action. Some of the effects of chosen and unchosen actions are same, but other effects are uncommon to both chosen or unchosen actions. It is these uncommon effects, which yield clues regarding the intentions of another person. A perceiver gains most of the information about personal characteristics of another person, from a small number of uncommon effects, which have low valance. According to Kelley (1967) the observers evaluate the motives for the behaviour of others using a number of criteria. Observers use this information to form a casual schema with which they make sense of things happening around them. Attribution theory and social cognition has been applied in a number of different settings. Of our relevance is cognitive theory of depression by Beck This theory describes the faulty inferences people make when in a depressed state. These depressed persons blame themselves when something goes wrong, think othershaveinterferedandnothingcanbegood for them even in the future. Self-perception: We use, much the same processes for self-attribution, as that for other attribution. When we want to make attributions about our own behaviour, we become observers of that behaviour and make attributions much as if we were observing someone else. Therefore, with our behaviour we would first determine whether the environment, has caused the behaviour through some strong external force. If this does not seem likely, we then, assume, the behaviour occurred because of some internal motives or personality traits. Internal states are inferred by ruling out externalforces. Errors in attribution: We underestimate the situational causes of behaviour, jumping to conclusions about dispositions of person. This bias toward disposition rather than situational attributions is called fundamental attribution error. Due to the expectation people tend to see, what they want to see and hear what they want to, our motives and emotions may also lead us to expect to perceive certain things. Projective tests, capitalise on these influences of motivation and emotion on perception. Perhaps, the greatest influence of motivation on perception is to be found in perception of such complex events as social and interpersonal relationships. This is so, because social situations are often indefinite and ambiguous. Our perception of them are less, definite and stable than our perceptions of physical objects. Expectancy or set, refers to the idea that we may be ‘ready’ and ‘prepared for’ certain kind of sensory input. Expectancy  32 has much to do with selection of what we perceive or attend to. It also has a large role to play in the way, we perceive ambiguous situations. Clinical Applications Sensory Defects When sensory apparatus is damaged or partially destroyed the impairment of perception may not be an accurate reflection of sensory damage. In Hemianopia, for example destruction in visual cortex of brain can render one half of visual receptor apparatus inactive, so that patient’s visual field is cut in half vertically. Surprisingly patient may not report this as a handicap to his everyday activities, as he has been able to readjust or compensate for it. Gestalt psychologists investigated such patients to demonstrate their principle of closure in perception. A circle presented to such a patient, so that it overlapped the functioning and blind areas was reported as a complete circle. As in other situation where, closure operates hemianopic perceived the whole figure when the amount presented was sufficient to determine the nature of whole. Similar closure effects have been seen in patients suffering from deafness; affecting only certain sound frequencies, and in patients with disorder of tactile sensations. A more elaborate instance of this tendency to closure after defect occurs in phenomenon known as “phantom limbs”. Following amputation the patient may continue to experience realistic sensations in missing limb for sometime even for years. This odd phenomenon is related to the “perception of bodily self” or bodily image derived from sensations in muscles, tendons, joints and balancing mechanism, as well as from vision, hearing, taste, touch and smell. Perceptual Function Perceptual functions have been tested which basically are based on Gestalt principles. The Ishihara test for colour blindness is one of the examples, the subject is shown the series of cards, and each contains a mosaic made up of hundreds of little dots of different colours. Embedded in mosaic might be a numeral, which can be presented on the basis of the principle of similarity. A normal person will use colour, as basis of similarity but colour blind, will use brightness as basis of similarity. Pain Perception Melzack and Wall (1965) have proposed a “Gate control” theory of pain, which takes into account psychological variables as well as sensory inputs (see Chapter 25). Perception of intensity of pain, tolerance and its impact on the global functioning of the individual is dependent on perception of pain. Hallucinations Hallucinations are defined as percepts, which occur without an external stimulus. They can occur, in any of the senses and have all characters of normal perception, yet there is nothing in environment, which stimulate the sense receptors to produce experience. It is different from illusion, as in an illusion some of the sensory features of stimulus are identified but recognition of whole is incorrect. Hallucinations occur in patients with psychotic disorders especially chronic schizophrenics and in patients having organic psychosis. They can be classified in terms of particular sense through which they are apparently experienced, visual, auditory or tactile. Sensory Deprivation Sensory deprivation can lead to considerable psychological disturbance. Such disturbances are also known to occur in patients admitted for a very long duration in the hospital especially those patients confined for long  33 periods or indefinitely in respirators, those restricted by attachment to various pieces of recording equipment and life- support systems in intensive care units, and those deprived of sight for a period after eye surgery. Even more generally, we may note that the manifestations of impairment of consciousness in delirious states are commonly at night, which may in part be due to the lower level of sensory and perceptual stimulation at that time. The active modification of the sensory input is required in certain clinical situations. SUMMARY The sensory organs—vision, hearing, smell, touch and taste are highly complex systems and they do not make a straightforward response to each stimulus encountered. The knowledge comes to each one of us through our senses. Sensation is the primary source of all human knowledge. In human being unlike simple organism, sensation is only a small part of much more complicated information processing systems. A stimulus is any form of energy to which we can respond (pressure on the skin), a sense is a particular physiological pathway for respon- ding to a specific kind of energy. Sensation is the feeling we have in response to information that comes in through our sensory organs. Perception is the way our brain organises these feelings to make sense out of them. This involves recognition of objects that comes from a combination of sensations and the memory of previous sensory experiences. Sensation contains both qualitative as well as quantitative element, and both physical and physiological events are collectively called ‘sensation’. Sensation refers to the process of receiving information, whereas to perceive means to interpret and understand. Perception is the process of knowing the world outside you, by forming some mental representation. Perception is a complex process, extending far beyond the mere registering of light, sound, and other impulses from the external world. This external information must be internally coded and transformed before anyone can know what is really out there. Since any single external cue is likely to prove insufficient to narrow down the possibilities about the external world, we are forced to rely upon various combinations of cues. Much of what we perceive, the sensory patterns merely provide the ‘raw data’ for experience. The sensory infor- mation is transformed elaborated and combined with memories to create what we actually experience or perceive. Perceptual processes, which provide mean- ing to what we see or hear, are classified as— form, visual depth, constancy, movement perception, plasticity and individual differences. Visual illusions are a dramatic example of how perceptual cues can be assembled incorrectly. An illusion is any figure that gives rise to a bizarre interpretation of reality. The illusionsdemonstrate thatwhat we perceive often depends on processes that go far beyond the ‘raw data’ of sensory input. Specific instances in which the apparent curvature or length of a perceived line are not predictable from the curvature or length of its stimulus pattern, have been called the “Geometrical illusions”. But this does notmean that they occur only with regular lines and patterns; they can also be demonstrated with quite irregular drawings and with real objects in normal environment. The illusions are important because they may provide clues for our understanding of processes of shape perception. Throughout the life span of an individual some changes occur in the perceptual processes. Extrasensory perception or ESP, stimulates also called as parapsychological phenomenon is of two main kinds: 1. ESP a. Telepathy or thought transference from one person to another. b. Clairvoyance or, perception of objects or events not influencing the senses. 2. Psychokinesis or mentally manipulating objects without touching them. Social perception is concerned with our interpretation of behaviour in social settings and generally refers to how we perceive others, favourably or unfavourably. Social perception is of great relevance to medical profession. How the patient perceives the physician determines his trust for physician’s healing power. Attribution is making inferrences of others behaviour. Basic tendency to ascribe causes to events is believed to be an inherent part of how people process information in both their social and physical world. Sensory deprivation, phantom limb, hallucinations, perception of pain and perceptual disorders  34 are some of the examples of clinical application of understanding of perceptions. Social perception and attribution are important for physicians as these are related to their interpersonal relationship with the patients. ATTENTION Attention refers to the perceptual focussing on certain stimuli with the aim of including them in the conscious awareness. Ability to sustain attention for some time is called concentration. Attention is influenced by external and internal factors. The former includes intensity and size of the stimulus, novelty, contrast and movement. The internal factors include motivation and interest. Attention is of three types, namely, selective attention, sustained attention and divided attention. Selective attention refers to the ability to focus the thoughts on a particular stimulus, despite the presence of other factors. Sustained attention refers to the ability to hold attention over considerable period of time (vigilance). Divided attention implies focussing attention on two or more tasks simultaneously. Attention also involves automatic and conscious processing. Study of attention is important since attentional deficits are commonly seen in patients, especially those having anxiety, schizophrenia, somatic complaints and certain neurological conditions. Poor attention and difficulty in sustaining concentration is the primary complaint in children diagnosed as attention deficit hyperactivity disorder. MEMORY Memory is an ability to remember, this is a very important cognitive process for our learning. The memory process is divided into three main stages—encoding, storage and retrieval. There are three distinct ways of classifying memory: (i) neurological structure of the brain, which divides memory into verbal and nonverbal, (ii) on the basis of experimental model, memory is divided into sensory memory, short-term memory and long-term memory, and (iii) on the basis of clinical practice, memory can be divided into remote, recent and immediate. Their levels of processing also differentiate short- term and long-term memory. The two primary and secondary types of memory are, short-term memory wherein information is stored for maximum 30 seconds and has limited capacity. In long-term memory store, information is organised in semantic memory or in episodic memory. There are four main causes of forgetting: (i) interference due to similar material, (ii) faulty encoding, storage and retrieval. If the sensory registration or input of information is faulty then memory will not be established. Similarly each of these stages are important for good memory, (iii) motivated forgetting, and (iv) amnesias which could be biological, due to diseases of the brain or psychological. Memory could be improved with good planning, organisation, review and feedback. The other methods to improve memory are mnemonics, method of loci, pegword method, rhyming, making a story, and chunking. Some strategies have been developed to help and rehabilitate patients with severe memory defects such as head injury, dementias, normal aging. These strategies provide steps to enhance memory at different stages of processing. Clinical applications of memory extend from various psychiatric; child psychiatric disorders to neurological disorders especially head injury and dementia. LEARNING Learning is defined as any relatively permanent change in behaviour that occurs as a result of practice or experience. Methods of learning are classified as: classical conditioning, operant conditioning, cognitive learning and social learning, observational learning, latent learning and biological learning. In classical conditioning, a neutral stimulus CS is presented before the unconditioned stimulus (US), that  35 evokes an unconditioned response (UR). As a result of association, the previously neutral stimulus begins to elicit a conditioned response (CR). In operant conditioning, an action of the learner is instrumental in bringing about a change in the environment that makes the action more or less likely to occur again in the future. Reinforcement is basic in this form of learning. Cognitive learning refers to changes in the way information is processed as a result of experience a person has had. Insight learning and sign learning are examples of cognitive learning. Social learning emphasises the role of observation, imitation and modelling in learning. Biological learning places emphasis on differences in the capability of individuals. There are four principles of learning, namely, individual differences in the learner, all learning is contextual, motivation and feedback is important for learning to progress. Learning can be facilitated by defining a definite goal, giving feedback, spacing your study time, learning unit size that is easily grasped, understanding the material rather than rote learning and by avoiding anxiety. There are different learning styles used by the students. These are surface, deep and versatile; these learning styles also influence the learning outcome. Students need to adopt their own autonomous approaches to learning. Teachers and education environment play a crucial role in helping students to develop the learning styles. Clinical applications of learning are related to development of phobias, depression and other maladaptive behaviours. Behaviour therapy, social skills training and cognitive therapy are offshoot of learning theories. Learning pathologies cause failure and learning styles determine the learning outcome. Thus faulty learning styles can be modified. THINKING Thinking is a mental activity in which one responds to the problem by cognitive rearrange- ment or manipulation of both information from the environment and the information stored in a long-term memory. We think by means of symbols, concepts, schema, scripts, imagery and cognitive maps. Thinking has important function in problem solving, decision making and judging. Problem-solving has been explained on the basis of learning theory, Gestalt theory and information processing. To solve a problem generally we take three steps like we prepare or plan, we produce and we evaluate the solution. Decision making is important in clinical practice for the physicians as well as the patients. Cognitive bias may interfere with impartial rational judging. Problem-solving and decision making are used in every step in patient care. EMOTION Emotion is an important aspect of human relationship. Emotions have a psychological aspect related to behaviour and cognition, which influences the physiological aspect of emotion. It is a subjective awareness as happiness or fear, and an objective physiological change like heart rate and expressive motorbehaviour. Emotion has been viewed as a biological event. Emotional reactions are controlled by autonomic nervous system, which has two parts: sympathetic nervous system and para- sympathetic nervous system. It is the joint action of the two systems, which allows one to respond appropriately. When the individual is in a relaxed state, the parasympathetic nervous system increases its neural activities, while sympathetic nervous system slows down. A homeostatic balance is maintained between over arousal and under arousal. The physiological changes due to strong emotions are associated with arousal hormones produced by adrenal glands, namely, epinephrine and norepinephrine. The release of epinephrine and norepinephrine is under the control of sympathetic nervous system. General Adaptation Syndrome theory advocates that during excessive stress, the body goes through three stages mobilising its resources for an emergency. These three stages are the stage of alarm, the resistance and exhaustion.  36 James-Lange theory of emotion states that the emotions we experience result from our perception of the changes taking place in the body during emotion. However, the Cannon- Bard theory believes that emotional inputs were processed almost simultaneously by two different parts of the brain, the thalamus and the hypothalamus. The emotional feelings were controlled by the thalamus and the hypotha- lamus controlled bodily responses. Other physiological viewpoints do not agree with Cannon-Bard theory as the individuals with damaged thalamus also experience emotions. Thus, psychologists have given intrapsychic explanations; they view emotions as experiences that involve inner feelings, than physiological reactions. The cognitive-physiological theory of emotion states that the individual’s cognitive appraisal of any situation determines the emotional response, including its accompanying physiological changes. Appraisal is influenced by past experience and current availability of strategies for coping with threat. Though emotional reactions are shared by all cultures, but some emotional reactions are also learned through experience. Different research findings have pointed out that there are some emotions, which are universally expressed, these are termed as innate expressed emotion. There are some emotions, which are learned through culture and individual styles. The relationship between the arousal level and the performance determines its effectiveness. Performance is optimal at moderate levels. At low levels, the nervous system may not be fully functioning, and at high levels the performance declines. STRESS AND COPING We all experience stress in some or the other form, such as meeting time-bound targets, competitions, getting stuck in a traffic jam while on the way to attend an urgent task, noise, social pressures, etc. We differ in the extent to which we get affected by stressors as we all have different ways of dealing with these situations. Definition Hans Selye (1974), the pioneer in stress research, defined stress as a stimulus event of sufficient severity to produce disequilibrium in the homeostatic physiological systems. We feel stress when our responses to even disrupt or threaten to disrupt our physical or psychological functioning. Positive stresses called ‘Eustress’,like shifting to a new house, promotion in job. When stress has negative effect on the individual, it is distress, for example, failure in examination, chronic illness, break-up with loved ones. The stimulus that evokes a stress response is called a stressor. A stimulus becomes a stressor by virtue of the cognitive interpretation or meaning that the individual assigns to the stimulus or by virtue of the fact that the stimulus affects the individual by way of same sensory or metabolic process, which is in itself inherently stressful. In physiological terms stress is the body’s response to any stressful demand. Lazarus defined it in psychological terms as an Individual’s cognitive judgement that his or her personal resources will be taxed or incapable of dealing with the demands posed by a particular event. According to Reuben Hill a stressor event is one that makes demands on the family system, rather than on the individual. Components of Stress Stress comprises of stressor, the sources causing the stress and stress response, which is how the individual copes with the stressful situation, his coping resources like person’s skills and social support systems (Fig. 10.1). Stressor represents stimulus events requiring some form of adaptation or adjustment. Stressor can be internal stimuli like cognitions or thoughts or external stimuli like crowd, noise, and interpersonal difficulties. The stressed person shows several stages: (i) Stage of alarm, (ii) Stage of appraisal, and (iii) Stage of reaching for a coping strategy.  37 Fig. 10.1: Components of stress The stress response is a complex reaction pattern that consists of physiological, cognitive and behavioural components. The physiological component of the stress response activates the sympathetic and parasympathetic autonomic nervous system and elicits a set of physiological reactions. The stress response has three components namely the tonic—the resting or basal level of activity, the phasic—the reaction to the given stressor and recovery—return to the tonic level. Sylve had described a three-stage reaction to stress consisting of alarm, resistance and exhaustion known as general adaption syndrome (GAS). The three stages are as following: a. Alarm reaction, subdivided in two phases, shock and counter-shock. Shock phase is initial and immediate response. Counter shock is how the body rebounds to mobilise its defenses. b. Stage of resistance: This is adaptation where you try to fight back. c. Stage of exhaustion: This is extreme fatigue one feels after fighting against stress. Asanexampleimagineyouareinabuilding, which has caught fire. The place is full of people and there is only one exit door. Your first reaction wouldbeofshock.Forsome timeyouarenumb, but in no time you try to size up the situation. According to the second stage of resistance, you look for an alternative way to get out; you break open the window glass, jump into the balcony and finally get out of the building. In the process of getting out you may also help others to escape from fire. Finally when you are out from this stressful situationthenthereisextremeexhaustion and fatigue. The first two phases of GAS prepare one’s body to respond to stress in one of the two ways—either