An Outline of Psychology As Applied to Medicine PDF
Preview An Outline of Psychology As Applied to Medicine
An Outline of Psychology as applied to Medicine John Weinman BA PhD Reader in Psychology, Unit of Psychology as applied to Medicine Guy's Hospital Medical School London Second Edition WRIGHT 1987 Bristol © John Weinman, Unit of Psychology as Applied to Medicine, Guy's Hospital Medical School, London SE1 9RT. 1987. All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the Copyright owner. Published under the Wright imprint by IOP Publishing Limited, Techno House, Redcliffe Way, Bristol BS1 6NX, England. First edition, 1981 Reprinted, 1982 Second edition, 1987 British Library Cataloguing in Publication Data Weinman, John An outline of psychology as applied to medicine.—2nd ed. 1. Psychology 2. Medicine and psychology I. Title 150'.2461 BF131 ISBN 0 7236 0890 3 Typeset by Activity Limited, Salisbury, Wiltshire Printed in Great Britain by The Bath Press, Lower Bristol Road, Bath BA2 3BL. To My Family Preface to the Second Edition In planning the changes for the second edition, I have been guided by feedback from students and colleagues both in deciding on what changes to make to the original volume and in selecting new areas for inclusion. I have tried to improve the format of the book by clarifying the text where necessary and by a better use of subheadings and spacing. Many topics have been brought up to date by including references to more recent developments both in the text and in the recommendations for further reading at the end of each chapter. In addition, a number of other topics, which either were missing from the first edition or have developed mainly since that time, are now included. Thus there are new sections on psychological influences on the immune system and on psychological approaches to the management of pain, stress-related disorders and stressful medical procedures. Two chapters have undergone major structural changes. The chapter on Ooctor-patient communication' in the first edition is now entitled 'Patients and doctors' and begins with a consideration of health attitudes and behaviour prior to outlining more specific communication issues. The chapter on 'Coping with illness and handicap' replaces the one on 'Psychological reactions to physical illness and handicap' and focuses on the processes involved in coping with physical illness and with chronic and terminal illness. Finally, the last chapter now has an enlarged section on cognitive approaches to treatment and ends with an outline of counselling and its applications. The changes which have been made reflect the major developments in the field of psychology as applied to medicine and the emergence of 'health psychology' as a separate and substantial specialty. Since health psychology is concerned with the psychological aspects of health and illness, it is hoped that this book will provide both a starting point and a framework for the reader. J. W. Preface to the First Edition Psychology is the discipline concerned with the study and understanding of human behaviour. In recent years it has become an important part of the curriculum for students of medicine and allied health disciplines. This book is intended to provide an outline of the subject for the benefit of those students. In this book I have therefore tried to integrate basic and applied areas by including psychological topics which can be related to medicine as well as looking at psychological aspects of clinical issues. Although the earlier chapters tend to cover the basic topics and the later ones the clinical areas, there is deliberately a great deal of overlap. Wherever appropriate, clinical applications are used to illustrate so-called basic topics and areas of basic psychology are elaborated to clarify and augment the more clinical sections. References to research findings are supplied in the text. The use of these will be found to be variable between the chapters in that some sections lend themselves to the presentation of a fair amount of experimental evidence whereas in others a general description of the key issues seems more appropriate. Recommendations for further reading are also given at the end of each chapter and these will allow the interested reader to pursue any of the topics in greater depth. Many areas in psychology can appear complicated, controversial or even poorly resolved. I have attempted to look at some of these areas and to examine the evidence critically so that the reader can be aware of the current 'state of the art' rather than be presented with an over-simplified view of the issues. Thus this book has been written in the belief that the reader will welcome being given an insight into current issues as well as complexities inherent in attempting to understand human behaviour. J. W. Acknowledgements This book originally emerged from a course in psychology for medical students which began at Guy's Hospital Medical School twelve years ago. I am indebted to many students who have provided invaluable feedback not only about the course but also on the first edition of this book. Many colleagues also offered very useful advice and information for the first edition as well as helpful comments for preparing this edition. In particular David Armstrong has continued to provide encouragement and critical discussion. I would like to thank the following for the use of diagrams and tables which appear in the book: Plenum Publishing Co. for Fig. 2; Van Nostrand Reinhold Co. for Fig. 3; W. H. Freeman and Co. for Figs. 5 and 12; Churchill Livingstone for Figs. 6 and 14; Dr C. M. Hawkes and Medical Education for Fig. 15; British Journal of Orthodontics for Table 3. Many thanks are also due to Carol Butterfield for typing the manuscript so capably and to Tony Hale for drawing the cartoons. Finally, Mary Anne, Anna and Jonathan deserve my warmest thanks for supporting and putting up with me while I struggled to turn my thoughts into words. 1 Psychology and medicine In the first part of this chapter there is an attempt to outline the different ways in which psychology can relate to medicine. Following this there is an account of the mechanisms which mediate pain perception. The decision to include a discussion of pain mechanisms in this opening chapter has been made for two reasons. First, it is a fundamental topic in medicine and one in which a psychological perspective forms an integral part. Second, it provides a clear example of the limitations of adopting a narrow biological approach to health and disease. Thus the analysis of pain perception will be used to demonstrate the importance of considering psychological and biological approaches in conjunc- tion. • 1.1. Psychology in relation to medicine Psychology is concerned with understanding human behaviour and as such is inextricably bound up with the practice of medicine. In many ways psychology can be seen to have a more diverse relevance to medicine than the traditional preclinical sciences and because of this it is sometimes difficult to grasp an overall picture of the contributions which can be made. Five fairly distinct but nevertheless related areas of relevance can be identified and the reader might find such an overview useful before proceeding with the other sections. These five areas are: a. Changes in behaviour associated with such factors as ageing, psychiatric illness and neurological impairment. b. The role of psychological factors in the aetiology of medical problems. c. Doctor-patient relations. d. The patient's response to illness and treatment. e. Psychological approaches to treatment. Each of these areas is covered in detail in different sections of the book but in this introductory chapter a brief summary of each is presented. a. Changes in behaviour Identifying signs and symptoms is a basic part of diagnosis and for a wide 1 2 An outline of psychology range of problems this may involve recognizing changes in behaviour. Psychiatric patients occupy the largest number of all hospital beds and it can also be argued that, in the majority of general practice patients, there is a significant psychological component in their illness. Also many of the disorders of development and ageing, as seen by paediatricians and geriatricians respectively, are characterized by changes in such aspects of behaviour as impairments of speech, learning or memory. Perhaps the most striking examples of changes in behaviour are those seen in neurology and which arise from damage to localized brain regions. These areas in medicine, in which the observation of behavioural change is central, should serve to illustrate the importance of understanding 1 aspects of 'normal behaviour and the relation between neurological structure and function as a basis for investigating and dealing with certain disorders. It might be thought from the foregoing discussion that this area of relatedness is directly parallel to the relation between, for example, anatomy and surgery in that the understanding of 'normal' functions serves as a basis for dealing with pathologies. Such a conclusion is only partly acceptable since the relation between normality and abnormality in behaviour is neither agreed nor clear-cut. For neurological disturbances of behaviour, a knowledge of psychological processes can be of direct value in understanding the nature of the dysfunction. For example, the sometimes dramatic losses of memory which can follow on from damage to certain brain regions can be more clearly understood with reference to unimpaired memory processes. However, the relation of normal to abnormal cannot really be extended to psychiatry in such a clear way. Many people imagine that psychiatric illness is abnormal in the sense that it falls far outside the realm of normal everyday behaviour and is therefore easily defined. While this may be true for a small number of bizarre psychological problems, many of the problems seen by psychiatrists or clinical psychologists comprise aspects of behaviour which many people show or feel at times. Anxiety and depression constitute two of the commonest psychiatric problems, yet just about everyone has experienced both of these to some degree at some time. Also there is no clear 'normal' state in relation to the clinical entity of depression and which corresponds to the way in which one might describe normal lung function in relation to a lung disorder such as bronchial asthma. It is important to bear these points in mind because problems of behaviour do not simply separate off in a simple and universally agreed way from so-called 'normal' behaviour. Normal behaviour is largely socially defined and so definitions of abnormal behaviour vary from generation to generation and from culture to culture. As we shall see, psychological problems are not purely defined by changes within the individual but will depend on the context within which they occur and the ability of the individual to cope. Moreover, with many psychological problems, subjective rather than objective criteria may be used for defining problems. The first nine chapters of this book present aspects of 'normal' behaviour. Chapters 2-4 are concerned with basic behavioural processes and their neuroanatomical substrates. Chapter 5 examines the nature of emotion and stress together with the links between associated physiological and psychological processes. Individual differences in personality and intelligence are described in Chapters 6 and 7 while the changes in behaviour which accompany child development and ageing are outlined in Chapters 8 and 9. In addition to
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