Behavioural Sciences in Medical Practice

268 Pages·2009·2.431 MB·English

by  Manju Mehta

Behavioural Sciences in
Medical Practice

Behavioural Sciences in
Medical Practice
Second Edition
Manju Mehta MA DM & SP PhD
Professor of Clinical Psychology
Department of Psychiatry
All India Institute of Medical Sciences (AIIMS)
New Delhi, India
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Behavioural Sciences in Medical Practice
© 2009, Jaypee Brothers Medical Publishers
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First Edition: 1998
Second Edition: 2009
ISBN 978-81-8448-629-2
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To
My parents

Preface
Medical practice and medical education, at the end of twenty first century, are being driven by
several factors. Behavioural Sciences can be considered as one of the most influential of these
factors. There was a time when medicine was equated with the study of pathophysiology, diagnosis
and treatment of diseases. We are now beginning to understand that the diseased individual is
a part of the complex human ecosystem, with several levels of organisation ranging from the
molecular to psychosocial and culture. Our recognition of the limitations of curative biomedicine
has also opened up alternative strategies such as behavioural and cognitive therapies, which have
enriched the field of medicine.
There has been a paradigm shift in the disease pattern of the society. While the age-old infectious
diseases and poverty-related illnesses are still haunting us, there has been sudden upsurge in
the lifestyle-related illnesses such as cardiovascular diseases, cancers, trauma and chronic degenerative
disorders, which cannot be tackled by biomedical sciences alone. The trauma of a terminally-
ill patient, the tale of an ill-fated HIV/AIDS positive individual or even a victim of stress in a fast
moving society have their genesis in the behavioural aspects of medicine.
The need for introducing behavioural science components in the curriculum of undergraduate
medical students has been keenly felt but hardly implemented. Many of the committees on medical
education and other forums have strongly expressed the need for introducing behavioural sciences.
A study conducted by the consortium of medical institutions, adopting inquiry-driven strategies
for innovation in medical education has clearly revealed that the young graduates are deficient
in communication and interpersonal skills, and humanistic aspects of medicine. Though the need
for incorporating behavioural sciences has been keenly felt, the attempts to formulate a well-
structured programme have been few and sporadic. This is mainly because of dearth of good
textbooks and resource materials. The present book is an attempt to bridge this void.
The contents of this book have been divided in six parts. The first part is an introduction
to the subject. The second part deals with basis of behaviour, which are core psychological processes
that determine human behaviour. These processes like learning, memory, stress are not only
relevant to medical practice, but an understanding of these processes can be of great importance
to the students themselves. Many psychosocial problems are related to the developmental process;
thus, the third part of the book is on development of behaviour from birth to death. A special
emphasis is given to adolescence and oldage as these periods are concerned with new emerging
specialities: adolescent psychiatry, medicine and geriatrics. A chapter has been devoted to enhance
the skills of medical students to deal with difficult situations like dying patients, breaking news
of death to the family members and to understand the bereavement process. The fourth part
is primarily related to social issues important in patient care, these being the attitudes, family and
compliance behaviour. Qualitative as well as quantitative research in any medical speciality often
viii Behavioural Sciences in Medical Practice
borrows methods and tools from behavioural sciences; hence fifth part deals with assessment
methods and various psychological methods of management; the most important of these being
counselling. A chapter on behavioural medicine has been included, as behavioural methods have
been integrated in management of certain disorders. The sixth part deals with special applications
of behavioural skills like communication skills, understanding illness behaviour and psychology
of pain.
The overwhelming response to the first edition of this book has encouraged me to work for
the second edition, which brings additions in some chapters. I hope these additions would be
helpful for the students. Behavioural Sciences need human dimensions, thus an attempt has been
made to explain the concepts and theories in simple manner. Real case studies with fictitious
names have been given in the beginning of each chapter, and clinical applications are discussed
to make the students comprehend, relate and use this information in their practical work. It was
not feasible to include some other important aspects of health care like economics, ethics, etc.
simply to keep the volume of information at a readable level. Again, not much emphasis has
been given on latest research finding as the objective of this book is to help the students understand
the relevance of behavioural sciences to medicine.
It is impossible to acknowledge all the sources of inspiration and information that I used while
writing this book. But first of all, I must thank my patients, whom I have met over the last three
decades; the experiences I have gained from them have helped me understand the clinical applications
of behavioural sciences. I am also grateful to Professor NN Wig, former Regional Director, WHO,
for stimulating my achievement motivation. I am greatly indebted to Mrs Roxana Samuel, Ms
Renuka Dutta, Ms Anubha Dhal and my students for the help provided to me, with their valuable
suggestions and the editing of this book.
Mrs Nani Gangadharan has painstakingly typed and retyped manuscript of this book, and
she deserves my whole-hearted gratitude. I also appreciate the enthusiasm of Sameer and Aditi
in making graphic illustrations on computer.
Last but not the least, this work would not have been possible without the patience, support
and encouragement that I received from my husband, Dr Anil Mehta and other members of
my family.
Manju Mehta
Contents
PART 1: Introduction
1. Behavioural Sciences................................................................................................. 1
PART 2: Basis of Behaviour
2. Sensory Processes and Perception ............................................................................7
3. Attention................................................................................................................... 19
4. Memory.....................................................................................................................24
5. Learning and Studying ............................................................................................35
6. Intelligence................................................................................................................48
7. Thinking ................................................................................................................... 58
8. Motivation ................................................................................................................67
9. Emotion....................................................................................................................77
10. Stress and Coping....................................................................................................88
11. Personality ..............................................................................................................100
PART 3: Development of Behaviour
12. Development—Infancy to Adolescence..................................................................111
13. Adulthood to Ageing ..............................................................................................124
14. Dealing with Death and Bereavement ..................................................................132
PART 4: Social Behaviour
15. Attitudes ................................................................................................................. 138
16. Family..................................................................................................................... 146
17. Compliance with Health Care............................................................................... 155