Handbook of Psychology and Health, Volume IV

Social Psychological Aspects of Health

Shelley E. Taylor, Jerome E. Singer, Andrew Baum, Shelley E. Taylor, Jerome E. Singer, Andrew Baum

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781000089660
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Originally published in 1984, the study of psychological aspects of health was a rapidly expanding enterprise. Most of the contributors to this volume were trained as social psychologists or by social psychologists. Some have been more applied in their focus or on the edge of several fields. All, however, share a common approach, focusing on the individual as he or she is buffeted about by social forces and copes with these forces. All consider situational and psychological factors in the determination of behavior, emotion, or cognition and all apply their expertise to the study of health-related issues.

The grouping of the chapters in this volume by the authors' subspecialty, social psychology, is a somewhat unconventional method of clustering. Ordinarily, the materials presented here would be published in journals or texts concerned with behavior or psychosocial in health and medicine, or in specialty publications dealing with a particular disease or health issue. That clustering of articles is functional in providing information to those most likely to utilize it, but it diffuses the origin and background of the studies. These chapters speak to the diversity of health issues that are amenable to successful social psychological analysis.

1 The Developing Field of Health Psychology

Shelley E. Taylor

University of California, Los Angeles

The field of health psychology is a new one, and it is rapidly growing. Health psychology is the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the maintenance of health, the prevention of illness and dysfunction, and the rehabilitation of those already disabled (Matarazzo, 1980). It can be distinguished from related terms, behavioral medicine and behavioral health, by its exclusively psychological emphasis and by its focus on all aspects of health, including prevention, illness, and rehabilitation. The increasing interest in health psychology is striking, easily documented by such factors as the numbers of health-related submissions to journals and to the American Psychological Association annual convention proceedings over the last few years. So much interest has been evidenced in health psychology that a new APA division, Division 38, was recently formed which now numbers over 2000 members. Two new journals, the Journal of Behavioral Medicine and Health Psychology have recently come into existence, and more are in the development phase. An American Psychological Association survey (1976) shows that the numbers of psychologists involved in health settings, the amount of time they spend on research, their responsibilities, and their salaries, are all increasing. Publishers are eager to enter the field of health psychology, as evidenced by new and forthcoming collections in this area, as well as the appearance of texts. Finally, new training programs have developed in many universities within the last few years that have partial or total emphasis on health psychology (Belar, Wilson, & Hughes, 1982).

Social psychology has been one of the most active contributors to health psychology. Given the substantial role of situational factors in the etiology, course, and treatment of illness and at least a moderate degree of control over those factors, the technologies of social psychology, both empirical and theoretical, are easily adapted to understanding health-related problems. But social psychology is only one of the subareas of psychology contributing to the development of health psychology. Other major ones include physiological and clinical. To understand the recent emergence of the field requires an understanding of both trends within medicine and developments within psychology more generally.

The Rise of Health Psychology: Reasons?

One may reasonably ask why such a great interest has developed in an area that just a few years ago attracted relatively few researchers. One answer is that there are now more health problems of psychological interest. As the distribution of illness in this country has shifted from acute infectious disease to chronic disease during this century, more issues of psychological interest have emerged, including adjustment to the diagnosis of a chronic illness, the institutional management of illness, adjustment to treatment, and self-management of chronic illness. Consider, for example, the issues created for a newly diagnosed juvenile diabetic who must now alter his life-style and manage a daily routine and diet in ways that may threaten his newly developing feelings of control and masculinity. Or consider the threat that chemotherapy poses to individuals who have valued their attractiveness and who now discover skin changing color, hair falling out, and bodily functions disrupted. These are just two examples of a range of problems raised by chronic illness and the changing epidemiology of disease (see Taylor, 1978).

Problems of etiology likewise create issues of psychological interest. Stress is implicated as an etiological factor in virtually all diseases from the cold to cancer. Nowhere is this relationship more dramatically illustrated than in the life of Lyndon Johnson, who suffered a major illness during every election campaign he undertook. He once said that if his Great Society Program were terminated, he would die with it; in fact, on the day Richard Nixon signed the bill ending the Great Society Programs, Lyndon Johnson died (Kearns, 1976). Obviously most cases of the relationship between stress and illness are not this dramatic, but the role of stress in the etiology of illness is now undeniable (Glass, 1977; Lipowski, Lipsitt, & Whybrow, 1977).

Even the design of delivery systems creates issues of psychological concern. Many people now belong to health maintenance organizations (HMOs). As a consequence, they may have no regular physician, but rather see whatever physician is available. Visits often involve waiting long periods of time as one is shunted from clinic to clinic or physician to physician, creating anger, frustration, and in many cases disinclination to return to the facility or noncompliance with recommended medical procedures (see, for example, Freidson, 1961). Assessing these unintended costs of otherwise seemingly cost-effective delivery systems is a task that can be mounted together by sociologists and psychologists (Taylor, 1979; 1981).

Prevention creates a range of psychologically relevant problems. The technology of attitude change research of the 1950s and 1960s provides a basis for developing techniques for getting people to stop smoking, control their diet, obtain exercise, and engage in other practices that have been tied to good health (e.g., Evans, Rozelle, Maxwell, Raines, Dill, Guthrie, Henderson, & Hill, 1981). And finally, with the ever increasing discoveries of the role of both psychological and physical factors in the etiology of disease and the increasing role of the patient in the self-management of chronic disease, there arises the need for a major effort toward patient education. With their knowledge of attitude change and behavior change, psychologists can help in the design of technologies to induce patients to take better care of themselves (see Evans, this volume; DiNicola & DiMatteo, this volume).

A second general reason for the current interest in health psychology is that this is an area in which psychologists have already made important advances. Janis’s (1958) groundbreaking surgery studies demonstrated the importance of having accurate expectations regarding the aftereffects of surgery for successful adjustment. An enormous literature on feelings of psychological control (see Thompson, 1981 for a review) has demonstrated that when people have accurate expectations regarding the sensations they can expect or information regarding what steps they can take to reduce pain, they often cope better, they may require fewer medications, and they may even be able to leave the hospital earlier.

A set of less noble reasons for interest in health psychology concerns the presence of jobs and other resources. Research in health psychology and behavioral medicine continues to be funded while other more traditional topics in psychology have sustained budget cuts. The area of health psychology is expanding in a time when other outlets for psychologists are shrinking. Accordingly, this is an area that rises at a time when the rest of the field must, of necessity, modify its complexion to meet the vagaries of the economic and political scene.

Finally, the increased interest in health psychology is due to a new receptivity in medical establishments to psychological inputs. At one time psychologists’ roles in health settings were greatly limited, often restricted to psychological testing, involving little more than the administration, scoring, and interpretation of test materials of medical patients who were considered to have psychological complications. As criteria for competent research developed and pressures to adhere to such criteria within medical circles increased, the methodological and statistical training of the psychologist became useful to research-oriented health practitioners (e.g., physicians, nurses) who have comparatively less training in methodology and statistics.

It is now clear that the psychologist’s conceptual role in the health research process is also expanding. For example, the writer was recently visited by a cardiologist, who told her that he had tried to get funding from the National Heart, Lung, and Blood Institute, but was told that because his study was heavily psychological, he would need a psychologist consultant before his research project would be approved. For those of us who have been instructed to get medical or physician consultants on our projects in the past, this is indeed a heartening turn of the tables. Furthermore, it indicates that research on issues of health is no longer the exclusive province of medicine, but an area in which the contributions of psychology have recognized theoretical and practical legitimacy.

Accordingly, then, there are at least four main classes of reasons that have led to the increase in interest in health psychology—problems of psychological interest, success of psychological ventures, the presence of resources, and receptivity by the medical establishment. Many of us, as a consequence, are attempting to fill this void by creating programs that will train what appear to be much needed health psychologists. However, one must first ask exactly what role health psychologists will play. Or, put another way, what is a health psychologist? Because we are developing a social psychologically oriented health psychology program at UCLA, we had an interest in exploring this question systematically. Accordingly, we identified 22 psychologists, primarily social psychologists, whose work has been heavily in the areas of health and illness over the past years and wrote to them with several specific questions. We asked them to outline: what they had included in their training program in health psychology, formal or informal; what they thought an ideal program in health psychology ought to include; and where they had placed their students. We also asked them to conjecture as to the shape of the job market for social psychologically oriented health psychologists over the next ten years.

What Is a Health Psychologist?

The survey of our 22 psychologists revealed remarkable consistency. First, let us outline the shape of the employment picture. At least three kinds of academic jobs appear to be available on a continuing basis to health psychologists. First, because of growing interest in health psychology, traditional academic departments of psychology and sociology will continue to have places for people who do health-related work. Medical schools and schools of public health employ behavioral scientists, including psychologists, on a continuing basis, and this source of positions is likely to continue. Health psychology programs constitute a new potential set of openings in the academic job market. (See Belar et al., in press, for a list of such programs.)

In all subareas of psychology, more psychologists will be moving into applied positions and this will also be true in health psychology. The position most frequently mentioned by our 22 respondents as likely to be available to health psychologists is that of evaluation researcher in large ongoing, health-related projects. These are positions that are frequently funded by soft money and hence are somewhat unstable; but they often have a life expectancy of at least 5 years, which is little different from the average life expectancy of a junior faculty position. The advantages of evaluation positions are that they are heavily applied and often action oriented, with policy level applications. The disadvantages include the fact that the evaluation researcher is often brought into the project after the initial design has already been developed, with the result that he or she must do a patching-up job rather than a full-scale evaluation from the outset (Gutentag & Struening, 1975; Weiss, 1972).

A second source of nonacademic position is research-oriented consulting firms. Because the government is making money available to study health issues, consulting firms will continue to have a share in those funds. Such firms will require the talents of psychologists. Third, government agencies, particularly funding agencies, may be a source of continuing employment, although their job focus will be at least as much on administration as on conducting research.

Another source of nonacademic positions will be as liaison psychologists or psychosocial experts on treatment units. Some of these programs and their positions are relatively well defined; but because many are relatively new, the role is often ill defined. A young social psychologist, who recently interviewed for such a position in a veterans’ hospital, was enthusiastically hired by the administration. When she arrived at her position, she asked the people in charge of her unit what she was expected to do as a psychosocial expert. They responded with some surprise that inasmuch as she was the psychosocial expert, she should decide what to do, and that they could scarcely tell her what her job was. No one quite knows what a psychosocial expert does; and hence the activities involved in these positions can be as varied as they are numerous.

To summarize, the social psychologically oriented health psychologist’s role is not expected to be radically different from that of most psychologists. The primary activities will be research, teaching, and program evaluation. However, more of the work will be applied and the money will be softer than is usually the case in academic positions.

Problems Associated with Health Psychologists’ Roles

As with any newly developing role, a number of problems are likely to emerge for the health psychologist. One is role ambiguity, exemplified in the story of the psychosocial expert on the treatment ward. It is simply not always clear what one’s role as a health psychologist is. Coupled with role ambiguity is a certain amount of isolation. Whereas academic psychologists enjoy the luxury of colleagues, health psychologists, particularly those in treatment settings, are less likely to do so, and indeed may find themselves alone in an area otherwise dominated by health professionals. Finding university liaisons and colleagues, then, is often a task of the health psychologist in a nonacademic setting.

Another potential problem is the question of status. Although psychologists are now held in greater esteem than they once were (indeed, some used to feel their position was just slightly below that of orderly in the medical establishment), there is still a clear pecking order, with physicians at the top. These status issues often emerge indirectly rather than directly. As one health psychologist (Leonard Saxe, personal communication) has noted, the sole indication of a status problem may be one’s own vague longings to become a physician in midcareer. This should be taken as an immediate sign that one is taking the status hierarchy somewhat too seriously.

Psychologists and medical personnel often have competing, or at least not always cooperating needs. Although this point has been discussed at length elsewhere (Taylor, 1978), it bears repeating here. Health care professionals are often action oriented, looking for physical and psychological prescriptions to use with their patients, whereas psychologists are more theoretical and tentative in conclusions, avoiding broad generalizations and hard-and-fast rules. Problems in collaboration and differences in goals can result.

Funding presents some problems for the health psychologist. Although research money is available to do health psychology research, government funding organizations are organized by disease rather than by concept. For example, a psychologist may be interested in coping and want to study it across several different diseases; however, because funding is organized by disease, the psychologist may have to target a proposal to one particular funding agency (e.g., the Heart, Lung, and Blood Institute). To generalize one’s results beyond a single disease often requires at least a second proposal identical to the first but targeted for a different agency. Although division by disease does not impede the progress of medically oriented research, it can impede the progress of psychologically oriented research. A second problem is that psychologically oriented proposals will often take a back seat to more medically relevant proposals. Hence, a relatively mundane drug study may be given priority over a more creative and competent psychosocial proposal. Although there is now a study section on behavioral medicine within the National Institutes of Health that reviews crossdisease and heavily psychological proposals, funding must still come from an institute; hence, these problems in some cases persist.

Another problem health psychologists need to anticipate is that politics enters the funding picture. Some institutes are more prestigious than others and hence draw off more dollars. Each year there are target areas for research, and if one has a proposal that addresses a priority area, one’s proposal is more likely to be funded than is a somewhat more competent proposal in a target area with less high priority. These target areas often turn around on a yearly basis. Within some institutes, there is also an implicit war over dollars between prevention and rehabilitation. The argument favoring the prevention focus is that if one can stop ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Copyright Page
• Table of Contents
• Preface
• 1. The Developing Field of Health Psychology
• 2. Social Psychological Models of Health Behavior: An Examination and Integration
• 3. Practitioners, Patients, and Compliance with Medical Regimens: A Social Psychological Perspective
• 4. A Three-Stage Model of Treatment Continuity: Compliance, Adherence, and Maintenance
• 5. Improving Adherence to Medical Recommendations: Prescriptive Hypotheses Derived from Recent Research in Social Psychology
• 6. Preferences for Self-Care and Involvement in Health Care
• 7. Psychological Interventions and Coping with Surgery
• 8. Accuracy of Symptom Perception
• 9. Illness Representations and Coping With Health Threats
• 10. Social Support, Stress, and the Buffering Hypothesis: A Theoretical Analysis
• 11. The Role of Social Support in Coping With Chronic or Life-Threatening Illness
• 12. Life Changes, Moderators of Stress, and Health
• 13. Deterring Cigarette Smoking in Adolescents: A Psychosocial-Behavioral Analysis of an Intervention Strategy
• 14. Institutional Relocation and Its Impact on Mortality, Morbidity, and Psychosocial Status
• Author Index
• Subject Index