VI Critical Applications
Critical Health Psychology
Antonia C. Lyons and Kerry Chamberlain
The Development of Health Psychology
Health psychology is a broad field that is concerned with the application of psychological knowledge to all aspects of physical health and illness. It now encompasses a wide range of approaches, areas of study and applications that inform theory and practice. Health psychology is diverse, covering issues ranging from health promotion (staying healthy and well) to biomedical issues (psychological and social factors affecting our biological systems), and from behavioural medicine to cultural diversity in health and medical practices. It developed at a time when there were growing critiques of the dominant biomedical framework of health and disease by people working across a range of social sciences, including medical sociology, medical anthropology and health economics. Through the 1960s and 1970s, psychologists also turned their attention to health and health care, and health psychology developed as a perceptible sub-discipline of psychology in North America and Europe during the 1970s.
Health psychology was formally established as a sub-discipline in the late 1970s, culminating in the creation of Division 38 of the American Psychological Association in 1980. Matarazzo’s (1980) definition of health psychology was foundational for this division and is still widely used today. This definition stated that health psychology was concerned with integrating
A.C. Lyons (*) • K. Chamberlain
Massey University, Palmerston North, New Zealand © The Author(s) 2017
B. Gough (ed.), The Palgrave Handbook of Critical Social Psychology, DOI 10.1057/978-1-137-51018-1_26
“the specific educational, scientific, and professional contributions of the discipline of psychology” (Matarazzo, 1980, p. 815) to four key health-related areas, namely (1) promoting and maintaining health, (2) preventing and treating illness, (3) identifying causal and diagnostic correlates of health and illness, and (4) improving the health-care system and health policy formation. Health psychologists have historically focused their attention more on individuals’ attitudes and behaviours (and changing these) than on changing health-care systems or developing policy. In fact, Matarazzo (1980) promoted this individual orientation from the beginning in his foundational paper, citing earlier work by Knowles (1977), a physician and social philosopher, who had argued:
[O]ver 99 per cent of us are born healthy and made sick as a result of personal misbehavior and environmental conditions. The solution to the problems of ill health in modern American society involves individual responsibility, in the first instance, and social responsibility through public legislative and private volunteer efforts, in the second instance. ... Most individuals do not worry about their health until they lose it ... I believe the idea of a “right” to health (guaranteed by government) should be replaced by the idea of an individual moral obligation to preserve one’s own health—a public duty if you will. (Knowles,
1977, pp. 58-59)
The field of health psychology was quickly dominated by the positivist approaches employed in mainstream psychology, and the ‘scientific’ nature of the field was emphasised. This functioned to establish the credibility of health psychology within the broader array of biomedical and health disciplines (Murray, 2014a), as did the enthusiastic adoption of Engel’s (1977) biopsychosocial model of health and illness, a model positing that health is the interplay of three specific areas of life: the biological, the psychological and the social.
Health psychology has grown rapidly since its inception. The rise in the application of psychological knowledge to health, disease and illness has been attributed to a number of factors, particularly a growing awareness of the role that a person’s behaviour plays in the development of many chronic diseases. For example, many epidemiological studies have demonstrated evidence linking ‘lifestyle’ factors (simple everyday behaviours such as diet, exercise and social connections) to health, disease and mortality rates in longitudinal studies with large samples and across a range of Western countries (e.g., Belloc & Breslow, 1972; Haveman-Nies, Burema, Cruz, Osler, & van Staveren, 2002; Wiley & Camacho, 1980). Such findings led to a great deal of research time and money being spent on identifying those behaviours associated with poorer health outcomes and on interventions to get people to change such behaviours. Psychology’s focus on the individual and individual behaviour fits very neatly within neo-liberal societies with their increasing ideology of health as the responsibility of the autonomous individual (Crawford, 2006; Horrocks & Johnson, 2014; Marchman Andersen, Oksbjerg Dalton, Lynch, Johansen, & Holtug, 2013; Minkler, 1999). Health psychology has also grown rapidly because of an increasing disenchantment with traditional, biomedical health care and the escalating costs of health-care services with little improvement in basic health indicators (Kaplan, 2000).
As health psychology developed as a discipline, so too did different views and approaches to the field. In 2002, Marks outlined four different forms of health psychology, namely clinical, public, community and critical. Clinical health psychology has remained the dominant approach, with a focus on the individual, illness, health care and health services. It is heavily research-based and draws on positivist notions of science and knowledge production. Public health psychology works towards promoting health and preventing illness, rather than focusing on treating illness. It emphasises social, economic and political aspects of health and illness to improve population health. Community health psychology aims to promote positive well-being in communities through empowerment, social action and praxis. Critical health psychology is somewhat less demarcated, but is concerned with power and macro-social processes in health and illness. These four forms of health psychology have many areas of overlap and are not as independent as this framework suggests. A traditional, biomedical approach views ill-health as the result of biological or physiological processes; however, public, community and critical health psychology all share the much broader perspective that social, cultural, political and economic influences (among other factors) are all important in keeping people healthy, influencing health outcomes, accessing health care and experiencing illness. Thus a critical approach is implicated within much of public and community health psychology.