Health Psychology. Michael Murray
constant evolution. Although the majority of people in any society organize meaning-making through the use of loosely organized indigenous belief systems, the character of these is connected in some form with expert belief systems.
Kleinman (1980) described three overlapping sectors of any health care system:
The popular sector refers to the lay cultural arena where illness is first defined and health care activities initiated.
The professional sector refers to the organized healing professions, their representations and actions.
The folk sector refers to the non-professional, non-bureaucratic, specialist sector that shades into the other two sectors.
Although this three-fold division is widely cited, other researchers (e.g., Blumhagen, 1980) have preferred a simpler two-fold division into professional and popular realms. The former are said to consist of systematicity, coherence and interdependence (Blumhagen, 1980: 200). Conversely, a lay health belief system can appear disconnected, inconsistent and at times plainly contradictory. This broad classification avoids an accusation that certain specialized health belief systems are classified as ‘folk’ when they have limited status in society, although they may offer an extensive classification of health complaints and treatments. These two broad kinds of belief systems interact such that the lay person can draw upon more specialized knowledge but also the specialist will make use of more popular knowledge. Further, both ways of thinking about health draw upon a more general worldview located within particular local socio-political contexts. Blumhagen (1980) argues that these two kinds of health belief systems should be considered distinct from an individual belief system that a person employs to understand their personal experience of illness. Dominant expert health belief systems have the tendency to become doctrinal in nature, with principles and guidelines that inform practitioners and specialists in systems of treatment for different illnesses.
Western Health Belief Systems
Classical views of health
The classical view of health and illness in the West is derived from the Graeco-Arabic medical system known as Galenic medicine. This provided an expert system developed from the Greeks, in particular the work of Hippocrates and his colleagues. We discussed the central concepts in Galen’s formulation in Chapter 1.
Besides focusing on understanding natural processes, the Galenic tradition placed responsibility on individuals to look after themselves. Ill health was viewed as one consequence of natural processes, not a result of divine intervention. In many ways Galen’s ideas not only prefigured but also continue to influence much of contemporary health beliefs in industrialised societies.
Christian ideas
Galenic ideas dominated medicine in Europe for almost two millennia. However, during the Middle Ages in Europe, Galen’s work became confined more to the learned few and other ideas based upon religion became more commonplace. Illness was often seen as punishment for humankind’s sinfulness. The Church’s seven deadly sins came to be associated with pathological conditions of the body. For example, pride was symbolized by tumours and inflammations, while sloth led to dead flesh and palsy (Thomas, 1979).
Christianity drew upon different traditions. The ascetic tradition scorned concern for the body and instead promoted acts such as fasting and physical suffering, which supposedly led to spirituality. With the Protestant Reformation this belief was replaced with the idea that the body had been given to humans by God. It was the individual’s religious duty to look after and care for the body. Illness was seen as a sign of weakness and neglect. To honour God required living a healthy life and abstaining from excess, especially in terms of sex and diet.
Despite the authority of the Church, these religious interpretations began to decline with the growth of medical science. While in terms of the expert belief system there has been increasing acceptance of a naturalistic view of disease, the moral basis of health continues to underlie much of contemporary health belief. Externalizing religious health beliefs has also been shown to influence health and well-being outcomes. For example, in a US survey of religion and health (n = 2948), belief in divine control over health has been shown to impact negatively upon health outcomes, while also contributing to a better sense of life satisfaction (Hayward et al., 2016)
Biomedicine
Two streams of thought in knowing the world dominated during the Enlightenment. The first was the acceptance of the distinction between superstition and reason. The second was the emergence of positivism, which emphasized that science based upon direct observation, measurement and experimentation gave direct access to the real world. This approach concentrated attention on material reality and a conception of the body as distinct from the mind. A central figure was Descartes (1596–1650), who conceived the human being as composed of mind and body. The former was not open to scientific investigation, whereas the latter could be conceived as a machine.
The eighteenth century saw the rise of individualism in Western society. In previous eras the group or collective organized ways of thinking and acting, which in turn was interconnected with the physical and spiritual world. Professional understanding of health and illness became more closely entwined with knowledge of the individual physical body. Foucault (1976) described how between the mid-eighteenth and mid-nineteenth centuries the ‘medical gaze’ came to focus on the interior of the human body. The symptoms of illness now became signs of underlying pathophysiology. Foucault noted that the change in perspective of the physician was illustrated in the change in the patient query from ‘How do you feel?’ to ‘Where does it hurt?’. For this new physician the stethoscope became the symbol of having insight into the bodily interior. Treatment centred on changing the character of this physiology by either medical or surgical means.
This approach to the study of health and illness has become known as biomedicine, or ‘cosmopolitan’ or ‘allopathic’ medicine (Leslie, 1976). It came to dominance for several reasons, including the fact that it was in accord with a broader view of humans, its alliance with physical science and the steady improvement in the health of the population that was attributed to medical intervention. The focus on the body is in accord with the Western emphasis on the individual. Further, the separation of mind and body ‘offers a subtle articulation of the person’s alienation from the body in Western society, but this alienation is found, as well, in every sphere of economic and political life’ (Benoist and Cathebras, 1993: 858). Biomedicine separates the person from the body.
Non-Western Views of Health
Chinese views of health
Traditional Chinese Medicine (TCM) is greatly influenced by the religion and philosophy of Taoism. According to this view, the universe is a vast and indivisible entity and each being has a definite function within it. The balance of the two basic powers of yin and yang governs the whole universe, including human beings. Yang is considered to represent the male, positive energy that produces light and fullness, whereas the yin is considered the female, negative force that leads to darkness and emptiness. A disharmony in yin and yang leads to illness. A variety of methods including acupuncture and herbal medicines can be used to restore this harmony. There are at least 13,000 medicinal substances with 50 fundamental herbs, including the roots, twigs and leaves of cannabis, ginseng, ginger, licorice, peony and rhubarb.
Confucianism is influential in the traditional Chinese views on health. Within this culture, human suffering is traditionally explained as the result of destiny or ming. Cheng (1997: 740) quotes the Confucian teacher Master Meng: ‘A man worries about neither untimely death nor long life but cultivates his personal character and waits for its natural development; this is to stand in accord with Fate. All things are determined by Fate, and one should accept what is conferred.’ An important part of your destiny depends upon your horoscope or pa-tzu. During an individual’s