A new aspect of the interface between Medicine and Psychology has emerged in the United States during the recent past, and has led to a new speciality within both Medicine and Psychology, called Behavioural Medicine in the former and Health Psychology in the latter. The new specialities focus on the relationship between disease, the province of Medicine, and behaviour, the subject-matter of Psychology.
The relationship between health and behaviour has long been recognised in Psychosomatic Medicine and Clinical or Medical Psychology. But the kinds of behaviour which are the focus of Behavioural Medicine and Health Psychology are different from those which Psychosomatic Medicine and Medical Psychology have dealt with. The behaviour that the time-honoured sciences have studied in relation to bodily illness pertains to emotional reactions (fear, anger, anxiety, etc.), personality traits (perfectionism, passivity, etc.) and inner conflicts. The newer disciplines of Health Psychology and Behavioural Medicine, on the other hand, deal with that aspect of human behavior which has come to be called “life-style”.
The shift in emphasis seems to have come about as a result of two main factors, namely, the revolution that has taken place in the health-care needs of the nation, and, secondly, the growing disillusionment with traditional approaches as an answer to the new pattern of health problems faced by the United States today. Since the American life-style has been spreading to other parts of the world, including India, what the American people are learning about the relationship between health and life-style is valuable for people of other countries also.
The revolutionary change in the health-care needs of America has been documented by Knowles in a book published in 1977 entitled “Doing Better and Feeling Worse: Health in the United States”. Knowles points out that at the beginning of the century, the morbidity and mortality rates of Americans were related mainly to infectious diseases; the greatest number of illnesses and deaths were due to influenza, pneumonia, tuberculosis, gastroenteritis, and diphtheria. On the other hand, during the past 75 years, morbidity and mortality have been related chiefly to chronic disorders, such as heart disease, cerebrovascular disease, respiratory diseases, and the various cancers. Thus of the nearly two million deaths in the United States in 1969, fifty percent were the result of heart disease and strokes, and sixteen percent were due to various cancers. Even more appalling are statistics pertaining to premature death and disability: heart disease took the lives of 178,000 persons and chronically disabled 1.2 million people, all between the ages of 45 and 64.
According to Knowles, 25 to 35 million Americans have high blood pressure, nearly half of whom are not even aware of it. This is a dismal situation in view of the fact that high blood pressure is involved as a primary cause in about 60,000 deaths every year, and is a significant cause in more than 1.5 million heart attacks each year.
Another widely prevalent chronic condition in the United States today is obesity. It is estimated that sixteen percent of the population under the age of thirty suffer from obesity, and about 80 million people (forty percent of the total population) weigh twenty pounds or more in excess of their optimum weight. This too is regarded as a serious state of affairs in view of the fact that obesity is a predisposing condition in many illnesses, including degenerative arthritis of various joints, diseases of the liver and gall bladder, cancer of the gastrointestinal tract, diabetes, strokes, and heart attacks.
The above-mentioned chronic conditions, says Stachnik, a psychologist in the Department of Psychiatry at Michigan State University, “are in part a product of how we live, that is, what and how much we eat and drink, how we exercise, how we deal with daily stresses, whether or not we smoke, and so on.”It is these factors that are nowadays referred to as ‘life-style’, a term, which though somewhat too stylish, is more expressive than the more familiar term ‘behaviour’.” The fact that current morbidity and mortality is related predominantly to chronic diseases which are in a good measure a function of the life-style behaviour, leads Stachnik to draw the following striking conclusion: “… the most serious medical problems that today plague the majority of Americans are not ultimately medical problems at all; they are behaviour problems, requiring the alteration of characteristic response patterns, and thus fall squarely within the province of psychology.”
Knowles, who is a physician, expresses a similar opinion: “Meanwhile, the people have been led to believe that national health insurance, more doctors and greater use of high-cost, hospital-based technologies will improve health. Unfortunately, none of them will. …Control of the present major health problems in the United States depends directly on modification of the individual’s behaviour and habits of living.”
The second factor that seems to have brought about an emphasis on a healthy life-style is the growing despair in the treatment of chronic diseases. Such treatment is at best palliative, so that though symptoms may be temporarily alleviated, the disease process and the accompanying malaise continue to progress, not to speak of the cumulative side-effects of long-administered drugs which often take their own insidious toll. The result is a condition in which, to use the expression of Knowles’s book-title, the patient is “doing better and feeling worse”.
Such a state of affairs has led to the realisation of the absurdity of waiting until people are sick, chronically ill, or disabled to be concerned about their health. Both professional and lay people are increasingly realising the indispensable need for prevention if a successful battle against chronic diseases is to be waged. Preventive measures for chronic conditions are related to such factors as nutrition, exercise, habits pertaining to drugs of everyday life (alcohol, nicotine, caffeine, etc.), and stress management, to wit, the life-style of the individual. Stachnik’s statement quoted above bears repetition:… “the most serious medical problems that today plague the majority of Americans are not ultimately medical problems at all; they are behaviour problems.”
Dr. A.S. Dalal
(Dr. A.S. Dalal was earlier the Director of Klamath Mental Health Centre at Oregon, USA, and the Co-director of the Institute of Integral Psychology, Ojai, California. He has been the compiler of many books on mental health, psychology and yoga.)
