Torn between two lovers - on being a psychologist in a university medical centre

Abstract

Background: Psychology as applied to health and illness has a relatively short history. Nevertheless, that history shows a rapid development of the theoretical models that guide the field over the past 60 years. Core theoretical approaches are concisely reviewed, in the context of Kaplan's paper 'Behavior as the central outcome in health care' (1990), which is used as a model to examine the extent to which these approaches embrace Kaplan's notions.

Advances: Empirical studies from the health psychology domain are used, which demonstrate the gains in terms of quality of life and behavioural outcomes in patients with (chronic) somatic diseases. Over a period of some 60 years, theoretical models and core concepts in psychology as applied to health and illness have evolved from psychosomatic views to neuropsychology, quality of life, patient education, self-management, illness perceptions, patient-reported outcome measures (PROMs), shared decision-making (SDM) and health humanities (HH). The more recent models (SDM, HH) appear to align to a considerable degree with adopting 'behavior as the central outcome an outcome in health care'; shared decision-making and health humanities focus on encouraging patients to make sense of and give meaning to their illness in order to attain optimal psychosocial adjustment.

Conclusions: In addition to 'behavior as the central outcome in health care', a new definition of the concept of health (i.e. 'the ability to adapt and to self-manage' - Huber et al., 2011) seems to favour patients, healthcare providers, society, and health psychology. Incorporating this concept into medical care may be viewed as a challenge for health psychologists - and as a source of continual struggle with strong biomedical forces.

Keywords: Medical psychology; health humanities; history of health psychology; outcome research; university medical centre.

Figure 1.

Theoretical approaches to health psychology research and clinical care for patients with somatic diseases, 1960 – present [*PROM = patient-reported outcome measures; SDM = shared decision-making; HH = health humanities].

Figure 2.

Patient education, “19th century style” (Neff & Petty, 1971).

Figure 3.

‘We don’t need no education’ – patient education old style (Kaptein et al., 2021).

Figure 4.

Health humanities: applications of four genres, with patient in passive or active role. [1 Bravender et al., ; 2 Pennebaker, ; 3 Jones et al., ; 4 Rayment et al., ; 5 van der Heijden et al., , 6 https://disabilitymovies.com/2011/benda-bilili-2; 7 Quan et al., ; 8 and 9 Broadbent et al., ; Williams, 2012].

Figure 5.

Conceptual model of health-related quality of life (Ferrans et al., , p. 338).