THE FRAMEWORK AND CONCEPTS OF MEDICAL PSYCHOLOGY. PROFESSOR DOINA COZMAN, MD, PhD

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1 THE FRAMEWORK AND CONCEPTS OF MEDICAL PSYCHOLOGY PROFESSOR DOINA COZMAN, MD, PhD

2 THE DEFINITION OF MEDICAL PSYCHOLOGY The level of individual psychological issues The level of doctor patient relationships The level of social and cultural issues Conceptual models of illness: - The biomedical model - The bio-psycho-social model

3 THE DEFINITION OF MEDICAL PSYCHOLOGY Medical psychology refers to: ü Attitude towards the sick person and illness ü Attitudes of both sick and healthy individuals towards healthcare systems ü This logically includes the attitude of the physician towards the medical profession The separation clinical psychology understood as actionoriented and case-related and medical psychology is artificial; medical psychology employs the clinical method as assessment tool.

4 Arguments in favour of employing the term medical psychology (IONESCU G., 1995) It incorporates a wider field than clinical psychology, by including the psychological issues adjacent to the patient per se Without dispensing of the applicative nature, medical psychology presents great oportunities of essentializing and theorizing facts, data and observations stemming from clinical assessment It goes beyond the direct and individual observation, but preserves the field of interpersonal relationships as basic underlying foundation It preserves more extended relationships with other psychology fields, standing up as a field of applied psychology, as opposed to clinical psychology which is firmly rooted in the patient

5 The relationship Medical Psychology Psychology Medical psychology currently develops by intertwining with other knowledge and research fields: psychopathology, holistic psychology, anthropology, psychoanalysis and dynamic psychology, chronobiology, ethology, sociology, experimental psychology and neurophysiology With each of these fields, medical psychology has bilateral connections and an ongoing informational exchange Medical psychology and the field of general psychology are linked through aspects related to: ü Communication ü Developmental psychology ü Personality

6 The relationship Medical Psychology Psychology Medical and social psychology are connected in various ways: ü From the doctor-patient relationship to the impact of medical profession on complementary professions pharmacists, biologists, chemists ü From the bio-psycho-social model of illness to the therapeutic models in the field of medication ü Quality of life as modern indicator for the assessment of therapy and medical management

7 The relationship Medical Psychology Medical Sciences The relationship between medical psychology and psychiatry is arguably the deepest of all connections with medical sciences, both historically and methodologically, and not by chance almost all the founding researchers of medical psychology were psychiatrists Psychiatry represents both for medical, and clinical psychology, the field from which they draw information, but also the field in which psychological thechniques and resulting data are comprehensively employed

8 Postulates of medical psychology

9 1. The individuality of the patient The importance of individuality and individuation The dicton there are no illnesses, only sick persons should be rephrased more correctly: there are no illnesses outside patients (with their individual features) who suffer those illnesses Sometimes fighting off illness, other times changing individual specific reactions may be decisive for therapeutic success From the viewpoint of medical psychology, these specific reactions are not only somatic, but also person-related

10 How does this individual specificity develop? Such as in any biological issue, there are inherited/ genetic and environmental factors to be considered (nature and nurture) Environment is seen as: ü Physical environment ü Biotic environment (animals, plants, microorganisms: bacteria, viruses one interacts with) ü Socio-cultural environment

11 Environmental factors Each environmental factor has a dynamic influence, in relation with the lability of the respective developmental phase evolution or involution Environmental factors mostly intervene by mediating a life experience. One may generally state that the relative importance of experiential factors (compared to innate, congenital, hereditary ones) in generating bodily or behavioural reaction is higher if the individual is situated on a more evolved phylogenetic level. Experiential factors are essential in personality development in humans The illness factor represents one of the key determinants of personality, through its interconnection with the heredity and environment factors

12 2. The level of doctor patient relationships Doctor patient relationships entail a variety of contrary impressions, from romantic idealism to cynical despair. According to the way in which each actor plays their role, based on various expectations, the premises of either satisfying and efficient relationships, or relationships saturated with suspicion, frustrations and disappointment may be developed Patients are commonly tolerant concerning therapeutic limitations of medicine in the context of respect and genuine listening from doctors/ medical staff Doctors and medical staff work with sick people, not clinical syndromes; sick people bring a complex influence of biological factors, psychological drives and social context to the therapeutic relationship

13 Conceptual models of illness Under the influence of Virchow and Pasteur s discoveries, medicine was dominated by a strictly biological causality model in the end of the 19th century and the beginning of the 20th century Engel G., underlying the multifactorial causality of illness, in which specific (biological) elements intertwine with non-specific (psychological and social ones), coins the bio-psycho-social model of illness, regarded as much more pertinent. The bio-psycho-social model stems from the general theory of systems ü The biological system: emphasizes the anatomical, structural, mollecular background of illness and its impact on biological functioning ü The psychological system: emphasizes the impact of motivation and personality on the experiencing of illness and reaction to illness ü The social system: emphasizes the cultural, environmental, family influences on the experiencing of illness and is expression

14 Engel G supported that, within his model, each system can impact on, and be impacted by any of the other systems The novel morbidity of the 20th-21st centuries requires a complex explanatory paradigm for the approach and management of disease, directed mainly towards prevention through identifying and modifying risk factors The current status of research data proves that the traditional (biomedical) model of explaining and approaching chronic illnesses is unilateral and restrictive, and does not take into account non-biological variables The novel bio-psycho-social paradigm incorporates both the developments of biological medicine, and the psycho-behavioural, social, cultural and ecological variables, as important factors in the causality (etiology) and evolution of illnesses (Matarazzo, 1980).

15 The biomedical model Reductionist model (takes only biological factors into account) It incorporates a liniar causality (bacillus illness) Incorporates cartesian dualism (separating body from psyche) Emphasizes the state of illness, ignoring prevention of illness Focuses on the sick organ, ignoring the sick person per se It places the responsibility of treating disease on the doctor

16 The bio-psycho-social model The bio-psycho-social model developed as a reaction to the biomedical one, having the following features: ü Illness has a multifactorial causality ü Psyche cannot be separated from body, and conversely ü Dwells on both health and illness ü Emphasizes both treatment and prevention ü Organ uffering generates the suffering of the person ü Medical staff, society and the sick person in question are all responsible for prevention, treatment and recovery

17 - the website of the Discipline of Clinical Psychology Teaching staff: Professor DOINA COZMAN, MD, PhD Head of Discipline, Head of Department Senior Teaching Assistant Dana-Cristina Herța