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This document provides an overview of the Psychology for Health and Wellbeing course offered by IGNOU. The 6-credit course aims to teach students about health, illness, stress management, and strategies for promoting physical and mental health. It is divided into four blocks covering these topics through 12 units prepared by an expert committee and course coordination team. The course material provides learning objectives, summaries, illustrations, self-check questions, references, and end-of-unit questions to support student comprehension. Audio-visual supplements and tutor-marked assignments are also included.
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0% found this document useful (0 votes)
152 views37 pages

Block 1

This document provides an overview of the Psychology for Health and Wellbeing course offered by IGNOU. The 6-credit course aims to teach students about health, illness, stress management, and strategies for promoting physical and mental health. It is divided into four blocks covering these topics through 12 units prepared by an expert committee and course coordination team. The course material provides learning objectives, summaries, illustrations, self-check questions, references, and end-of-unit questions to support student comprehension. Audio-visual supplements and tutor-marked assignments are also included.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 37

BPCG-173

PSYCHOLOGY FOR HEALTH


AND
WELL BEING

School of Social Sciences


Indira Gandhi National Open University
EXPERT COMMITTEE
Prof. Swaraj Basu Prof. Suhas Shetgovekar Prof. Swati Patra (Convenor)
Former Director, School of Social Sciences Faculty, Discipline of Psychology Faculty, Discipline of Psychology
IGNOU, New Delhi School of Social Sciences School of Social Sciences
IGNOU, New Delhi IGNOU, New Delhi
Prof. Vimala Veeraraghavan
Former Emeritus Professor Dr. Monika Misra Course Coordinator
Discipline of Psychology Faculty, Discipline of Psychology Prof. Suhas Shetgovekar
IGNOU, New Delhi School of Social Sciences Faculty, Discipline of Psychology
Dr. Kamlesh Singh IGNOU, New Delhi School of Social Sciences
Associate Professor Dr. Smita GuptaFaculty IGNOU, New Delhi
School of Humanities and Social Sciences Discipline of Psychology General Editor
IIT, New Delhi School of Social Sciences Prof. Suhas Shetgovekar
IGNOU, New Delhi Discipline of Psychology
SOSS, IGNOU
COURSE PREPARATAION TEAM
Block 1 Introduction
Unit 1 Introduction to Health and Well being Dr. Arti Singh
Unit 2 Models of Health and Illness Dr. Arti Singh

Block 2 Introduction to Stress


Unit 3 Stress: An Introduction Prof. Suhas Shetgovekar
Unit 4 Factors Contributing to Stress Proneness Prof. Suhas Shetgovekar
Unit 5 Effect of Stress Prof. Suhas Shetgovekar
Block 3 Stress Management
Unit 6 Coping with Stress Prof. Suhas Shetgovekar
Unit 7 Stress Management Techniques I Prof. Suhas Shetgovekar
Unit 8 Stress Management Techniques II Prof. Suhas Shetgovekar
Block 4 Promotion of Physical and Mental Health
Unit 9 Physical Illness Experiences I Prof. Suhas Shetgovekar
Unit 10 Physical Illness Experiences II Prof. Suhas Shetgovekar
Unit 11 Mental Illness Experiences Prof. Suhas Shetgovekar
Unit 12 Prevention, Management and Intervention Prof. Swati Patra

Course Coordinator : Prof. Suhas Shetgovekar


General Editors : Prof. Suhas Shetgovekar
Block 1, Block 4 : (Unit 12) : Prof. Suhas Shetgovekar
Block 2, Block 3 and Block 4 (Units 9 and 10) : Dr. Tima D’Cunha
Block 4 : (Unit 11) : Dr. Monika Misra

PRINT PRODUCTION
Mr. Rajiv Girdhar Hemant Kr. Parida
Assistant Registrar (P) Section Officer (P)
MPDD, IGNOU, New Delhi MPDD, IGNOU, New Delhi

December, 2020
© Indira Gandhi National Open University, 2020
ISBN-81
All right reserved. No part of this work may be reproduced in any form by mimeograph or any other means, without permission
in writing from the Indira Gandhi National Open University.
Further information about the Indira Gandhi National Open University courses may be obtained from the University’s office at
Maidan Garhi, New Delhi-110068
Printed and published on behalf of the Indira Gandhi National Open University, New Delhi by Registrar, MPDD, IGNOU, New Delhi.
Laser Typeset by: Rajshree Computers, V-166A, Bhagwati Vihar, (Near Sector-2, Dwarka), Uttam Nagar, New Delhi-110059
2
Printed at:
BPCG 173 PSYCHOLOGY FOR HEALTH
AND WELL BEING
The course on Psychology for Health and Wellbeing (BPCG 173) is a 6 credits
course offered under Bachelors Degree Programme of IGNOU. The objectives
of this course are to acquaint learners with the spectrum of health and illness,
to identify and manage stress, to learn approaches to enhance well being and
to acquaint learners with strategies to prevent illnesses, promote and manage
health and well being
The course is divided into four blocks. Each of these blocks represents a specific
theme which is discussed in terms of units. The units are arranged in a logical
sequence so as to cover the main aspects of each theme.
Before proceeding to read the units, you are advised to go through instructions
about how to read the course material. Given below is the explanation of the
organization and sequencing of the unit.
Organization and Sequencing of a Unit
The following is the structure of each unit:
1.0 Objectives
1.1 Introduction
1.2 Section (Theme of the section)
1.2.1 Subsection of 1
……………….
Check Your Progress I
1.3 Section (Theme of the section)
1.3.1 Subsection of 2
……………….
Check Your Progress II
Let Us Sum Up
References
Key Words
Answers to Check Your Progress
Unit End Questions
As the scheme suggests, each unit is divided into sections for easy reading and
better comprehension. The numbering and length of each section and subsection
may vary from one unit to the other, depending upon the depth of information
in each unit. Each section is indicated by BOLD CAPITALS and each sub-
section by a relatively smaller but bold typeface. Divisions within the sub-
sections are in relatively smaller bold typeface so as to make it easy for
you to understand. 3
Let us now discuss each section of a unit.
Objectives
We begin each unit with the section Objectives. It tells you briefly about the
objectives of the unit, what you will learn after you study the unit.
Introduction
The section Introduction will mainly focus on introducing the theme of the present
Unit.
Illustration
There are several illustrations in each unit in the form of figures and diagrams.
The main purpose of these illustrations is to make the study comprehensive and
interesting.
Check Your Progress
We have given self-check exercises under the caption Check Your Progress
at the end of main sections. You can provide your answers in the space given
below each question/ exercise. You will be tempted to have a glance of the
main text as soon as you come across an exercise. But we do hope that you
will resist this temptation and turn to the main text only after completing the
answers.
You should read each unit and note the important points in the margin provided
in the course material. This will help in your study. It will also help you to
answer the self-check exercises and the assignment questions, as well as help
in revising your course before appearing for your Term End Examination (TEE).
Let Us Sum Up
This section of each unit under the heading Let Us Sum Up summarises the
whole unit for the purpose of ready reference and recapitulation.
References
We have given a list of references at the end of each unit. This is a list of
books and articles used by the course writers to prepare the units. This reflects
that your course material is based on a wide spectrum of literature available
on a particular theme, related to your course. This also informs you of the wide
literature available in the particular area of study. If interested in widening your
knowledge, you may look for the mentioned references. Each reference mentions
the name of the author, year of publication, title of the book/article, name of
publisher and place of publication.
Suggested readings help you to increase your level of understanding of a
particular theme in each unit.
Key words
The key words explain the basic ideas, technical terms and difficult words.
Answers to Check Your Progress
The answers to check your progress are given here.
4
Unit End Questions
Besides Check Your Progress, we have given Unit End Questions in each Unit.
Practicing these questions will help you in answering assignments and Term End
Examination Question Paper, though the pattern and style of questions asked
may not be similar.
Audio and Video Aids
Some Units have been selected for the audio and video programmes to
supplement the printed material. This will help you to understand the units with
greater clarity.
Apart from this, you may also access IGNOU’s FM radio channel, Gyanvani
(105.6 FM), which is available across many cities in India, for regular
programmes, related to themes on Psychology. You can listen to the live
discussions by faculty and experts on the topic of the day and interact with
them through telephone, email, and through chat mode.
You may also watch Gyandarshan TV channel (free to air educational channel),
for programmes related to topics on Psychology. The schedule of Gyanvani and
Gyandarshan is displayed on www.ignou.ac.in. The radio and TV channels may
also be accessed on Gyandhara, webcast facility for Gyanvani and Gyandarshan,
provided by the University.
Assignment
You will receive a set of assignments for the whole programme. These are Tutor
Marked Assignments, which are to be submitted to the respective Study Centre
after completion. These assignments will be evaluated by academic counsellor
from your Study Centre. Ensure that you complete all your assignments because
the grades that you get in each of these assignments are included in the final
evaluation of your degree. Before answering the assignments, read all the units
and additional material (if available).
Guidelines for assignments
While working on assignment, kindly ensure the following points,
1) Clearly write your Enrollment number
2) Answer them in your handwriting and in your own words (do not copy
the sentences from the course material or any other source).
3) Write clearly and neatly so that it is easy to read your answers
4) Leave margins on one side of your answer-sheets so that evaluator may
write his/ her comments on your performance.
5) Organise your answers well based on the question asked.
6) You will submit the assignments at your Study Centre on or before the
date mentioned as per the admission cycle. Kindly check the dates from
www.ignou.ac.in or your Regional Centre website.

5
Term End Examination (TEE)
Consider the following points while answering TEE.
1) Questions need to be answered in one’s own words and they need to
be focused based on the question asked.
2) Answer the questions keeping in mind the word limit.
3) Organise answers well based on the question asked and also keep in mind
any bifurcation given in the marks.
4) Ensure that you mention correct question numbers for respective answers.
Preparation of Course Material
The syllabus of course material BPCG-173 is designed by an Expert Committee
(see page 2 of this course) and prepared by Course Preparation Team which
comprises the author(s) of units, content editor(s), language editor, and the course
coordinator. The expert committee selected the themes and sub-themes of the
blocks and units, keeping in view the prescribed syllabi of UGC (CBCS
model).The authors of units have provided their expertise in elaborating them
in the form of the main text of each unit. The content editor has carefully examined
the course contents and has made an attempt to make the material clear and
comprehendible.
For any query or feedback related to the course, you may kindly contact
the course coordinator at,
Prof. Suhas Shetgovekar
Room No. 121, Block-F,
School of Social Sciences
IGNOU, New Delhi
Email: [email protected]

6
Course Contents
BLOCK 1 : INTRODUCTION ............................................................ 11
Unit 1 : Introduction to Health and Wellbeing .......................... 13
Concept and Definition of Health ...................................... 14
Cross-cultural Perspectives of Health ................................. 17
Health-Illness Continuum ..................................................... 19
Unit 2 : Models of Health and Illness ....................................... 24
Medical Model of Health and Illness ................................ 25
Holistic Model of Health .................................................... 27
Biopsychosocial Model ....................................................... 29
Social Model of Health ...................................................... 30
Concept of Wellbeing ......................................................... 31
BLOCK 2 : INTRODUCTION TO STRESS .................................... 37
Unit 3 : Stress: An Introduction ................................................... 39
Concept of Stress .............................................................. 40
Nature of Stress ................................................................. 42
Sources of Stress ............................................................... 45
Measurement of Stress ....................................................... 49
Unit 4 : Factors Contributing to Stress Proneness .................... 53
Factors Contributing to Stress Proneness .......................... 54
Moderators of Stress ......................................................... 52
Unit 5 : Effect of Stress ................................................................ 62
Effect of Stress on Health ................................................. 63
Effect of Stress on Performance and Productivity ............ 66
Effect of Stress on Relationship ......................................... 69
BLOCK 3 : STRESS MANAGEMENT ............................................. 75
Unit 6 : Coping with Stress ........................................................... 77
Definition and Nature of Coping ....................................... 78
Coping Styles ...................................................................... 81
Unit 7 : Stress Management Techniques I ................................. 88
Relaxation Techniques ......................................................... 89
Meditation ........................................................................... 91
Yoga .................................................................................... 93
Mindfulness .......................................................................... 96

7
Biofeedback ........................................................................ 98
Unit 8 : Stress Management Techniques II ............................. 103
Cognitive Restructuring ...................................................... 104
Time Management ............................................................. 107

BLOCK 4 : PROMOTION OF PHYSICAL AND MENTAL


HEALTH .......................................................................... 115
Unit 9 : Physical Illness Experiences I ..................................... 117
Illnesses Related to Food, Diet, Obesity ........................ 118
Problems Related to Sexual Health ................................. 123

Unit 10 : Physical Illness Experiences II ................................... 132


Acute and Chronic Pain ...................................................133
Chronic Illnesses ............................................................... 135

Unit 11 : Mental Illness Experiences .......................................... 144


Depression ......................................................................... 145
Anxiety .............................................................................. 147
Psychosomatic Illnesses ..................................................... 150
Substance Use ..................................................................152

Unit 12 : Prevention, Management and Intervention ................ 162


Cultivating Human Strengths
and Virtues ........................................................................ 163
Hope and Optimism ......................................................... 165
Gainful Employment .......................................................... 168
Work Life Balance ........................................................... 170
Exercise, Nutrition, ............................................................ 171
Yoga and Meditation ........................................................ 172

8
BPCG 173 PSYCHOLOGY FOR HEALTH
AND WELL BEING
Dear Learner,
Psychology for Health and Well Being is a six credits course and the main
objectives of this course are to acquaint learners with the spectrum of health
and illness, to identify and manage stress, to learn approaches to enhance well
being and to acquaint learners with strategies to prevent illnesses, promote and
manage health and well being.
Block 1 is titled Introduction and covers mainly two units, Unit 1 and
2. The first unit is titled Introduction to Health and Wellbeing and this unit will
extensively discuss about the concept and definition of health and cross cultural
perspectives on health. Further, Health-Illness will also be covered in this unit.
The second unit is titled ‘Models of Health and Illness’ and covers the medical
model of health and illness, the holistic model of health and the biopsychosocial
model and social model of health. It also introduces the concept of wellbeing.
Block 2 of this course is divided into three Units; Units 3, 4 and 5. Unit
three is titled ‘Stress: An introduction’ and this unit will serve as a basis to
rest of the units that will be covered in this block. It will cover the concept,
nature, sources and measurement of stress. Discussion on the concept and nature
of stress will provide a fair idea about the term and will set a framework for
comprehension of other topics and subtopics discussed in this block. Sources
of stress mainly focus on frustration, conflict of motives and pressure, that can
be termed as general sources of stress. Measurement of stress is relevant and
necessary for effective diagnosis of stress. There are various ways in which
stress can be measured. Varied methods of measurement like physiological
measures, psychological tests, checklist and interview will be discussed under
this unit.
Unit four mainly focuses on the factors contributing to stress proneness including
Type A personality, hostility, perfectionism, procrastination and learned helplessness/
learned pessimism. Various moderators of stress will also be discussed in this
unit. The moderators play an important role in relationship between the stress
and corresponding reactions. These moderators may lead to individuals experiencing
high or low stress. Various moderators of stress including personality, locus of
control, social support, optimism and pessimism and gender and culture will
be covered in the unit.
Unit five will highlight the effect of stress. Mainly the effect of stress on health,
performance and productivity and on relationships will be covered in this unit.
Block 3 constitutes Units 6, 7 and 8 six. Unit six is related to coping with
stress and covers coping and coping styles. In this unit not only the concept
of coping will be discussed but various coping styles will also be highlighted.
Units seven and eight will cover various stress management techniques. In the
previous block we studied about stress as a concept and in the present block
we will cover how to manage and deal effectively with stress. Unit seven will
cover relaxation techniques, meditation, Yoga, mindfulness and biofeedback and
Unit eight will mainly cover cognitive restructuring and time management.
9
Block 4 focuses on promotion of physical and mental health. This block
is again divided in to four units. Units 9, 10, 11 and 12. Unit nine and
10 deal with physical illness experiences. Unit nine will highlight the illnesses
related to food, diet, obesity. It will also focus on the problems related to sexual
health. And Unit 10 will discuss acute and chronic pain besides chronic illnesses.
Unit 11 discusses mental illness experiences including, depression, anxiety,
psychosomatic illnesses and substance use. The last unit (Unit 12) is related
to the prevention, management and intervention and the topics that are covered
in this unit include cultivating human strengths (intra and inter personal) and
virtues, hope and optimism, gainful employment and work life balance. Further,
the unit will also discuss exercise, nutrition, Yoga and meditation.
Some suggestions and tips to enhance your study of this course are as follows:
1) Ensure that your basic concepts, given in this course, are clear. If you
don’t understand the terms, read again. The first unit is a foundation to
rest of the units, so ensure that you read and learn this unit first.
2) After you read each section, try to attempt the Check Your Progress for
that section and cross check your answers from Answers to Check Your
Progress given in the later section of the unit. This will provide you with
a feedback on what you have learned and what you need to further focus
on and understand.

10
BLOCK 1
INTRODUCTION TO HEALTH AND WELLBEING

11
UNIT 1
Introduction to Health and Wellbeing 13
UNIT 2
Models of Health and Illness 25

12
UNIT 1 INTRODUCTION TO HEALTH
AND WELLBEING*
Structure
1.0 Objectives
1.1 Introduction
1.2 Concept and Definition of Health
1.3 Cross-cultural Perspectives on Health
1.3.1 Western Perspective
1.3.2 Eastern Perspective on Health
1.3.3 Indian Perspective on Health

1.4 Health-Illness Continuum


1.5 Let Us Sum Up
1.6 References
1.7 Key Words
1.8 Answers to Check Your Progress
1.9 Unit End Questions

1.0 OBJECTIVES
After reading this unit, you will be able to:
 discuss the concept and definition of health;
 explain the perspectives of health; and
 describe the Health-Illness continuum.

1.1 INTRODUCTION
Rahul and Samina are a happily married couple in their early 30s. They
both work in a multi national company and are doing very well in their
jobs. But despite of high income and a comfortable lifestyle, Rahul was
recently diagnosed with hypertension and Type II diabetes and Samina is
stressed all the time and has developed sleep problem for which she is
consulting a physician.
Nirav is a ten year old boy and though he has always been on a healthier
side, he has been recently diagnosed as being obese. Doctor has attributed
his obesity to lack of healthy diet, (including fruits and vegetables that
are rich in fibre) and to regular consumption of junk food, soft drink and
sweets.
Arun was a topper throughout his school years and managed to get
admission to one of the best colleges in his cities to pursue a programme

* Dr. Arti Singh, Academic Associate, Discipline of Psychology, SOSS, IGNOU, New Delhi 13
Introduction in management. During this time, he started consuming alcohol and also
started smoking, that soon developed in to a habit and addiction. As a
result not only his studies suffered but his relationship with his family and
friends has also been negatively affected. His parents have now admitted
him to a de-addiction centre to help him recover.
After loosing her mother to a terminal illness, Savita who was once a bubbly
eight year old has now become secluded and lonely. She has stopped
interacting with her friends and refuses to attend school. She is also not
able to eat and sleep adequately. Her family doctor recommended her to
a clinical psychologist who has diagnosed her with having depression.
The above examples, highlight some of the aspects of health. It can be said
that health is one of the most important but most deprived aspect of our life.
Nowadays, our lifestyle has become more leisure oriented, indoor, technology-
centered and dependent on food such as pizza, burger, chips, cold drink, etc.
In all probability, this lifestyle is damaging our health and increasing the burden
of non-communicable diseases on our healthcare system. Moreover, conventional
hospital treatment has been found to be inefficient in treating lifestyle-related
diseases. It is thus important to focus on health and deal with it at multiple
levels not only by making adequate health services available but also by
encouraging healthy lifestyle amongst the individuals.
In the very first unit of this course, we will discuss about the concept and
definition of health. The difference between illness, disease, and sickness will
also be focused on. Further, the conceptualisation of health according to western
and eastern perspectives will also be explained. The Health-Illness continuum
will also be described.

1.2 CONCEPT AND DEFINITION OF HEALTH


What do you mean by health? The answer to this question is a complex one,
as it holds many different meanings across time, culture, society, social class
and even age groups. In this section, we will discuss the meaning of health
and how it has been conceptualised among lay people, by the World Health
Organisation, and among different cultures.
Many studies have been conducted to understand what common people think
and understand by health. In a study done by Bauman (1961), she asked people
to explain ‘what does being healthy mean for them?’ Majority of the participants
reported either of the following three types of responses:
1) health means a ‘general sense of wellbeing.’
2) health is identified with ‘the absence of symptoms of disease’ and,
3) health can be seen in ‘the things that a person who is physically fit is able
to do’.
Thus, according to layperson health has three components; feeling, symptom
orientation and performance. In another study, Benyamini, Leventhal, and
Leventhal (2003) found that according to 500 elderly participants, health is an
ability to perform physical functions and vitality. Krause and Jay (1994) also
conducted a study to understand the frame of reference for judging one’s health.
14 They found that for older participants the frame of reference was the absence
or presence of health problems. Whereas, for the younger participants, health Introduction to Health
and Well-being
promoting behaviour was the frame of reference. These studies suggest that the
meaning of health is very subjective and it changes with social factors and factors
like age group can also play a role.
The term health has been derived from ‘Hoelth’, that is, an old English word
that denotes ‘the state or condition of being whole or sound’ (Melquiades, 2015,
pg. 3).
Pindar, in 5th Century BC defined health as “harmonious functioning of the
organs”. (Svalastog et al, 2017, pg. 431) This definition mainly focused on the
physical aspect of health including the functioning of the physical organs as well
as the absence of pain and experience of comfort. Hippocrates described health
in relation to lifestyle of the individual and the environmental factors including
climatic conditions, air quality, lifestyle habits, quality of water and food as well.
The term ‘positive health’ was introduced by him, that focuses on diet as well
as exercise (Svalastog et al, 2017).
Health has also been described in terms of a person’s ability to adjust to the
environmental influences. Thus, if he/ she is not able to adapt then he/ she may
experience some illness or develop a disease (Svalastog et al, 2017). Most
of the modern definitions define health as not mere absence of disease but an
increased capacity for realisation and fulfilment of self. It has been explained
as a state in which the individual is able to adequately function at physical,
mental, social as well as spiritual level and is able to express his/ her potentials
in the context of the environment within which he/ she exists (Svalastog et al,
2017).
In 1946, The Constitution of World Health Organisation (WHO) came up with
a definition of health as “a state of complete physical, mental and social wellbeing
and not merely the absence of disease or infirmity”. Later in its 1998 constitution,
WHO again modified its definition and defined health as “a dynamic state of
complete physical, mental, spiritual and social wellbeing and not merely the
absence of disease or infirmity”. Few points should be noted down from these
definitions of health by World Health Organisation; (i) health is not equivalent
to absence of disease or symptoms, (ii) health is dynamic in nature, (iii) not
just your physical wellbeing but your mental, social and spiritual wellbeing are
equally important and, (iv) our health is a combination of four dimensions;
physical, mental, social and spiritual.
As you can see in the definition of health given by WHO, the term wellbeing
has been used. Wellbeing is also known as ‘Subjective Well-being’ (SWB).
The concept of wellbeing is closer to the concept of mental health, life satisfaction,
and happiness. Wellbeing is a subjective feeling, which involves evaluation of
those affective and cognitive aspects of life which are getting affected by disease
and illness directly or indirectly. Often it involves evaluation of happiness, sense
of contentment, sense of belongingness, achievement and being without any
distress and discomfort. We will discuss about it in detail in the next unit of
this course.
Other important terms related to health are ‘illness’, ‘disease’ and ‘sickness’.
Often used interchangeably, these three terms are used to describe the ill health
of the person. However, in the scientific community, these terms are used to
explain different connotations of ill health. Let us have a look at the basic
definition of these terms. 15
Introduction Disease: This term is used by the doctors or physicians to describe the
pathological (symptoms, causes etc.) and biological aspects of the health
condition of his/her patients.
Illness: It refers to the general term that people use to describe their perceived
deteriorated health conditions that may or may not have been yet diagnosed
by a doctor. Thus, this term represents subjective experiences of the person’s
ill health.
Sickness: It is the societal role and perception related to illness such as taking
rest, days off from work, stigma, etc.
Being healthy can be denoted not only by absence of illness but also presence
of physical, mental and social wellbeing, ability of an individual to adapt well
to his/ her environment. Health is also denoted by a movement towards wellbeing
or wellness. Illness on the other hand can be characterised by decreased
functioning in terms of physical, emotional, mental, social and spiritual aspects.
Illness can be determined by presence of symptoms as well as by the diminished
ability to function effectively in day to day life. It can also be determined by
how the individual is feeling.
Health can be described in terms of its three domains as proposed by Dalal
and Mishra (2012). They suggested the field of health broadly comprised of
three domains, namely, restoration, maintenance, and growth. The objective
of the first domain (restoration) is to help an individual in recovering his health
from the state of illness. Thus, this domain involves all kinds of interventions
that will help a patient in recovering from his illness symptoms, bodily pain,
and sufferings. The second domain of health is maintenance, and its objective
is to help people in maintaining good health and protecting them from diseases.
All kinds of health-promoting behaviour such as yoga, exercise, eating good
food, etc, are part of this domain. The last domain; growth, sees health not
just in the physical terms but it considers social factors and spirituality as its
parts as well. Therefore, this domain helps patients to achieve and grow in all
spheres of their life.
Check Your Progress I
1) Define Health.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
2) List the three domains of health.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................
16 ................................................................................................................
Introduction to Health
1.3 CROSS-CULTURAL PERSPECTIVES ON and Well-being

HEALTH
The way in which health is defined or perceived may vary based on culture.
In this sub section of the unit, we will try to understand varied cross cultural
perspectives on health.
Since cultural beliefs are intricately woven into the health beliefs of patients,
therefore to understand any health-related behaviour it is essential to acknowledge
and understand the role of culture and society first. In this section, we will discuss
how western and eastern societies conceptualise health and illness. Before starting
this section, first let’s discuss the concept-Karma. Karma refers to the
metaphysical principle of cause and effect. It is a belief that the accumulated
effects of your deeds of last birth have an effect on the events of present life.
Studies have suggested that in India patients with life-threatening chronic diseases
such as AIDS, heart disease, and cancer tend to attribute the cause to karmic
factors more. Whereas, in western countries very few patients attribute illness
to karmic factors. What do you think, why there is a difference in their causal
attribution? The reason could be ‘cultural differences’ in the conception of the
role of Karma in life-events. This example suggests that cultural notions
significantly affect our conception of health.

1.3.1 Western Perspective


Culture never remains constant. It changes with time. Therefore, cultural
conception about health also changes with time. For instance, ancient Greek
culture (a western civilisation) believed in the role of four humors (blood, yellow
bile, black bile, and phlegm) in our health and investigated health as a whole.
Hippocrates, one of the renowned scholars of ancient Greek civilisation had
described in his writings about how mind, body, and spirit are interrelated and
work together to maintain our health. However, with the passage of time and
especially after the Renaissance, the scientific revolution led to considerable
development in the physical medicine. The explanation of the illness became
more scientific and physiological based. Further, during the seventeenth century,
French philosopher René Descartes’s philosophies about the dualism of mind
and body influenced contemporary and later philosophers and scholars alike.
As a result of this, western medicine started considering the mind and body
as entirely separate entities, and this philosophy still dominates their medical
theories. This theory of dualism is responsible for the idea of viewing the human
body as a machine and is known as the reductionist or mechanistic viewpoint.
According to this viewpoint, we can understand our body through its constituent
parts (cells, DNA, different body parts) and there is no role of concepts like
mind and spirit or spirituality in one’s health. The underlying assumption of
Western view on health is that the cause of the illness lies outside one’s body
in the form of germs and bacteria. Further, its (germs and bacteria) removal
will lead to the achievement of optimal health. Thus, it can be concluded that
the Western system of medicine treats patients only at the physical level and
thus ignoring his or her feelings, beliefs as well as cultural background. This
viewpoint underpins the medical or bio-medical model of health and illness.
We will discuss this model in detail in unit two. 17
Introduction 1.3.2 Eastern Perspective on Health
Eastern perspective refers to the viewpoint of eastern civilisation such as India
and China on health and its related issues. The basic premise of all eastern
civilisations is that health is more than just an absence of disease or its symptoms.
If you are healthy, then you will experience happiness, wellbeing, satisfaction
with life, be able to function optimally as a member of your social community
and, will be able to set goals and achieve them. Thus, you will be able to
function as a whole. So, it can be suggested that the WHO definition of health
supports eastern view more. In contrast to the western view, all eastern
civilizations primarily view health as a whole and, not in parts. Seeing health
as a whole means health is made up of many interrelated components such
as physical, social, mental and spiritual, and any imbalance among them will
manifest itself in the form of disease or illness. The eastern viewpoint underpins
the holistic model of health and illness. According to the holistic model, the
cause of illness does not lie outside but it is inside our body and harmony between
physical, mental, social and spiritual components will lead to the state of optimal
health.
1.3.3 Indian Perspective on Health
As culture plays a significant role in Indian life, it is important to understand
the traditional Indian view on health. The Sanskrit word for health is Swastha,
‘swa’ means ‘inner self’ and ‘-sth’ means ‘conscious’. Thus, in Indian tradition,
being healthy has been considered equivalent to being conscious of your inner-
self (Gupta et al., 2011). Dalal and Mishra (2011) have also pointed out the
inner- directedness of Indian view about health. It means the cause of all illnesses
lie within ourselves and if we became conscious of our inner selves, only then,
we can achieve optimal health. All traditional Indian systems like Ayurveda and
Siddha consider “physical, psychological, philosophical, ethical and spiritual
wellbeing of mankind” and harmony with the cosmos, nature, and science is
a necessary condition for wellbeing (Ravishankar & Shukla, 2007, p. 321).
Conceptualisation of health in traditional Indian system is in contrast to the
contemporary bio-medical health model. Instead of only treating symptoms of
the disease, all traditional Indian treatments aim to heal and improve the wellbeing
of the person.
Check Your Progress II
1) Complete the sentences.
a) Ancient Greek culture believed in the role of four humors, namely
.........................................................................................................
.........................................................................................................
.........................................................................................................
b) The basic premise of all eastern civilisation is that
.........................................................................................................
.........................................................................................................
.........................................................................................................
c) The Sanskrit word for health is ....................................................
18
Introduction to Health
1.4 HEALTH-ILLNESS CONTINUUM and Well-being

As we have now developed an understanding of the concept of health, let us


discuss about the Health-Illness continuum. Health-illness continuum was introduced
by John Travis in the year 1972 and it can be explained as a graphical
representation of wellness. Wellness here is not mere absence of illness but
denotes healthy mental and emotional state. As can be seen in the Fig. 2.1,
there are two arrows in the figure that move in opposite direction with ‘neutral
point’ indicating the midpoint. Neutral point denotes absence of illness as well
as wellness. As we move towards the left of the figure, that is, towards premature
death, we can see that there are three steps, namely, signs, symptoms and
disability that result in premature death, thus indicating deterioration of health
ultimately leading to premature death. On the other hand, as we move towards
the right of the figure, the steps are awareness, education, growth present that
result in wellness. Thus, indicating increasing wellbeing or health of an individual.
The figure also shows treatment paradigm that denotes that if adequate treatment
is given the person can be brought back to neutral point.

Fig. 2.1: Health-Illness continuum

According to the Health-Illness continuum, health is dynamic. Our health moves


back and forth within a continuum, with optimum health or highest health at
one end and death or complete disability at the other end of this continuum.
One day you may feel energetic, another might have a headache for all day
long, while on the third day you may feel fine again. These situations suggest
that our health never remains constant and it changes or fluctuates throughout
one’s life. According to this model, since our health continuously changes;
therefore, our adaption or response to that change matters most as it affects
our health directly. For the same stressful situation, one person might respond
positively while another person might get anxious. The person who responded
positively will have better health than the second one.
19
Introduction Check Your Progress III
1) Who introduced Health-Illness Continuum?
.................................................................................................................
.................................................................................................................

2) Complete the figure of Health-Illness continuum.

1.5 LET US SUM UP


In the present unit we mainly discussed about the concept and defition of health.
The term health has been derived from ‘Hoelth’, that is, an old English word
that denotes ‘the state or condition of being whole or sound’. WHO defines
health as “a dynamic state of complete physical, mental, spiritual and social
wellbeing and not merely the absence of disease or infirmity”. The concept of
wellbeing was also briefly discuss in this Unit. Wellbeing is a subjective feeling,
which involves evaluation of those affective and cognitive aspects of life which
are getting affected by disease and illness directly or indirectly. Other important
terms related to health, namely, ’illness’, ‘disease’ and ‘sickness’, were also
explained. Further, the three domains of health, namely, restoration, maintenance
and growth were also highlighted. The unit also covered the cross- cultural
perspectives of health including the western perspective, the eastern perspectives
and the Indian perspective. The Health-Illness continuum was then discussed
with the help of a figure. Health-illness continuum was introduced by John Travis
in the year 1972 and it can be explained as a graphical representation of wellness.
In the next unit, that is, unit two, we will discuss about the various models
of health and illness.

1.6 REFERENCES
Bauman, B. (1961). Dversities in the Conception of health and Physical Fitness.
Journal of Health and Human Behaviour, 2, 39-46
20
Benyamini, Y., Leventhal, E. A., & Leventhal, H. (2003). Elderly People’s Introduction to Health
and Well-being
Ratings of the Importance of Health-Related Factors to their Self-assessments
of Health. Social Science & Medicine, 56(8), 1661-1667.

Boyd, K. M. (2000). Disease, Illness, Sickness, Health, Healing and Wholeness:


Exploring Some Elusive Concepts. Medical Humanities, 26(1), 9-17.

Brannon, L., Feist, J., & Updegraff, J. A. (2013). Health Psychology: An


Introduction to Behaviour and Health. Cengage Learning.

Dalal, A. K., & Misra, G. (Eds.). (2012). New Directions in Health


Psychology. SAGE Publications India.

Ghosh, M. (2015). Health Psychology: Concepts in Health and Wellbeing.


New Delhi: Dorling Kindersley (India) Pvt. Ltd.

Marks, D. F; Murray, M; Evans, Brian; Willig, C; Woodall, C and Sykes, C.


M. (2008). Health Psychology: Theory, Research and Practice. New Delhi:
Sage.

Melquiades, 2015. Concept of Health, Illness and Wellness. Retrieved from


https://www.researchgate.net/publication/275365494_ Concept_of_
Health_Illness_and_Wellness on 13/06/2019 at 2:55 pm.

Morrison, V., & Bennett, P. (2009). An Introduction to Health Psychology.


Pearson Education.

Rao, K., Paranjpe, A. C., & Dalal, A. K. (2008). Handbook of Indian


Psychology. Cambridge University Press India/Foundation Books.

Sanderson, C. (2013). Health Psychology. USA: John Wiley and Sons Inc.

Svatastog, A. L; Doney, D; Kristoffersen, N. J and Gajovic, S. (2017), Concepts


and Definitions of Health and Health-Related Values in the Knowledge
Landscapes of the Digital Society. Croatian Medical Journal, 58(6): 431–435,
doi: 10.3325/cmj.2017.58.431.

Undén, A. L., & Elofsson, S. (2001). Health from the Patient’s Point of View.
How does it Relate to the Physician’s Judgement? Family Practice, 18(2), 174-
180.

Wikman, A., Marklund, S., & Alexanderson, K. (2005). Illness, Disease, and
Sickness Absence: an Empirical Test of Differences between Concepts of Ill
Health. Journal of Epidemiology & Community Health, 59(6), 450-454.

1.7 KEYWORDS
Disease: Used by doctors or physicians to describe the pathological and
biological aspects of health conditions of his/her patients.
Dualism: Perspective prevalent in western societies, which states that mind and 21
Introduction body are two separate entities and have no connection between them.

Health: As defined by WHO, “it is a dynamic state of complete physical, mental,


spiritual and social wellbeing and not merely the absence of disease or infirmity”.

Holistic model: This is the model of health and illness majorly followed by
all eastern civilisations.

Illness: An individual’s experiences and descriptions of his/her ill health.

Sickness: It refers to social role and expectations associated with the patients
and its caregivers.

Wellbeing: Wellbeing is a subjective feeling, which involves evaluation of those


affective and cognitive aspects of life which are getting affected by disease and
illness directly or indirectly.

1.8 ANSWERS TO CHECK YOUR PROGRESS


Check Your Progress I

1) Define Health

Health is a dynamic state of complete physical, mental, spiritual and social


wellbeing and not merely the absence of disease or infirmity (WHO).

2) List the three domains of health

The three domains of health are restoration, maintenance, and growth.

Check Your Progress II

1) Complete the sentences.

a) Ancient Greek culture believed in the role of four humors, namely


blood, yellow bile, black bile, and phlegm.

b) The basic premise of all eastern civilisation is that health is more than
just an absence of disease or its symptoms.

c) The Sanskrit word for health is Swastha.

Check Your Progress III

1) Who introduced Health-Illness Continuum?

John Travis

2) Complete the figure of Health-Illness Continuum.

22
Introduction to Health
and Well-being

1.9 UNIT END QUESTIONS


1) How is the conceptualisation of health by lay people different from
conceptualisation of WHO. Explain.

2) Discuss the cross-cultural perspectives of health.

3) Write a note on Indian perspective on health.

4) Explain Health-Illness continuum.

23
UNIT 2 MODELS OF HEALTH AND
ILLNESS*
Structure
2.0 Objectives
2.1 Introduction
2.2 Medical Model of Health and Illness
2.3 Holistic Model of Health
2.4 Biopsychosocial model
2.5 Social Model of Health
2.6 Concept of wellbeing
2.7 Let Us Sum Up
2.8 References
2.9 Key Words
2.10 Answers to Check Your Progress
2.11 Unit End Questions

2.0 OBJECTIVES
After reading this unit, you will be able to:
 discuss the medical model of health and illness;
 describe the holistic model of health;
 explain the biopsychosocial model;
 discuss the social model of health; and
 elucidate the concept of wellbeing.

2.1 INTRODUCTION
In recent times many public celebrities like Deepika Padukone (a Bollywood
actress) have become more vocal about their mental illness (Depression in the
case of Deepika Padukone), that was quite positively received. Do you think,
reactions would have been received around 50 years ago if some one had talked
about his or her state of depression? May be not because the probability of
social rejection and taboo were much higher at that time and also, because
of the prevalent health models that labeled and defined an illness. Models provide
a theoretical framework so as to enhance our understanding of the concept,
in this case, health.
So why do we need to study health models? Because the model of the health
and illness adopted by society can have many important implications. It not
only influences the line of treatment but also influences people’s perception,
attitude and cultural beliefs. Another benefit we can gain from studying these

24 * Dr. Arti Singh, Academic Associate, Discipline of Psychology, SOSS, IGNOU, New Delhi
health models is that they can help us in appreciating their role in establishing Models of Health and
Illness
health psychology as a separate branch. Health psychology has been briefly
described in Box 2.1.

Box 2.1: Health Psychology


Health psychology is a subfield of psychology that mainly covers the
application of principles of psychology to the field of health. According
to Sanderson, (2013), health psychology aims to study the influence of
an individual’s behaviour on his/ her health, wellness and illness. It also
deals with the influence of various psychological factors on the experience
and reaction to stress, maintenance and promotion of health, coping with
pain and the effect of varied illnesses on the psychological wellbeing and
functioning of an individual. Ghosh (2015, pg. 4), defines health psychology
as “a scientific field that applies psychological theory and methods to the
study of health and tries to explain the entire range of behaviour from illness
to wellness’’.
As stated by Josepth Matarazzon, the major goals of health psychology
include, promotion and maintenance of health, prevention and treatment of
illness, identification of causes and the diagnostic correlated of illness and
other related dysfunctions and carrying out analysis and bringing about
improvements in health policies (Ghosh, 2015).
Health psychology as a separate field emerged with the realisation and
research evidence that (i) contemporary health model is efficient in dealing
with many illnesses, (ii) biological factors alone are not sufficient in
maintaining our health and, (iii) psychological mechanisms can help in
understanding wide-range of health issues.

In the previous unit we discussed about the concept of health and also focused
on the cross-cultural perspectives of health besides the Health-Illness continuum.
This unit tries to offer an overview of important health models that have played
a vital role in the development of health psychology. Further, the concept of
wellbeing will also be described at the end of the present Unit.

2.2 MEDICAL MODEL OF HEALTH AND


ILLNESS
What images come to your mind with the word: hospital? White coats, patients
resting on beds, X-ray machines, MRI scan machines, patients standing in the
queue for their turn to see the doctor, the smell of drugs, injection and many
more. Even though this description of contemporary treatment setup looks like
a part of our common sense but it would not have been for our great-great-
grandfathers and other ancestors. Why? Because this conception of medical
treatment is fairly recent. Since the 19th century, the medical model is the most
prevalent model of health and illness among contemporary healthcare
practitioners. The medical model is also known as “Biomedical model”. The
term ‘biomedical’ comes from the Greek word bios (meaning ‘life’) and the
Latin word medicus (meaning ‘healing’). But ironically, healing is not a part
of the practicing medical professionals as it focuses only on the physical aspect
of the disease. To understand the medical model, we will discuss some of its
major characteristics: 25
Introduction Cause of Disease: This model considers health as equivalent to a state
of absence of disease and symptoms. The root cause of a disease according
to this model is always some external pathogenic agents like virus, bacteria
or some other physiological problem or cellular abnormalities. (Guttmacher,
1979). Further, it denies any role of emotional and psychological factors in
disease.

Responsibility for disease: This model considers that the cause of illness is
not dependent on the individual. Due to this reason, individuals are not seen
as responsible for their illness. Patients are considered as only victims of some
external factor or internal abnormalities.

Treatment: Since the focus of the medical model is always on biological or


physical aspect. Therefore, treatment also focuses only on the human body’s
physical aspect. It involves removal of pathogenic agents either through drugs
or through interventional strategies like surgery. The objective of treatment is
the removal of symptom and relief from any type of pain.

Techno-oriented Model: This is the only model of health which relies heavily
on machines and technologies. From making a generic drug to performing a
surgery, everything here requires technology.

Practitioner-Physician relationship: This model considers that


physicians possess all the required knowledge, expertise, and skill to treat
patients. The medical model further considers patients as only passive
recipiens of their physician’s expertise and expects patients to only corporate
with their treatment regime. Thus, the model considers practitioners superior to
patients.

There is no doubt that the medical model is very effective in critical medical
conditions. Therefore, it is often referred to as “quick fix” approach. It can
provide immediate relief and quickly minimise the symptoms of the disease.
However, many researchers have pointed out a number of limitations of medical
treatment. According to George Engel (1997) and Guttmacher (1979), the
medical model have many drawbacks. Some of the major limitations are as
follows:

 It has a reductionist approach to human body and views it in the mechanistic


framework. It does not give importance to the concept of ‘mind’ and
considers mind-body dualism.

 It ignores any role of social, emotional, spiritual and psychological factors


in health and illness. Thus, it does not talk about the wellbeing or healing
aspect of the disease.

 It is not always effective in treating many diseases. Specifically, any


psychosomatic diseases, chronic and lifestyle-related diseases.

 The issue of affordability is also associated with this model. Hospital


treatment offers impersonal professional care, leading to a burden on one’s
pocket because of high fees. Its accessibility also depends on one’s socio-
economic status.
26
Check Your Progress I Models of Health and
Illness

1) Why is medical model characterised as techno-oriented model?

................................................................................................................

................................................................................................................

................................................................................................................
2) State any one limitation of the medical model of health and illness.
................................................................................................................
................................................................................................................
................................................................................................................
................................................................................................................

2.3 HOLISTIC MODEL OF HEALTH


In response to the various limitations of the medical model, many scholars came
up with new models for health and illness. One such model is known as the
holistic model. The term Holistic medicine was first used by F. H. Hoffman
in 1960 (Derick, 2009). It refers to conceptualising health as a ‘whole’.
Guttmacher (1979) has suggested that holistic model considers health as
equivalent to “a sense of wellbeing” and disease is not considered as a presence
or absence of a pathogenic agent only. Instead, according to the holistic model,
a disharmony between social, psychological and spiritual dimensions of one’s
life causes disease. In this way, the holistic model puts responsibility for ill health
on the individual also. This model also gives equal importance to the role of
practitioners and patients. Unlike biomedical model, it considers a practitioner
as a mentor and role model, whose role is to motivate patients to be self-
responsible for their health instead of having blind faith in practitioners’ efficacy.
In recent times the concept of holism has become quite popular among scholars
and health care. As a result of this, there are many associations that are promoting
the concept of holistic health. Some of these prominent associations include the
American Holistic Medical Association, British Holistic Medical Association,
American Holistic Health Association and, American Holistic Nurses Association.
According to one such association; American Holistic Medical Association (n.d.)
Holistic medicine is “the art and science of healing that addresses care of the
whole person-body, mind, and spirit. The practice of holistic medicine integrates
conventional and complementary therapies to promote optimal health, and
prevent and treat disease by addressing contributing factors”. Based on this
definition and earlier discussion we can conclude following points about the
holistic model:
 Holism refers to a complete and comprehensive analysis of health and
illness.
 We need to understand health from multiple perspectives as there is no
single cause of illness.
 A holistic practitioner may treat patients from a wide range of healthcare
options, that is, he/she may use medication along with alternative therapies. 27
Introduction As a result, many researchers called for an alternative model which can
incorporate all dimensions of health and treats health as a whole. First holistic
model “Biopsychosocial” was proposed by Engel in 1977, since then many other
holistic models have been proposed by researchers such as Biopsychosocial-
Spiritual Model (Sulmasy, 2002), Expanded WHO ICF Model of Illness (Wade,
2004), BMSEST model (Body, Mind, Spirit, Environment, Social, Transcendent)
(Anandarajah, 2008), Eastern Body-Mind-Spirit Model (Chan, 2008). Studies
have reported that treatment based on the holistic models can lead to an
improvement in perceived wellbeing, depression and quality of life and decrease
in depression and anxiety among its patients (Chan et. al, 2005; Targ & Levine,
2002; Sulmasy, 2002).
Check Your Progress II
1) Describe the holistic model of health.
................................................................................................................
................................................................................................................
................................................................................................................

Box 2.1: A Summary of Major Differences between the Medical


Model and Holistic Models

Medical Model Holistic Models

1. Health: Absence of disease. Health: A sense of wellbeing.

2. Disease: Pathogenic agents, Disease: Disharmony between the


such as a chemical irritant or individual and his/her environment
bacteria or cellular abnormalities, or a disintegration social,
and can be identified by psychological, and spiritual
distinctive symptoms. dimension.

3. Healing: Is the treatment of Healing: Healing must entail a


physical symptoms. reintegration of basic dimensions.

4. Role of Practitioner: Possesses Role of the Practitioner: Guide,


the necessary specialized mentor and role model.
technical knowledge and skill to
cure the disease.

5. Role of the Patient: The patient Role of the Patient: Individual


must cooperate with the physician patient is essentially responsible
and comply with instructions. for the outcome of an illness episode.

6. Treatment Outcomes: Treatment Outcomes: Long-term


Immediate relief, long-term relief, fewer complications, higher
complications, lowering of Health- HR-QoL, fewer psychological
Related–Quality of Life (HR-QoL), problems, lesser dependency on
psychological problems such as drugs and, higher self-
depression and anxiety, dependency responsibility.
on drugs and, lower self-
responsibility.
28
Models of Health and
2.4 BIOPSYCHOSOCIAL MODEL Illness

In this section, we will discuss the most famous holistic model, Biopsychosocial
model. Between the 1960s and 1980s, George Engel published a series of papers
criticising medical model and advocating the need for a new model of health
and illness. He proposed that,
‘‘........the existing biomedical model does not suffice. To provide a basis for
understanding the determinants of disease and arriving at rational treatments and
patterns of health care, a medical model must also take into account the patient,
the social context in which he [sic] lives, and the complementary system devised
by society to deal with the disruptive effects of illness, that is, the physician
role and the health care system. This requires a biopsychosocial model’’ (Engel
1977, pg. 132)
Biopsychosocial model, as the name suggests, conceptualises health as consisting
of multiple dimensions. The medical or biomedical model focuses only on the
physical aspect of health, but Engel’s new model includes psychological and
social aspects as well. It is based on the idea that “humans are inherently
biopsychosocial organisms in which the biological, psychological, and social
dimensions are inextricably intertwined” (Melchert, 2007, pg. 37). Engel did
not completely reject the benefits of the medical model but emphasised on giving
equal importance to psychological and social factors in the process of treatment.
This model suggests that other than physiological abnormalities, germs and
viruses, our behaviours, thoughts, and feelings may also influence our physical
state. Further, Engel also argued that physicians should also give importance
to subjective experiences of their patients.
Broadly, there are three areas in which the biopsychosocial model has offered
new insights: (1) patient’s subjective experience is as important as objective
biomedical data, (2) a comprehensive causation can give fuller and deeper
understanding of our health and illness, and (3) patients should not be treated
as passive recipients of the treatment. They should be given more power in
the clinical process.
The main advantage of this model is that it leads to numerous development
in technology and research. It also contributes to the diagnoses and effective
treatment of varied illnesses. It also leads to increase in life expectancy and
enhancement of life expectancy. Though the model tends to rely on technology
and thus could be cost ineffective and may not be affordable. The focus of
this mode is also more on treatment than on actual promotion of good health.
Check Your Progress III
1) What are the three areas in which the biopsychosocial model has offered
new insights?
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
............................................................................................................... 29
Introduction
2.5 SOCIAL MODEL OF HEALTH
Social model of health finds its roots in the social model of disability and as
such is a reaction to the medical model. In this model various factors that play
an important role in health, like, social, political, economical, cultural and even
environmental are taken in to consideration. For instance, environmental pollution
can lead to detrimental effects on health. This model can be termed as a
community based approach where the focus is on prevention of the illnesses/
diseases. Thus, relevance is given to the awareness programmes and policies
related to health so as to modify the lifestyle and health related behaviour of
the individuals so as to promote their health and wellbeing. Thus, according
to this model health can be promoted by keeping in mind the social, political,
economical, cultural and environmental factors.

The main characteristics of this model are as follows (Yuill, Crinson and
Duncan, 2010):

1) Social context in which the individual exists has a significant influence on


the health related experiences, choices and behaviour of the individual. The
social context includes class, ethnicity, gender and so on.

2) The human body is social, psychological and biological simultaneously.

3) Cultural variations exist in the way health and illness are perceived.

4) Though, biomedicine and medicine are relevant in the context of health,


there are other aspects as well that play a role.

5) Health and social determinants of health are influences by political decisions.

6) The opinions of persons from non-medical background are relevant as they


may provide a different perspective on health.

Social model thus focuses on the social responsibility in order to ensure that
people have a healthy lifestyle and environment. And strategies at varied
levels, like, economical, political and so on, need to be developed in order
to promote health amongst individuals. Thus, the social model of health focuses
on varied determinants of health and also strives towards decreasing social
inequalities. It focuses on empowerment of not only individuals but communities
as well.

Some of the major advantages of this model are that this model promotes
education amongst the individuals and is also cost effective. It also puts the
onus on the individual so that he/ she develops healthy lifestyle. The model is
based on community approach and seeks involvement of both governmental and
non-governmental agencies. Despite of the advantages, the social model may
also display some issues or disadvantages. Individuals may not be motivated
or may lack awareness regarding health behaviour and lifestyle. Further, brining
about change in an individual’s health related behaviour is not easy. This is a
long term measure and thus quick results may not be achieved.
30
Check Your Progress IV Models of Health and
Illness
1) State any one characteristic of social model of health.

................................................................................................................

................................................................................................................
................................................................................................................

2.6 CONCEPT OF WELLBEING


The concept of wellbeing can be termed as broad and finds application in varied
situations like economic, social, psychological and so on (King, 2007). According
to Veenhoven (2004), the term ‘wellbeing’ broadly “denotes that something is
in a good state”. Though the term does not specify what is in the good state
and what constitutes that good state.
There were mainly two approaches to defining wellbeing. The hedonic tradition
and the eudaimonic tradition. The hedonic tradition focuses on constructs such
as happiness, positive emotions and life satisfaction. The eudaimonic tradition
on the other hand described wellbeing in terms of effective and positive
psychological functioning and development. Despite of these two different views,
as such wellbeing as a construct is seen as multi-dimensional (Dodge et al, 2012).
Lets us now look at various definitions of wellbeing.
Shin and Johnson (1978, pg. 478) stated that “wellbeing is a global assessment
of a person’s quality of life according to his own chosen criteria”.
Shah and Marks (2004, pg. 2) explained that “wellbeing is more than just
happiness. It is feeling satisfied and happy. Wellbeing means developing as a
person, being fulfilled, and making a contribution to the community’’.
According to Dalal and Misra (2006), the concept of wellbeing is closer to
the concept of mental health, life satisfaction, and happiness. The concept of
wellbeing refers to a subjective feeling, which involves an evaluation of those
affective and cognitive aspects of life which are getting affected by disease and
illness directly or indirectly. Often it involves evaluation of happiness, sense of
contentment, sense of belongingness, achievement and being without any distress
and discomfort.
Wellbeing can be of two types: subjective wellbeing and objective wellbeing.
Subjective wellbeing: It is that part of one’s wellbeing which can be measured
only by asking people directly about three aspects of wellbeing; evaluative
wellbeing (life satisfaction), hedonic wellbeing (positive emotions such as feelings
of happiness, sadness, etc), and eudemonic wellbeing (sense of purpose and
meaning in life). “Subjective wellbeing consists of three interrelated components:
life satisfaction, pleasant affect, and unpleasant affect. Affect refers to pleasant
and unpleasant moods and emotions, whereas life satisfaction refers to a cognitive
sense of satisfaction with life” (Diener & Suh, 1997, pg. 200).
Objective wellbeing: This type of wellbeing has its roots in the discipline of
economics. It can be measured through self-reports as well as by studying
objective measures such as mortality rate, life expectancy etc. This form of 31
Introduction wellbeing measures whether people have basic human needs and rights such
as education, food, water and health facilities.
Wellbeing can also be categories as emotional wellbeing, physical wellbeing,
social wellbeing, workplace wellbeing and societal wellbeing (Davis, 2019).
 Emotional wellbeing denotes an individuals ability to adequately manage
stress, display resilience and display positive emotions.
 Physical wellbeing is explained in terms of improving one’s bodily functioning
by exercising and eating healthy.
 Social wellbeing is described in terms of effective communication and ability
to develop relationships and having adequate social support.
 Workplace wellbeing is an individuals ability to develop in his/her profession
and pursue one’s interest, values and gain meaning and happiness.
 Societal wellbeing is about active participation in activities related to
community and environment.
Check Your Progress V
1) What is subjective wellbeing?
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................
.................................................................................................................

2.7 LET US SUM UP


To summarise, since the last 200 years medical model has dominated the
healthcare system. This model has a reductionist approach with regard to human
body and equates the absence of symptoms as equivalent to good health.
Dissatisfaction with the medical model motivated many scholars to switch to
the holistic model. This model proposes to treat illness not just at the physical
level but also at psychological, social and spiritual level. Biopsychosocial model
(given by George Engel in 1977) is one such holistic model which attempts
to treat patients as whole. Social model of health finds its roots in the social
model of disability and as such is a reaction to the medical model. In this model
various factors that play an important role in health, like, social, political,
economical, cultural and even environmental are taken in to consideration.
The topic of health is not complete without understanding the concept of
wellbeing. Wellbeing involves evaluation of happiness, a sense of contentment,
sense of belongingness, achievement and being without any distress and
discomfort. The concept of wellness can be broadly categorised as subjective
wellbeing and objective wellbeing.
In the next block, that is block 2, we will discuss about stress and stress
32 management.
Models of Health and
2.8 REFERENCES Illness

Baum, A.,& Posluszny, D. M.(1999). Health Psychology: Mapping


Biobehavioral Contributions to Health and Illness. Annual Review of Psychology,
50, 137-163.
Callahan, D. (1973). The WHO Definition of ‘Health’. The Hastings Center
Studies, 1(3), The Concept of Health, 77-87.
Davis, T. (2019). What Is Well-Being? Definition, Types, and Well-Being Skills.
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201901/what-is-well-being-definition-types-and-well-being-skills on 17/06/2019
at 11:20 am.
Dalal, A. K., & Misra, G. (2006). Psychology of Health and Wellbeing: Some
Emerging Perspectives. Psychological Studies.
Dalal, A. K. & Misra, G. (2011). New Directions in Health Psychology (1 st
ed.). New Delhi: Sage Publication.
Diener, E., & Suh, E. (1997). Measuring Quality of Life: Economic, Social, and
Subjective Indicators. Social Indicators Research, 40 (1-2), 189-216. http://
dx.doi.org/10.1023/A:1006859511756
Dodge, R., Daly, A., Huyton, J., & Sanders, L. (2012). The Challenge of
Defining Wellbeing. International Journal of Wellbeing, 2(3), 222-235. doi:10.5502/
ijw.v2i3.4
Engel, G. L. (1977). The Need for a New Medical Model. Science,196, 129-136.
Farre, A., & Rapley, T. (2017, November). The New Old (and Old New)
Medical Model: Four Decades Navigating the Biomedical and Psychosocial
Understandings of Health and Illness. In Healthcare (Vol. 5, No. 4, p. 88).
Multidisciplinary Digital Publishing Institute.
Ghosh, M. (2015). Health Psychology: Concepts in Health and Wellbeing. New
Delhi: Dorling Kindersley (India) Pvt. Ltd.
Guttmacher, S. (1979). Whole in Body, Mind, and Spirit: Holistic Health and
the Limits of Medicine. The Hasting Center Report, 9(2), 15-21.
Marks, D. F; Murray, M; Evans, Brian; Willig, C; Woodall, C and Sykes, C.
M. (2008). Health Psychology: Theory, Research and Practice. New Delhi: Sage.
Sanderson, C. (2013). Health Psychology. USA: John Wiley and Sons Inc.
Shah, H., & Marks, N. (2004). A Wellbeing Manifesto for a Flourishing Society.
London: The New Economics Foundation
Shah, P., & Mountain, D. (2007). The Medical Model is Dead–Long live the
Medical Model. The British Journal of Psychiatry, 191(5), 375-377.
Shin, D., & Johnson, D. (1978). Avowed Happiness as an Overall Assessment
of the Quality of Life. Social Indicators Research, 5(1), 475–492. http://
dx.doi.org/10.1007/BF00352944
Veenhoven, R. (2004) “Subjective Measures of Wellbeing.” Discussion Paper
No. 2004/07. United Nations University: WIDER. 33
Introduction Wade, D. T., & Halligan, P. W. (2004). Do Biomedical Models of Illness Make
for Good Healthcare Systems?. BMJ: British Medical Journal, 329(7479),
1398.
Wade, D. (2006). Why Physical Medicine, Physical Disability, and Physical
Rehabilitation? We should Abandon Cartesian Dualism.
Wade, D. T. (2009). Holistic Health Care. What is it, and how can we Achieve
it? Oxford Centre for Enablement,1-35.
Yuill, C., I. Crinson, and E. Duncan, Key Concepts in Health Studies. Sage
Key Concepts. 2010, Los Angeles; London: Sage.

2.9 ANSWERS TO CHECK YOUR PROGRESS


Check Your Progress I
1) Why is medical model characterised as techno- oriented model?
Medical model is characterised as techno-oriented model because, this is the
only model of health which relies heavily on machines and technologies.
From making a generic drug to performing a surgery, everything here
requires technology.
2) State any one limitation of the medical model of health and illness.
The medical model ignores any role of social, emotional, spiritual and
psychological factors in health and illness. Thus, it does not talk about the
wellbeing or healing aspect of the disease.
Check Your Progress II
1) Describe the holistic model of health.
Holistic model considers health as equivalent to “a sense of wellbeing” and
disease is not considered as a presence or absence of a pathogenic agents
only. Instead, according to the holistic model, a disharmony between social,
psychological and spiritual dimensions of one’s life causes disease.
Check Your Progress III
1) What are the three areas in which the biopsychosocial model has offered
new insights?
The three areas in which the biopsychosocial model has offered new insights
are:
 patient’s subjective experience is also as important as objective
biomedical data,
 a comprehensive causation can give fuller and deeper understanding
of our health and illness,
 patients should not be treated as passive recipients of the treatment.
They should be given more power in the clinical process.
Check Your Progress IV
1) State any one characteristic of social model of health.
Social context in which the individual exists has a significant influence on
the health related experiences, choices and behaviour of the individual. The
34 social context includes class, ethnicity, gender and so on.
Check Your Progress V Models of Health and
Illness
1) What is subjective wellbeing?
It is that part of one’s wellbeing which can be measured only by asking
people directly about three aspects of wellbeing; evaluative wellbeing (life
satisfaction), hedonic wellbeing (positive emotions such as feelings of
happiness, sadness, etc), and eudemonic wellbeing (sense of purpose and
meaning in life).

2.10 KEY WORDS


Medical model : The dominant model of health in the
contemporary healthcare sector. It focuses
only on the physical aspect of the disease and
follows mind-body dualism.
Holistic model : Treats patients as a whole. The aim of this
model is not just to cure but heal patients.
Biopsychosocial model : Propounded by Engel in 1977. It views illness
not only from the physical dimension but gives
equal importance to psychological and social
dimensions.
Wellbeing : The concept of wellbeing refers to a subjective
feeling, which involves an evaluation of those
affective and cognitive aspects of life which
are getting affected by disease and illness
directly or indirectly.

2.11 UNIT END QUESTIONS


1) What is medical model? Explain its major characteristics.
2) What is the holistic model of health? Write a note on factors that lead
to dissatisfaction with the medical model.
3) Differentiate between the medical model and holistic model.
4) Write a note on wellbeing.

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