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Psychology and Medicine

Many different specialties within psychology relate to health and medicine. We will discuss four: psychosomatic medicine,rehabilitation psychology, behavioral medicine, and health psychology. Then we will look at two topics–stress and addiction–that commonly concern medical health care workers as well as psychologists.

Psychosomatic Medicine

One of the oldest disciplines at the intersection of psychology and medicine is psychosomatic medicine. The field is concerned with psychological influences on medical syndromes.

Psychosomatic medicine evolved as a discipline. It started in the early 20th Century being wedded to Freudian concepts, and one of its main concerns was investigating disease personalities, a now-discredited proposal that people with certain personalities were disposed to develop particular diseases.

In the second half of the century, psychosomantic medicine dropped its connection to Freudian theory and broadened its scientific base. Now it is open to any research that relates a psychological variable to a medical condition. In practice, that has led to considerable overlap or convergence with behavioral medicine and health psychology.

What is the concern of psychosomatic medicine?

In the United States, the American Psychosomatic Society is the sponsor of the journal Psychosomatic Medicine and host of an annual convention where researchers share their results. Here is a sampling of the topics discussed at one convention, to given you an idea of topics discussed under the heading of psychosomatic medicine.

–personality and blood pressure

–motivation and obesity

–ethnic differences in stress-related high blood pressure

–hostility and heart rate variability

–cancer-related fatigue and self-rated quality of life

–behavioral correlates of menstrual breast discomfort

–hormones, stress, and premenstrual depression

–emotional reactions to a diagnosis of Hepatitis C

–depression and suicidal thoughts in patients with disfiguring skin disorders

–effects of meditation on blood pressure

–Pavlovian conditioning of nausea

–psychological determinants of asthma control

–negative emotions in chronic lung disease

–anxiety and in vitro fertilization

–sexual and physical abuse as predictors of poor health after giving birth

–insecure attachment in a subgroup of ulcerative colitis sufferers

–reducing psychological distress in post heart attack patients

–stress management in positive adaptation to breast cancer

–family factors affecting outcome of bone marrow transplant

–cognitive deficits after surgery and radiation treatment for brain tumors

–marital satisfaction related to blood pressure

–writing about traumatic experiences benefitting asthmatics

–chronic stress influences on variations in blood glucose levels

That is only a small fraction of the abstracts for the convention each representing the efforts of a researcher or team, sometimes extending over years. What all the topics have in common is that they investigate some psychological variable (mood, reactions to stress, life experiences) as it might relate to some medical condition (such as asthma, recovery from surgery, or high blood pressure).

How does the list reflect a trend in psychology?

Notice the complete absence of Freudian constructs like Oedipal Complex or even neurosis. Instead there is a mix of behavioral, cognitive, and biological perspectives.

One could find no better illustration of the modern trend cited in Chapter 1: psychology has moved past a preoccupation with competing schools (Freudian, behavioral, cognitive) toward a task- or problem-oriented approach. Researchers tackle a problem, using whatever tools are appropriate.

Clues from Hypnosis and Placebo Effects

Early researchers in psychosomatic medicine received a powerful clue that disorders might be influenced by psychological factors when hypnosis was found to alter medical conditions. Hypnosis involves no drugs or other medical treatments, and most modern psychologists do not believe there is any special "trance" state that enables phenomena of hypnosis: it is all a matter of suggestion, expectation, and social interaction with a trusted person.

An example of the power of hypnosis is its ability to make warts disappear. In an essay from his book Lives of a Cell (1979), Lewis Thomas, a noted biolo­gist, past president of Sloan-Kettering Cancer Center, and professor of pathology and medicine at Cornell University, wrote about warts:

Warts are wonderful structures. They can appear overnight on any part of the skin, like mushrooms on a damp lawn, full grown and splendid in the complexity of their architecture. Viewed in stained sections under a microscope, they are the most specialized of cellular arrangements, constructed as though for a purpose...

And they can be made to go away by something that can only be called thinking... This is a special property of warts that is absolutely astonishing... It is one of the great mystifications of science: Warts can be ordered off the skin by hypnotic suggestion. [p.47] fictitious

Why did warts fascinate Lewis Thomas? What evidence did he cite?

Thomas cited two sources of evidence, one anecdotal, the other experimental. The anecdotal evidence came from a "distinguished old professor of medi­cine" who said he treated warts by painting a colored substance on a wart and assuring the patient it would be gone in a week "and he never saw it fail."

The research evidence came from a "meticulous" study by "good clinical investigators" in which 14 patients with "seemingly intractable generalized warts" (in other words, lots of warts that would not go away) were hypnotized. Thomas wrote:

The suggestion was made that all the warts on one side of the body would begin to go away. Within several weeks the results were indisputably positive; in nine patients, all or nearly all of the warts on the suggested side had vanished, while the control side had as many as ever. (Thomas, 1979)

However, one of the subjects got right and left confused, which is common even without hypnosis. That person "destroyed the warts on the wrong side."

What happened when a subject in the hypnosis/warts study got left and right confused?

This example raises profound ques­tions, which is why Thomas wrote about it. How can suggestion produce a specific biological response that targets an isolated structure on the skin? When scientists can answer that question, they will be able to answer many other questions about mind/body interactions.

What are some examples of powerful placebo effects?

Placebo effects are a more familiar example of a profound psychosomatic effect. Patients believe they are getting a genuine medicine when they receive a placebo treatment. (That is what defines it as a placebo treatment.) Often they respond by getting better.

Brown (1998) summarized many power­ful effects of placebos or "inert sub­stances" presented as medicines. For example, "Typically, 30 to 40 percent of depressed patients benefit from taking a placebo." (Brown, 1998, p.91).

In one study of the beta-blocker propran­olol, often prescribed after heart attack, people who took the drug experienced a 50% reduction in death rate, compared to a control group. However, people who took a placebo pill also experienced a 50% reduction in death rate! No wonder Brown's article was subtitled, "Should doctors be prescribing sugar pills?"

What is Brown's explanation of placebo effects?

Brown suggested that placebos may achieve their effect by reducing stress and anxiety, "lessening the apprehension associated with disease." He notes that placebo effects are most powerful with disorders known to become worse when a patient is upset, such as high blood pressure, asthma, and chronic pain.

Brown concludes, "It is not inconceivable that by reducing anxiety, placebos could influence countless diseases, including some that we do not usually think of as subject to psychological influence" (p.93).

One student discovered that psycho­somatic effects worked on a gastro­intestinal disorder:

When I was a junior in high school, I developed a "nervous stomach." Every time I was in a stressful situation I would have terrible stomach cramps and throw up. I went to the doctor, and he pre­scribed some "stomach relaxers."

Every time I got nervous, I took one of those pills and they relaxed me. Years later, after I had gotten over my ner­vousness, I found out that the pills were placebos: sugar pills. Apparently because I thought that the pills were helping me, I learned to relax myself. [Author's files]

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References:

Brown, W. A. (1998, January) The placebo effect. Scientific American, pp.90-95.

Thomas L. (1974) Lives of a cell: notes of a biology watcher. New York: Penguin Books.


Write to Dr. Dewey at psywww@gmail.com.


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