Psychology and Health

Culture, Place, History

Wade Pickren

• Publisher: Routledge
• Year: 2019
• ISBN:
  9781000762587
• Edition: 1
• Topic: Psicologia
• Subtopic: Storia e teoria della psicologia

Weaving together the various foundations of psychology and health into a compelling narrative, this book culturally and historically situates the practice, strengths, and shortcomings of the field. Historian of psychology Wade Pickren traces the development of the relationship of health and psychology through a critical history that incorporates context, culture, and place from the early modern period to the present day.

Covering a range of topics and time periods including psychology and health in the nineteenth century; stress in post-World War II USA; and the relationship between body, mind, and emotion in the modern world, Psychology & Health: Culture, Place, and History outlines the journey of an understanding of health rooted in nature, to a commodity governed by the neoliberal values of the marketplace, including an exploration of the roles of self-help, emotions, and resilience. The book closes with an outline of contemporary alternatives in health psychology and points toward a future when, once again, psychology and health are grounded in nature. Throughout, the rich connections across cultures illustrate the importance of cultural variations in understanding health, disease, and treatment.

This book is essential reading for scholars and students of health psychology at all levels. It will also be of interest to professionals and practitioners in related fields, as well as those interested in the enduring connection between health and psychology.

1 The Historical Ground of Health and Illness

Culture, Place, and Context

Psychology and health are intertwined in the modern social imaginary of the Global North, whether through complementary and alternative health approaches, the multitudinous branches of contemporary biomedicine, or some combination of health practices and treatment (e.g., Nordstrom, 1988). What is the history of the relationship of psychology and health? How did its current expressions come to the fore of the public imagination? What is missing from these expressions, and why? What are some alternative modes of understanding psychology and health? Why is culture so important to understanding the links between the two? The chapters that follow will address these questions and others using multiple sources, always paying attention to culture, place, and historical context. An international perspective will be used in order to indicate the rich connections across cultures as well as illustrate the importance of cultural variations in understanding psychology, health, disease, and treatment.

The Cultural Grounding of Health and Illness

Health knowledge and health practices are always in dialogue with the culture, context, and place in which they occur. Psychology is inextricably linked to culture. I have argued elsewhere that the relationship is reflexive in that every cultural setting contains the conditions of possibility to create psychological thought, experiences, and practices, while the embodiment/enaction of the psychological, in turn, molds the culture (Kirmayer & Ramstead, 2017; Pickren, 2018). This relationship is dynamic as both culture and psychology are ever changing through constant contact across cultural, social, temporal, and intellectual boundaries (see Canclini, 2005; Hayward, 2011).

Over the course of human history and into our own time, there has been constant borrowing of ideas and adoption/adaptation of practices across cultures, including those related to health, illness, and treatment. Some scholars refer to this phenomenon of cultural exchange as occurring in cultural contact zones (Hermans & Kempen, 1998; Mahalingam, 2008; Pratt, 1991) or as a global mélange (Pieterse, 2018). Such exchanges are typically marked by differences in power and resources among the parties involved (see Mignolo, 2011).

Our understanding of health and the illness experience has emerged from particular histories that are linked to distinctive cultures and places. Models of personhood and social relations are embedded in these cultures and reflected in their histories. What counts as health or sickness and which problems need health care are culturally and socially constituted (Kirmayer, 2004, 2012).

There is no best way to categorize beliefs about health and illness across cultures and time. One that will be used here is Kirmayer’s common systems of healing (2004). Though not exhaustive, the model is useful. Illness may be caused by an imbalance in diet, humors, energy, or life force; because spirits were offended; or due to sin, the effects of magic, or psychological conflict. In biomedicine, illness is due to dysfunction of one or more physical organs or internal systems, or because of the introduction of pathogens from outside the body. All of these are culturally based belief systems about health, illness, and appropriate treatment (see Lupton, 2012).

Psychologists in the Global North, especially those in North America, have long had difficulty with the concept of culture. Typically, they have turned culture or cultures into static entities that often lead to stereotyping and essentializing, among other problems, and result in statements about groups that may fail to convey the richness and variety that are found in every culture (see Adams & Markus, 2004; Seligman, Choudhury, & Kirmayer, 2015). Most often, statements are made about East/West cultural differences, where East means East Asia, and West means North America. Most of these statements characterize cultures of the East as interdependent and collective in orientation, while Western cultures are independent and individualist in orientation. The loss of information in such characterizations is staggering and impedes our ability to grasp the importance of culture in health.

A more accurate, though necessarily provisional and incomplete, approach would recognize that there is great heterogeneity in every culture and that people pick and choose which elements they most identify with or view as authentic. Carolyn Nordstrom beautifully documented this in her work on health providers in Sri Lanka (1988).

To illustrate the complexity and mutability of health beliefs and practices over time and across cultures, I use the example of balance theories of health and illness. Such theories have ancient roots and are found across time and cultures. For example, Ayurveda and Unani medicine in India, Islamic medicine in the Middle East and beyond, Traditional Chinese Medicine, many medicinal approaches of native and aboriginal groups, and such New Age approaches as aromatherapy all posit that health is due to a balance of forces, energy, or other elements, and illness occurs when these elements are out of balance. Here, I will trace the Graeco-Roman humoral theory of health and sickness, an example of a balance theory, through Islamic medicine and into one of its expressions in contemporary Malaysia. We will be able to see some of its trajectory of influence and how it was modified through cultural contacts and exchanges. It should be noted that in each of the cultures touched by this trajectory, the practice of medicine based in humoral theory may have been dominant, but it existed alongside belief in spiritism and magic as explanatory sources and practical treatment of illness and disease.

Humoral theory as it developed in Greece was a theory of balance and imbalance in relation to health and personality. Traditional medical history suggests that humoral theory was first articulated by Hippocrates (circa 460–370 bce). Humor refers to bodily fluids. A balance among the four humors was necessary for health; each one was also associated with a temperament or, as we might say in the twenty-first century, a personality type. Thus, physical health and personality were linked as part of the greater whole of a person’s life. Blood, hot and moist, was related to a sanguine (confident, cheerful) temperament. Phlegm, cold and moist, indicated a calm, unemotional, or phlegmatic personality. Yellow bile, hot and dry, was expressed as an angry or irascible choleric temperament, while black bile, cold and dry, was related to a melancholic (sad, gloomy) personality. Health, then, was related to personality in ways that made each person unique. Greek medicine was not as reductionistic as this brief sketch appears. Rather, health and personality were part of a larger circle of life that included the environment, climate, sociality and community, the polity, and the stars and planets. These interlinked aspects all contributed to the health of the community and the health of the individual (Nutton, 2004).

Treatment was also particular to the person, and successful treatment required that the physician know the patient well. Only then could the doctor see how the elements of the great circle of life influenced the patient’s current state of illness and what needed to be done to rebalance the patient’s life and return them to health.

The elaboration of the theory in the second century ce by the Roman physician Galen resulted in the approach being referred to as Graeco-Roman. The theory and its variants underlay Western medicine well into the nineteenth century. Graeco-Roman medicine, especially the interpretation of humoral theory developed by Galen, was imported into the Islamic world beginning in the ninth century ce (Ebrahimnejad, 2011). As in Greece and Rome, spiritual influences on health and notions that some illnesses were caused by the “evil eye” or another malign force remained part of everyday health beliefs and practice (Van der Eijk, 2011).

Many of Galen’s medical treatises were translated into Arabic, thus preserving classic works of Greek and Roman medicine. These works laid the foundations for further elaboration by Islamic scholars over the next several centuries, such as the Canon or Medical Code, produced by Avicenna (980–1037 ce), perhaps the most influential of his 270 scholarly titles. The scholarly and practical writings of physicians in the Islamic world from the ninth to the fifteenth centuries helped preserve, extend, and systematize medical knowledge and treatment (Porter, 1997). As the power and influence of Islam spread across much of southern Europe, North Africa, and parts of Asia, so did the humoral theory of health and disease. In each place, it intersected with and was modified by the health beliefs and practices of local cultures, just as Graeco-Roman medicine had been modified when imported into the Islamic world.

The history of the influence of Islamic humoral theory of health on the Malay peninsula provides an example of what often happens in cultural contact zones. The Malay peninsula, which encompasses the contemporary country of Malaysia, is home to several distinct cultures. Over the course of its history, there has been a continuing influence of China and India, and, since the fourteenth century, Islam. Chinese, Indian, and Islamic (through the already described influence of Graeco-Roman medicine) cultures all embrace balance theories of health and illness (Hoizy & Hoizy, 1988; Laderman, 1992; Obeyesekere, 1977). When the Malay peninsula was conquered by Islamic forces in the fourteenth century, much of the population converted and with the conversion adapted Islamic humoralism to their own longstanding balance theories of health. The Malayan groups that were converted were prepared to adopt and adapt humoralism through the Chinese and Indian, especially, Ayurvedic, influences they had experienced for more than a thousand years. This is an example of the dynamism of cultures and of what often happens in cultural contact zones. A balance of heat and cold was and is central to the health beliefs of Malays, as it was in Islamic medicine. But the valence was opposite. Islamic medicine held that while moderation or balance between hot and cold was necessary, preference was given to heat. But heat and cold, dryness and moisture, did not refer to physical thermal or moisture properties. Rather, they were humoral degrees, and a balance among them was necessary for health. For example, spinach was cold, but when prepared with elements that were hot, such as salt, it was balanced.

With the introduction of Islam to the Malay peninsula, some of its characterization of humoral or balance theory were adopted, such as the belief that the physical universe was composed of the four elements of air, fire, earth, and water. But, in many ways, what the Malays did was adapt Islamic humoral theory to their own extant beliefs about health. In traditional Malay balance theory, hot and cold referred to actual temperatures of the body, food, blood, etc. Heat was thought to be the primary cause of human illness and trouble, while coolness and moisture were associated with health. That blood was hot was what made humans mortal, and hot foods and hot activities were thought to speed the processes of mortality. Psychological disorder or discomfort was also due to hot factors.

As argued above, culture and psychology make each other up through a reflexive, unending process (see also Shweder, 1991). To grasp the necessary relation of psychology and health is to understand health beliefs and practices as an inextricable part of this reflexive process.

The Long Past of Psychology and Health: Shamans, Gardens, and Dreams

Health knowledge and health practices always have a history. They emerge in the context of their historical moment and place, and are always in a reflexive dialogue with the culture in which they occur. Shamans are among the earliest known health practitioners. The term “shaman” originated among a small group of hunters and herders in Siberia, but it has spread around the world to indicate native or indigenous healers (Vitebsky, 1995). As the Indian psychoanalyst Sudhir Kakar noted, they were and are at once healers, priests, mystics, and doctors (1982). At the same time, they are also expected to be responsible members of their local groups and have ordinary daily tasks to carry out to benefit the group. Shamanism is not a religion. Rather, it speaks to a religious or spiritual sensibility that is dependent on and emergent from particular social groups. Thus, there is no set of unified practices, even though there are similarities of practice across widely scattered and divergent groups. The practices of shamans and related native healers, for example, curanderos (Trotter & Chavira, 1997), are based on the view of humans as part of the natural world and not separate from it, as has developed in the modern Western dichotomy of human and nature (de la Cadena, 2015; Escobar, 2017).

Shamans, by whatever name, have roles to play in both physical and psychological health, often by engaging in rituals and other practices intended to restore cosmic equilibrium between the group or individual and the spiritual world, however defined. The historian of the unconscious Henri Ellenberger has argued that shamans offered psychological healing through their dealings with the spiritual or unconscious aspects of life (Ellenberger, 1970). Their practices were grounded in the worldview of their communities and thus offered a natural fit for treatment of the group’s ills. If the worldview saw illness as due to soul loss, perhaps because the soul had been stolen, then the task of the shaman was to travel, in dreams or in trance, to find the soul. Once found, the shaman used whatever strategy was congruent to regain the lost soul, perhaps bargaining or fighting with the spiritual forces that had stolen the soul. The shaman, if victorious, then restored the soul through a set of ritualistic practices and in so doing restored balance to the cosmos. The particular expressions of this were unique to each group, even while the principles were similar across groups.

Recall that we are working within the framework that health knowledge and healt...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Table of Contents
• About the Author
• 1 The Historical Ground of Health and Illness: Culture, Place, and Context
• 2 Psychology and Health in the Long Nineteenth Century
• 3 Psychology and Health for Moderns: Body, Mind, and Emotions
• 4 Stress, Lifestyle, and Psychology in Post-World War II USA
• 5 Biomedicine, Behavior, Psychologists, and Health
• 6 Present Alternatives and Future Possibilities
• Index