Article

Towards a Critical Health Psychology Practice

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

The field of critical psychology is exerting an influence in the way various sub-disciplines within psychology operate. In this article we use a critical psychology framework to review the field of health psychology. Through the use of values, assumptions and practices we review progress in health psychology and offer recommendations for aligning contemporary practices with current thinking in critical psychology. We discuss typical expectations, critical formulations and critical practice for interventions with individuals, groups and communities along these dimensions.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Cette approche questionne la façon dont les déterminants sociaux influencent les comportements de santé. Elle vise également à se positionner comme une grille de lecture du contexte social (Prilleltensky, Prilleltensky, 2003). ...
... La psychologie critique permet d'analyser les éléments de compréhension des comportements de dépistage précédemment décrits en les inscrivant dans différents niveaux d'analyse. Il s'agit de naviguer entre le niveau microsocial constitué des relations interindividuelles, au niveau macrosocial représenté par le contexte social et culturel, en passant par le niveau mesosocial des relations intergroupe (Fox, Sloan, Austin, 2008 ;Prilleltensky, Prilleltensky, 2003). L'articulation de ces différents niveaux permet une compréhension plus globale des questions étudiées, ainsi que la prise en compte des interactions dynamiques et des enjeux de pouvoir entre les différents acteurs d'une situation spécifique (Fox, Sloan, Austin, 2008). ...
... Le dépistage du cancer du sein, à travers les interactions sociales qui le composent, peut être investigué du point de vue de la psychologie critique de la santé (Prilleltensky, Prilleltensky, 2003). Le rapport qu'ont les femmes à la mammographie de dépistage influence la perception qu'elles en ont et en même temps, leurs comportements et leurs discours à ...
Thesis
Contexte : Dans un contexte d’augmentation significative de l’exposition aux rayonnements ionisants (RI) en imagerie médicale, un nombre croissant de travaux sur les risques radio induitsen médecine ont été publiés (Mathews, 2013 ; Colin, et al, 2017). Pourtant, cette question ne fait pas consensus (IRSN, 2012). En effet, les différences de perception des risques de cancer radio-induits associés aux faibles doses de RI, entrainent des pratiques hétérogènes chez les radiologues, notamment au sujet des femmes de moins de 50 ans qui réalisent des mammographie de dépistage.Ce travail de thèse en psychologie sociale de la santé vise à investiguer les enjeux de santé publique liée à l’exposition aux RI en mammographie de dépistage, sur la base d’un regard psychosocial intégrant les interactions entre les individus, le contexte social et l’objet étudié(Apostolidis, Dany, 2012). Il s’agit de comprendre ce qui guide les pratiques à la fois des radiologues et des femmes effectuant ou non le dépistage, dans les spécificités du contexte français. La théorie des représentations sociales (Moscovici, 1961) constitue en ce sens un ancrage solide pour appréhender la sociogenèse des connaissances, face à l’objet méconnu et abstrait que sont les risques radio-induits (Apostolidis, et al, 2002 ; Jodelet, 1989).Problématique : Fondée sur l’articulation entre enjeux de terrain et perspectives théoriques,cette thèse vise à investiguer les représentations sociales de la mammographie, notamment son caractère irradiant, ainsi que la perception des risques qui lui sont associés et cela dans le cas spécifique des femmes de moins de 50 ans.Méthodes : Pour étudier cette question, quatre études ont été mises en place :• Étude d’un corpus de 236 documents institutionnels visant à appréhender dans le contexte national, le point de vue des institutions de santé publiques au sujet du dépistage du cancer du sein en France.• Étude d’un corpus de 430 articles issus de la presse grand public visant à recueillir les éléments de langage transmis dans le sens commun à propos de la mammographie de dépistage.• Étude auprès de 1300 femmes représentatives de la population française visant à investiguer les représentations de la mammographie de dépistage.• Étude auprès de 292 radiologues afin d’interroger leurs représentations et leur perceptions des risques associés à la mammographie de dépistage.Résultats principaux : Les résultats des différentes études permettent de mettre en évidence le fait que les radiologues et les femmes ont majoritairement tendance à faire des mammographies avant 50 ans, incité par le poids des normes sociales de santé, bien que les recommandations nationales invitent à la prudence. L’analyse des données a également permis d’appréhender le réseau des représentations sociales dans lequel s’inscrivent les risques associés à la mammographie de dépistage. Au sein de ce réseau, les risques radio induits semblent appartenir à une zone muette (Chokier, Moliner, 2006). Ce résultat questionne l’information faite aux femmes dans un contexte de décision médicale (Gesbert,Mamzer, 2016 ; Rakowski, 1993).Conclusion : Le dépistage individuel du cancer du sein semble s’inscrire dans un contexte global partisan du dépistage précoce, pour aider à circonscrire au mieux le cancer. Néanmoins,la prévention du cancer semble se faire au détriment d’une information exhaustive pour les femmes en ce qui concerne les rayonnements ionisants utilisés en mammographie. Ce travail invite alors à se questionner sur les modèles de prise de décision en santé et il ouvre des perspectives de recherche autour des questions de dépistage auprès des médecins généralistes et gynécologues, prescripteurs de la mammographie chez les femmes de moins de 50 ans.
... This is essential because many of these identities (newcomer, visible minority, patient, woman) are associated with relatively less power and relatively greater disadvantage and marginalization. This article argues for going beyond the limits of mainstream psychology's focus on the individual and deemphasis on contextual factors such as cultural specificity, ideology, and social inequality, oppression, and power imbalances (Prilleltensky and Prilleltensky, 2003;Rogers, 1996). Critical health psychology and other social sciences, however, emphasize the ways in which history, politics, economy, values, and ideologies impact and shape health care, beliefs, practices, and outcomes (e.g. ...
... Critical health psychology and other social sciences, however, emphasize the ways in which history, politics, economy, values, and ideologies impact and shape health care, beliefs, practices, and outcomes (e.g. Christodoulou, 2010;Crossley, 2001aCrossley, , 2001bCrossley, , 2008Prilleltensky and Prilleltensky, 2003;Rogers, 1996;Stam, 2000;Yardley, 1996). ...
... Likewise, while mainstream health psychology focuses on facilitating behavioral change in the individual in order to change health status, critical health psychology focuses on bringing about changes in the social, political, and ideological contexts of health and health care to achieve better health outcomes (Christodoulou, 2010;Prilleltensky and Prilleltensky, 2003). ...
Article
Full-text available
Canada has one of the world's largest refugee resettlement programs in the world. Just over 48 percent of Canadian refugees are women, with many of them of childbearing age and pregnant. Refugee and asylum-seeking women in Canada face a five times greater risk of developing postpartum depression than Canadian-born women. Mainstream psychological approaches to postpartum depression emphasize individual-level risk factors (e.g. hormones, thoughts, emotions) and individualized treatments (e.g. psychotherapy, medication). This conceptualization is problematic when applied to refugee and asylum-seeking women because it fails to acknowledge the migrant experience and the unique set of circumstances from which these women have come. The present theoretical article explores some of the consequences of applying this psychiatric label to the distress experienced by refugee and asylum-seeking women and presents an alternative way of conceptualizing and alleviating this distress.
... Moreover, Martin (2015) found that Muslims across the country faced discrimination and other social issues, including being misunderstood and lacking appropriate places to pray. Researchers who study Muslims and their mental health concerns found that Muslims in the U.S. face many psychosocial and academic issues (Ahmed et al., 2014;Ali & Milstein, 2012;Amri & Bemak, 2013;Aprahamian et al., 2011;Bagasra, 2010;Bagasra & Mackinem, 2014;Bektas et al., 2009;Ciftci et al., 2013;Cook-Masaud & Wiggins, 2011;Franciso & Tanhan, 2015;Goforth et al., 2014;Herzig et al., 2013;Khan, 2006;Martin, 2015;Nadal et al., 2012;Soheilian & Inman, 2009;Strack et al., 2016;Tanhan, 2014 (Holmes, 2013;Prilleltensky, 2008Prilleltensky, , 2012Prilleltensky & Prillelltensky, 2003 ...
... people, including key people like the ones providing health services, are being manipulated by the system. As a result, even key people forget about the larger systems they live in and just get stuck within their individual life and circumstances, evaluating other people and blaming them from such an individual, narrow, and acontextual perspective.Prilleltensky and Prilleltensky (2003) stressed, especially regarding minority people, a critical health psychology perspective that calls attention to work with entire communities at the individual, interpersonal, and collective levels from an ecological perspective. They stressed the importance of working at all spheres of the ecological model both from a treatment and a p ...
Thesis
Full-text available
The Muslim community in the Southeastern U.S., being a small part of the larger Muslim population in the U.S., faces many psychosocial issues and underutilizes mental health services. Muslims’ underutilization of mental health services to address their psychosocial issues affect both Muslims and non-Muslims alike. Given today’s highly interconnected world, the issues of one individual or community often impact others in ways not experienced at other times in history. However, there is lack of research on Muslims and especially for those in the Southeastern U.S. regarding their approach toward mental health issues and seeking formal mental health services. Researchers stress the necessity to understand Muslims’ approach toward mental health issues and seeking the services by utilizing well-grounded theories to create and/or shape contextual theoretical frameworks (models). However, few researchers have utilized clear theoretical frameworks to ground their studies, which creates an unsystematic approach to research and clinical practice for this vulnerable population. In their study with 88 counselors in the U.S. Cashwell et al. (2013) found that although the participants rated the integration of religious/spiritual aspects into counseling as very important, they integrated these aspects less frequently into their counseling practice than how ratings of importance would suggest. Young and Cashwell (2011) stressed attending to client’s spiritual/religious perspective by stating, “meeting the client where [they] are, without judgment and with compassion, is the foundational building block” (p. 22) to address issues in counseling. The purpose of this study was to understand how Muslims in the Southeastern U.S. approach mental health issues and seeking formal mental health services. A second purpose was to partially test (examine) the proposed contextual theoretical framework based on Theory of Planned Behavior/Theory of Reasoned Action (TPB/TRA) and Brofenbrenner’s Social Ecological Model (SEM) to answer the eight research questions. In total 209 participants’ responses were used for statistical analyses. The results indicated that the participants had slightly higher than the moderate/favorable level on the five constructs: cultural beliefs about mental health issues/problems and their causes and treatments (CBMHP-cultural beliefs), knowledge about formal mental health services (KFMHS-knowledge), and perceived behavioral control toward seeking formal mental health services (PBC) constructs; and a moderately favorable level on attitudes toward seeking formal mental health services (ATFMHS-attitudes) construct; and slightly under the moderate level (meaning participants had a little stronger stigma than moderate level) for perceived social stigma toward seeking formal mental health services (PSTSFMHS-stigma) construct. Meaning that, the participants did not strongly favor or disfavor the five constructs. In addition, the participants strongly aligned with a medical/scientific explanation of mental health issues and their causes and treatments based on responses to the measure of CBMHP-cultural beliefs. The paths (relationships/analyses) among the five main constructs were positively or negatively significant except for one. In an open-ended question, the largest group of the participants defined mental health providers from a medical/psychopathology perspective while the others fell under three other categories. In addition, majority of the participants did not feel safe and attributed it to the current climate of exosystem and macrosystem systems in which they live. In sum, nearly all researchers in the Muslim mental health literature have stressed the importance of understanding contextual factors for more culturally, spiritually, and structurally appropriate interventions and services. Therefore, it was first necessary to assess and understand how Muslims in the Southeastern U.S. approach to mental health issues and seeking formal mental health services through a well-grounded theoretical framework. In this way, mental health providers and researchers will be able to understand Muslims within a more culturally and structurally contextual perspective and address the mental health issues of this population more effectively by utilizing the results of this study.
... Counseling as a profession has been criticized for implementing helping strategies that are primarily aimed at fostering individual intrapsychic interventions without recognizing and addressing contextual-environmental factors which contribute to the manifestation of mental health problems (House & Martin, 1998;Ibrahim & Arredondo, 1986;Ibrahim & Ohnishi, 2001;Sue, Arredondo, & McDavis, 1992;Toporek & Liu, 2001;Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006;Toporek, Lewis, & Crethar, 2009;Vera & Speight, 2003). According to recent research, many people seeking counseling services suffer from trauma caused by racism, sexism, classism, homophobia, exclusion due to cultural and religious differences from the mainstream population of the United States, and unintentional and intentional acts of oppression (Carter & Forsyth, 2009;House & Martin, 1998;Ibrahim & Ohnishi, 2001;Prilleltensky, 1994;Prilleltensky & Prilleltensky, 2003). These forms of injustice cause people immense pain and suffering resulting in shortened life span, ill health, anxiety, and depression (Carter & Forsyth, 2009;Prilleltensky, 1994;Prilleltensky & Prilleltensky, 2003). ...
... According to recent research, many people seeking counseling services suffer from trauma caused by racism, sexism, classism, homophobia, exclusion due to cultural and religious differences from the mainstream population of the United States, and unintentional and intentional acts of oppression (Carter & Forsyth, 2009;House & Martin, 1998;Ibrahim & Ohnishi, 2001;Prilleltensky, 1994;Prilleltensky & Prilleltensky, 2003). These forms of injustice cause people immense pain and suffering resulting in shortened life span, ill health, anxiety, and depression (Carter & Forsyth, 2009;Prilleltensky, 1994;Prilleltensky & Prilleltensky, 2003). ...
... As the limitations of both the biomedical and lifestyle approaches to health have become more apparent, more critical perspectives on health research and action have emerged (e.g. Murray, 2004;Murray & Campbell, 2004;Poland, Coburn, Robertson & Eakin, 1998;Prilleltensky & Prilleltensky, 2003). Indeed, professionals from different disciplines have argued that for health research to be relevant, it must take account of the broader sociopolitical context in which health is shaped. ...
... First, failure to think and practice systemically may inadvertently lead to 'victim-blaming'. Mainstream health research and action is micro-centered and seldom takes into account more macrosocial determinants of health (Prilleltensky & Prilleltensky, 2003). Second, systems thinking is important for practice. ...
Article
Full-text available
Community-based action research has received increased attention in health research as an important vehicle for both knowledge creation and community capacity-building. This approach to research is value-driven, attuned to power issues, committed to stakeholder participation, and action-oriented. Efforts to build capacity within the health research community to engage collaboratively with communities in action research projects must be predicated on a framework that delineates the preferred knowledge base/core concepts, skill sets, and the combination of classroom-based, academic learning, and supervised field learning that is required. In this article we propose a praxis framework that integrates the core concepts, core competencies, and training processes for graduate education in community health action research. We review current opportunities for training in this approach in Canada and illustrate how two graduate programs in different disciplines currently operationalize the elements of the proposed framework.
... Τα βασικά της θεωρητικά εργαλεία είναι οι έννοιες της «συνειδητοποίησης» και της «πράξης» (Campbell & Murray, 2004). Οι Prilleltensky & Prilleltensky (2003) συζητούν τη δυναμική της εξουσίας που αναπτύσσεται στα ιατρικά και κλινικά περιβάλλοντα: ασύμμετρες σχέσεις μεταξύ επαγγελματιών υγείας και ασθενών, στερεότυπα ως προς το φύλο και την εθνικότητα, έμφαση στην ατομική ευθύνη, μονοδιάστατες παρεμβάσεις, κυρίως, συμπτωματικές με μικρή εμπλοκή των ασθενών στις θεραπευτικές αποφάσεις. Η εξατομικευμένη προσέγγιση λειτουργεί παραπλανητικά, καθώς δεν αποκαλύπτει τις πραγματικές αιτίες των κλινικών συμπτωμάτων. ...
Book
Full-text available
TOPICS AND FIELDS OF APPLICATION OF CLINICAL SOCIOLOGY Networks of empowerment, intervention and healing in a society in crisis SOTIRIS CHTOURIS Main author ANASTASIA ZISSI Clinical Sociology (C.S) is an important field of application of the Social Sciences. In many countries and academic schools, C.S. is better known as Applied Sociology, and is often referred to by this name in the United States, the country of its origin in the famous Chicago School. As the reader will easily understand, the fields of application of C.S. are close to the socially oppressed groups, the community in social danger but also to whole societies which encounter significant social problems. Our recent social experiences show that many problems perceived as economic, psychological-individual and political are mainly rooted in social functions and structures of the wider society and our everyday life. While human issues that are in the fields of specialist clinical therapists in Medicine, Psychology, Law are not able to be raised and treated effectively if their treatment does not find a solid basis in the social ties, community and general sociality of the individual. S.Chtouris
... Τα βασικά της θεωρητικά εργαλεία είναι οι έννοιες της «συνειδητοποίησης» και της «πράξης» (Campbell & Murray, 2004). Οι Prilleltensky & Prilleltensky (2003) συζητούν τη δυναμική της εξουσίας που αναπτύσσεται στα ιατρικά και κλινικά περιβάλλοντα: ασύμμετρες σχέσεις μεταξύ επαγγελματιών υγείας και ασθενών, στερεότυπα ως προς το φύλο και την εθνικότητα, έμφαση στην ατομική ευθύνη, μονοδιάστατες παρεμβάσεις, κυρίως, συμπτωματικές με μικρή εμπλοκή των ασθενών στις θεραπευτικές αποφάσεις. Η εξατομικευμένη προσέγγιση λειτουργεί παραπλανητικά, καθώς δεν αποκαλύπτει τις πραγματικές αιτίες των κλινικών συμπτωμάτων. ...
... We conceptualise health and wellbeing in broad terms, which includes psychological, social and physical dimensions that overlap and can contribute to an overarching sense of wellness when combined and balanced (Prilleltensky & Prilleltensky, 2003). In fact, this understanding is in line with the World Health Organization's (WHO 1946, p. 1) definition of health as "a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity". ...
Article
Full-text available
When conceptualising health and wellbeing among disabled people, the experience of internalised ableism must be considered. In this article, we argue that internalised ableism is indeed a health and wellbeing issue that materialises in numerous complex psychological, social and physical consequences. For theoretical grounding, we utilise critical disability studies, feminist theorising about solidarity and disability activists’ concept of ‘disability justice’. We draw on data from focus-group interviews with disabled young people, comprising ten men and eleven women, with different impairment types. The focus-group discussions revolve around various aspects of their wellbeing and participation in society, and possible and actual threats to the wellbeing of disabled children and young people in general. The analysis reflects various negative effects of internalised ableism on the identity, health and wellbeing of disabled young people. Family support, access to safer spaces and positive peer interactions are factors defining how internalised ableism develops, is maintained or defied. Peer support and solidarity are strong indicators of promoting healing from internalised ableism. We argue that disability scholars need to address the health and wellbeing of disabled people in an ableist world.
... Partnerships with New Zealand women's health Palmer du Preez et al. Harm Reduct J (2021) 18:111 and gender equality organisations, in combination with theoretically informed and gender-sensitive research, may support and increase the quality of health promotion initiatives to reduce gambling harm for women [90]. Supporting gender equality aligns with key public health opportunities to address gambling harm: increasing community and broader societal accountability, and enhancing community engagement in decision making about health promoting/constraining environments [14,82]. ...
Article
Full-text available
Background Gambling harm affects men and women relatively equally, and gender influences the social determinants of gambling harm. Responses to preventing and minimising women’s gambling harm have been shaped and constrained by population research identifying male gender as a key risk factor for gambling problems. Gender analysis in gambling studies is rare and has lacked theoretical underpinning and coherence, limiting possibilities for gender-responsive and gender-aware harm prevention and reduction activities. Methods Two influential qualitative studies of gambling harm in New Zealand (involving total n = 165 people who gambled, affected others, community leaders, gambling and community support service providers, policy makers and academics) neglected to explore the role of gender. This study revisited data collected in these studies, using thematic analysis informed by feminist social constructionist theory. The overarching research questions were: How do gender-related issues, notions and practices influence women’s gambling related harm? What are the implications for women’s gambling harm reduction? Results Women’s socio-cultural positioning as primary caregivers for families and children constrained their ability to access a range of recreational and support options and increased the attractiveness of local gambling opportunities as accessible and ‘safe’ outlets for stress reduction. Patriarchal practices of power and control within family contexts operated to maintain gambling behaviour, shut down alternative recreational opportunities, and limit women’s autonomy. Consideration of these themes in relation to current health promotion practice in New Zealand revealed that national programmes and strategies appear to be operating without cognisance of these gender dynamics and therefore have the potential to exacerbate or cause some women harm. Conclusions This study demonstrates the value of theoretically informed gender analysis for gambling harm reduction research, policy and practice. International guidelines for gender-aware and gender-responsive health research and practice should be engaged as a foundation for strategic and effective gambling harm reduction programmes, projects, research and policy, and as an essential part of developing and implementing interventions for gambling harm.
... Sağlık, iyilik hâlinin merkezi kavramlarından birisi olup iyilik hâlinin hem bir sonucu hem de öncüsüdür (Prilleltensky & Prilleltensky, 2003). Sağlık, genel olarak "vücudun hasta olmaması durumu, sıhhat" olarak tanımlanmaktadır (Türk Dil Kurumu, 2019). ...
... Les limitations dues à l'état psychique mesurent quant à elle la gêne dans les activités quotidiennes tel que le temps moins important passé au travail ou le travail bâclé. Le fait d'être autonome dans ses activités quotidiennes et de « fonctionner » au travail semble prépondérant dans cette échelle, au détriment d'autres dimensions ou valeurs(Prilleltensky & Prilleltensky, 2003). ...
Article
Résumé L’amélioration des techniques médicales a bouleversé les pratiques de soins en oncologie. Les soins de support, orientés vers l’accompagnement des patient·e·s aux prises avec une maladie chronique occupent désormais une place importante aux côtés des traitements visant la survie. Ces changements ont conduit certain·e·s professionnel·le·s de santé à davantage s’intéresser à la qualité de vie des patient·e·s et, notamment, à l’impact du cancer sur la sexualité. En effet, les répercussions sur la sexualité constituent souvent l’un des aspects les plus problématiques de la qualité de vie après un cancer. L’objectif de cet article est de dresser une revue de la littérature anglophone et francophone sur cette « nouvelle » préoccupation qui semble encore poser de nombreux défis dans la pratique. Notre examen souligne qu’en dépit de la reconnaissance de l’importance de la prise en charge de la sexualité post-cancer, les médecins comme les infirmières peinent à aborder ce sujet. De plus, il relève que les représentations sociales dominantes de la sexualité – notamment en termes de genre, d’orientation sexuelle et d’âge – imprègnent les subjectivités des professionnel·le·s de santé et, par la même, influent sur les prises en charge de la sexualité et interfèrent avec une discussion systématique de ces questions tout au long du parcours de soins. Notre discussion questionne le manque d’implication des psychologues, tant dans les travaux de recherches que dans la prise en charge clinique de ces questions. Notre conclusion souligne les apports de la psychologie face aux enjeux que pose la sexualité en oncologie.
... Interventions have been developed for women's health concerns in ways that bridge the individual-social (e.g., Ussher et al., 2002). These approaches encourage clinicians to collaborate with community, advocacy, and social justice groups in addressing the needs of their clients, including promoting social action leading to healthpromoting cultures and environments (Prilleltensky & Prilleltensky, 2003). As yet, there is little evidence in the literature of critical psychological work in the area of gambling harm reduction for women. ...
Article
At present, gambling studies literature has multiple understandings of family and others affected (FAOs) by gambling harm and their support needs in play, each with different possibilities and constraints for harm reduction engagement with women. Individual psychological approaches have been privileged, eschewing the social and relational situation of gambling and harm in women’s lives. In Australasia, the majority of those seeking support in relation to a significant others’ gambling are women. Gender has been posited as a shaping force in the social stratification system, distribution of resources, and gambling and harm within society. There has been minimal engagement with the lived experiences of FAOs, which limits gambling harm reduction service development and planning. This research critically engaged with gambling harm reduction studies for FAOs, alongside interviews with eight women FAOs who presented to community services from a social constructionist perspective. The aim was to provide insight into how women FAOs position themselves and their support needs in relation to gambling harm and recovery. Data was analysed using thematic analysis informed by feminist poststructuralist theories of language. Results suggested that this small group of women were subject to intersecting patriarchal constraints and economic determinants of gambling harm. Powerful normative and moral constructions of ‘good/bad’ mothers operated to individualise some women’s responsibility for addressing harm in families and to alienate these women from gambling support services. These findings suggest that gambling services must support women and families in ways that go beyond personal functioning, extending into the social and political conditions of possibility for harm and recovery. Critical psychology and coherent gender analysis may offer opportunities to expand the role of gambling support to include advocacy, community development, and more client-led and gender-aware practice with women affected by gambling harm.
... In the European context, professional social work plays an important role in the reform of child protection services [16][17][18]. If a family comes into contact with child protection workers, it is often the mother who becomes their client [19][20][21]. Mothers are viewed as a "decisive variable" in child welfare services. Social workers can thus succumb to the motherhood mystique, that is, a view of motherhood that believes that women are uniquely suited to raising children, that all women want to be mothers, and that motherhood is the ultimate fulfilment of women's life [22]. ...
Article
Full-text available
Child protection was traditionally based on a presumption that the mother best knows what is in the best interest of her child. The discourse began to be questioned in the Czech Republic in the 1990s, followed by efforts to bring interests and needs of children into focus, as well as the ways in which they can be taken into account in the assessment process as a basis for intervention. This paper aimed to identify key features of the child-centered approach in the professional discourse of the Czech child protection and to analyze the conditions of its application. The goal was achieved through qualitative thematic analysis of professional texts in the area of social and legal protection of children since 1990 and also of legislative and methodological materials regulating child protection. This paper shows the changing of the paradigm in the social and legal protection of children and points out the shortcomings in social work practice. The reason for optimism may be the fact that an umbrella body of state administration for child protection is aware of shortcomings and, in the form of projects focusing on various topics of social work with families, works to improve competences and knowledge.
... Critical health psychology is specifically concerned with health and illness and emphasises the social, cultural, economic, political, and historical context(s) in which these are constructed, (re)negotiated, and experienced (Lyons & Chamberlain, 2006;Prilleltensky & Prilleltensky, 2003). Health and illness are therefore understood as complex social phenomena that include, but are not fully explained by or experienced as, physiological and biological processes. ...
Thesis
Sexuality and sexual health needs are inadequately addressed in mental health settings. This is misaligned with the espoused recovery orientation underpinning mental health services in Australia, and with individuals’ self-identified needs and desire for support. How mental health clinicians currently understand and respond to sexuality and sexual health concerns is still not well understood. In this thesis, I aimed to explore how mental health clinicians in Australia perceived sexuality and sexual health, and to critically examine how they oriented toward these in their work. An exploratory qualitative design was selected to address these aims, guided by social constructionist and critical health psychology frameworks. A single dataset was generated via in-depth interviews with psychologists, psychiatrists, and mental health nurses working in Australia. Four critical thematic analyses were conducted in relation to this dataset, each driven by a different analytic aim. In Chapter Three, I provide a reflexive account of nondisclosure of sexual identity within the research interviews as a lens through which to read the four analyses presented subsequently, contributing to transparency and rigour within this thesis. Participants’ conceptualisations of sexuality and sexual health are presented in Chapter Four. There was no single shared conceptualisation of sexual health within or across disciplines, however conceptualisations were primarily biomedical, reductionist, and risk-oriented with a focus on (primarily heterosexual) sexual intercourse. Sexuality was mostly understood as sexual identity and rarely discussed beyond reference to non-heterosexual identities, contributing to the positioning of hetero-sex as normal. Participants tended to perceive sexuality as relevant within their clinical practice when they also perceived danger or risk in relation to this, and this is explored in Chapter Five. I demonstrate how participants drew on a neoliberal framework of (sexual) health and self-regulation to construct sexual danger, locating this within sexual expression itself or within distressed individuals who were perceived to lack self-regulation. Outside of perceived danger, sexuality was largely omitted from participants’ everyday practice, and this silence is examined across two analyses. In Chapter Six, I demonstrate how participants accounted for omissions of sexuality in their own and their colleagues’ everyday practice by deprioritising sexuality and locating it outside of mental health settings. In Chapter Seven, I examine how the institutional context in which participants learn and work shaped sexuality-related perception and practice, according to their own accounts. I argue that these workplaces and institutions produce and maintain a broader silencing and peripheralisation of sexuality within mental health settings. The discussion in Chapter Eight brings together the results from all four analyses and synthesises these with the broader literature to make recommendations for practice and future research regarding sexuality and sexual health in mental health settings. I argue that improved practice in mental health settings will not be facilitated through a continued focus on biomedical aspects of sexuality and on individual clinicians’ relevant knowledge, comfort, and competence. Rather, there is a need to broaden the approach to sexuality in both clinical practice and research, and to recognise the wider institutional contexts in which sexual and mental health care are conceptualised and delivered.
... We call on internationally competent counseling psychologists, therefore, to consider collaborating with and supporting international colleagues in advocating for a conceptualization of mental health and wellness to include peoples' strengths and competencies as understood in their respective context. In their efforts, internationally competent counseling psychologists might also consider challenging the influence pharmaceutical corporations have on mental health around the globe (e.g., Fernando, 2014;Prilleltensky & Prilleltensky, 2003). An expanded conceptualization of mental health and wellness is likely to result in psychology training that attends more intentionally to cultural contexts. ...
Article
Full-text available
In this article, we provide examples of how historical and sociopolitical events have shaped the development of psychology and psychological services in Iceland, South Africa, Thailand, and Turkey. These examples are offered to (a) enhance international competencies related to the countries’ cultures, ecological system, and subsystems, and (b) inspire counseling psychologists to collaborate with colleagues around the world on efforts to indigenize psychology paradigms and promote accessible service delivery systems. Common themes across these countries indicated that (a) provision of psychological services is highly influenced by the biomedical model of mental health, (b) access to mental health care is influenced by cost and stigma, and (c) a limited connection exists between traditional healing practices and Western-based diagnostic and mental health services. In all countries there was a struggle for greater recognition of psychological services; in Iceland, Thailand, and Turkey, counseling psychology is not recognized as a legally sanctioned profession. Suggestions are offered for internationally competent counseling psychologists who intend to promote the provision of culturally responsive psychological services worldwide.
... Nevertheless, there are several foreign studies dealing with this topic. Bullock and Lott (2001), Prilleltensky and Prilleltensky (2003), Gerson (2007), Swick and Williams (2010) all state that mothers in shelters are perceived as 'bad mothers' and they believe that society perceives them as some kind of anti-mother. ...
Article
The article discusses the impact of the construct of motherhood on the process of reintegration of single mothers from shelters into permanent forms of housing in the Czech Republic. At the beginning of the article, we deal with the construct of women and mothers in Czech society and apply this construct to the construct of homeless mothers who are clients of shelters. We also describe the system of shelters in the Czech Republic. Our research involved 33 communication partners, who were either currently staying in a shelter or already reintegrated into permanent housing. When analyzing the results of the research, it showed that the construct of motherhood was one of the key themes and oppressive mechanisms. Mothers in interviews thematised the label of ‘bad mother’, the forced masculinization of their own conduct and takeover of the competence of mothers by the service, the construct of anti-mother and the need for ‘public mothering’. Based on the research data, we created a two-level model of the reintegration process.
... Critical consciousness involves developing awareness and understanding of the sociopolitical environment and oppression through selfreflection and dialogue, and then taking action against this oppression, or praxis (Freire, 1970;Watkins & Shulman, 2008). Counseling and psychology practitioners from this liberatory perspective are acutely aware of the sociopolitical environment and they work collaboratively with clients and communities to address injustice and promote wellness (Prilleltensky, 2001;Prilleltensky & Prilleltensky, 2003;Watts & Flanagan, 2007). ...
... In recent decades, illness and health have become focal points of research interest in psychology, especially within qualitative approaches (Davidsen 2013). These experiences are complicated concepts which profoundly shape one's psychosocial lifeworlds (Prilleltensky & Prilleltensky 2003). A comprehensive and holistic approach to health and illness research is therefore essential for improved understandings, especially vis-à-vis chronic illnesses and their impacts (Chamberlain & Murray 2008). ...
Article
In this article, we present a reflection on the research process of combining photographs with phenomenologically oriented interviews. Two studies in the field of chronic illness with marginalized individuals (Lesbian, Gay, Bisexual and Trans* people living with MS; men diagnosed with breast cancer) are employed to illustrate a range of conceptual, methodological and pragmatic issues. Both studies draw upon an integrative theoretical framework within a critical health psychology epistemological paradigm informed by phenomenological psychology and visual methodologies. The data collected for both studies have been analyzed through interpretative phenomenological analysis (IPA). We offer some thoughts regarding certain challenges and opportunities of synergizing verbal and visual data, and illustrate our arguments through a series of examples from the two studies, which are critically discussed. We argue that qualitative research in psychology benefits from an enhanced multi-methodological approach employing existential phenomenological psychology and visual methodologies; especially when exploring chronic illness in marginalized communities, and outline benefits for the wider community of qualitative researchers in psychology.
... Critical psychologists argued that psychological research can never be purely objective since it is laden with values and political interests inherent in the research community and in the societal structures that enable research to be carried out (Marks, 2002a). In fact, it can also be potentially used to reveal unequal power relations in society and suggest ways of helping liberate the impoverished and oppressed (Fox & Prilleltensky, 1997;Marks, 2002b;Parker, 1999;Prilleltensky & Prilleltensky, 2003;Willig, 1999). ...
... The ability to perceive the many things that we share, is compromised by the experience of isolation, and by reinforcing this ideology of individualism we are (a) de-emphasizing (at best), and ignoring (at worst) the social and cultural impacts that precipitate and maintain our psychological states, and (b) limiting ourselves to a blinkered and myopic approach to interventions that are typically directed toward individuals (cf. Prilleltensky & Prilleltensky,, 2003). As Ingham, Blissmer, and Wells Davidson (1999) have observed, "far from being politically neutral, the work of many applied sport psychologists unwittingly sustains the system of oppression and exploitation, and focuses on normalizing the individual's responses to such systems as if adjustment and accommodation are the only solutions to distress". ...
Article
Full-text available
The aim of this paper is to present a critical reflection on mental toughness using a creative analytic practice. In particular, we move from intrapersonal technical reflections to an altogether more interpersonal cultural analysis that (re)considers some of the assumptions that can underpin sport psychology practice. Specifically, in the ripples that extend from these initial technical reflections, we argue that it is important to understand vulnerability, and consider (a) wounded healers, (b) the ideology of individualism, and (c) the survivor bias to help make sense of current thinking and applied practice. Emerging from these ripples are a number of implications (naming elephants, tellability, neoliberalism) from which sport psychologists may reflect upon to enhance their own practice. In making visible the invisible, we conclude that vulnerability can no longer be ignored in sport psychology discourse, research, and practice. Should this story of vulnerability resonate, we encourage you, where appropriate to share this story.
... For example, future research should examine and compare the lived experience of resilience in women from various cultural backgrounds living in urban centers with greater access to culturally relevant supports and resources with women living in rural areas, where there are fewer resources available. A health and wellness framework that accounts for influences on health and resilience at micro, meso, and macro levels (e.g., Prilleltensky & Prilleltensky, 2003) may also be useful for conceptualizing future research at a broader contextual level. ...
Article
While resilience research in the context of intimate partner violence (IPV) is increasing, there remains little known about women's lived experience of resilience. Using a phenomenological approach, this study examined the experience of resilience for adult female survivors of IPV. Sixteen women who were currently experiencing or had previously experienced abuse by an intimate partner participated in semi-structured interviews. Resilience was experienced as multiple cognitive, emotional, and behavioral shifts across three theme areas: toward resistance, in the experience of control, and toward positivity. The results of this study suggest a number of applications for clinical practice and intervention.
... Research therefore can contribute to our quest for knowledge so that we can make meaning from the world around us. How our view of the world is framed by an awareness of one's own social position in their culture or social group is important (Prillelltensky & Prillelltensky, 2003). ...
... In hospital settings, staff practices are continuously disempowering patients. The rules, the biomedical culture, the frailty of the patient's condition, the expected "sick role", everything seems to contribute to reducing the patient's power and to increasing the professionals' power to control the situation (Sakalys, 2000, Faulkner, 2001b, 2001a, Prilleltensky and Prilleltensky, 2003. ...
... Under this reactive, ameliorative strategy, community practitioners serve clients with the primary aim of helping people cope with the negative aspects of society (Gil, 1998; Ife, 2002; Mullaly, 1997; Prilleltensky & Nelson, 2002). Short-term, individualistic approaches too often ignore the assets of their constituents and communities (Albee, 1986; Butcher & Robinson, 2007; Evans et al., 2011; McCubbin, 2009; Prilleltensky, 2005; Prilleltensky & Prilleltensky, 2003). Alternatively, critical or transformative community practice suggests a politicized role for human service practitioners and organizations to promote equality, solidarity, community, and social justice (Mullaly, 1997; Withorn, 1984). ...
Article
Full-text available
What does it mean to practice critically in community settings? How do counselors, psychologists, social workers, community development workers, and other human service practitioners get beyond patching up the wounded and sending them back to contend with the toxic conditions in communities and society? What individual and organizational beliefs and practices would support those in need while simultaneously contributing to changing social conditions? This paper explores a model of critical community practice that highlights the theoretical underpinnings, practical applications, and organizational implications of community practice that is more radical and transformative. It also serves as an introduction to the four papers that follow in this special section.
... Since then, research in health psychology began to focus on diverse areas, including: illness treatment and prevention; the role of psychological factors in health and illness; and improving health care services and policies [3][4][5]. Today, Division 38 has over 6000 formal members, one of the largest in the American association, and includes several rigorous research programs, involving: associations among clinically diagnosable mental disorders and the pathogenesis of physical ailments such as cardiovascular disease (clinical health psychology) [6,7]; effective health intervention, promotion and prevention of disease and illness in schools, work sites and "daily living" (public health psychology) [8,9]; community health justice and social action (community health psychology) [10][11][12][13]; the identification and comparison of major etiological agents of illness in a variety of cultures (cultural health psychology) [14][15]; critiques of mainstream "Western" approaches to and understandings of health and illness (critical health psychology) [16][17][18][19]; psychneuroimmunology [20,21]; and biological models linking the social world and physical health [22][23][24], to name a few. ...
Article
Full-text available
The current status of the “Biopsychosocial” Model in health psychology is contested and arguably exists in a stage of infancy. Despite original goals, medical researchers have developed theoretical and empirical integrations across bio-psycho-social domains only to a limited extent. This review article addresses this issue by making connections across research findings in health psychology and related medical fields in order to strengthen the associations across bio-psycho-social domains. In particular, research in sociosomatics, neuroplasticity and psychosocial genomics are in-troduced and explored. The role of “culture” as conceived of within the Biopsychosocial Model is also ambiguous and somewhat problematic. Arthur Klienman’s conceptions of culture as what is at stake for individuals in their local social and moral worlds is adopted to offer a critique of previous perspectives of culture and question its role amidst bio-psycho-social domains. Overall, a multilevel integrative or ‘holistic’ perspective is advanced to strengthen the Bi-opsychosocial Model for use within health psychology and biomedical research. In the end, some clinical implications are discussed.
... Os métodos qualitativos são ineficazes, por eles mesmos, para a resolução de questões internas da Psicologia da saúde (Chamberlain, 2000;Stam, 2000;Crossley, 2008 Algumas objeções foram feitas à proposta de Marks (2002) de apresentar a Psicologia da saúde crítica como uma das abordagens que compõem o campo teórico da Psicologia da saúde. Bolam e Chamberlain (2003) argumentam que a abordagem crítica fica em desvantagem se for compreendida como uma alternativa a outras formas de práticas em Psicologia da saúde, pois a orientação crítica pode ser aplicada a todos os tipos de prática (Prilleltensky & Prilleltensky, 2003 (Stam, 2000;Chamberlain, 2000;Crossley, 2001a;Crossley, 2001bCrossley, , 2008Marks, 2002 Prática profissional reflexiva: a literatura identifica quatro tipos de reflexividade que envolvem trabalhadores do campo da saúde: técnica, prática, processual e crítica (Yip, 2006). A reflexividade técnica relacionase ao conhecimento e à racionalidade técnica, e envolve habilidades para resolver problemas. ...
Article
Full-text available
This paper presents a discussion about health psychology in the hospital from a historical and ethical perspective. The essay explains how the development of this field was characterized by the emergence of two perspectives: the traditional health psychology and the critical health psychology. The model of four approaches to health psychology is presented and reformed to include the concept of general health psychology, and the practice in health psychology is discussed from the point of view of the concept of reflexivity. Finally, some questions derived from critical health psychology are asked about the psychologist's practice in the hospital setting.
... Critical psychologists argued that psychological research can never be purely objective since it is laden with values and political interests inherent in the research community and in the societal structures that enable research to be carried out (Marks, 2002a). In fact, it can also be potentially used to reveal unequal power relations in society and suggest ways of helping liberate the impoverished and oppressed (Fox & Prilleltensky, 1997;Marks, 2002b;Parker, 1999;Prilleltensky & Prilleltensky, 2003;Willig, 1999). ...
... Prilleltensky & Prilleltensky, 2003). In failing to mention religion and spirituality as a widely available cultural resource for empowerment and health,Oman and Thoresen (2003) argued that critical health psychology risks "a deDownloaded by [University of Saskatchewan Library] at 12:19 03 October 2013 ...
Article
Full-text available
The current status of the “biopsychosocial” model in health psy- chology is contested and arguably exists in a stage of infancy. Despite original goals, researchers have developed theoretical inte- grations across biopsychosocial domains only to a limited extent. In addition, the marginalization of “spirituality” in contempo- rary biopsychosocial health perspectives is questionable. This article addresses these issues by providing evidence that supports the inclu- sion of spirituality within current perspectives while at the same time discussing implications this inclusion bears on the concept of health. Overall, a biopsychosocial–spiritual or “holistic” perspective is advanced for use within health psychology, provided it can be approached from a multilevel integrative analysis. In the end, some clinical implications are discussed.
... Finally, this project reviews both direct and indirect approaches used with children, attempting to deepen the understanding of health and health risks and to develop strategies that will contribute to the reduction in suffering and an improvement in quality of life (Ferris, Maticka-Tyndale, Murray, Nelson, & Poland, 2004). The health psychological approach is central to wellness; it is both reactive to present concerns that children demonstrate, such as acting-out behaviour, depression and/or anxiety, and proactive to future concerns by developing programs that address the prospects of later development of health problems, including substance abuse, criminal activity and mental illness (Prilleltensky & Prilleltensky, 2003). This project addresses the following question: How can early intervention be incorporated into the school system to support children at-risk of later juvenile delinquency, substance abuse, and/or mental health concerns? ...
Article
Background Gambling studies literature is a space where discourses call objects such as ‘gambling harm reduction’ and ‘women harmed by gambling’ into being and give them status as namable and describable. Methodology and methods A poststructural feminist analysis of the positioning of women who gamble in gambling studies literature was carried out to explore possibilities and constraints for gambling harm reduction practices. Gambling studies literature was accessed to enable a range of historically emerging framings of women’s gambling practices and harm to be brought to light. Discourse analysis drew on key concepts (discourse, subjectivity, power/knowledge) and principles (reversal, discontinuity, specificity and exteriority) developed by Michel Foucault. Findings Gambling studies have constructed women as: ‘risky gamblers’, ‘vulnerable women’, and as subject to gendered socio-cultural determinants of gambling and harm. Dominant conceptualisations of women in gambling studies tend to bring individual women who gamble into focus, obscuring the social, governmental and commercial determinants of gambling and harm, and often reproducing some unhelpful gender stereotypes in the process. Conclusions Holistic, environmental and Indigenous women’s health discourses have the potential to shift gambling harm reduction from a health services approach to one that is focused on supporting community wellbeing. This includes women’s co-production and ownership of harm reduction strategies. It is concluded that opportunities women’s gambling harm reduction may be found in critical psychology, and/or approaches which emphasize coherent and critical gender analysis, collaborative action, community development and client-led practice.
Article
On the occasion of the 50th Anniversary of The Counseling Psychologist, we reflect on the many contributions that counseling psychologists have made and are poised to make in the areas of behavioral health and behavioral health care. We note that psychologists’ engagement in health promotion and prevention of behavioral, mental, and emotional disorders is consistent with counseling psychology values. We provide a concise review of theories that are widely applied in behavioral health contexts and discuss ways in which counseling psychologists may apply these theories to help ameliorate health disparities, empower communities to take control of their own health, and promote social justice. In addition, we highlight the need to create interdisciplinary partnerships to conduct culturally sensitive research on the bi-directional relationship between mental health and physical health. The article ends with wide-ranging implications and recommendations for theory development, research, training, practice, and advocacy.
Article
Anti-fat bias is a persistent and widespread barrier to body liberation that psychotherapists are ethically bound to do something about. Though academics and clinicians have written about the implications of weight stigma in psychotherapy, the prevalence of anti-fat bias in our profession remains and often goes unexamined. Here we explore the nature of anti-fat bias and reasons to shift to a weight-inclusive stance. We offer examples of how anti-fat bias operates in the therapy room and the harm it causes. Anti-fat bias and body-based oppression as forms of microaggressions are explored, and we make the case for body liberation as a social justice issue. We conclude with recommendations for addressing anti-fat bias, including: developing a liberatory consciousness, the importance of moving from awareness to action, examining our relationship to diet culture, ways to avoid stigmatizing language, bringing a social justice lens into the room, and doing our own work so that we stop locating the problem in people’s bodies and provide truly bias-free psychotherapy.
Article
This article explores the potential of complex adaptive systems theory to inform behaviour change research. A complex adaptive system describes a collection of heterogeneous agents interacting within a particular context, adapting to each other’s actions. In practical terms, this implies that behaviour change is 1) socially and culturally situated; 2) highly sensitive to small baseline differences in individuals, groups, and intervention components; and 3) determined by multiple components interacting “chaotically”. Two approaches to studying complex adaptive systems are briefly reviewed. Agent-based modelling is a computer simulation technique that allows researchers to investigate “what if” questions in a virtual environment. Applied qualitative research techniques, on the other hand, offer a way to examine what happens when an intervention is pursued in real-time, and to identify the sorts of rules and assumptions governing social action. Although these represent very different approaches to complexity, there may be scope for mixing these methods – for example, by grounding models in insights derived from qualitative fieldwork. Finally, I will argue that the concept of complex adaptive systems offers one opportunity to gain a deepened understanding of health-related practices, and to examine the social psychological processes that produce health-promoting or damaging actions.
Article
This study is a review of the literature regarding the psychologist 's insertion in the Brazilian public health system, his professional education and performance. It was observed that Psychology regulation as a profession occurred 45 years ago, and the psychologist 's insertion in public health only happened 20 years later, but even so it was non-contextualized and related only to mental health issues. According to authors, however, health psychology cannot be limited to mental health, but to the development of practices that may meet the needs of the population in a larger context. As for professional education, it is recommended that the emphasis should be placed on improving theoretical and technological knowledge in addition to curricular practices that may favor and give support to their performance models, as well as extend their service to a global context, particularly focusing on the local needs and proposals directed to public health.
Chapter
Contrary to prevalent notions that well-being is a personal issue, in this chapter we argue that it is also relational, organizational and communal. If we were to define well-being strictly in terms of subjective reports, as most of the literature on the topic does, we would be hard pressed to denote organizational or communal well-being. After all, the walls of organizations or the streets of communities do not feel or report ill-or well-being. However, if we define well-being as inclusive of social indicators such as levels of unemployment, organizational climate and social capital, the story changes dramatically. Our assumption is that levels of relational, organizational and communal well-being, as measured by different methods and indicators, have a potent influence on the well-being of a particular individual.
Chapter
This chapter traces the developments in the three interrelated fields of health, namely, epidemiology, medical sociology and health psychology. In epidemiology, people like Chadwick, Snow, Farr and Virchow began to question the bio-centricism of medical thought and highlighted the environmental and economic factors as responsible for the occurrence of certain kinds of diseases in certain kinds of populations. The sanitary movements in England in the late nineteenth century and the discussions on economic causation of disease (relating disease with poverty) are instances of the impact of methodological holism on epidemiology. The entire shift of focus in epidemiological studies from the population to an individual, from social, economic and natural environmental factors of disease aetiology to behavioural and bio-chemo-physiological factors of disease aetiology, is part and parcel of the shift in the philosophical paradigm from methodological holism to methodological individualism. In medical sociology, the prominent figures included Talcott Parsons, Evert Hughes, Robert Merton and August Hollingshead. Medical sociology can be described as the study of social factors in health and illness (referring to illness as the experience of becoming and being ill and its behavioural counterparts) or as the construction of medical health and illness, reality and social factors in health care. Unfortunately, it has restricted itself to ‘theories of middle range’ and to even narrower hypotheses, which in the last few years have tended to hide behind the pretentious concept of ‘models’. Medical sociology then becomes a mere instrument of propaganda for the welfare state or a producer of ideologies, as formulated by the German sociologist Lepsius. In health psychology, the impact of methodological individualism has been overwhelming, manifesting itself in the form of behaviourism. Behaviourism has been the most instrumental force in structuring the cult of ‘victim blaming’ in public health.
Article
In an ethnographically designed study, guided by a critical community psychology framework, Black staff members at a historically White Afrikaans university campus conducted email conversations relating to issues of race, social justice and reconciliation. The conversations were initiated by the author (Black) who mainly used prompts found in the local institutional context to elicit responses from colleagues. A critical discourse approach to thematic analysis of the email conversations was followed. The main findings are: Compared to the potential number of respondents (32 Black staff members or 18% of all faculty staff), very few colleagues (9 or 28% of Black staff members) responded via email to the invitations but, when met in person, all expressed strong views on the topics or prompts used in the initialising emails. The critical discourse approach revealed clear psychopolitical awareness and strong discourses of fear, powerlessness and bitterness, as well as a discourse of non-engagement. These discourses appeared in all three domains of analysis: local, institutional and societal. Theoretical explication is sought mainly in resistance theory for the discourse of non-engagement and the scarcity of responses located in the local domain. Transformative resistance is suggested so that alternative discourses are inculcated, at least, in faculties of education at some historically White Afrikaans university campuses.
Article
This study describes the nature of quality of life (QoL) from the perspective of older South Africans (n = 41) in residential care facilities (female =75%; age range 62-95 years) The residents participated in individual in-depth interviews and focus groups They also set down their narrative reflections on their QoL in journals Data were analysed by means of interpretative phenomenological analysis Findings reveal the resident older South Africans regard QoL as a spiritually informed worldview of life events, coping with challenges and being mindful of others The residents perceived QoL to include proximity and quality and reciprocity with others QoL among older people is context and people specific
Article
While interdisciplinary knowledge is critical to moving beyond categorical ways of knowing, this comes with its own set of pedagogical challenges. We contend that acknowledging existing knowledge hierarchies and epistemological differences, recognizing the ideological baggage that students' bring to the classroom in terms of their understandings of health, embracing intellectual uncertainty, and encouraging learning-as-witnessing, are fundamental to fostering an interdisciplinary pedagogy that opens up a space for dialogue between psychology and sociology. We draw on the case of obesity and physical inactivity in the Canadian context as an exemplar of a kinesiology dilemma in which both psychology and sociology have important, albeit different, roles to play. We suggest that the anxiety provoked by such an approach is not only necessary but productive to forge an intellectual space where psychologists and sociologists may better hear one another.
Book
Full-text available
Shifting Paradigms in Public Health: From Holism to Individualism This transdisciplinary volume outlines the development of public health paradigms across the ages in a global context and argues that public health has seemingly lost its raison d’être, that is, a population perspective. The older, philosophical approach in public health involved a holistic, population-based understanding that emphasized historicity and interrelatedness to study health and disease in their larger socio-economic and political moorings. A newer tradition, which developed in the late 19th century following the acceptance of the germ theory in medicine, created positivist transitions in epidemiology. In the form of risk factors, a reductionist model of health and disease became pervasive in clinical and molecular epidemiology. The author shows how positivism and the concept of individualism removed from public health thinking the consideration of historical, social and economic influences that shape disease occurrence and the interventions chosen for a population. He states that the neglect of the multifactorial approach in contemporary public health thought has led to growing health inequalities in both the developed and the developing world. He further suggests that the concept of ‘social capital’ in public health, which is being hailed as a resurgence of holism, is in reality a sophisticated and extended version of individualism. The author addresses paradigmatic shifts in public health discourse from the ancient to the modern world, with a focus on epidemiology. The author also draws on perspectives from the social sciences, medicine, and history, while discussing the shift in public health discourses from a population focus to methodological individualism, with adverse consequences for the population. http://www.springer.com/public+health/book/978-81-322-1643-8
Article
This article investigates the way the methodology of process drama, and specifically the convention of dramatised poetry, can enhance the anger-management skills of adolescent girls. The article presents findings from a recent study that set out to teach anger-management skills to adolescent girls using process drama conventions. The argument explores the notion of process drama propounded by the prominent applied drama scholar Cecily O'Neill (1995) and the applicability of this methodology for stimulating the perception, awareness and identification of various forms of anger as prerequisites to anger management in adolescent girls. As the adolescent girl finds herself at the crossroads of childhood and adulthood, emotions of frustration and anger towards parents and peer groups often surface. It is therefore beneficial for her to be empowered with the insight and skills required to identify and manage her anger. The fictitious world within process drama creates a safe space where sensitive issues can be explored without uncovering personal issues. Poetry is, in many instances, loaded with emotional content and can therefore be used as a vehicle for considering emotional issues that would otherwise not be possible. This article therefore reports on a multidiscipline research project, namely the dramatisation of poetry, as a convention of the methodology of process drama, to enhance anger management, as an emotional competence in the 14- to 15-year-old adolescent girl.
Article
Full-text available
There is a rise in calls for counselors to be advocates for social justice. Counselors can meet the growing need to expand their roles to include advocacy by using the ACA (American Counseling Association) Advocacy Competencies (J. A. Lewis, M. S. Arnold, R. House, & R. L. Toporek, 2002). This article operationalizes the client/student level of the competencies and explores implications for the profession.
Article
Fibromyalgia is a chronic musculoskeletal pain disorder that affects an estimated 5 million adults in the US. The hallmark is burning, searing, tingling, shooting, stabbing, deep aching, or sharp pain. Fibromyalgia is generally considered to be a "central sensitivity syndrome" where central sensitization is regarded as the cause of pain in its own right. Nonetheless, the case continues to be made that all central and spatially distributed peripheral components of fibromyalgia pain would fade if the peripheral generators could be silenced. Although neural mechanisms are clearly important in pain sensitivity, cognitive and social mechanisms also need to be considered. The aim of this review is to examine four mechanisms responsible for heightened pain sensitivity in fibromyalgia: peripheral sensitization, central sensitization, cognitive-emotional sensitization, and interpersonal sensitization. The purpose of framing the review in terms of pain sensitivity in fibromyalgia is to highlight that different mechanisms of sensitization are appropriately regarded as intervening variables when it comes to understanding individual differences in the experience of pain. The paper concludes by considering the implications of the findings of the review for explanations of fibromyalgia pain by nurses working in multidisciplinary teams. The trend appears to be able to explain the cause of fibromyalgia pain in terms of sensitization per se. The recommended alternative is to explain fibromyalgia pain in terms of changes in pain sensitivity and the role of underlying neural and psychosocial mechanisms.
Article
Full-text available
Since the beginning of the epidemic, Psychology has contributed in the fight against AIDS through psychological care for those living with AIDS, their relatives and STD/AIDS prevention. Related to the AIDS social movement, a new context of work for psychologists emerged: the AIDS non-governmental organizations. Considering the scarcity of Brazilian literature about the contribution of Psychology in this context, the objective of this article is to describe the psychological practices developed at an AIDS non-governmental organization in Ribeirão Preto/São Paulo/Brazil, the Grupo Humanitário de Incentivo à Vida. The diversity of activities performed by psychologists in this NGO goes from individual psychotherapy and coordination of different types of group to the organization of the structure of the NGO and the supervision of its political actions. Among the challenges faced by the psychologist in this context are the integration between professional practice and social activism and the relationship between the HIV carrier and the psychologist. They point out how AIDS challenges traditional professional practices and demands changes in healthcare.
Article
This study employed an action research model known as the community wellness cycle of praxis in research with culturally diverse community members from the St Albans region (Melbourne, Australia). The major aim of the study was to gain a theoretical and pragmatic understanding of well-being from a multicultural perspective. In order to meet this aim, a qualitative study was designed to find out (1) What are the community ideals; needs; and strengths of residents of St Albans, and (2) What actions can be undertaken to improve the well-being of the community? The research involved focus groups with a total of 29 Anglo, Maltese, Vietnamese and Italian community members. The first research question was addressed by asking community members systematically about positive and negative aspects of personal, relational and collective well-being. The second research question was addressed by asking community members to generate ideas on what could be done to improve well-being and by identifying issues of concern that emerged throughout the research. The issues identified by participants offer a rich picture of community ideals, strengths and needs, as well as possible actions that could improve personal, relational and collective wellness in St Albans.
Article
The authors adopt a historical perspective and exhibit the debates held within Health Psychology in the Anglo-Saxon universe since the 1980s. They show how the development of the North-American mainstream approach has aroused several objections. These objections were firstly methodological (qualitative methods) then, theoretical and epistemological. This evolution has allowed the creation of two main approaches: Qualitative Health Psychology and Critical Health Psychology. While this course is not yet well-known in France, it illustrates, however, the present developments and the richness of the discussion within Anglo-Saxon Psychology. The conclusion shows that these debates should be known and accepted if we intend to improve our models in Psychology, so that they take into account the situated nature of the human being, its dynamics, its temporality as well and its complexity. Hence, Health Psychology perspectives as a whole will gain in pertinence in the fields of research and intervention.
Article
Full-text available
The field of research and practice that is generally incorporated under the rubric of "health communication" is currently dominated by social psychological models of behavior and theoretical perspectives informed by the stimulus–response school of communication. This article argues that the field needs to incorporate critical cultural and political theory into its scholarly inquiry and informed practice to a greater extent than it currently does.
Article
Full-text available
Violence and harassment in the workplace have garnered substantial public and research attention in the past decade. Most attention has been focused on the more extreme forms of physical violence such as homicide and, to a lesser degree, sexual and racial harassment in the workplace. However, recent surveys of workplaces suggest there is another form of violence that is more frequent, has similar effects as physical, sexual, and racial violence, yet appears to be more socially acceptable. Emotional abuse is the term coined in this review to capture the hostile verbal and nonverbal behaviors that are not explicitly tied to sexual or racial content yet are directed at gaining compliance from others. Examples of these behaviors include yelling or screaming, use of derogatory names, the "silent treatment," withholding of necessary information, aggressive eye contact, negative rumors, explosive outbursts of anger, and ridiculing someone in front of others. Despite increasing public awareness, systematic research has been slow in coming. This article reviews the currently available research literature in an effort to identify what is known and what questions are still unanswered. Theoretical propositions are derived from researchers' definitions of abuse and examined with respect to workplace abuse research and other literatures (e.g., occupational stress, destructive criticism, sexual harassment). Additional areas of target responses and antecedent conditions for emotional abuse are also explored. Discussion throughout the review emphasizes future directions for research and the implications for organizational policies and prevention/intervention efforts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
In Health Psychology in Context it was argued that, if we are to make any sense of it, the subject matter of health psychology must be understood in the context of social, political and economic forces. That theme is continued here with a brief examination of how freedom, responsibility and power enter into the generation of conflicts, including the recent outbreak of war. The interplay of commercial and state interests in academic and health research settings is then discussed. The assumptions, values and meanings of work in health psychology are examined in that light. These are divided between four evolving approaches in health psychology: clinical, public, community and critical health psychology. A framework is presented for positioning these approaches within a system for the production of health and social care.
Article
Full-text available
The increasing turn to qualitative research in health psychology raises a number of issues about the appropriate use and relevance of qualitative methods in this field. In this article I raise concerns about methodolatry: the privileging of methodological concerns over other considerations in qualitative health research. I argue that qualitative researchers are in danger of reifying methods in the same way as their colleagues in quantitative research have done for some time. Reasons for the pre-eminence of methods are discussed briefly and their consequences considered. The latter include: a concern with 'proper' or 'correct' methods; a focus on description at the expense of interpretation; a concern with issues of validity and generalizability; an avoidance of theory; an avoidance of the critical; and the stance of the researcher. I offer some suggestions for avoiding methodolatry and some opinions on how we might develop and use qualitative research more effectively in health psychology.
Article
Full-text available
Health and illness in contemporary psychology are remarkably undertheorized, with the consequence that implicit definitions of these topics are unquestionably imported into health psychology. Largely inspired and oriented to the medical system, health psychology is often subservient to biomedically inspired theory or directed to solving the problems of the health care system, not those of its patients or those who might ultimately benefit from health knowledge. Qualitative approaches have attempted to reintroduce the voice of the patient/sufferer/individual back into health psychology but without adequate theoretical integration this work has been marginalized and ignored by mainstream health psychology in the service of medical modelling. The point is not to develop a health psychology as an exclusive disciplinary enclave but rather to open up the possibilities of a responsible knowing. Using Kathryn Addelson's work on professional knowing I argue that the collective activity that constitutes health psychology can be made more explicit not only by devising reflexive theories and practices but by focusing on what the outcomes of that activity might be. Functional theories of health and illness, on the other hand, obscure our epistemological and moral commitments.
Article
Full-text available
Determining the patient's major reasons for seeking care is of critical importance in a successful medical encounter. To study the physician's role in soliciting and developing the patient's concerns at the outset of a clinical encounter, 74 office visits were recorded. In only 17 (23%) of the visits was the patient provided the opportunity to complete his or her opening statement of concerns. In 51 (69%) of the visits the physician interrupted the patient's statement and directed questions toward a specific concern; in only 1 of these 51 visits was the patient afforded the opportunity to complete the opening statement. In six (8%) return visits, no solicitation whatever was made. Physicians play an active role in regulating the quantity of information elicited at the beginning of the clinical encounter, and use closed-ended questioning to control the discourse. The consequence of this controlled style is the premature interruption of patients, resulting in the potential loss of relevant information.
Article
Full-text available
There is a disquieting sense that many theoretically based health behavior change programs have been only minimally effective. Part of the problem may be that most current theories have considerable overlap, primarily focus on intraindividual and other individual-level variables, and tend to neglect the environment and issues related to program implementation. A framework is developed for health promotion and disease prevention programs that makes use of epidemiological and health indicator data and Healthy People 2000 goals to prioritize efforts, provides a schema to formulate programs on the basis of timing (prevention) and level of intervention, and addresses the marketing approach to target and implement programs. The framework integrates current theories to guide marketing and phases of research.
Article
How can psychologists incorporate recent insights about power, values and inequality in their work? What is the role of social justice in the practice of psychology? In this highly readable book Prilleltensky and Nelson tackle these questions and propose workable solutions. This is the first book to translate into action the principles of critical psychology. Using a value-based framework the authors propose guidelines for training and critical practice in clinical, counselling, educational, health, community, and work settings. The authors base their approach on a combination of values for the promotion of personal, interpersonal, and collective well-being. They propose a set of values consisting of self determination, caring and compassion, health, respect for diversity, participation, community support and social justice. Because of its wide coverage, the book should be of interest to students and practitioners in psychology, mental health, and to users of psychological services in most fields of practice. Doing Psychology Critically: § translates critical psychology theory into practice § applies to most fields of applied psychology § is written in an accessible style § includes tables and diagrams that illustrate recommendations for practice § follows a coherent framework § is a useful resource for training programmes in health, clinical, counselling, educational, community, and organisational psychology ISAAC PRILLELTENSKY is Professor of Psychology and Director of the Wellness Promotion Unit at Victoria University in Melbourne. He is the author of The Morals and Politics of Psychology and co-editor of Critical Psychology: An Introduction (with Dennis Fox) and Promoting Family Wellness and Preventing Child Maltreatment (with Geoffrey Nelson and Leslea Peirson). GEOFFREY NELSON is Professor of Psychology at Wilfrid Laurier University in Canada. He has served as Editor of the Canadian Journal of Community Mental Health and is the author of Shifting the Paradigm in Community Mental Health (with John Lord and Joanna Ochocka) and co-editor of Promoting Family Wellness: Fundamentals for Thinking and Action (with Isaac Prilleltensky and Leslea Peirson).
Chapter
This chapter will provide an analysis of the concept of health promotion which is mainly based on the formulation which the World Health Organisation (WHO) has developed, largely since the launch of the movement to achieve Health for All by the Year 2000 (HFA2000) at the 30th World Health Assembly in 1977. Both ideological and functional aspects of health promotion will be identified and, more particularly, its commitment to empowerment will be discussed. The importance of the potentially synergistic relationship between education and healthy public policy will also be emphasised. The implications of these various key features of health promotion for professional practice in a number of key settings and contexts will then be explored.
Article
This paper provides a preliminary address to the question of whether mainstream health psychology needs to be 'rethought'. In order to do this, it first provides a definition of 'mainstream' health psychology, characterizing it as a discipline wedded to the increasingly popular 'biopsychosocial' model of health care and practice. Because of the need to provide data consistent with 'biomedical' data and amenable to statistic analysis and modelling, commitment to the biopsychosocial model routinely involves the quantification of subjective experiences of health and illness. Accordingly, health psychology has become increasingly acceptable to medical clinicians and researchers who are familiar with the language and procedures of quantitative investigation. But this paper asks, at what cost? Taking a number of broad substantive areas of health psychology as illustrative (e.g. health behaviour, pain, disease, death and dying), it is argued that a characteristic feature of people's subjective orientation to such issues involves reflexive consideration of ethical, moral and emotional issues. It is argued that mainstream health psychology largely bypasses such issues in its pursuit of a goal-oriented 'technical' programme akin to that of medical science and practice. Not only does this represent a relinquishing of the unique subject matter of human (health,) psychology, it may also be unethical, potentially perpetuating the objectification and depersonalization experienced by so many people in health care.
Article
This paper provides a preliminary address to the question of whether mainstream health psychology needs to be 'rethought'. In order to do this, it first provides a definition of 'mainstream' health psychology, characterizing it as a discipline wedded to the increasingly popular 'biopsychosocial' model of health care and practice. Because of the need to provide data consistent with 'biomedical' data and amenable to statistic analysis and modelling, commitment to the biopsychosocial model routinely involves the quantification of subjective experiences of health and illness. Accordingly, health psychology has become increasingly acceptable to medical clinicians and researchers who are familiar with the language and procedures of quantitative investigation. But this paper asks, at what cost? Taking a number of broad substantive areas of health psychology as illustrative (e.g. health behaviour, pain, disease, death and dying), it is argued that a characteristic feature of people's subjective orientation to such issues involves reflexive consideration of ethical, moral and emotional issues. It is argued that mainstream health psychology largely bypasses such issues in its pursuit of a goal-oriented 'technical' programme akin to that of medical science and practice. Not only does this represent a relinquishing of the unique subject matter of human (health) psychology, it may also be unethical, potentially perpetuating the objectification and depersonalization experienced by so many people in health care.
Article
The article describes the findings of outcome and process evaluations of a value-based approach to smoking prevention. The program was conducted with a community of immigrants from Latin America living in Canada. The approach is based on participatory community planning, sensitivity to cultural diversity, and on a comprehensive philosophy of health. Qualitative and quantitative methods were used to assess outcomes and processes. Quantitative measures indicate that when compared to a control group, program children, ages 8 to 14, engaged in more community activism and showed a decrease in intentions to smoke; however, no difference was found in knowledge regarding tobacco use. The qualitative evaluation indicated that parents, children, and staff were highly satisfied with the impact of the program as well as with the processes employed to deliver it. Implications for improving the program and a value-based model for program development and evaluation are discussed.
Article
This paper argues that traditional psychological approaches to health promotion and education, relying predominantly on behaviourist and cognitivist models of behaviour, fail to address the complexity of health related behaviours. The emergence of more critical approaches within health psychology has initiated a greater appreciation of the way in which “healthy” and “risky” behaviours are tied, in a complex fashion, to issues of self, identity and morality. Drawing on such recent critical research, this paper documents the way in which health related behaviours can be understood in the context of “lay rationalities” in which values other than health (as defined by health professionals) take precedence. In particular, engagement in “healthy” and “risky” behaviours incorporates complex moral and value laden meanings. It is argued that such behaviours constitute important strategies of “survival” and ways of adapting to life in contemporary society. This issues forth critical questions relating to the ethics of attempting to change peoples' health related behaviours. Should the pursuit of health be “imposed” over other important human values? A consideration of the social and cultural structuring of individual perceptions of health leads the paper to the conclusion that non-intervention runs the risk of ignoring and perpetuating health inequalities. Nevertheless, if health promotion and education is to succeed, more complex understandings are required.
Article
This article introduces the special issue entitled ‘Power, Control and Health’. The five articles in this issue, using qualitative observation and theory-building, deconstruct individualistic explanations of the roles of power, empowerment, control, self-efficacy, etc. in producing health and well-being outcomes, and reconstruct models and pathways to population health and well-being that are profoundly anchored in the social, economic and political dimensions of human life which create, structure, and reinforce power and powerlessness at individual and collective levels. The theory developed here contributes to the understanding of how population health and well-being are intimately related to and are consequences of power and powerlessness. This is the first published collection addressing the etiology of population health from the perspective of power and powerlessness; as such it not only advances knowledge about the determinants of population health, but provides a more scientific basis for interventions aimed at ‘empowering’ marginalized persons and classes of persons. The topics dealt with include a deconstruction of self-efficacy theory and the ‘socialization’ of that concept, a model concerned with work and work stress for pathways to health and illness emphasizing class and gender, reflections on the meaning of empowerment in the prevention of unsafe sex practices, a study of empowerment and recovery in the context of changes in a community mental health system, and a systemic model based on the lifecourse perspective for child wellness and resilience centred around power and control. Those articles are followed by a commentary which stresses the need to ‘depsychologize’ community psychology, noting that even the articles in this special issue retain notable vestiges of reductionism to the individual level. This introduction describes the evolution of the public health field into the ‘population health field’ and the pertinence of a focus on power for understanding pathways to health, illness and well-being. Copyright © 2001 John Wiley & Sons, Ltd.
Article
The literature on powerlessness, empowerment and control tends to be adult-centric and psycho-centric. It is adult-centric in that most studies deal with the experience of powerlessness in adults or interpret children's realities from an adult point of view. At the same time, the literature is quite psycho-centric in that it focuses on the emotional and cognitive dimensions of powerlessness, to the relative neglect of social and political power. The purpose of this article is to redress these biases and elucidate the role of power and control in pathways toward health, resilience and problems in children's lives. We define wellness as a satisfactory state of affairs, brought about by the acquisition and development of material and psychological resources, participation and self-determination, competence and self-efficacy. Power and control are defined as opportunities afforded by social, community, and family environments to develop these three dimensions of health and wellness. We highlight basic research which describes pathways toward wellness, resilience, and problems in life, as well as applied research on promising interventions to improve children's health and wellness. This literature is interpreted in terms of our conceptual framework that links power/control and wellness through the three dimensions that we have proposed. Copyright © 2001 John Wiley & Sons, Ltd.
Article
This article discusses three key traditions of feminist research: positivist empiricist, experiential and discursive. It explores the ways in which each is used in developing understandings of women's health and improving health care services, focusing in particular on breast cancer research and activism, including my own work in this area. It is argued that all three research traditions are important for advancing feminist political goals: positivist empiricism enables us to expose the biases of mainstream health research and to develop better (i.e. more objective) research; experiential approaches enable us to engage with the diversity of women's subjective experiences of health and health care; and discursive research enables us to explore issues related to identity management, accountability of conduct and the moral order of social life surrounding health and illness.
Article
Health psychology has tended to undervalue analyses of media representations of health, disease and illness. In this article I argue that critical approaches to media texts and images are valuable for health psychologists because: (1) individuals are socially located and gain their beliefs about health and illness from the discourses and constructions that are available to them; (2) media representations of health, illness and disease produce and reproduce meaning concerning health and illness, for lay people and professionals alike; and (3) media representations mediate individuals’ lived experiences. These arguments are illustrated throughout with examples from critical and feminist research on representations of women, menopause and midlife. I go on to argue that critical approaches are particularly important in analysing media representations because they explicitly examine the social, cultural and political context of health and illness. Critical approaches increase awareness of control and power issues surrounding dominant representations and also provide possibilities for change and resistance.
Article
The topic of the body is now firmly on the agenda for psychology, as it has been for sociology for some time. What contribution will health psychology make to this debate? This article argues that the biomedical view of the physical body is inappropriate for a psychology addressing the key concerns of suffering and healing. Instead, health psychology needs to theorize what it means to be embodied in the context of illness and of health care. To do this requires investigation of the practical relationships between staff and patients as well as of experiences of sufferers. By reflecting critically upon the relationship between clinical practice and the conceptualization of the body, a health psychology embracing the idea of embodiment becomes possible.
Article
Health psychology generally prioritizes scientific method as its means of enquiry, and positivism as its theoretical foundation. In the broader domain of social psychology, however, we are now seeing the emergence of a new paradigm, 'critical social psychology', which draws extensively upon postmodern theorizing, and, in particular, discursive methods of analysis and inquiry. In this article, I describe what is meant by critical social psychology, how it differs from the mainstream, and examine some of its implications for health psychology. My aim is to open up debate between mainstream and critical approaches. In adopting an explicit challenge to the way health psychology is currently conceived, it invites dialogue over the methods, theorization and practical applications of our discipline.
Article
Health promotion and disease prevention programs are becoming important components of contemporary health care. There are at least 2 pathways to the enhancement of population health status through disease prevention. The first pathway requires the early diagnosis and treatment of disease. The second pathway promotes healthy lifestyles and disregards the requirement that a condition must be diagnosed before intervention is recommended. Data from several evaluations suggest that prevention efforts that rely on diagnosis have produced somewhat limited benefits, whereas primary prevention efforts may have substantial benefits. Current health policy places greater emphasis on secondary prevention. The objectives of improved population health might be better achieved by devoting relatively more resources to primary prevention through the promotion of healthy behaviors.
Article
Differences in the health of individuals reflect inherent features of the societies in which they live. The way a society organizes itself and delivers wellbeing to its members are major determinants of health. Social, economic and political factors have an important influence on health and longevity. Social position and lifestyle only partially explain ill health. Psychosocial factors, such as a sense of isolation, deprivation or loss of control, are also important. Governments can reduce health inequalities by ensuring that all policies are assessed for their potential impact on the health of all sectors of society.
The physician and the patient
  • C Samson
Health and the psychosocial environment at work
  • M Marmot
  • J Siegrist
  • T Theorell
  • A Feeney