Historical Overview

Modern Ayurveda

Ayurveda the Science of Life

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The theory and practice of holistic health, i.e., the view that there are delicate interrelationships between the mind and the body, are found in ancient literary documents from Babylonia and Greece. On the theoretical level, for example, Hippocrates proposed a relationship between bodily fluids or humors and personality temperaments. On the practice level, physicians embraced the holistic approach to health by virtue of having multiple roles: philosophers-teachers, priests, and healers.

The 17th century, however, marked the demise of holistic health. The traditional view of the reciprocal relationship between the psyche and the soma was considered unscientific. It culminated in the relegation of the study of the mind to religion and philosophy and the study of the body to physical medicine. For example, the dualistic view of health espoused by the French philosopher Rene Descartes was further entrenched in medical research and practice by the discovery in the 19 th century of microorganisms as causal agents in certain diseases. Mechanical laws or physiological principles assumed acceptable approaches to the science and practice of medicine.

The strict dualistic approach to health mellowed in the mid-19th century, and holistic health reemerged in the 20th century. Renewed interest in holistic health was due primarily to the inherent limitations of the biomedical approach. The biomedical model presented difficulties in the diagnostic classification of diseases. It did not provide complete understanding of the etiology and maintenance of a variety of diseases, nor the comprehensive treatment of physical disorders. For example, the dualistic orientation of medicine was a source of puzzlement for those dealing with disorders in which the influence of the "emotions of the mind" seemed apparent (McMahon & Halstrup, 1980). An individual with an unexplained pain in the back baffled practitioners with a strictly biomedical model. An important consequence of the inherent limitations of the biomedical approach to health was the gradual emergence of "an ambiguously defined diagnostic category . . . called 'nervous' . . . to accommodate what we know today as 'psychosomatic' disorders" (McMahon & Halstrup, 1980).

A second important historical consequence of the limitation of the biomedical approach to health was the emergence of the psychoanalytic and psycho-dynamic theories (Alexander, 1950), in particular that of Sigmund Freud. The psychoanalytic/psychodynamic theories postulated unconscious mechanisms in physiological processes and contributed to the growth of the field of psy-chophysiological medicine (e.g., Wolff, 1953). Social and psychological factors were investigated in physical health and well-being and contributed to the development of effective psychological approaches to the treatment of physical disorders (Feuerstein, Labbe, & Kuczmierczyk, 1986; Gatchel & Baum, 1983; Lipowski, 1977). Health psychology contributed significantly to the mental health and developmental disabilities components of health in the aftermath of World War II. Since the 1960s, the contribution of health psychology to the integration of the behavioral sciences with the science and practice of medicine has been noteworthy (Carmody & Matarazzo, 1991; Matarazzo, 1980; Schofield, 1969). The development of health psychology as the 38th division of the American Psychological Association (APA) in 1978 and the establishment of several health psychology journals since 1982 are testimony to the significant role that psychology played in the field of behavioral medicine.

The history of health psychology in Canada is not well documented (Hearn & Evans, 1993). While Canadian psychology entered into the field of health through medicine early in the 20th century, there was difficulty defining its role both in medical schools and within the health care system. The two major operative reasons were the dominance of the biomedical model in medicine and the experimental orientation of psychology (Hearn & Evans, 1993; Matheson, 1983). Nevertheless, the Section of Health Psychology was established as Section 8 of the Canadian Psychological Association in 1980. The factors that provided the impetus for the eventual birth of health psychology in Canada were manifold. Psychologists became involved in the physical rehabilitation of World War I veterans. Psychologists also established psychology departments as autonomous entities in general hospitals. Needless to say, the numbers of psychologists working with physicians and their clientele continue to grow. A brief sketch of the short but explosive history of health psychology in North America and Europe is presented in Table 1.3.

The field of health psychology in North America and Europe has evolved considerably and is in a state of maturity, with continued potential for growth and development. For example, four years after the foundation of Division 38, a membership of 2400 for the field of health psychology was reported (Belar, Wilson, & Hughes, 1982). Surveys of education and training in health psychology at the predoctoral, internship, and postdoctoral levels have shown considerable opportunities and growth in these programs (Belar & Siegel, 1983; Belar et al., table 1.3 Historical Landmarks in Health Psychology

1975 National Register of Health Service Providers in Psychology

1978 Foundation of Division 38, Health Psychology, American Psychological Association

1980 Foundation of Section 8, Health Psychology, Canadian Psychological Association

1982 Publication of first issue of Health Psychology

1983 Arden House Training Conference

1984 Foundation of Council of Directors of Health Psychology Training Programs

1985 Publication of first issue of Psychology and Health

1986 European Health Psychology Society

1987 Canadian Register of Health Service Providers in Psychology

1992 European Federation of Professional Psychologists' Associations Task Force on Health

Psychology

1993 Full affiliation status of American Board of Health Psychology with American Board of

Professional Psychology

1993 Publication of the first issue of the Canadian Health Psychologist

1994 Emergence of cross-cultural health psychology

1996 Publication of the first issue of Journal of Health Psychology

1996 Publication of the first issue of British Journal of Health Psychology

1997 Formal APA recognition of Health Psychology as a Specialty

1982; Gentry, Street, Masur, & Askin, 1981). Whereas a survey of graduate training programs in psychology in 1980 identified 6 of 42 programs offering pre-doctoral training in health psychology within another area of psychology (Belar et al, 1982), about a decade later, 46 doctoral programs with a primary focus on health psychology were listed in the 1991 Division of Health Psychology. At present, health psychologists play a vital scientist-practitioner role on a variety of health care teams, including anesthesiology, cardiology, dentistry, family practice, oncology, pediatrics, and rehabilitation.

Several factors, summarized in Table 1.4, have contributed to the maturity of the field and its potential for continued growth (Bishop, 1994; Carmody & Matarazzo, 1991; Marks, 1996; Sarafino, 1998; Taylor, 1999). The prevailing biomedical model of health has been incomplete in explaining health behavior. The model has also been limited in its focus on infectious disease, oblivious to behavioral sciences contributions to health behavior, and invariant with respect to issues pertaining to chronic care and illness prevention. The fields of behavioral medicine, behavioral health, and health psychology have made significant scientific and practical advancements in chronic pain, cardiovascular disease, neurological disorders, behavioral oncology, and the psychology of treatment adherence (Carmody & Matarazzo, 1991). Issues relating to quality of life, health care costs, and alternate approaches to traditional health care, however, have been of concern from both the biomedical and biopsychosocial perspectives on health.

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