Psychology of Health and Illness
This paper is dedicated to the study of most popular approaches in the social psychology and their application to a real-life situation. Approaches that will be considered are: biological, cognitive, behaviourist, humanistic and psychodynamic. The latter two will be used to analyse the situation. The term of psychology will be also described along with its relevance in the nursing practice. In particular, the ways in which psychological principles can be realised in practice will be shown.
Psychology is the science dedicated to the laws of the development and functioning of the psyche as a special form of life. It is the scope of knowledge about the inner – psychic – world of people. The term originated in the XVIII century means the actual doctrine of the soul, or science of the soul. The main goal of this science is understanding of groups and individuals by analysing specific cases and defining general principles.
Among the most important concepts that will be used in this paper there are:
Perception – the process of attaining understanding and awareness of the person’s environment by the way of interpreting and organizing sensory information.
Cognition – mental processes, including remembering, attention, understanding and producing language, making decisions, and solving problems.
Emotion – complex psychophysiological experience that a person has when being in interaction with external and internal influences.
Behaviour – defined as mannerisms and actions that are made by systems, organisms and artificial entities when they interact with the environment.
PSYCHOLOGY IN THE NURSING CARE
One of the main factors influencing interaction between the sciences of psychology and nursing is their common goal – understanding biological and emotional needs of the patients. Nurses usually have a function of not only providing basic care, but also developing the ability of individual to become more independent and regain self-confidence if it is necessary (Barker, 2007). In any case, they offer support to the person, which is very topical in the period of patient’s recovery.
Among the ways psychology can help in the nursing practice is changing people’s behaviour and thought patterns in particular. The nurse that can engage patients into the positive mode of thinking can be of great help to patients, speeding the recovery process considerably (Halligan and Aylward, 2006). Thus, when nurses understand the necessity of incorporating psychological principles and approaches into their practice, and learn how to do it properly, have all the chances to become better professionals.
OVERVIEW OF BIOLOGICAL, COGNITIVE AND BEHAVIOURIST APPROACHES
The first approach that is going to be considered is biological. Its main focus is the study of the ways systems of the human body interact between one another. Besides, followers of this approach study emotions very closely, finding the reasons people feel them and analysing their consequences. In order to understand the approach, it is necessary to take into account that the human brain consists of more than 10 billion nerve cells and of virtually infinite number of interconnections between them. Perhaps, it is the most complex structure in the universe (Atkinson et al., 2000).
Generally, all mental events somehow correspond to the activity of the brain and nervous system. The biological approach to the study of people is trying to establish the relationship between the external manifestation of behaviour and electrical and chemical processes occurring inside the body, particularly in the brain and nervous system (Carlson, 2004). Proponents of this approach seek to determine which neurobiological processes underlie specific behaviour and mental activity.
As to the nature of emotions, there are two views. According to the first of them, emotions of people are based in the lower brain, and people are driven by primeval feelings. The second states that only higher mammals can feel emotions, which is conditioned by the centre responsible for emotions that is located in neocortex (Panksepp, 2006).
Cognitive psychology is largely based on the analogy between the transformation of information in a computing device and the implementation of cognitive processes in humans. Numerous structural components (blocks) of cognitive and executive processes, especially memory, were identified on this ground.
The most popular version became the one of the computer where the mind is represented as a device with a fixed capacity to transform signals (Gross, 2005). Here the main role is given to the internal cognitive patterns and activity of an organism in the process of knowledge obtaining. This trend has formed under the influence of information approach.
Let us consider the actions performed by a computer: receiving, manipulating symbols, storing of the information in the memory, their retrieval from the memory, etc. It allows researchers to assume that the cognitive system of people is real and can be studied appropriately. Thus, the human cognitive system is considered as a system having devices of input, storing, displaying information in view of its capacity (Hayes, 2000).
Cognitive psychology studies how people get information about the world, how it is presented by humans, stored in the memory, transformed into knowledge, which can further affect our mind and behaviour. All of this leads to the understanding of cognitive psychology as a direction, the task of which is to prove the critical role of knowledge in the subject's behaviour. Thus, it becomes possible to study the organization of knowledge in the subject's memory, including the relationship between verbal and image components in the process of remembering and thinking.
There are several theories in the behaviouristic psychology that have to be considered to understand its sense. The first is the theory of Skinner. He identifies the development a learning process, pointing at the only difference between them: if learning covers certain limited periods of time, development lasts for relatively long time. The core of this concept is reinforcement (Oates, Wood, and Grayson, 2007). Skinner distinguishes between positive reinforcement and reward, encouragement, and negative reinforcement and punishment, taking advantage of the division of reinforcers into primary and secondary. Primary are food, water, extreme cold or heat. Secondary reinforcers are initially neutral stimuli, which have taken the function through their combination with the primary forms of reinforcers.
The second theory is of Bijou and Baer. According to it, behaviour can be reactive (responsive) or operant. Operant is first produced, and then gets reinforcements. Incentives can be physical, chemical, organismic, or social (Rana and Upton, 2009). The difference between the response and operant behaviour is particularly important for mental development. Operant behaviour creates incentives, which in their turn, influence considerably the response behaviour. In this case, there are three groups of effects: 1) environment, 2) a person with established habits, and 3) the changing impact of the individual on the influencing environment. According to Bijou and Baer, personal development includes the following steps: 1) basic stage (the satisfaction of biological needs), 2) the main stage (liberation from organismic constraints) a) early childhood, and b) the middle childhood, and c) youth, and 3) social stage (adulthood), a) maturity, and b) old age (Smith and Mackie, 2007).
Humanistic psychology is a special branch that is different from other schools by a number of statements fundamentally important for understanding of the human nature. Traditionally, it involves such concepts as the trait theory of personality by G. Allport, the theory of self-actualization by Maslow (1967), theory and non-directive psychotherapy of Carl Rogers (1961), C. Buhler’ understanding of the individual’s life, the ideas of R. May.
Each of these theories uses its own conceptual apparatus, creating a genuine understanding of the inner world of a person and his life in the process of development, testing and justifying the data obtained in the course of empirical research and in the process of psychotherapeutic work with clients (Peterson and Seligman, 2004). Differences existing between the theories are not an obstacle for examining them from a position of general methodological principles.
These principles are as follows:
1. The principle of development: it means that a person is constantly striving for new goals and self-improvement due to inborn needs – the ones of self-realization, self-actualization, and the wish to carry out continuous progressive development.
2. The principle of integrity, which allows for viewing a person as a complex open system, aimed at the realization of its potential.
3. The principle of humanity, which means that the human nature is good and free, and only circumstances, preventing the development of its true essence, can make it aggressive.
4. The principle of targeting determinism, suggesting to regard personality traits in the aspect of person’s orientation to the future, i.e. in terms of expectations, goals and values, while rejecting the idea of causal determinism (Oliver, 2003).
5. The principle of activity, allowing for acceptance of individual as an independently thinking and acting being, in whose life the other person (for example, the therapist) may play a role of supporting, accepting person, creating favourable conditions for the development of the partner. The therapist can modify the client’s beliefs, help to take responsibility for themselves, but he does not teach.
6. The principle of non-experimental study of personality, which is based on the idea of integrity, and therefore cannot adequately study the personality of the individual fragments, since the system (such as a person is) often has such properties, which are not inherent to its individual parts (Seligman, Steen, Park, and Peterson, 2005).
7. The principle of representation, meaning that the aim and object of study in humanistic psychology are the same as the problems of studying the normal and fully functioning human being implemented in the selection of healthy, self-actualizing individuals.
The observational record that will be analysed presents a woman named Claire with a learning disability who gets upset when one of her carers doesn’t give her a possibility to choose what she wants for breakfast. He makes this choice himself, which is why she cries, although still feeling satisfied because of the fact that her needs are taken care of.
In the case described in the observation the carer thought that it wasn’t important and didn’t try to make Claire happy. He just wanted to complete his job. The second carer, at the same time, really cared about the woman and allowed her to feel important and responsible for her life. I believe that the second carer was acting in the best way from the point of view of humanistic psychology.
Psychodynamic approach in psychology dates back to the works of Sigmund Freud. The ideas expressed by Freud inspired many psychologists, some of whom followed him literally, while others built their own theories on its basis. The term psychodynamic psychology covers all areas of psychology, which are focused at the content of the unconscious part of our psyche (Ahles, 2004).
Most psychologists agree that not all our experiences and emotions lie in the sphere of consciousness. However, the Freudian concept of the dynamic unconscious, which is such a type of unconscious that drives us to a specific behaviour, is not shared by all psychologists (Horowitz, 2001). The terms psychoanalysis and psychoanalytic refer to the original concept of human consciousness and notions of psychotherapy that were developed by Freud.
According to psychodynamic approach, the determining factor in understanding the nature of people and their illness lies in the fact that all mental phenomena are the result of interaction and control of intrapsychic forces. According to the theory of conflict of instincts, Freud described the main forces in this struggle, which are involved in the origin of neuroses: a person falls ill as a result of intrapsychic conflict between the demands of instinctual life and resistance to it (Smith et al., 2003). The aetiology of the neuroses he considered to be sexual in nature. Psychoanalytic approach includes five basic principles: dynamic, economic, structural, principle of development and of adaptation.
These principles formed the basis of psychoanalytic heritage, for which the most important are the following provisions:
1. Human instinctual impulses are the most important, as well as their expression, transformation, and, most importantly, suppression, by which it is possible to avoid painful feelings or experiences of unpleasant thoughts, desires, and the effects of consciousness.
2. The belief that such suppression is, in essence, sexual, and that the cause of illness is improper libidinal or psychosexual development.
3. The idea that the roots of improper psychosexual development are in the distant past, in children's conflicts or traumas, especially it is related to the parent’s Oedipus complex, expressed in the classical desire for the parent of the opposite sex (Stuart-Hamilton, 2000).
4. Confidence in resisting the identification of the Oedipus complex, its quick recovery.
5. The idea that, in essence, we are dealing with internal struggles between biological impulses (or instincts) and the ego acting as a protection against the external reality – in the general context of moral rules and standards (superego).
6. Commitment to the concept of psychic determinism, or causality, according to which mental phenomena, as well as behaviour, undoubtedly do not change randomly, and are associated with events that precede them, and if not made conscious, serve as a ground for repetition(Diekelmann, 2002).
If the observational situation is considered in the scope of the psychodynamic approach, it becomes clear that Claire’s behaviour is the result of subconscious. Consciously she understands that she should be happy that she is taken care of by both of the carers, and she doesn’t even understand, why she feels the emotions she has. I believe that she feels even guilty of such her reaction, and cannot do anything with such her reaction. The roots of this problem may lie in her childhood, if, for instance, the initiative that she had was suppressed. Then such behaviour of the carer can touch those old feelings of regret, causing such a reaction.
Actions of the second carer make her really happy, which can also be analysed from psychodynamic standpoint. Every person has to feel important and needed, and has to feel responsibility for action he/she takes. The root of it lies also in the sphere of unconscious. Behaviour of the second carer is much more positive, bringing better results in all respects, making Claire much happier and bringing up positive associations in her unconscious area.
Upon completion of the analysis presented in this paper, it is possible to make a conclusion that psychology can help considerably in the nursing practice if applied properly. All the approaches of the social psychology have interesting aspects and deserve attention, and I believe that every person has to choose those approaches that are the most appealing to them and apply them in practice. For me it was very interesting to discover the levels of needs hierarchy and how they can influence the people’s behaviour and the way unconscious influences the life of people. I will definitely apply this knowledge in future practice.
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