Reconstructing Health Psychology: An Introduction - SAGE Journals

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Reconstructing Health Psychology: An Introduction

Journal of Health Psychology Copyright © 2000 SAGE Publications London, Thousand Oaks and New Delhi, [1359–1053(200007)5:3] Vol 5(3) 267–271; 013540

MICHAEL MURRAY Memorial University of Newfoundland, Canada T H I S I S S U E of the Journal of Health Psychology includes an edited selection of some of the papers that were presented at the First International Conference on Critical and Qualitative Approaches to Health Psychology [www.med.mun.ca/health99/] which was held in St John’s, Newfoundland, Canada on 28–31 July 1999. As a collection, it provides an entry to the current critical debates about theory and method within health psychology. This introduction very briefly looks back on the development of these debates, summarizes some of the issues contained in this special issue and considers how these debates can be extended.

Debates old and new The current growth of critical debate within psychology can trace its recent past to the social upheavals that spread across the world in the 1960s and 1970s. This was a period of mass demonstrations, general strikes and widespread civil unrest (to use mediaspeak), especially in Europe and North America which mirrored the sustained movement towards political independence in the former colonial world. Academia could not remain aloof from this period of social questioning and there was considerable debate about the form and purpose of education. This contributed to student demonstrations, sit-ins and attempts to develop alternative more critical forms of education. Within psychology there were various attempts to reflect upon the underlying values of the discipline. In Europe perhaps the most

sustained debate within psychology took place in Germany with the creation of a distinct critical psychology (see Tolman, 1994). In the English-speaking world the debate took different forms. There were those influenced by Marxist ideas who attempted to develop a more politically aware psychology (e.g. the journal Ideology & Consciousness). There were also those who attempted to develop a more humanistic form of psychology which could address issues of personal alienation. In Latin America there was the move to connect psychology with the broader liberation movements and the critical pedagogy of Paulo Freire (see Wiesenfeld & Sanchez, 1991) Within psychology, the debate was most pronounced within social psychology which was the section of the discipline that had most pretensions to being socially relevant. However, despite addressing such vitally important issues as prejudice and violence there was a generalized tendency to avoid any political engagement and to maintain a supposed scientific neutrality (see Israel & Tajfel, 1972). In introducing his edited collection of critical essays entitled Reconstructing Social Psychology, Nigel Armistead (1974) expressed the unease felt by many of his colleagues:

This book has arisen out of our dissatisfaction with much of what is called psychology. That dissatisfaction is felt most acutely in relation to the lives we are leading and the world that we see around us. We feel that social psychology should be 267

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making some sense of our experience and that it doesn’t: we feel disappointed. (p. 7) A similar dissatisfaction is felt by many contemporary health psychologists. In the 1970s, health psychology was largely undeveloped and did not contribute to the debate. More detailed discussion of the historical background to these debates can be found elsewhere (e.g. Parker, 1989). To a large extent the so-called crisis in social psychology was short-circuited by the rise of social cognitivism. The rise of health psychology has been strongly conditioned by the dominant social cognitive ideas. The past 10 years have seen a renewal of the discussion about the assumptions underlying theories and methods within psychology. This discussion reflects the larger epistemological debates throughout the social sciences (e.g. Seidman, 1994). In psychology this renewed debate is demonstrated in a series of recent books (e.g. Fox & Prilleltensky, 1997; Ibanez & Iniguez, 1997; Parker & Spears, 1996), conferences (e.g. Millennium World Conference in Critical Psychology), journals (e.g. Feminism & Psychology, Culture & Psychology, Theory & Psychology, International Journal of Critical Psychology) and societies and networks (e.g. International Society of Theoretical Psychology, Critical Psychology Network). As we enter the 21st century, once again, psychology is reflecting on the nature of the discipline and future directions. This time health psychology is a more developed discipline and increasingly it is participating in these broader debates. This is apparent in articles published in this journal (e.g. Marks, 1996; Stainton Rogers, 1996) and in recent books (e.g. Murray & Chamberlain, 1999; Yardley, 1997). It was an awareness of this growing debate that encouraged the convening of a specialist conference in 1999 which would provide an opportunity for critical health psychologists to meet and to review the current terrain of the discipline. In response to a call for papers, a total of 126 health psychologists from 20 countries (Australia, Belgium, Brazil, Canada, Finland, France, Germany, Hong Kong, Hungary, Ireland, Japan, the Netherlands, New Zealand, Norway, Portugal, South Africa, Sweden, Switzerland, the United Kingdom and the United States of America) travelled to St John’s, Newfoundland, 268

Canada for the conference. As such, this was probably one of the most international gatherings of health psychologists held. Indeed, many more potential participants planned to attend but could not for financial reasons. During the four days of the conference, seven workshops, 61 free papers and 12 plenary papers were presented. Full details of the programme are provided at the end of this special issue. The informal nature of the conference ensured that discussion about theories and methods spilled out of the meeting rooms into the bars and restaurants around St John’s. It was indeed an exhilarating experience, especially for those participants who had been working in isolation. The conference provided an opportunity to meet with many like-minded people, to share stories and to discuss both intellectual and personal issues.

Special issue At the end of the conference it was agreed to solicit contributions for a special issue of this journal. This resulted in a large number of submissions, which were submitted for peer review. Unfortunately, many excellent papers could not be included but will hopefully appear in future issues of the journal. This special issue contains a total of 11 articles by authors resident in seven different countries (Canada, Germany, Ireland, New Zealand, South Africa, the United Kingdom and the United States) on a variety of issues which can be loosely grouped into four categories. The first includes the articles by Hank Stam and Kerry Chamberlain which as a pair can be considered an appeal for greater connection with the broader theoretical debates in the social sciences. Stam argues that mainstream health psychology has uncritically adopted various forms of functionalism. This article’s critique reminded me of the comments made by Ken Gergen (1998) in his critical review of a new handbook of social psychology. He identified three forms of insularity apparent in that particular book, viz. insularity from ‘critical issues confronting society’, from ‘virtually all social psychology not committed to biocognitive reductionism’ and from ‘virtually all forms of outside intellectual life’ (p. 88). He warned that this insularity could ‘ultimately bring this bold

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but fragile venture of social psychology to a close’. Gergen added that a philosophy colleague of his had recently compared reading social psychological research to ‘discovering the work of an obscure order of medieval monks’ (p. 89). All of these comments could be applied to the rather abstract ‘model building’ typical of much mainstream health psychology which Stam castigates in his article. His remarks are very much complemented by the article by Chamberlain. He argues that there is a danger that the uncritical adoption of qualitative methods within health psychology carries with it the danger of ignoring the broader theoretical debates. A fascination with technical details, which has so plagued psychology historically, evades the need to attend to theory. The next two articles consider different aspects of embodiment and suffering. In many ways it is surprising that health psychology has remained largely aloof from the extensive debates about embodiment that are current in the arts and social sciences. Indeed, it was recently estimated that discussion on embodiment is currently the largest area for debate within the humanities. This discussion is now being joined by a number of psychologists (e.g. Radley, 1991; Stam, 1996; Ussher, 1997; Yardley, 1997). In his article, Alan Radley argues that positivist health psychology cannot address the central concerns of suffering and healing because of its implicit separation of mind and body. Instead, he argues that health psychology must grasp the concept of embodiment if it is to tackle these issues. Kugelmann extends this discussion to consider the meaning of pain which has traditionally challenged mind/body dualism. Instead Kugelmann develops a hermeneuticalphenomenological conception of pain as performance. There then follows a group of five articles on different ways of approaching the social construction of health and illness. The first by Uwe Flick provides details of a number of studies of social representations of health and illness and introduces work that has been ignored by many health psychologists. This is complemented by my own article which considers different levels of narrative analysis of illness and ways of articulating the more social levels with the personal level. Darrin Hodgetts and Kerry Chamberlain explore historical changes in the way people of

lower socioeconomic status have apparently changed in the way they account for health and illness and so emphasize the importance of the historical context of our research. Antonia Lyons considers the importance of the media as a subject of research for health psychologists. Finally, Sue Wilkinson provides an extensive review of the work of feminists in studying psychological aspects of illness, especially of breast cancer. In contrasting three research traditions (positivist empiricist, experiential and discursive), Wilkinson avoids favouring one over the other but instead argues that each can contribute to the broader feminist project which is concerned not just with understanding but also with improving women’s lives. The last two articles begin to consider more the cultural and political dimensions of health and illness which are often implicit in the other articles. Mac MacLachlan begins by reviewing the cultural embeddedness of health and illness and asks how health psychologists can begin to integrate an awareness of this into their practice without adopting an imperialist stance. Finally, the article by Brinton Lykes is both an intellectual travelogue and an appeal for political commitment. As such it complements and extends the comments by many of the other authors in this special issue on the need for health psychologists to challenge the many social injustices if they are to promote health. In this she draws our attention to the work of the El Salvador psychologist, Ignacio Martín-Baró, who dedicated his life to fighting political oppression and finally paid for his resoluteness and dedication when he was assassinated by government soldiers in 1989. His writings (Martín-Baró, 1994) serve as a monument to his life and as an inspiration for psychologists not only in Latin America but throughout the world. As he himself stressed; ‘No knowledge can be true if it has not attached itself to the task of transforming reality’ (p. 41).

Future Besides this special issue, it was agreed to establish a network to extend the work of the conference and to plan future activities. Already we have established a website [http: //www.med. mun.ca/chpn/] and an electronic discussion group. Plans are now under way for the second 269

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critical health psychology conference. The important challenge is to develop theories and methods which are emancipatory and contribute in many ways to the creation of a healthier society. As Stam emphasizes in his article, our investigations of health and illness carry with them implicit moral commitments upon which we need to reflect. To rephrase Marx’s famous thesis, it is not sufficient merely to describe or even understand human suffering: the challenge is surely to contribute to its alleviation. This work can take a variety of forms but it clearly needs to be informed by an awareness of the broad social, cultural and political context. It also requires a questioning of the positivist assumptions that pervade health psychology. A major challenge is the continuing inequalities in health both within and between societies. Health psychology can no longer stand aloof from this challenge but must develop means to assist not only with the investigation but also the eradication of these gross injustices. It must be able to cast aside its supposed impartiality and be prepared to engage in the real world. But I have said enough. I would urge readers to study the articles in this special issue and to participate in the exciting discussions that are developing within the growing community of critical health psychologists.

Acknowledgements Many, many people contributed much to ensuring that the conference at which the articles included in this special issue were originally presented was such a success. From the early planning stages the following individuals were extremely helpful in providing the essential financial and moral support: from Memorial University of Newfoundland—Dr Kevin Keough (Vice-President, Research and International Affairs), Dr Ian Bowmer (Dean of Medicine), Dr Roy West (Associate Dean of Community Health), Dr Howard Strong (Chair of Psychiatry) and Dr Falah Maroun (Chair of Surgery); from the Health Care Corporation of St John’s—Sister Elizabeth Davis (Chief Executive Officer), from the Newfoundland Cancer Treatment and Research Foundation—Ms Bertha Paulse (Chief Executive Officer); and from the Government of Newfoundland and 270

Labrador Department of Health and Community Services—Ms Joan Dawe (Deputy Minister). I would also like to thank the Government of Newfoundland and Labrador Department of Tourism and Heritage Affairs, Sage Publications, Carfax Publications, Harwood Academic Publications and Air Canada for their support. A special thanks to all the staff at Hotel Newfoundland, in particular to Mary-Catherine Fowler (Conference Administrator), and to all the student assistants—Susan Sparrow, John Campbell, Chantelle Reid and Sukanta Saha, who ensured that the conference ran so smoothly. I would also like to thank the manuscript reviewers, who ensured that the articles included in this special issue are of a consistent quality. Last but not least I would like to thank all the conference participants for braving the fog, the flight delays and the airport closure to join me in making this such an exciting and, most definitely, historic event. I look forward to the next one.

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MURRAY: RECONSTRUCTING HEALTH PSYCHOLOGY health psychology. Journal of Health Psychology, 1, 65–78. Stam, H. J. (Ed.) (1996). Special issue: The body and psychology. Theory & Psychology, 6(4). Tolman, C. (1994). Psychology, society and subjectivity: An introduction to German critical psychology. New York: Routledge. Ussher, J. M. (Ed.) (1997). Body talk: The material and

discursive regulation of sexuality, madness and reproduction. London: Routledge. Wiesenfeld, E., & Sanchez, E. (1991). Introduction: The why, what and how of community social psychology in Latin America. Applied Psychology, 40, 113–117. Yardley, L. (Ed.) (1997). Material discourses of health and illness. London: Routledge.

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