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 HEALTH PSYCHOLOGY

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 viii Contents

The Digestive System and the Metabolism of Food 25 Genetics and Health 30
Overview 25 Overview 30
The Functioning of the Digestive System 25 Genetics and Susceptibility to Disorders 30
Disorders of the Digestive System 26 The Immune System 31
The Gut–Brain Connection 27
Overview 31
The Renal System 27 B O X 2.2 Portraits of Two Carriers 32

Overview 27 Infection 32
Disorders of the Renal System 28 The Course of Infection 32
The Reproductive System 28 Immunity 33
Disorders Related to the Immune System 34
Overview 28
The Ovaries and Testes 28
Fertilization and Gestation 28
Disorders of the Reproductive System 29

PA R T 2

HEALTH BEHAVIOR AND PRIMARY PREVENTION

CHAPTER 3 Cognitive–Behavioral Approaches to Health Behavior

Health Behaviors 40 Change 53
An Introduction to Health Behaviors 41 Cognitive–Behavioral Therapy (CBT) 53
Self-Monitoring 53
Role of Behavioral Factors in Disease and Disorder 41
Stimulus Control 53
Health Promotion: An Overview 41 The Self-Control of Behavior 53
Health Behaviors and Health Habits 41 B O X 3.1 Classical Conditioning 54

Practicing and Changing Health Behaviors: B O X 3.2 Operant Conditioning 55

An Overview 42 B O X 3.3 Modeling 56

Barriers to Modifying Poor Health Behaviors 43 Social Skills and Relaxation Training 56
Intervening with Children and Adolescents 43 Motivational Interviewing 57
Intervening with At-Risk People 45 Relapse Prevention 57
Health Promotion and Older Adults 46 Evaluation of CBT 58
Ethnic and Gender Differences in Health Risks The Transtheoretical Model of Behavior Change 59
and Habits 47
Stages of Change 59
Changing Health Habits 47 Using the Stage Model of Change 60
Attitude Change and Health Behavior 47 Changing Health Behaviors Through Social Engineering 61
The Health Belief Model 49
Venues for Health-Habit Modification 61
The Theory of Planned Behavior 50
Criticisms of Attitude Theories 50 The Practitioner’s Office 61
Self-Regulation and Health Behavior 51 The Family 61
Self-Determination Theory 51 Self-Help Groups 62
Implementation Intentions 52 Schools 62
Health Behavior Change and the Brain 52 Workplace Interventions 62

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 Contents ix

Community-Based Interventions 63 Obesity in Childhood 89

The Mass Media 63 SES, Culture, and Obesity 90
Cellular Phones and Landlines 64 Obesity and Dieting as Risk Factors for Obesity 91
The Internet 64 Stress and Eating 92
Interventions 92
B O X 5.2 Don’t Diet 93
CHAPTER 4 Cognitive–Behavioral Therapy (CBT) 94
Health-Promoting Behaviors 67 Evaluation of Cognitive–Behavioral Weight-Loss
Exercise 68 Techniques 96
Taking a Public Health Approach 96
Benefits of Exercise 68
B O X 5.3 The Barbie Beauty Battle 97
Determinants of Regular Exercise 69
Exercise Interventions 70 Eating Disorders 97
Accident Prevention 71 Anorexia Nervosa 98
Bulimia 99
Home and Workplace Accidents 72
Binge Eating Disorder 100
Motorcycle and Automobile Accidents 73
Alcoholism and Problem Drinking 100
Vaccinations and Screening 73
The Scope of the Problem 100
Vaccinations 73
What Is Substance Dependence? 101
Screenings 73
Alcoholism and Problem Drinking 101
Colorectal Cancer Screening 74
Origins of Alcoholism and Problem Drinking 101
Sun Safety Practices 75 Treatment of Alcohol Abuse 102
Developing a Healthy Diet 76 Treatment Programs 102
B O X 5.4 After the Fall of the Berlin Wall 103
Changing Diet 77
B O X 5.5 A Profile of Alcoholics Anonymous 104
Resistance to Modifying Diet 77
Evaluation of Alcohol Treatment Programs 104
Sleep 79
B O X 5.6 The Drinking College Student 105
What Is Sleep? 79 Preventive Approaches to Alcohol Abuse 106
Sleep and Health 79 Drinking and Driving 107
Rest, Renewal, Savoring 81 Is Modest Alcohol Consumption a Health
Behavior? 107
Smoking 107
CHAPTER 5
Synergistic Effects of Smoking 107
Health-Compromising Behaviors 83
A Brief History of the Smoking Problem 108
Characteristics of Health-Compromising Behaviors 84 Why Do People Smoke? 110
Marijuana Use 85 Nicotine Addiction and Smoking 111
Interventions to Reduce Smoking 112
Obesity 86
Smoking Prevention Programs 115
What Is Obesity? 86 B O X 5.7 The Perils of Secondhand Smoke 116
B O X 5.1 The Biological Regulation of Eating 89

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 x Contents

PA R T 3

STRESS AND COPING

CHAPTER 6 Some Solutions to Workplace Stressors 141

Stress 120 Combining Work and Family Roles 141
What Is Stress? 121
What Is a Stressor? 121 CHAPTER 7
Appraisal of Stressors 121 Coping, Resilience, and Social Support 144
Origins of the Study of Stress 121 Coping with Stress and Resilience 145
Fight or Flight 121 Personality and Coping 145
Selye’s General Adaptation Syndrome 121 B O X 7.1 The Measurement of Optimism:
Tend-and-Befriend 123 The LOT-R 147
How Does Stress Contribute to Illness? 123 Psychosocial Resources 147
The Physiology of Stress 124 B O X 7.2 Religion, Spirituality, Coping, and

Effects of Long-Term Stress 125 Well-Being 149

Individual Differences in Stress Reactivity 126 Resilience 150
Physiological Recovery 127 Coping Style and Coping Strategies 150
Allostatic Load 127 B O X 7.3 The Brief COPE 151

B O X 6.1 Can Stress Affect Pregnancy? 128 B O X 7.4 Coping with HIV 152

Problem-Focused and Emotion-Focused Coping 153

What Makes Events Stressful? 128
Dimensions of Stressful Events 128 Coping and External Resources 154
Must Stress Be Perceived as Such to Be Stressful? 130 Coping Outcomes 154
Can People Adapt to Stress? 130 Coping Interventions 155
Must a Stressor Be Ongoing to Be Stressful? 130
Mindfulness Meditation and Acceptance/Commitment
How Has Stress Been Studied? 131 Therapy 155
Studying Stress in the Laboratory 131 Expressive Writing 155
Inducing Disease 131 Self-Affirmation 156
Stressful Life Events 131 Relaxation Training 156
B O X 6.2 Post traumatic Stress Disorder 132 Coping Skills Training 156
B O X 6.3 Can an Exciting Sports Event Kill You?
Social Support 158
Cardiovascular Events During World Cup
What Is Social Support? 158
Soccer 134
Effects of Social Support on Illness 159
Daily Stress 134
B O X 7.5 Is Social Companionship an Important
B O X 6.4 A Measure of Perceived Stress 135
Part of Your Life? 160
Sources of Chronic Stress 135 Biopsychosocial Pathways 160
Effects of Early Stressful Life Experiences 135 Moderation of Stress by Social Support 161
B O X 6.5 The Measurement of Daily Strain 136 What Kinds of Support Are Most Effective? 162
Chronic Stressful Conditions 137 B O X 7.6 Can Bad Relationships Affect

Stress in the Workplace 137 Your Health? 163

B O X 6.6 Can Prejudice Harm Your Health? 138 Enhancing Social Support 164

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 Contents xi

PA R T 4

SEEKING AND USING HEALTH CARE SERVICES

CHAPTER 8 B O X 9.2 What Are Some Ways to Improve

Using Health Services 168
Recognition and Interpretation of Symptoms 169
Recognition of Symptoms 169
Interpretation of Symptoms 170
Cognitive Representations of Illness 170
Adherence to Treatment? 187
Improving Patient–Provider Communication and Increasing
Adherence to Treatment 188
Teaching Providers How to Communicate 188
B O X 9.3 What Can Providers Do to Improve

B O X 8.1 Can Expectations Influence Sensations? Adherence? 189

The Case of Premenstrual Symptoms 171 The Patient in the Hospital Setting 190
Lay Referral Network 172 Structure of the Hospital 191
The Internet 172 The Impact of Hospitalization
Who Uses Health Services? 172 on the Patient 192
B O X 9.4 Burnout Among Health Care
Age 172
Gender 172 Professionals 193
Social Class and Culture 173 Interventions to Increase Information in Hospital
Social Psychological Factors 173 Settings 194
Misusing Health Services 174 The Hospitalized Child 194
Using Health Services for Emotional B O X 9.5 Social Support and Distress from
Disturbances 174 Surgery 195
B O X 8.2 The June Bug Disease: A Case of Preparing Children for Medical
Hysterical Contagion 175 Interventions 195
Delay Behavior 175 Complementary and Alternative Medicine 196
Philosophical Origins of CAM 197
CAM Treatments 198
CHAPTER 9
Dietary Supplements and Diets 198
Patients, Providers, and Treatments 179
Prayer 199
Health Care Services 180 Acupuncture 199
Patient Consumerism 180 Yoga 199
Structure of the Health Care Delivery System 180 Hypnosis 200
Patient Experiences with Managed Care 181 Meditation 200
Guided Imagery 200
The Nature of Patient–Provider Communication 182 Chiropractic Medicine 201
Setting 182 Osteopathy 201
Provider Behaviors That Contribute to Faulty Massage 201
Communication 183 Who Uses CAM? 201
B O X 9.1 What Did You Say?: Language Barriers to Complementary and Alternative Medicine: An Overall
Effective Communication 184 Evaluation 202
Patients’ Contributions to Faulty Communication 184 The Placebo Effect 203
Interactive Aspects of the Communication
History of the Placebo 203
Problem 185
B O X 9.6 Cancer and the Placebo Effect 204
Use of Artificial Intelligence 186
What Is a Placebo? 204
Results of Poor Patient–Provider Communication 186 Provider Behavior and Placebo Effects 204
Nonadherence to Treatment Regimens 186 Patient Characteristics and Placebo Effects 205

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 xii Contents

Patient–Provider Communication and Placebo Pain Control Techniques 220

Effects 205 Pharmacological Control of Pain 220
Situational Determinants of Placebo Effects 205 Surgical Control of Pain 220
Social Norms and Placebo Effects 205 B O X 10.4 The Opioid Crisis 221
The Placebo as a Methodological Tool 206 Sensory Control of Pain 221
Biofeedback 222
Relaxation Techniques 222
CHAPTER 10
Distraction 223
The Management of Pain and
Coping Skills Training 223
Discomfort 209
Cognitive–Behavioral Therapy 224
The Elusive Nature of Pain 211 Pain Management Programs 225
B O X 10.1 A Cross-Cultural Perspective on Pain: Initial Evaluation 225
The Childbirth Experience 212 Individualized Treatment 225
Measuring Pain 212 Components of Programs 226
B O X 10.2 Headache Drawings Reflect Distress and
Involvement of Family 226
Disability 214 Relapse Prevention 226
The Physiology of Pain 214 Evaluation of Programs 226
B O X 10.3 Phantom Limb Pain: A Case History 216

Neurochemical Bases of Pain and Its Inhibition 216

Clinical Issues in Pain Management 217
Acute and Chronic Pain 217
Pain and Personality 219

PA R T 5

MANAGEMENT OF CHRONIC AND TERMINAL

HEALTH DISORDERS

CHAPTER 11 Coping with Chronic Health Disorders 236

Management of Chronic Health Coping Strategies and Chronic Health Disorders 236
Disorders 230 Patients’ Beliefs About Chronic Health Disorders 237
Quality of Life 232 Comanagement of Chronic Health Disorders 238
What Is Quality of Life? 232 Physical and Behavioral Rehabilitation 238
Why Study Quality of Life? 233 B O X 11.2 Chronic Fatigue Syndrome and Other

Emotional Responses to Chronic Health Disorders 233 Functional Disorders 239

B O X 11.3 Epilepsy and the Need for a Job
Denial 233
Redesign 240
Anxiety 234
Vocational Issues in Chronic Health Disorders 240
Depression 234
B O X 11.1 A Future of Fear 235
Social Interaction Problems in Chronic Health
Disorders 240
Personal Issues in Chronic Health Disorders 235 B O X 11.4 Who Works with People with Chronic

The Physical Self 235 Health Disorders? 241

The Achieving Self 236 Gender and the Impact of Chronic Health
The Social Self 236 Disorders 243
The Private Self 236

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 Contents xiii

Positive Changes in Response to Chronic Health CHAPTER 13

Disorders 244
When a Child Has a Chronic Health Disorder 244
Psychological Interventions and Chronic Health
Disorders 246
Pharmacological Interventions 246
Individual Therapy 246
Relaxation, Stress Management, and Exercise 247
Social Support Interventions 247
B O X 11.5 Help on the Internet 248
Support Groups 248
CHAPTER 12
Psychological Issues in Advancing and
Terminal Illness 250
Death Across the Life Span 251
Death in Infancy and Childhood 252
Death in Adolescence and Young Adulthood 254
Death in Middle Age 255
Death in Old Age 255
B O X 12.1 Why Do Women Live Longer
Heart Disease, Hypertension, Stroke, and
Type 2 Diabetes 270
Coronary Heart Disease 271
What Is CHD? 271
Risk Factors for CHD 271
Stress and CHD 272
Women and CHD 274
Personality, Cardiovascular Reactivity, and CHD 275
B O X 13.1 Hostility and Cardiovascular Disease 276
Depression and CHD 277
Other Psychosocial Risk Factors and CHD 278
Management of Heart Disease 279
B O X 13.2 Picturing the Heart 280
Prevention of Heart Disease 283
Hypertension 283
How Is Hypertension Measured? 283
What Causes Hypertension? 283
Treatment of Hypertension 286
The Hidden Disease 286
Stroke 287

Than Men? 256 Risk Factors for Stroke 288

Consequences of Stroke 288
Psychological Issues in Advancing Illness 257
Rehabilitative Interventions 289
Continued Treatment and Advancing Illness 257
Type 2 Diabetes 290
B O X 12.2 A Letter to My Physician 258

Psychological and Social Issues Related to Dying 258
B O X 12.3 Ready to Die: The Question of Assisted
Death 259
The Issue of Nontraditional Treatment 260
Are There Stages in Adjustment to Dying? 260
Kübler-Ross’s Five-Stage Theory 260
Evaluation of Kübler-Ross’s Theory 261
Psychological Issues and the Terminally Ill 262
Medical Staff and the Terminally Ill Patient 262
The Promise of Palliative Care 263
Counseling with the Terminally Ill 263
The Management of Terminal Illness in Children 264
Alternatives to Hospital Care for the Terminally Ill 264
Hospice Care 264
Home Care 265
Problems of Survivors 265
B O X 12.4 Cultural Attitudes Toward Death 266
The Survivor 266
Death Education 268
Health Implications of Diabetes 292
Psychosocial Factors in the Development of
Diabetes 292
B O X 13.3 Stress Management and the Control of
Diabetes 293
The Management of Diabetes 293
CHAPTER 14
Psychoneuroimmunology and
Immune-Related Disorders 296
Psychoneuroimmunology 297
The Immune System 297
Assessing Immune Functioning 297
Stress and Immune Functioning 297
B O X 14.1 Autoimmune Disorders 299
Negative Affect and Immune Functioning 299
Stress, Immune Functioning, and Interpersonal
Relationships 300
Psychosocial Resources and Immune Functioning 300
Interventions to Improve Immune Functioning 301

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 xiv Contents

HIV Infection and AIDS 302 Psychosocial Factors and the Course of Cancer 313
A Brief History of HIV Infection and AIDS 302 Adjusting to Cancer 314
HIV Infection and AIDS in the United States 303 Psychosocial Issues and Cancer 314
The Psychosocial Impact of HIV Infection 304 Post traumatic Growth 315
Interventions to Reduce the Spread of HIV Interventions 315
Infection 305 Therapies with Cancer Patients 316
Coping with HIV+ Status and AIDS 309 Arthritis 317
Psychosocial Factors That Affect the Course of HIV Rheumatoid Arthritis 317
Infection 309 Osteoarthritis 318
Cancer 310 Type 1 Diabetes 319
Why Is Cancer Hard to Study? 311 Special Problems of Adolescents with Diabetes 320
Who Gets Cancer? A Complex Profile 311
Psychosocial Factors and Cancer 313

PA R T 6

TOWARD THE FUTURE

CHAPTER 15 Trends in Health and Health Psychology 332

Health Psychology: Challenges for the Research of the Future 332
Future 324 The Changing Nature of Medical Practice 333
Health Promotion 326 Systematic Documentation of Cost-Effectiveness and
Treatment Effectiveness 334
A Focus on Those at Risk 326
International Health 335
Prevention 326
A Focus on Older Adults 326 Becoming a Health Psychologist 337
Refocusing Health Promotion Efforts 327 Undergraduate Experience 337
Promoting Resilience 327 Graduate Experience 337
Health Promotion and Medical Practice 327 Postgraduate Work 338
Health Disparities 328 Employment 338
Stress and Its Management 330
Where Is Stress Research Headed? 330 GLOSSARY 340

Health Services 331 REFERENCES 350

Building Better Consumers 331
NAME INDEX 431
Management of Serious Illness 331
Quality-of-Life Assessment 332 SUBJECT INDEX 467

The Aging of the Population 332

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 P R E FAC E

When I (Dr. Taylor) wrote the first edition of Health Psychology over 30 years ago,
the task was much simpler than it is now. Health psychology was a new field and
was relatively small. In recent decades, the field has grown steadily, and great
research advances have been made. Chief among these developments is the use
and refinement of the biopsychosocial model: the study of health issues from the
standpoint of biological, psychological, and social factors acting together. Increas-
ingly, researchers have identified the biological pathways by which psychosocial
factors such as stress may adversely affect health and potentially protective factors
such as social support may buffer the impact of stress. With Dr. Stanton joining
as an author, our goal in the 11th edition of this text is to convey this increasing
sophistication of the field in a manner that makes it accessible, comprehensible,
and exciting to undergraduates.
Like any science, health psychology is cumulative, building on past research
advances to develop new ones. Accordingly, we have tried to present not only the
fundamental contributions to the field but also the current research on these issues.
Because health psychology is developing and changing so rapidly, it is essential
that a text be up to date. Therefore, we have not only reviewed the recent research
in health psychology but also obtained information about research projects that
will not be available in the research literature for several years. In so doing, we are
presenting a text that is both current and pointed toward the future.
A second goal is to portray health psychology appropriately as being intimately
involved with the problems of our times. The aging of the population and the shift
in numbers toward the later years have created unprecedented health needs to
which health psychology must respond. Such efforts include the need for health
promotion with this aging cohort and an understanding of the psychosocial issues
that arise in response to aging and its associated chronic disorders. Because AIDS
is a leading cause of death worldwide, the need for health measures such as con-
dom use is readily apparent if we are to halt the spread of this disease. Obesity is
now one of the world’s leading health problems, nowhere more so than in the
United States. Reversing this dire trend that threatens to shorten life expectancy
worldwide is an important current goal of health psychology. Increasingly, health
psychology is an international undertaking, with researchers from around the world
providing insights into the problems that affect both developing and developed
countries. The 11th edition includes current research that reflects the international
focus of both health problems and the health research community.
Health habits lie at the origin of our most prevalent disorders, and this fact
underscores more than ever the importance of modifying problematic health behav-
iors such as smoking and alcohol consumption. Increasingly, research documents
the importance of a healthy diet, regular exercise, and weight control among other
positive health habits for maintaining good health. The at-risk role has taken on
more importance in prevention, as breakthroughs in genetic research have made it
possible to identify genetic risks for diseases long before disease is evident. How
people cope with being at risk and what interventions are appropriate for them
represent important tasks for health psychology research to address.

xv

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 xvi Preface

Health psychology is both an applied field and a basic research field. Accord-
ingly, in highlighting the accomplishments of the field, we present both the scien-
tific progress and its important applications. Chief among these are efforts by
clinical psychologists to intervene with people to treat biopsychosocial disorders,
such as post traumatic stress disorder; to help people manage health habits that
have become life threatening, such as eating disorders; and to develop clinical
interventions that help people better manage their chronic illnesses.
Finding the right methods and venues for modifying health continues to be a
critical issue. The chapters on health promotion put particular emphasis on the
most promising methods for changing health behaviors. The chapters on chronic
diseases highlight how knowledge of the psychosocial causes and consequences of
these disorders may be used to intervene with people at risk—first, to reduce the
likelihood that such disorders will develop, and second, to deal effectively with the
psychosocial issues that arise following diagnosis.
The success of any text depends ultimately on its ability to communicate the
content clearly to student readers and spark interest in the field. In this 11th edi-
tion, we strive to make the material interesting and relevant to the lives of student
readers. Many chapters highlight news stories related to health. In addition, the
presentation of material has been tied to the needs and interests of young adults.
For example, the topic of stress management is tied directly to how students might
manage the stresses associated with college life. The topic of problem drinking
includes sections on college students’ alcohol consumption and its modification.
Health habits relevant to this age group—tanning, exercise, and condom use, among
others—are highlighted for their relevance to the student population. By learning
from anecdotes, case histories, and specific research examples that are relevant to
their own lives, students learn how important this body of knowledge is to their
lives as young adults.
Health psychology is a science, and consequently, it is important to commu-
nicate not only the research itself but also some understanding of how studies were
designed and why they were designed that way. The explanations of particular
research methods and the theories that have guided research appear throughout
the book. Important studies are described in depth so that students have a sense
of the methods researchers use to make decisions about how to gather the best
data on a problem or how to intervene most effectively.
Throughout the book, we have made an effort to balance general coverage of
psychological concepts with coverage of specific health issues. One method of doing
so is by presenting groups of chapters, with the initial chapter offering general
concepts and subsequent chapters applying those concepts to specific health issues.
Thus, Chapter 3 discusses general strategies of health promotion, and Chapters 4
and 5 discuss those issues with specific reference to particular health habits such
as exercise, smoking, accident prevention, and weight control. Chapters 11 and 12
discuss broad issues that arise in the context of managing chronic health disorders
and terminal illness. In Chapters 13 and 14, these issues are addressed concretely,
with reference to specific disorders such as heart disease, cancer, and AIDS.
Rather than adopt a particular theoretical emphasis throughout the book,
we have attempted to maintain a flexible orientation. Because health psychology is
taught within all areas of psychology (e.g., clinical, social, cognitive, physiological,
learning, and developmental), material from each of these areas is included in the
text so that it can be accommodated to the orientation of each instructor. Conse-
quently, not all material in the book is relevant for all courses. Successive chapters

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 Preface xvii

of the book build on each other but do not depend on each other. Chapter 2, for
example, can be used as assigned reading, or it can act as a resource for students
wishing to clarify their understanding of biological concepts or learn more about
a particular biological system or illness. Thus, each instructor can accommodate
the use of the text to his or her needs, giving some chapters more attention than
others and omitting some chapters altogether, without undermining the integrity
of the presentation.

■ NEW TO THIS EDITION

• More than 300 new citations
• Discussion of artificial intelligence and health care (Chapters 1, 9)
• Expanded coverage of web-based interventions (Chapters 1, 3, 11)
• Coverage of the significance of telomeres (Chapters 2, 6)
• Coverage of the gut–brain connection (Chapter 2)
• Discussion of telemedicine (Chapters 2, 8, 15)
• Expanded coverage of dementia (Chapters 2, 11)
• Discussion of socio cultural values and health (Chapters 3, 14)
• Expanded coverage of aging and health (Chapters 3, 4, 11, 14)
• Coverage of just-in-time interventions (Chapters 3, 15)
• Enhanced coverage of marijuana use (Chapter 5)
• New research on positive parenting, stress, and health (Chapter 6)
• Expanded converge on the health effects of prejudice and discrimination
(Chapters 6, 13, 14, 15)
• Coverage of the benefits of a sense of purpose and meaning in life (Chapter 7)
• Coverage of research on attempts to cope through actively approaching or
avoiding stressful experiences (Chapter 7)
• Enhanced coverage of couples’ attempts to cope with shared stressors
(Chapter 7)
• Expanded coverage of mindfulness and mindfulness meditation (Chapters 7, 10)
• Enhanced coverage of the health consequences of social support and loneli-
ness (Chapter 7)
• Discussion of the opioid crisis (Chapter 10)
• Expanded coverage of suicide (Chapter 12)
• Coverage of palliative care and end-of-life options (Chapter 12)
• Expanded discussion of bereavement (Chapter 12)
• Enhanced coverage of the prevention and treatment of HIV/AIDS (Chapter 14)
• Expanded coverage of contributors to cancer onset and progression (Chapter 14)
• The changing face of health psychology (Chapter 15)

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 ®

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 FOR STUDENTS

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 xx Preface

® The 11th edition of Health Psychology is now available online with Connect,
McGraw-Hill’s integrated assignment and assessment platform. Connect also offers
SmartBook® 2.0 for the new edition, which is an adaptive reading experience
proven to improve grades and help students study more effectively. All of the title’s
ancillary content is also available through Connect, including:
• An Instructor’s Manual for each chapter, with student learning objectives and
lab exercises.
• A full Test Bank of multiple-choice questions that test students on central
concepts and ideas in each chapter.
• Lecture Slides and an Image Bank for instructor use in class.

■ ACKNOWLEDGMENTS
Our extensive gratitude goes to Alexandra Jorge and Rachel Caprini for the many
hours they put in on the manuscript. We thank our team at McGraw-Hill, Erika Lo
and David Patterson, and our development editor Ann Loch, who devoted much
time and help to the preparation of the book. We also wish to thank the following
reviewers who commented on all or part of the book:
Kaston D. Anderson-Carpenter, Michigan State University
Elizabeth Ash, Morehead State University
Eric Benotsch, Virginia Commonwealth University
David Chun, Montclair State University
Len Lecci, University of North Carolina Wilmington
Suzanne Morrow, Old Dominion University
Ilona Yim, University of California, Irvine
Shelley E. Taylor and Annette L. Stanton

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 Introduction to Health
PA R T

1
Psychology

Africa Studio/Shutterstock

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 CHAPTER
What Is Health Psychology?
1
Jacom Stephens/Getty Images
tay53902_ch01_001-013.indd 2
CHAPTER OUTLINE
Definition of Health Psychology
Why Did Health Psychology Develop?
The Mind–Body Relationship: A Brief History
The Rise of the Biopsychosocial Model
Psychosomatic Medicine
Advantages of the Biopsychosocial Model
Clinical Implications of the Biopsychosocial Model
The Biopsychosocial Model: The Case History of
Nightmare Deaths
The Need for Health Psychology
Changing Patterns of Illness
Advances in Technology and Research
Expanded Health Care Services
Increased Medical Acceptance
Health Psychology Research
The Role of Theory in Research
Experiments
Correlational Studies
Prospective and Retrospective Designs
The Role of Epidemiology in Health Psychology
Methodological Tools
Qualitative Research
What Is Health Psychology Training For?
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Every day, we see headlines about health. We are told
that smoking is bad for us, that we need to exercise
more, and that we’ve grown obese. We learn about new
treatments for diseases about which we are only dimly
aware, or we hear that a particular herbal remedy may
make us feel better about ourselves. We are told that
meditation or optimistic beliefs can keep us healthy or
help us get well more quickly. How do we make sense
of all these claims? Health psychology addresses
important questions like these.
■ DEFINITION OF HEALTH
PSYCHOLOGY
Health psychology is an exciting and relatively new field
devoted to understanding psychological influences on
how people stay healthy, why they become ill, and how
they respond when they do get ill. Health psychologists
both study such issues and develop interventions to
help people stay well or recover from illness. For ex-
ample, a health psychology researcher might explore
why people continue to smoke even though they know
that smoking increases their risk of cancer and heart
disease. Understanding this poor health habit leads to
interventions to help people stop smoking.
Fundamental to research and practice in health
psychology is the definition of health. Decades ago, a
forward-looking World Health Organization (1948) de-
fined health as “a complete state of physical, mental,
and social well-being and not merely the absence of
disease or infirmity.” This definition is at the core of
health psychologists’ conception of health. Rather
than defining health as the absence of illness, health is
recognized to be an achievement involving balance
among physical, mental, and social well-being. Many
use the term wellness to refer to this optimum state of
health.
tay53902_ch01_001-013.indd 3
Chapter 1 What Is Health Psychology? 3
Health psychologists focus on health promotion
and maintenance, which includes issues such as how to
get children to develop good health habits, how to pro-
mote regular exercise, and how to design a media cam-
paign to get people to improve their diets.
Health psychologists study the psychological as-
pects of the prevention and treatment of illness. A health
psychologist might teach people in a high-stress occu-
pation how to manage stress effectively to avoid health
risks. A health psychologist might work with people
who are already ill to help them follow their treatment
regimen.
Health psychologists also focus on the etiology and
correlates of health, illness, and dysfunction. Etiology
­refers to the origins or causes of illness. Health psy-
chologists especially address the behavioral and social
factors that contribute to health, illness, and dysfunc-
tion, such as alcohol consumption, drug use, exercise,
the wearing of seat belts, and ways of coping with
stress.
Finally, health psychologists analyze and attempt
to improve the health care system and the formulation of
health policy. They study the impact of health institu-
tions and health professionals on people’s behavior to
develop recommendations for improving health care.
In summary, health psychology examines the psy-
chological and social factors that lead to the enhance-
ment of health, the prevention and treatment of illness,
and the evaluation and modification of health policies
that influence health care.
Why Did Health Psychology Develop?
To many people, health is simply a matter of staying
well or getting over illnesses quickly. Psychological and
social factors might seem to have little to contribute.
But consider some of the following puzzles that cannot
be understood without the input of health psychology:
• When people are exposed to a cold virus, some
get colds whereas others do not.
• Men who are married live longer than men who
are not married.
• Throughout the world, life expectancy is increasing.
But in countries going through dramatic social
upheaval, life expectancy can plummet.
• Women live longer than men in all countries
except those in which they are denied access to
health care. But women are more disabled, have
more illnesses, and use health services more.
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 4 Part One Introduction to Health Psychology
• Infectious diseases such as tuberculosis, pneumo-
nia, and influenza used to be the major causes of
illness and death in the United States. Now chronic
disorders such as heart disease, cancer, and diabetes
are the main causes of disability and death.
• Attending a church or synagogue, praying, or
otherwise tending to spiritual needs is good for
your health.
By the time you have finished this book, you will
know why these findings are true.
■ THE MIND–BODY
RELATIONSHIP: A BRIEF
HISTORY
During prehistoric times, most cultures regarded the
mind and body as intertwined. Disease was thought to
arise when evil spirits entered the body, and treatment
consisted primarily of attempts to exorcise these spir-
its. Some skulls from the Stone Age have small, sym-
metrical holes that are believed to have been made
intentionally with sharp tools to allow the evil spirit to
leave the body while the shaman performed the treat-
ment ritual.
The ancient Greeks were among the earliest civili-
zations to identify the role of bodily factors in health
Sophisticated, though not always successful, techniques for the treatment of illness were
developed during the Renaissance. This woodcut from the 1570s depicts a surgeon
drilling a hole in a patient’s skull, with the patient’s family and pets looking on.
Source: The National Library of Medicine.
tay53902_ch01_001-013.indd 4
and illness. Rather than ascribing illness to evil spirits,
they developed a humoral theory of illness. According
to this viewpoint, disease resulted when the four hu-
mors or circulating fluids of the body—blood, black
bile, yellow bile, and phlegm—were out of balance. The
goal of treatment was to restore balance among the
humors. The Greeks also believed that the mind was
important. They described personality types associ-
ated with each of the four humors, with blood being
associated with a passionate temperament, black bile
with sadness, yellow bile with an angry disposition,
and phlegm with a laid-back approach to life. Although
these theories are now known not to be true, the em-
phasis on mind and body in health and illness was a
breakthrough for that time.
By the Middle Ages, however, the pendulum had
swung to supernatural explanations for illness. Disease
was regarded as God’s punishment for evildoing, and
cure often consisted of driving out the evil forces by
torturing the body. Later, this form of “therapy” was
replaced by penance through prayer and good works.
During this time, the Church was the guardian of med-
ical knowledge, and as a result, medical practice as-
sumed religious overtones. The functions of the
physician were typically absorbed by priests, and so
healing and the practice of religion became virtually
indistinguishable.
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Beginning in the Renaissance and continuing into
the present day, great strides were made in
understanding the technical bases of medicine. These
advances include the invention of the microscope in
the 1600s and the development of the science of au-
topsy, which allowed medical practitioners to see the
organs that were implicated in different diseases. As
the science of cellular pathology progressed, the hu-
moral theory of illness was put to rest. Medical prac-
tice drew increasingly on laboratory findings and
looked to bodily factors rather than to the mind as
bases for health and illness. In an effort to break with
the superstitions of the past, practitioners resisted ac-
knowledging any role for the mind in disease processes.
Instead, they focused primarily on organic and cellular
pathology as a basis for their diagnoses and treatment
recommendations.
The resulting biomedical model, which has gov-
erned the thinking of most health practitioners for the
past 300 years, maintains that all illness can be explained
on the basis of aberrant somatic bodily processes, such
as biochemical imbalances or neurophysiological ab-
normalities. The biomedical model assumes that psy-
chological and social processes are largely irrelevant to
the disease process. The problems with the biomedical
model are summarized in Table 1.1.
TABLE 1.1 | T
 he Biomedical Model: Why Is It
Ill-suited to Understanding Illness?
• Reduces illness to low-level processes such as
disordered cells and chemical imbalances
• Fails to recognize social and psychological processes as
powerful influences over bodily states—assumes a mind–
body dualism
• Emphasizes illness over health rather than focusing on
behaviors that promote health
• Cannot address many puzzles that face practitioners:
why, for example, if six people are exposed to a flu virus,
do only three develop the flu?
■ THE RISE OF THE
BIOPSYCHOSOCIAL MODEL
The biomedical viewpoint began to change with the rise
of modern psychology, particularly with Sigmund
Freud’s (1856–1939) early work on conversion hysteria.
According to Freud, specific unconscious conflicts can
produce physical disturbances that symbolize repressed
psychological conflicts. Although this viewpoint is no
longer central to health psychology, it gave rise to the
field of psychosomatic medicine.
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Chapter 1 What Is Health Psychology? 5
Psychosomatic Medicine
The idea that specific illnesses are produced by peo-
ple’s internal conflicts was perpetuated in the work of
Flanders Dunbar in the 1930s (Dunbar, 1943) and
Franz Alexander in the 1940s (Alexander, 1950). For
example, Alexander developed a profile of the ulcer-
prone personality as someone with excessive needs for
dependency and love.
Dunbar and Alexander maintained that conflicts
produce anxiety, which becomes unconscious and
takes a physiological toll on the body via the auto-
nomic nervous system. The continuous physiological
changes eventually produce an organic disturbance. In
the case of the ulcer patient, for example, repressed
emotions resulting from frustrated dependency and
love-seeking needs were thought to increase the se-
cretion of acid in the stomach, eventually eroding the
stomach lining and producing ulcers (Alexander, 1950).
Dunbar’s and Alexander’s work helped shape the
emerging field of psychosomatic medicine by offering
profiles of particular disorders believed to be psychoso-
matic in origin, that is, caused by emotional conflicts.
These disorders include ulcers, hyperthyroidism, rheu-
matoid arthritis, essential hypertension, neurodermati-
tis (a skin disorder), colitis, and bronchial asthma.
We now know that all illnesses raise psychological
issues. Moreover, researchers now believe that a par-
ticular conflict or personality type is not sufficient to
produce illness. Rather, the onset of disease is usually
due to several factors working together, which may in-
clude a biological pathogen (such as a viral or bacterial
infection) coupled with social and psychological fac-
tors, such as high stress, low social support, and low
socioeconomic status.
The idea that the mind and the body together de-
termine health and illness logically implies a model for
studying these issues. This model is called the biopsy-
chosocial model. Its fundamental assumption is that
health and illness are consequences of the interplay of
biological, psychological, and social factors.
Advantages of the
Biopsychosocial Model
How does the biopsychosocial model of health and ill-
ness overcome the disadvantages of the biomedical
model? The biopsychosocial model maintains that bio-
logical, psychological, and social factors are all impor-
tant determinants of health and illness. Both macrolevel
processes (such as the existence of social support or
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conducted congregation, and hoped that great good would result
from our efforts. This opposition, also, the Lord overruled to increase
our influence, and to give point and publicity to our assaults upon
the kingdom of Satan.
Though disappointed thus, some of the Publicans resolved to have
revenge. On the following Saturday evening, when a large meeting
was being addressed in our Green Street Church, which had to be
entered by a great iron gateway, a spirit merchant ran his van in
front of the gate, so that the people could not leave the Church
without its removal. Hearing this, I sent two of my young men to
draw it aside and clear the way. The Publican, watching near by in
league with two policemen, pounced upon the young men whenever
they seized the shafts, and gave them in charge for removing his
property. On hearing that the young men were being marched to the
Police Office, I ran after them and asked what was their offence?
They replied that they were prisoners for injuring the spirit
merchant’s property; and the officers tartly informed me that if I
further interfered I would be taken too. I replied, that as the young
men only did what was necessary, and at my request, I would go with
them to the Office. The cry now went through the street, that the
Publicans were sending the Missionary and his young men to the
Police Office, and a huge mob rushed together to rescue us; but I
earnestly entreated them not to raise disturbance, but allow us
quietly to pass on. At the Office, it appeared as if the lieutenant on
duty and the men under him were all in sympathy with the
Publicans. He took down in writing all their allegations, but would
not listen to us. At this stage a handsomely dressed and dignified
gentleman came forward and said,—
“What bail is required?”
A few sharp words passed; another, and apparently higher, officer
entered, and took part in the colloquy. I could only hear the
gentleman protest, in authoritative tones, the policemen having been
quietly asked some questions,—
“I know this whole case, I will expose it to the bottom; expect me
here to stand by the Missionary and these young men on Monday
morning.”
Before I could collect my wits to thank him, and before I quite
understood what was going on, he had disappeared; and the superior
officer turned to us and intimated in a very respectful manner that
the charge had been withdrawn, and that I and my friends were at
liberty. I never found out exactly who the gentleman was that
befriended us; but from the manner in which he asserted himself and
was listened to, I saw that he was well known in official quarters.
From that day our work progressed without further open opposition,
and many who had been slaves of intemperance were not only
reformed, but became fervent workers in the Total Abstinence cause.
Though intemperance was the main cause of poverty, suffering,
misery, and vice in that district of Glasgow, I had also considerable
opposition from Romanists and Infidels, many of whom met in
clubs, where they drank together and gloried in their wickedness and
in leading other young men astray. Against these I prepared and
delivered lectures, at the close of which discussion was allowed; but I
fear they did little good. These men embraced the opportunity of
airing their absurdities, or sowing the seeds of corruption in those
whom otherwise they could never have reached, while their own
hearts and minds were fast shut against all conviction or light.
One infidel Lecturer in the district became very ill. His wife called
me in to visit him. I found him possessed of a circulating library of
infidel books, by which he sought to pervert unwary minds. Though
he had talked and lectured much against the Gospel, he did not at all
really understand its message. He had read the Bible, but only to find
food there for ridicule. Now supposed to be dying, he confessed that
his mind was full of terror as to the Future. After several visits and
frequent conversations and prayers, he became genuinely and deeply
interested, drank in God’s message of salvation, and cried aloud with
many tears for pardon and peace. He bitterly lamented the evil he
had done, and called in all the infidel literature that he had in
circulation, with the purpose of destroying it. He began to speak
solemnly to any of his old companions that came to see him, telling
them what he had found in the Lord Jesus. At his request I bought
and brought to him a Bible, which he received with great joy, saying,
“This is the book for me now;” and adding, “Since you were here last,
I gathered together all my infidel books; my wife locked the door, till
she and my daughter tore them to pieces, and I struck the light that
reduced the pile to ashes.”
 As long as he lived, this man was unwearied and unflinching in
testifying, to all that crossed his path, how much Jesus Christ had
been to his heart and soul; and he died in the possession of a full and
blessed hope.
Another Infidel, whose wife was a Roman Catholic, also became
unwell, and gradually sank under great suffering and agony. His
blasphemies against God were known and shuddered at by all the
neighbours. His wife pled with me to visit him. She refused, at my
suggestion, to call her own priest, so I accompanied her at last. The
man refused to hear one word about spiritual things, and foamed
with rage. He even spat at me, when I mentioned the name of Jesus.
“The natural man receiveth not the things of the Spirit of God; for
they are foolishness unto him!” There is a wisdom which is at best
earthly, and at worst “sensual and devilish.” His wife asked me to
take care of the little money they had, as she would not entrust it to
her own priest. I visited the poor man daily, but his enmity to God
and his sufferings together seemed to drive him mad. His yells
gathered crowds on the streets. He tore to pieces his very bed-
clothes, till they had to bind him on the iron bed where he lay,
foaming and blaspheming. Towards the end I pled with him even
then to look to the Lord Jesus, and asked if I might pray with him?
With all his remaining strength, he shouted at me,—
“Pray for me to the devil!”
Reminding him how he had always denied that there was any
devil, I suggested that he must surely believe in one now, else he
would scarcely make such a request, even in mockery. In great rage
he cried,—
“Yes, I believe there is a devil, and a God, and a just God, too; but I
have hated Him in life, and I hate Him in death!”
With these awful words, he wriggled into Eternity; but his
shocking death produced a very serious impression for good,
especially amongst young men, in the district where his character
was known.
How different was the case of that Doctor who also had been an
unbeliever as well as a drunkard! Highly educated, skilful, and gifted
above most in his profession, he was taken into consultation for
specially dangerous cases, whenever they could find him tolerably
sober. After one of his excessive “bouts,” he had a dreadful attack of
delirium tremens. At one time, wife and watchers had a fierce
struggle to dash from his lips a draught of prussic acid; at another,
they detected the silver-hafted lancet concealed in the band of his
shirt, as he lay down, to bleed himself to death. His aunt came and
pled with me to visit him. My heart bled for his poor young wife and
two beautiful little children. Visiting him twice daily, and sometimes
even more frequently, I found the way somehow into his heart, and
he would do almost anything for me and longed for my visits. When
again the fit of self-destruction seized him, they sent for me; he held
out his hand eagerly, and grasping mine, said,—
“Put all these people out of the room, remain you with me; I will be
quiet, I will do everything you ask!”
I got them all to leave, but whispered to one in passing to “keep
near the door.”
Alone I sat beside him, my hand in his, and kept up a quiet
conversation for several hours. After we had talked of everything that
I could think of, and it was now far into the morning, I said,—
“If you had a Bible here, we might read a chapter, verse about.”
He said dreamily, “There was once a Bible above yon press; if you
can get up to it, you might find it there yet.”
Getting it, dusting it, and laying it on a small table which I drew
near to the sofa on which we sat, we read there and then a chapter
together. After this, I said, “Now, shall we pray?”
He replied heartily, “Yes.”
I having removed the little table, we kneeled down together at the
sofa; and after a solemn pause, I whispered, “You pray first.”
He replied, “I curse, I cannot pray; would you have me curse God
to His face?”
I answered, “You promised to do all that I asked; you must pray, or
try to pray, and let me hear that you cannot.”
He said, “I cannot curse God on my knees; let me stand, and I will
curse Him; I cannot pray.”
I gently held him on his knees, saying, “Just try to pray, and let me
hear you cannot.”
 Instantly he cried out, “O Lord, Thou knowest I cannot pray,” and
was going to say something dreadful as he strove to rise up. But I just
took the words he had uttered as if they had been my own, and
continued the prayer, pleading for him and his dear ones as we knelt
there together, till he showed that he was completely subdued and
lying low at the feet of God. On rising from our knees he was
manifestly greatly impressed, and I said,—
“Now, as I must be at College by daybreak and must return to my
lodging for my books and an hour’s rest, will you do one thing more
for me before I go?”
“Yes,” was his reply.
“Then,” said I, “it is long since you had a refreshing sleep; now, will
you lie down, and I will sit by you till you fall asleep?”
He lay down, and was soon fast asleep. After commending him to
the care and blessing of the Lord, I quietly slipped out, and his wife
returned to watch by his side. When I came back later in the day,
after my classes were over, he, on hearing my foot and voice, came
running to meet me, and clasping me in his arms, cried,—
“Thank God, I can pray now! I rose this morning refreshed from
sleep, and prayed with my wife and children for the first time in my
life; and now I shall do so every day, and serve God while I live, who
hath dealt in so great mercy with me!”
After delightful conversation, he promised to go with me to Dr.
Symington’s church on Sabbath Day; there he took sittings beside
me; at next half-yearly communion he and his wife were received
into membership, and their children were baptized; and from that
day till his death he led a devoted and most useful Christian life.
Henceforth, as a medical man he delighted to attend all poor and
destitute cases which we brought under his care; he ministered to
them for Jesus’ sake, and spoke to them of their blessed Saviour.
When he came across cases that were hopeless, he sent for me to visit
them too, being as anxious for their souls as for their bodies. He
died, years after this, of consumption, partly at least the fruit of early
excesses; but he was serenely prepared for death, and happy in the
assured hope of eternal blessedness with Christ. He sleeps in Jesus;
and I do believe that I shall meet him in Glory as a trophy of
redeeming grace and love!
 In my Mission district, I was the witness of many joyful departures
to be with Jesus,—I do not like to name them “deaths” at all. Even
now, at the distance of nearly forty years, many instances, especially
amongst the young men and women who attended my classes, rise
up before my mind. They left us, rejoicing in the bright assurance
that nothing present or to come “could ever separate them or us from
the love of God which is in Christ Jesus our Lord.” Several of them,
by their conversation even on their deathbed, were known to have
done much good. Many examples might be given; but I can find
room for only one. John Sim, a dear little boy, was carried away by
consumption. His childish heart seemed to be filled with joy about
seeing Jesus. His simple prattle, mingled with deep questionings,
arrested not only his young companions, but pierced the hearts of
some careless sinners who heard him, and greatly refreshed the faith
of God’s dear people. It was the very pathos of song incarnated to
hear the weak quaver of his dying voice sing out,—
“I lay my sins on Jesus,
The spotless Lamb of God.”

Shortly before his decease he said to his parents, “I am going soon

to be with Jesus; but I sometimes fear that I may not see you there.”
“Why so, my child?” said his weeping mother.
“Because,” he answered, “if you were set upon going to heaven and
seeing Jesus there, you would pray about it, and sing about it; you
would talk about Jesus to others, and tell them of that happy meeting
with Him in Glory. All this my dear Sabbath school teacher taught
me, and she will meet me there. Now why did not you, my father and
mother, tell me all these things about Jesus, if you are going to meet
Him too?”
Their tears fell fast over their dying child; and he little knew, in his
unthinking eighth year, what a message from God had pierced their
souls through his innocent words. One day an aunt from the country
visited his mother, and their talk had run in channels for which the
child no longer felt any interest. On my sitting down beside him, he
said,—
“Sit you down and talk with me about Jesus; I am tired hearing so
much talk about everything else but Jesus; I am going soon to be
with Him. Oh, do tell me everything you know or have ever heard
about Jesus, the spotless Lamb of God!”
At last the child literally longed to be away, not for rest, or freedom
from pain—for of that he had very little—but, as he himself always
put it, “to see Jesus.” And, after all, that was the wisdom of the heart,
however he learned it. Eternal life, here or hereafter, is just the vision
of Jesus.
Amongst many of the Roman Catholics in my Mission district,
also, I was very kindly received, and allowed even to read the
Scriptures and to pray. At length, however, a young woman who
professed to be converted by my classes and meetings brought things
to a crisis betwixt them and me. She had renounced her former faith,
was living in a Protestant family, and looked to me as her pastor and
teacher. One night, a closed carriage, with two men and women, was
sent from a Nunnery in Clyde Street, to take her and her little sister
with them. She refused, and declined all authority on their part,
declaring that she was now a Protestant by her own free choice.
During this altercation, a message had been sent for me. On arriving,
I found the house filled with a noisy crowd. Before them all, she
appealed to me for protection from these her enemies. The
Romanists, becoming enraged, jostled me into a corner of the room,
and there enclosed me. The two women pulled her out of bed by
force, for the girl had been sick, and began to dress her, but she
fainted among their hands.
I called out,—
“Do not murder the poor girl! Get her water, quick, quick!” and
leaving my hat on the table, I rushed through amongst them, as if in
search of water, and they let me pass. Knowing that the house had
only one door, I quickly slipped the key from within, shut and locked
the door outside, and with the key in my hand ran to the Police
Office. Having secured two constables to protect the girl and take the
would-be captors into custody, I returned, opened the door, and
found, alas! that these constables were themselves Roman Catholics,
and at once set about frustrating me and assisting their own friends.
The poor sick girl was supported by the arms into the carriage; the
policemen cleared the way through the crowd; and before I could
force my way through the obstructives in the house, the conveyance
was already starting. I appealed and shouted to the crowds to protect
the girl, and seize and take the whole party to the Police Office. A
gentleman in the crowd took my part, and said to a big Highland
policeman in the street,—
“Mac, I commit that conveyance and party to you on a criminal
charge, before witnesses; you will suffer, if they escape.”
The driver lashing at his horse to get away, Mac drew his baton
and struck, when the driver leapt down to the street on the opposite
side, and threw the reins in the policeman’s face. Thereupon our
stalwart friend at once mounted the box, and drove straight for the
Police Office. On arriving there, we discovered that only the women
were inside with the sick girl—the men having escaped in the scuffle
and the crush. What proved more disappointing was that the
lieutenant on duty happened to be a Papist, who, after hearing our
statement and conferring with the parties in the conveyance,
returned, and said,—
“Her friends are taking her to a comfortable home; you have no
right to interfere, and I have let them go.” He further refused to hear
the grounds of our complaint, and ordered the police to clear the
Office.
Next morning, a false and foolish account of the whole affair
appeared in the Newspapers, condemnatory of the Mission and of
myself; a meeting of the directors was summoned, and the
Superintendent came to my lodging to take me before them. Having
heard all, and questioned and cross-questioned me, they resolved to
prosecute the abductors of the girl. The Nunnery authorities
confessed that the little sister was with them, but denied that she had
been taken in there, or that they knew anything of her case. Though
the girl was sought for carefully by the Police, and by all the members
of my class, for nearly a fortnight, no trace of her or of the coachman
or of any of the parties could be discovered; till one day from a cellar,
through a grated window, she called to one of my class girls passing
by, and begged her to run and let me know that she was confined
there. At once, the directors of the City Mission were informed by
me, and Police were sent to rescue her; but on examining that house
they found that she had been again removed. The occupiers denied
all knowledge of where she had gone, or who had taken her away
from their lodging. All other efforts failed to find her, till she was left
at the Poor House door, far gone in dropsy, and soon after died in
that last refuge of the destitute and forsaken.
Anonymous letters were now sent, threatening my life; and I was
publicly cursed from the altar by the priests in Abercromby Street
Chapel. The directors of the Mission, fearing violence, advised me to
leave Glasgow for a short holiday, and even offered to arrange for my
being taken for work in Edinburgh for a year, that the fanatical
passions of the Irish Papists might have time to subside. But I
refused to leave my work. I went on conducting it all as in the past.
The worst thing that happened was, that on rushing one day past a
row of houses occupied exclusively by Papists, a stone thrown from
one of them cut me severely above the eye, and I fell stunned and
bleeding. When I recovered and scrambled to my feet, no person of
course that could be suspected was to be seen! The doctor having
dressed the wound, it rapidly healed, and after a short confinement I
resumed my work and my studies without any further serious
annoyance. Attempts were made more than once, in these Papist
closes, and I believe by the Papists themselves, to pour pails of
boiling water on my head, over windows and down dark stairs, but in
every case I marvellously escaped; and as I would not turn coward,
their malice tired itself out, and they ultimately left me entirely at
peace. Is not this a feature of the lower Irish, and especially Popish
population? Let them see that bullying makes you afraid, and they
will brutally and cruelly misuse you; but defy them fearlessly, or take
them by the nose, and they will crouch like whelps beneath your feet.
Is there anything in their Religion that accounts for this? Is it not a
system of alternating tyranny on the one part, and terror, abject
terror, on the other?
About this same time there was an election of elders for Dr.
Symington’s congregation, and I was by an almost unanimous vote
chosen for that office. For years now I had been attached to them as
City Missionary for their district, and many friends urged me to
accept the eldership, as likely to increase my usefulness, and give me
varied experience for my future work. My dear father, also, himself
an elder in the congregation at Dumfries, advised me similarly; and
though very young, comparatively, for such a post, I did accept the
office, and continued to act as an elder and member of Dr.
Symington’s kirk session, till by-and-by I was ordained as a
Missionary to the New Hebrides, where the great lot of my life had
been cast by the Lord, as yet unknown to me.
All through my City Mission period, I was painfully carrying on my
studies, first at the University of Glasgow, and thereafter at the
Reformed Presbyterian Divinity Hall; and also medical classes at the
Andersonian College. With the exception of one session, when failure
of health broke me down, I struggled patiently on through ten years.
The work was hard and most exacting; and if I never attained the
scholarship for which I thirsted—being but poorly grounded in my
younger days—I yet had much of the blessed Master’s presence in all
my efforts, which many better scholars sorely lacked; and I was
sustained by the lofty aim which burned all these years bright within
my soul, namely,—to be qualified as a preacher of the Gospel of
Christ, to be owned and used by Him for the salvation of perishing
men.
 CHAPTER IV.
FOREIGN MISSION CLAIMS.

The Wail of the Heathen.—A Missionary Wanted.—Two Souls on

the Altar.—Lions in the Path.—The Old Folks at Home.—
Successors in Green Street Mission.—Old Green Street Hands.
—A Father in God.

Happy in my work as I felt, and successful by the blessing of God, yet

I continually heard, and chiefly during my last years in the Divinity
Hall, the wail of the perishing Heathen in the South Seas; and I saw
that few were caring for them, while I well knew that many would be
ready to take up my work in Calton, and carry it forward perhaps
with more efficiency than myself. Without revealing the state of my
mind to any person, this was the supreme subject of my daily
meditation and prayer; and this also led me to enter upon those
medical studies, in which I purposed taking the full course; but at the
close of my third year, an incident occurred, which led me at once to
offer myself for the Foreign Mission field.
The Reformed Presbyterian Church of Scotland, in which I had
been brought up, had been advertising for another Missionary to join
the Rev. John Inglis in his grand work in the New Hebrides. Dr.
Bates, the excellent convener of the Heathen Missions Committee,
was deeply grieved, because for two years their appeal had failed. At
length, the Synod, after much prayer and consultation, felt the claims
of the Heathen so urgently pressed upon them by the Lord’s repeated
calls, that they resolved to cast lots, to discover whether God would
thus select any Minister to be relieved from his home-charge, and
designated as a Missionary to the South Seas. Each member of
Synod, as I was informed, agreed to hand in, after solemn appeal to
God, the names of the three best qualified in his esteem for such a
work, and he who had the clear majority was to be loosed from his
congregation, and to proceed to the Mission field—or the first and
second highest, if two could be secured. Hearing this debate, and
feeling an intense interest in these most unusual proceedings, I
remember yet the hushed solemnity of the prayer before the names
were handed in. I remember the strained silence that held the
Assembly while the scrutinizers retired to examine the papers; and I
remember how tears blinded my eyes when they returned to
announce that the result was so indecisive, that it was clear that the
Lord had not in that way provided a Missionary. The cause was once
again solemnly laid before God in prayer, and a cloud of sadness
appeared to fall over all the Synod.
The Lord kept saying within me, “Since none better qualified can
be got, rise and offer yourself!” Almost overpowering was the
impulse to answer aloud, “Here am I, send me.” But I was dreadfully
afraid of mistaking my own emotions for the will of God. So I
resolved to make it a subject of close deliberation and prayer for a
few days longer, and to look at the proposal from every possible
aspect. Besides, I was keenly solicitous about the effect upon the
hundreds of young people and others, now attached to all my classes
and meetings; and yet I felt a growing assurance that this was the call
of God to His servant, and that He who was willing to employ me in
the work abroad, was both able and willing to provide for the on-
carrying of my work at home. The wail and the claims of the Heathen
were constantly sounding in my ears. I saw them perishing for lack of
the knowledge of the true God and His Son Jesus, while my Green
Street people had the open Bible, and all the means of grace within
easy reach, which, if they rejected, they did so wilfully, and at their
own peril. None seemed prepared for the Heathen field; many were
capable and ready for the Calton service. My medical studies, as well
as my literary and divinity training, had specially qualified me in
some ways for the Foreign field, and from every aspect at which I
could look the whole facts in the face, the voice within me sounded
like a voice from God.
It was under good Dr. Bates of West Campbell Street that I had
begun my career in Glasgow—receiving £25 per annum for district
visitation in connection with his congregation, along with instruction
under Mr. Hislop and his staff in the Free Church Normal Seminary
—and oh, how Dr. Bates did rejoice, and even weep for joy, when I
called on him, and offered myself for the New Hebrides Mission! I
returned to my lodging with a lighter heart than I had for some time
enjoyed, feeling that nothing so clears the vision, and lifts up the life,
as a decision to move forward in what you know to be entirely the
will of the Lord. I said to my fellow-student, who had chummed with
me all through our course at college,—
“I have been away signing my banishment” (a rather trifling way of
talk for such an occasion). “I have offered myself as a Missionary for
the New Hebrides.”
After a long and silent meditation, in which he seemed lost in far-
wandering thoughts, his answer was,—
“If they will accept of me, I also am resolved to go!”
I said, “Will you write the convener to that effect, or let me do so?”
He replied, “You may.”
A few minutes later his letter of offer was in the post office. Next
morning, Dr. Bates called upon us early, and after a long
conversation, commended us and our future work to the Lord God in
fervent prayer.
My fellow-student, Mr. Joseph Copeland, had also for some time
been a very successful City Missionary in the Camlachie district,
while attending along with me at the Divinity Hall. This leading of
God, whereby we both resolved at the same time to give ourselves to
the Foreign Mission field, was wholly unexpected by us, as we had
never once spoken to each other about going abroad. At a meeting of
the Heathen Missions Committee, held immediately thereafter, both
were, after due deliberation, formally accepted, on condition that we
passed successfully the usual examinations required of candidates
for the Ministry. And for the next twelve months we were placed
under the special committee for advice as to medical experience,
acquaintance with the rudiments of trades, and anything else which
might be thought useful to us in the Foreign field.
When it became known that I was preparing to go abroad as
Missionary, nearly all were dead against the proposal, except Dr.
Bates and my fellow-student. My dear father and mother, however,
when I consulted them, characteristically replied, “that they had long
since given me away to the Lord, and in this matter also would leave
me to God’s disposal.” From other quarters we were besieged with
the strongest opposition on all sides. Even Dr. Symington, one of my
professors in divinity, and the beloved Minister in connection with
whose congregation I had wrought so long as a City Missionary, and
in whose kirk session I had for years sat as an elder, repeatedly urged
me to remain at home. He argued, “that Green Street Church was
doubtless the sphere for which God had given me peculiar
qualifications, and in which He had so largely blessed my labours;
that if I left those now attending my classes and meetings, they might
be scattered, and many of them would probably fall away; that I was
leaving certainty for uncertainty—work in which God had made me
greatly useful, for work in which I might fail to be useful, and only
throw away my life amongst Cannibals.”
I replied, “that my mind was finally resolved; that, though I loved
my work and my people, yet I felt that I could leave them to the care
of Jesus, who would soon provide them a better pastor than I; and
that, with regard to my life amongst the Cannibals, as I had only once
to die, I was content to leave the time and place and means in the
hand of God, who had already marvellously preserved me when
visiting cholera patients and the fever-stricken poor; on that score I
had positively no further concern, having left it all absolutely to the
Lord, whom I sought to serve and honour, whether in life or by
death.”
The house connected with my Green Street Church, was now
offered to me for a Manse, and any reasonable salary that I cared to
ask (as against the promised £120 per annum for the far-off and
dangerous New Hebrides), on condition that I would remain at
home. I cannot honestly say that such offers or opposing influences
proved a heavy trial to me; they rather tended to confirm my
determination that the path of duty was to go abroad. Amongst many
who sought to deter me, was one dear old Christian gentleman,
whose crowning argument always was,—
“The Cannibals! you will be eaten by Cannibals!”
At last I replied, “Mr. Dickson, you are advanced in years now, and
your own prospect is soon to be laid in the grave, there to be eaten by
worms; I confess to you, that if I can but live and die serving and
honouring the Lord Jesus, it will make no difference to me whether I
am eaten by Cannibals or by worms; and in the Great Day my
resurrection body will arise as fair as yours in the likeness of our
risen Redeemer.”
The old gentleman, raising his hands in a deprecating attitude, left
the room exclaiming,—
“After that I have nothing more to say!”
My dear Green Street people grieved excessively at the thought of
my leaving them, and daily pled with me to remain. Indeed, the
opposition was so strong from nearly all, and many of them warm
Christian friends, that I was sorely tempted to question whether I
was carrying out the Divine will, or only some headstrong wish of my
own. This also caused me much anxiety, and drove me close to God
in prayer. But again every doubt would vanish, when I clearly saw
that all at home had free access to the Bible and the means of grace,
with Gospel light shining all around them, while the poor Heathen
were perishing, without even the chance of knowing all God’s love
and mercy to men. Conscience said louder and clearer every day,
“Leave all these results with Jesus your Lord, who said, ‘Go ye into all
the world, preach the gospel to every creature, and lo! I am with you
alway.’” These words kept ringing in my ears; these were our
marching orders.
Some retorted upon me, “There are Heathen at home; let us seek
and save, first of all, the lost ones perishing at our doors.” This I felt
to be most true, and an appalling fact; but I unfailingly observed that
those who made this retort neglected these home Heathen
themselves; and so the objection, as from them, lost all its power.
They would ungrudgingly spend more on a fashionable party at
dinner or tea, on concert or ball or theatre, or on some ostentatious
display, or worldly and selfish indulgence, ten times more, perhaps
in a single day, than they would give in a year, or in half a lifetime,
for the conversion of the whole Heathen World, either at home or
abroad. Objections from all such people must, of course, always
count for nothing among men to whom spiritual things are realities.
For these people themselves,—I do, and always did, only pity them,
as God’s stewards, making such a miserable use of time and money
entrusted to their care.
On meeting with so many obstructing influences, I again laid the
whole matter before my dear parents, and their reply was to this
effect:—“Heretofore we feared to bias you, but now we must tell you
why we praise God for the decision to which you have been led. Your
father’s heart was set upon being a Minister, but other claims forced
him to give it up. When you were given to them, your father and
mother laid you upon the altar, their first-born, to be consecrated, if
God saw fit, as a Missionary of the Cross; and it has been their
constant prayer that you might be prepared, qualified, and led to this
very decision; and we pray with all our heart that the Lord may
accept your offering, long spare you, and give you many souls from
the Heathen World for your hire.” From that moment, every doubt as
to my path of duty for ever vanished. I saw the hand of God very
visibly, not only preparing me for, but now leading me to, the
Foreign Mission field.
Well did I know that the sympathy and prayers of my dear parents
were warmly with me in all my studies and in all my Mission work;
but for my education they could, of course, give me no money help.
All through, on the contrary, it was my pride and joy to help them,
being the eldest in a family of eleven. First, I assisted them to
purchase the family cow, without whose invaluable aid my ever-
memorable mother never could have reared and fed her numerous
flock; then, I paid for them the house-rent and the cow’s grass on the
Bank Hill, till some of the others grew up and relieved me by paying
these in my stead; and finally, I helped to pay the school-fees, to
provide clothing—in short I gave, and gladly, what could possibly be
saved out of my City Mission salary of £40, ultimately advanced to
£45 per annum. Self-educated thus, and without the help of one
shilling from any other source, readers will easily imagine that I had
many a staggering difficulty to overcome in my long curriculum in
Arts, Divinity, and Medicine; but God so guided me, and blessed all
my little arrangements, that I never incurred one farthing of personal
debt. There was, however, a heavy burden always pressing upon me,
and crushing my spirit from the day I left my home, which had been
thus incurred.
The late owner of the Dalswinton estate allowed, as a prize, the
cottager who had the tidiest house and most beautiful flower-garden
to sit rent free. For several years in succession, my old sea-faring
grandfather won this prize, partly by his own handy skill, partly by
his wife’s joy in flowers. Unfortunately no clearance-receipt had been
asked or given for these rents—the proprietor and his cottars treating
each other as friends rather than as men of business. The new heir,
unexpectedly succeeding, found himself in need of money, and
threatened prosecution for such rents as arrears. The money had to
be borrowed. A money-lending lawyer gave it at usurious interest, on
condition of my father also becoming responsible for interest and
principal. This burden hung like a millstone around my grandfather’s
neck till the day of his death; and it then became suspended round
my father’s neck alone. The lawyer, on hearing of my giving up trade
and entering upon study, threatened to prosecute my father for the
capital, unless my name were given along with his for security. Every
shilling that I or any of us could save, all through these ten years of
my preparatory classes, went to pay off that interest and gradually to
reduce the capital; and this burden we managed, amongst us, to
extinguish just on the eve of my departure for the South Seas.
Indeed, one of the purest joys connected with that time was that I
received my first Foreign Mission salary and outfit money in
advance, and could send home a sum sufficient to wipe out the last
penny of a claim by that money-lender or by any one else against my
beloved parents, in connection with the noble struggle they had
made in rearing so large a family in thorough Scottish independence.
And that joy was hallowed by the knowledge that my other brothers
and sisters were now all willing and able to do what I had been doing
—for we stuck to each other and to the old folks like burs, and had all
things “in common,” as a family in Christ—and I knew that never
again, howsoever long they might be spared through a peaceful
autumn of life, would the dear old father and mother lack any joy or
comfort that the willing hands and loving hearts of all their children
could singly or unitedly provide. For all this I did praise the Lord. It
consoled me, beyond description, in parting from them, probably for
ever in this world at least.
The Directors of Glasgow City Mission along with the Great
Hamilton Street congregation, had made every effort to find a
suitable successor to me in my Green Street work, but in vain.
Despairing of success, as no inexperienced worker could with any
hope undertake it, Rev. Mr. Caie, the superintendent, felt moved to
appeal to my brother Walter,—then in a good business situation in
the city, who had been of late closely associated with me in all my
undertakings,—if he would not come to the rescue, devote himself to
the Mission, and prepare for the Holy Ministry. My brother resigned
a good position and excellent prospects in the business world, set
himself to carry forward the Green Street Mission and did so with
abundant energy and manifest blessing, persevered in his studies,
despite a long-continued illness through injury to his foot, and
became an honoured Minister of the Gospel, in the Reformed
Presbyterian Church first of all, and now in the Free Church of
Scotland, at Chapelton, near Hamilton.
On my brother withdrawing from Green Street, God provided for
the district a devoted young Minister, admirably adapted for the
work, Rev. John Edgar, M.A., who succeeded in drawing together
such a body of people that they hived off and built a new church in
Landressy Street, which is now, by amalgamation, known as the
Barrowfield Free Church of Glasgow. For that fruit too, while giving
all praise to other devoted workers, we bless God as we trace the
history of our Green Street Mission. Let him that soweth and him
that reapeth rejoice unfeignedly together! The spirit of the old Green
Street workers lives on too, as I have already said, in the new
premises erected close thereby; and in none more conspicuously
than in the son of my staunch patron and friend, another Thomas
Binnie, Esq., who in Foundry Boy meetings and otherwise devotes
the consecrated leisure of a busy and prosperous life to the direct
personal service of his Lord and Master. The blessing of Jehovah
God be ever upon that place, and upon all who there seek to win their
fellows to the love and service of Jesus Christ!
When I left Glasgow, many of the young men and women of my
classes would, if it had been possible, have gone with me, to live and
die among the Heathen. Though chiefly working girls and lads in
trades and mills, their deep interest led them to unite their pence
and sixpences and to buy web after web of calico, print, and woollen
stuffs, which they themselves shaped and sewed into dresses for the
women, and kilts and pants for men, on the New Hebrides. This
continued to be repeated year by year, long after I had left them; and
to this day no box from Glasgow goes to the New Hebrides Mission
which does not contain article after article from one or other of the
old Green Street hands. I do certainly anticipate that, when they and
I meet in Glory, those days in which we learned the joy of Christian
service in the Green Street Mission Halls will form no unwelcome
theme of holy and happy converse!
That able and devoted Minister of the Gospel, Dr. Bates, the
Convener of the Heathen Missions, had taken the deepest and most
fatherly interest in all our preparations. But on the morning of our
final examinations he was confined to bed with sickness; yet could
not be content without sending his daughter to wait in an adjoining
room near the Presbytery House, to learn the result, and instantly to
carry him word. When she, hurrying home, informed him that we
both had passed successfully, and that the day of our ordination as
Missionaries to the New Hebrides had been appointed, the apostolic
old man praised God for the glad tidings, and said his work was now
done, and that he could depart in peace,—having seen two devoted
men set apart to preach the Gospel to these dark and bloody Islands
in answer to his prayers and tears for many a day. Thereafter he
rapidly sank, and soon fell asleep in Jesus. He was from the first a
very precious friend to me, one of the ablest Ministers our Church
ever had, by far the warmest advocate of her Foreign Missions, and
altogether a most attractive, white-souled, and noble specimen of an
ambassador for Christ, beseeching men to be reconciled to God.
Stanford’s Geog. Estabt.,
London.