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Chapter 1

Life expectancy has grown from 47.3 years in 1900 to over 77 years today. Behavior
has also been a factor in the decline in deaths due to cardiovascular disease, but the major
gains in life expectancy during the 20th century were due to decreases in infant mortality.
Prevention of disease—such as vaccinations and safer drinking water--is also a
contributor to the increase in life expectancy.
B. Escalating Cost of Medical Care
In the United States, costs of medical care have escalated far beyond the inflation rate.
Between 1975 and 2005, medical costs rose over 600%, and during the early years of the 21st
century, over 15% of the gross domestic product was spent for health care. This escalating
cost has led some people to question the cost effectiveness of cures and to emphasize the role
of prevention as a way to contain medical costs.
C. What is Health?
The traditional view of health is the absence of disease, a definition that follows the
biomedical model of diseases produced by pathogens. The biopsychosocial model offers
an alternative view, adding psychological and social factors to biological factors. Theorists
who advocate this model study the interactions among biological, psychological, and social
factors in health and disease. This definition allows a definition of health as the attainment of
a positive state, and not merely the absence of disease.
The definition of health as attainment of a positive state of wellness is compatible with
the World Health Organization’s definition and also with the view proposed by positive
psychology. This movement within psychology includes health issues, such as the influence
of optimism on health and health-related behaviors.

II. Psychology's Relevance for Health

Health psychologists concentrate on the behavioral and lifestyle components in the
development of chronic diseases, but they also attempt to help people cope with stress, pain, and
chronic disease.
A. The Contribution of Psychosomatic Medicine
Psychosomatic medicine is based on the premise that physical illness has its roots in
psychological and emotional conflicts. This view emphasized the connection between
emotion and disease, which is a positive contribution, but the negative aspect of
psychosomatic medicine was the belief that disease has no real basis and is “all in the
person’s head.”
B. The Emergence of Behavioral Medicine
The development of behavioral medicine altered psychology’s role in medicine by
concentrating on behavioral rather than mental factors in health and illness. Behavioral
medicine is an interdisciplinary field that attempts to integrate behavioral and biomedical
knowledge and techniques and to apply this knowledge to prevention, diagnosis, treatment,
and rehabilitation.
C. The Emergence of Health Psychology
Health psychology is a field of psychology dealing with the scientific study of behaviors
that relate to health enhancement, disease prevention, and rehabilitation. This relatively
new discipline developed as a result of an APA taskforce that found a scarcity of health-
related research by psychologists. In 1976, psychologists interested in and working in
health-related settings formed Division 38 (Health Psychology) of the American
Psychological Association.

2
 Introducing Health Psychology

III. The Profession of Health Psychology

Psychologists in general and health psychologists in particular have the training to
contribute to the nation's good health. It has founded its own national and international
associations, established a number of its own journals, gained recognition in other fields of
health care, established graduate training programs, and has received recognition from the
American Board of Professional Psychology and other professional groups. In addition, its
historical involvement in changing human behavior places it in a position to help people
eliminate unhealthy practices as well as to incorporate healthy behaviors into an ongoing
lifestyle.
A. The Training of Health Psychologists
Health psychologists receive a solid core of generic training at the doctoral level in the
basic areas of psychology plus training in biological and medical specialty areas that prepares
them to work as part of interdisciplinary teams and possibly to become primary health care
providers.
B. The Work of Health Psychologists
Health psychologists have jobs that are similar to those of other psychologists—they
teach, provide assessments, conduct research, and provide services. Those who are employed
by a university typically teach and do research, and those who work in a clinical setting are
usually involved in assessment, diagnosis, and therapy. Health psychologists may also be
employed in medical schools where their duties include working with other health care
professionals in providing services for people with physical disorders or in clinics, HMOS, or
private practice providing services such as pain management, smoking cessation, stress
management, or other such applications.

Exploring Health on the Web

The Internet is a source for health information on all levels, from press releases to technical
research. Problems arise in selecting valid information from the many sources available.
Exploring Health on the Web offers information on selected Internet sites that provide credible
health information.

http://healthfinder.gov
One of the main websites for obtaining health-related information and for finding links to
other sites is healthfinder®. The U.S. Department of Health and Human Services maintains this
gateway website, and it is an excellent place to access information and to link to other sites
devoted to health information. This website is oriented toward consumers and includes a
homepage with a variety of choices that will help patients use the Internet to obtain information
and to find links to other sites. The site also provides options that allow users to gain access to
the technical health information collected by various government agencies.

http://www.nlm.nih.gov/medlineplus
MedlinePlus is a website that makes information available from the National Library of
Medicine. It includes information from the National Institutes of Health and other government
sources as well as information on hospitals and physicians, prescription and nonprescription
drugs, and a great deal more. MedlinePlus can be a basic resource for obtaining health

3
Chapter 1

information because this website contains no advertising, is screened for quality of information,
and is updated daily.
One feature on MedlinePlus is “A Guide to Healthy Web Surfing” (accessible at
http://www.nlm.nih.gov/medlineplus/healthywebsurfing.html ), which presents a series of
warnings to those who seek health information on the Internet. The Internet offers a vast amount
of information but little screening for quality or truth. The information in this website can help
students think critically about material they get from the Net.

http://www.health-psych.org/
This website is home for APA’s Division 38 and contains a section entitled “What is a
Health Psychologist?” and “Frequently Asked Questions about Training in Health Psychology.”
This site can be a good resource for students who are interested in training and career
opportunities in the field of health psychology.

http://www.sbm.org/
This website is the home for The Society of Behavioral Medicine. The Society for
Behavioral Medicine is an organization of researchers and practitioners concerned with the
development, evaluation, and integration of behavioral, psychosocial, and biomedical science
techniques relevant to prevention, diagnosis, treatment, and rehabilitation of a variety of health
conditions.

http://www.cbsnews.com/health/
Many media outlets such as CBS News provide video clips and articles related to new
developments in health research. The Health section of the CBS News website posts timely
general-interest health news and may be a useful resource for current, popular health information
and news. Many clips may provide useful introductions to the health issues discussed in the
textbook.

Suggested Activities
Personal Health Profile I — Personal Definition of Health
As a course project, you may choose to have your student complete a Personal Health
Profile in which they examine their personal health-related behaviors, review the literature
concerning these different behaviors, and write an analysis of things they are doing right and
things they could change to improve their health and lower their risks for disease. This activity is
designed to begin in this chapter and continue for the duration of the course.
For Chapter 1, students should examine their personal definitions of health as a beginning
for their Personal Health Profile. One way to examine personal definitions of health is through
completion of the Multidimensional Health Locus of Control Scale (link below).
Link: http://www.vanderbilt.edu/nursing/kwallston/mhlcscales.htm
Citation: Wallston, K. A., Strudler Wallston, B., & DeVellis, R. (1978). Development of the
multidimensional health locus of control (MHLC) scales. Health Education & Behavior, 6(1),
160-170.

International Mortality Rates

4
 Introducing Health Psychology

Chapter 1 presents the causes of death in the United States for the years 1900 and 2012.
During those years the causes of death in the U.S. have shifted from predominantly infectious
diseases to mostly chronic diseases. However, this trend has not occurred in all countries.
Ask your class to research the leading causes of death in other countries. One source for
life expectancy information is the CIA World Factbook, which is published yearly. They can
access this information by going to https://www.cia.gov/library/publications/the-world-factbook .
This website allows a download of the current Factbook or a search of the database. Examining
the information will allow your students to build a picture of patterns of illness and death in
countries around the world. After identifying these causes of death, discuss whether they are due
to illness or violence and whether the illnesses are acute or chronic.
The leading causes of death for some countries more closely match the United States in
1900 than those for 2012. Some countries have a similar pattern of causes of death but a lower
death rate than the United States. Discuss both types of differences and the economic and social
factors that contribute to each country’s leading causes of death.

Personal Beliefs about the Nature of Illness

Explore people’s conceptualization of illness by allowing your students to interview
people about their last illness. The interviewer should ask the person to explain the illness, why
he or she got sick, and what helped the person to get well.
Class members can examine the explanations for biological, psychological, and social
attributions for illness. These attributions may also appear in the explanations for getting well.
Do these people’s explanations of their illness reflect a biopsychosocial model of illness?

Interview a Health Psychologist

To better understand the work of health psychologists, your students can interview a
health psychologist. (To avoid burdening health psychologists, this activity might be best as a
group assignment. Divide your class into groups, each preparing a set of questions for the
psychologists.) Attempt to locate some health psychologists who work in academic settings and
some who provide assessment, diagnosis, and therapy services.
The health psychologists may be interviewed by students, participate in a panel
discussion, or even provide their answers over the Internet. After students have gathered the
information, they should participate in a discussion to examine how the information matches and
diverges from their conceptions of what health psychologists do.

Health Psychology in All Fields

Many students of health psychology are not psychology majors, but rather nursing or
public health majors. The last two sections of Chapter 1 discuss psychology’s relevance in health
fields and it may be useful for students to hear how the principles and theories they will learn this
semester can be applicable in their chosen field.

Reading Current Research

http://psycnet.apa.org/journals/psp/83/2/261/ - This study finds that older individuals with
more positive self-perceptions of aging lived 7.5 years longer than those with less positive self-
perceptions of aging, even after controlling for age, gender, SES, loneliness, and functional
health status. This article provides a nice introduction to the biopsychosocial model, as well as

5
Chapter 1

good fodder for a discussion of why these findings might appear. Why would a person’s beliefs
about aging influence their longevity? Discussion may lead to factors such as health behaviors,
the social environment, socioeconomic factors, as well as how people cope with stress.
Citation: Levy, B. R., Slade, M. D., Kunkel, S. R., & Kasl, S. V. (2002). Longevity
increased by positive self-perceptions of aging. Journal of Personality and Social Psychology,
83(2), 261-270.

Defining Health
In Chapter 1, students will learn that college is good for their health (“Would You
Believe…?”) but students likely will come into this course will differing perceptions of what
“health” means. Table 1.2 in the textbook lists definitions of health. Asking students to define
health before they read the chapter may provide useful information for you (and your students)
as you progress through the course. For example, asking students a wide range of questions
about their health before you begin the course may provide you with some data and current
health behavior of your students: What is health? What behaviors should one engage in to be
healthy? Are you engaging in these behaviors? Why or why not?

Video Recommendations
From Films for the Humanities & Sciences:

Promoting Healthy Behavior (1998) introduces the complexities of the concepts of health and wellness
and shows how people can become more actively involved in their health.

Achieving Psychosocial Health (1998) is a 29-minute program that highlights the role of psychological
and social factors in achieving comprehensive health.

Videos from the Web:

Chapter 1 introduces the topic of socioeconomic disparities in health. Several excellent and short
video clips are available that document these disparities. One of these clips is “Becoming
American: Wealth Equals Health” (http://youtu.be/NqzsMW8B0u4), a short video (1:41) that
briefly examines the impact of wealth on health in America and how often immigrant families
struggle with discrimination and poverty which impacts their health. Another is “Poverty, Stress,
and Diabetes Among Native Americans (http://youtu.be/_3CJKtC8aCc), a short video (3:21) that
is part of a larger documentary called Unnatural Causes (http://www.unnaturalcauses.org/) that
examines how inequalities can have physiological consequences.

Chapter 1 also introduces the biopsychosocial model. Two video clips examine this model. The
first clip, entitled “Holistic Medicine and the Biopsychosocial Approach”
(http://www.learner.org/series/discoveringpsychology/23/e23expand.html) is narrated by Dr.
Phil Zimbardo of Stanford University and examines how psychological factors impact physical
health. Another short clip (http://www.youtube.com/watch?v=OsBtjW61Vyw) showcases
Sheldon Cohen’s work on stress and colds (see “Would you Believe..?” box in Chapter 1). The
text also revisits these ideas again in Chapters 5 & 6, and students may enjoy reading a popular

6
 Introducing Health Psychology

press article summarizing Cohen’s work: http://www.bbc.com/future/story/20120619-how-

stress-could-cause-illness/1

Multiple Choice Questions

1. People’s beliefs about health and illness may be incorrect. Which of these common
beliefs is true?
a. The United States ranks in the top five nations in the world in terms of life
expectancy.
b. The 30-year increase in life expectancy that occurred in the United States during
the 20th century was due mostly to improved medical care.
c. Good health is the absence of disease.
d. None of these is true.
ANS: d REF: The Changing Field of Health

2. A century ago, life expectancy in the US was ______ years and currently life
expectancy in the US is ______ years.
a. 20; 60
b. 30; 70
c. 50; 80
d. 50; 70
ANS: d REF: The Changing Field of Health

3. Chronic diseases
a. develop and persist over a period of time.
b. are due to infectious agents such as bacteria or viruses.
c. are not as common today as during the 19th century.
d. include influenza and pneumonia.
ANS: a REF: The Changing Field of Health

4. _________ diseases are a class of diseases that consist of heart disease, cancer, and
stroke.
a. Infectious
b. Chronic
c. Unintentional
d. Cardiovascular
ANS: b REF: The Changing Field of Health

5. In 1900, most deaths in the United States were caused by ____, whereas today most
are due to ____.
a. pneumonia. . . cancer
b. chronic diseases. . . cancer
c. infectious diseases. . . chronic diseases
d. cancer. . . alcohol-related causes

7
Chapter 1

ANS: c REF: The Changing Field of Health

6. During the last few years of the 20th century, chronic diseases in the United States
a. began to rise more rapidly than during the previous 50 years.
b. began to decrease while deaths not due to lifestyles began to increase.
c. began to increase while deaths not due to lifestyles began to decrease.
d. were replaced by acute diseases as the leading cause of death.
ANS: b REF: The Changing Field of Health

7. The leading cause of death in the United States

a. is due to acute, infectious disease.
b. is due to risky sexual behaviors.
c. has shifted from cardiovascular disease to cancer.
d. has shifted from acute to chronic diseases.
ANS: d REF: The Changing Field of Health

8. In the United States during the early years of the 21st century,
a. deaths from Alzheimer’s and Parkinson’s diseases increased.
b. deaths from accidents increased significantly.
c. deaths from heart disease increased significantly.
d. deaths only moderately related to lifestyle decreased significantly.
ANS: a REF: The Changing Field of Health

9. In the United States, young people have a low mortality rate; those who die are most
likely to die from
a. cancer.
b. unintentional injuries.
c. homicide.
d. HIV infection.
ANS: b REF: The Changing Field of Health

10. Cardiovascular disease and cancer account for about _____ of all deaths in the US.
a. 40%
b. 50%
c. 60%
d. 70%
ANS: c REF: The Changing Field of Health

11. All of the following are factors in life expectancy EXCEPT:

a. age
b. education
c. ethnicity
d. mother’s personality
ANS: d REF: The Changing Field of Health

8
 Introducing Health Psychology

12. In the United States, young people ages 15 to 24 are most likely to die from _______
and _______.
a. cancer. . . . heart disease
b. unintentional injuries . . . . homicide
c. homicide . . . . cancer
d. suicide . . . . HIV infection
ANS: b REF: The Changing Field of Health

13. In the United States, the three leading causes of death for adults ages 35 to 44 are
a. unintentional injuries, cancer, and heart disease.
b. suicide, homicide, and HIV infection.
c. HIV infection, heart disease, and pneumonia.
d. cancer, HIV infection, and pneumonia.
ANS: a REF: The Changing Field of Health; Fig. 1.2

14. Cancer is the leading cause of death in which of the following ethnic groups?
a. European Americans
b. Hispanic Americans
c. African Americans
d. Asian Americans
ANS: d REF: The Changing Field of Health

15. What two factors can help explain some of the ethnic differences in health and life
expectancy?
a. Poverty and age
b. Poverty and low education level
c. Low education level and age
d. Low education level and drug use
ANS: b REF: The Changing Field of Health

16. People who graduate from college show the following positive outcomes EXCEPT
a. higher average incomes.
b. more likely to exercise.
c. better access to health care.
d. more likely to eat a high-fat diet.
ANS: d REF: The Changing Field of Health

17. The single most important contributor to an increase in life expectancy is

a. the decrease in the infant mortality rate.
b. the increase in individuals’ beliefs in the importance of exercise.
c. advancement in medical technology.
d. advancement in medical care.

9
Chapter 1

ANS: a REF: The Changing Field of Health

18. Rhona is a 32-year-old African American college professor. Gena is a 32-year-old

Hispanic American engineer. Leah is a 32-year-old European American who has been
unemployed for most of the past 10 years and living below the poverty level. Helen is
a 32-year-old Asian American dentist. The woman most at risk for poor health is
a. Rhona.
b. Gena.
c. Leah
d. Helen.
ANS: c REF: The Changing Field of Health

19. In the United States, people living below the poverty level generally
a. have low educational levels.
b. are more likely than other people to have health insurance.
c. are members of ethnic minority groups.
d. both a and c are correct.
ANS: d REF: The Changing Field of Health

20. The increase in life expectancy since 1900 is due mostly to

a. the decrease in cancer deaths.
b. the conquest of influenza.
c. major changes in lifestyle.
d. none of these.
ANS: d REF: The Changing Field of Health

21. Sheldon Cohen’s research on the common cold showcase that the ________ approach
to understanding sickness and infection is inadequate.
a. biopsychosocial
b. biomedical
c. the psychological
d. biochemical
ANS: b REF: It Takes More Than A Virus to Give You A Cold

22. In Sheldon Cohen’s research on the common cold, all participants received a cold
virus injection and after a week,
a. all participants showed signs of having a cold.
b. only participants who were sick to begin with got a cold.
c. only health participants got a cold.
d. only participants who had dealt with a stressful experience got a cold.
ANS: b REF: It Takes More Than A Virus to Give You A Cold

23. An inverse relationship exists between educational level and death rates, which means
that

10
 Introducing Health Psychology

a. people who graduate from high school have higher death rates than those who do
not.
b. people who attend college have higher death rates than those who drop out of high
school.
c. people who attend college live longer than those who have never attended college.
d. both a and b
ANS: c REF: The Changing Field of Health

24. College graduates generally live longer than people who drop out of high school.
Which of these conditions is most likely to explain these differences?
a. College graduates are more likely to smoke cigars.
b. High school dropouts are more likely to seek health care.
c. High school dropouts are less likely to use illicit drugs.
d. College graduates are less likely to smoke cigarettes.
ANS: d REF: The Changing Field of Health

25. Which of these has been a major health trend in the U.S. since 1900?
a. Cost of medical care has risen faster than inflation.
b. Health has been more frequently defined as the absence of illness.
c. Acute illnesses have replaced chronic diseases as the leading causes of death.
d. The biomedical model has been accepted by most psychologists.
ANS: a REF: The Changing Field of Health

26. During the past 30 years, death rate from heart disease in the United States has
declined. At the same time,
a. medical costs have increased.
b. smoking rates have increased.
c. life expectancy has decreased.
d. acceptance of the biomedical model has increased.
ANS: a REF: The Changing Field of Health

27. Which of the following has been the LEAST significant contributor to escalating
medical costs?
a. increases in population
b. the aging of the population
c. more sophisticated medical technology
d. increases in the number of complex surgical procedures
ANS: a REF: The Changing Field of Health

28. The biomedical model of disease

11
Chapter 1

a. was common during the 1800s but was replaced by the biopsychosocial model
during the early 1900s.
b. views pathogens as the causes of disease.
c. is more common among the public than among health care professionals.
d. cannot explain infectious illness or the prevalence of viral illness.
ANS: b REF: The Changing Field of Health

29. Many medical advances during the 19th century were prompted by the biomedical
model that
a. emphasized emotional rather than physical factors in diseases.
b. replaced the Cartesian model.
c. led to a search for microscopic organisms that cause disease.
d. took a holistic view of health and disease.
ANS: c REF: The Changing Field of Health

30. Cade attributes catching a "cold" to not getting enough sleep and feelings of distress.
Thus, Cade has an implicit acceptance of the ____ model of health.
a. biochemical
b. biomedical
c. Cartesian
d. biopsychosocial
ANS: d REF: The Changing Field of Health

31. Health psychologists are most likely to see health

a. from a biomedical viewpoint.
b. from a biopsychosocial viewpoint.
c. as the absence of illness.
d. as a single dimensional condition.
ANS: b REF: The Changing Field of Health

32. Before 1950, psychologists were involved with physical health primarily in the area
of
a. changing lifestyles.
b. changing attitudes.
c. pain management.
d. teaching in medical schools.
ANS: d REF: Psychology’s Relevance for Health

33. Psychosomatic medicine sees physical illnesses as

a. having emotional and psychological components.
b. having biological causes.
c. causing stress and subsequent organic illnesses.
d. all of these.
ANS: a REF: Psychology’s Relevance for Health

12
 Introducing Health Psychology

34. Presently, physicians and health psychologists are most likely to agree that
psychosomatic illnesses are
a. a primary means of coping with acute pain.
b. all in the head of the person with the illness.
c. diseases linked to a complex of biological, psychological, and social factors.
d. flow from unconscious factors and are a means of reducing anxiety.
ANS: c REF: Psychology’s Relevance for Health

35. Behavioral medicine assumes

a. a link between individual behaviors and health.
b. the existence of a specific pathogen in illness.
c. that disease can be controlled, but that health cannot be enhanced.
d. that the goals of medicine and psychology are incompatible.
ANS: a REF: Psychology’s Relevance for Health

36. The discipline that emphasizes the prevention of illness and the enhancement of
health in currently healthy people is called
a. behavioral health.
b. health psychology.
c. behavioral medicine.
d. medical psychology.
ANS: a REF: Psychology’s Relevance for Health

37. Health psychology is best defined as the scientific study of those behaviors related to
a. the adoption of the sick role for persons who believe themselves to be ill.
b. health enhancement, disease prevention, and rehabilitation.
c. the development of psychosomatic illness.
d. the development of psychological and emotional illness.
ANS: b REF: Psychology’s Relevance for Health

38. Health psychology is

a. a branch of medicine related to psychological health.
b. a discipline within psychology related to psychological health.
c. a new name for psychosomatic medicine.
d. a discipline within psychology related to health.
ANS: d REF: Psychology’s Relevance for Health

39. In the biopsychosocial model proposed by the textbook's authors, health and disease
outcomes flow DIRECTLY from
a. psychological factors.
b. biological factors.
c. sociological factors.
d. all of these.

13
Chapter 1

ANS: b REF: Psychology’s Relevance for Health; Fig. 1.4

40. In contrast to the biopsychosocial model, the biomedical model views health as
a. a positive condition.
b. an incorporation of psychological and social factors.
c. a result of a combination of factors such as genetics, beliefs, and stress.
d. the absence of disease.
ANS: d REF: Psychology’s Relevance for Health

41. During the last quarter of the 20th century, psychology became involved in the
changing field of health primarily by
a. treating physical diseases.
b. treating mental diseases.
c. studying behaviors that enhance health and prevent disease.
d. practicing psychosomatic medicine.
ANS: c REF: Psychology’s Relevance for Health

42. Most experts in health psychology recommend that

a. health psychologists should be physicians first.
b. health psychologists should receive at least two years of postdoctoral training.
c. health psychology should be a separate discipline from generic psychology.
d. the training of health psychologists should be shortened to meet the demands for
workers in the field.
ANS: b REF: The Profession of Health Psychology

43. The work of health psychologists is similar to other psychologists because it includes
a. counseling people with personal problems.
b. conducting research on personality and health habits.
c. assessment, research, and provision of services.
d. working in health care settings.
ANS: c REF: The Profession of Health Psychology

44. Janelle, a health psychologist, could do any of the following tasks EXCEPT
a. offer alternatives to pharmacological treatments.
b. provide behavioral interventions to treat physical disorders.
c. design effective health communication to promote positive physical health.
d. design drug trials to enable doctors to find a drug to treat breast cancer.
ANS: d REF: The Profession of Health Psychology

45. Health psychologists are MOST likely to

a. be part of an interdisciplinary team.
b. work as a practitioner in a solo private practice.
c. go to medical school after finishing a doctoral degree in psychology.
d. do all of these.

14
 Introducing Health Psychology

ANS: a REF: The Profession of Health Psychology

True/False Questions
1. Health is generally defined as an absence of disease.
ANS: F

2. Currently, the leading cause of death in the United States is cancer.

ANS: F

3. Most people in the United States die of chronic diseases.

ANS: T

4. Death rates in the United States from both heart disease and cancer are declining.
ANS: T

5. Stress is the leading cause of death in the United States.

ANS: F

6. African Americans have a higher death rate than European Americans.

ANS: T

7. Despite national media coverage to the contrary, poverty is not related to the mortality
rate in the United States.
ANS: F

8. College graduates generally have a higher death rate than high school dropouts.
ANS: F

9. The training of health psychologists includes earning doctoral degrees.

ANS: T

10. Health psychologists rarely work in hospitals.

ANS: F

Essay Questions
1. Trace the changes in patterns of disease during the 20th century. Are there signs that those
trends are changing? If so, how?
A. Chronic diseases became more prevalent during the 20th century, overtaking acute
diseases as leading causes of death.
1. In 1900, the leading causes of death were attributable to public or community health
problems.

15
Chapter 1

2. As the century progressed, diseases with behavioral components such as heart

disease, cancer, and stroke, became leading causes of death.
B. Beginning in the mid-1990s, the death rate from diseases with behavioral components
began to decrease (such as heart disease), whereas some causes of death with minor
behavioral contributions increased (such as Alzheimer’s disease).

2. What roles do age and ethnicity play in mortality?

A. Age is strongly related to illness and death.
1. The likelihood of chronic illness increases with age.
2. Children and young adults are much less likely to die than middle-aged and older
adults, but younger people are more likely to die of unintentional injuries and violence.
B. Ethnicity also plays a role in health and mortality.
1. European Americans (including Whites and Hispanics) have substantially longer life
expectancies than African Americans.
2. The role of ethnicity is not entirely clear because poverty and low socioeconomic
status also relate to ethnicity in the United States, and income relates to health.
a. Poverty is related to ethnicity and is a negative factor in life expectancy.
b. Educational level is related to ethnicity, and low educational level is an important
factor in poor health.

3. Discuss the implications of the acceptance of the biopsychosocial model over the biomedical
model.
A. Implications of the acceptance of one model over another are important because models
guide research and practice in any area.
B. Acceptance of the biomedical model, the view that disease is a mechanistic response to
pathogens, has promoted:
1. Acceptance of a mechanistic view of physiology as the source of both disease and the
only route to cures.
2. Exclusion of psychological and social factors relating to illness and health because
these factors do not fit into the model.
C. Acceptance of the biopsychosocial model promotes:
1. A more complex view of health and illness - multidimensional and contextual.
2. A definition of health that includes optimal functioning.
3. A focus on the behaviors that underlie the development of many chronic diseases.
4. A holistic approach to health and to treatment.

4. Before the development of health psychology, how was psychology involved in health?

16
 Introducing Health Psychology

A. Psychology's involvement in health traces back to the early years of the 20th century.
1. Psychologists were involved in medical education.
2. Despite long involvement, psychologists played a secondary role in medicine,
restricted to mental health treatment and consultation.
B. The development of psychosomatic medicine promoted the role of mental factors in
physical health.
1. The psychodynamic view holds that personality is a factor in the development of
disease.
2. The psychosomatic view began to lose popularity, replaced by behavioral medicine
and then by health psychology.

5. Trace the development of behavioral medicine and health psychology.

A. Behavioral medicine
1. Can be traced to the 1977 Yale conference but also has historical roots in
psychosomatic medicine.
2. Was founded by people working in the health care field, some of whom were
physicians but others who were in nursing, rehabilitation, and psychology.
3. Attempts to integrate biomedical and behavioral knowledge to enhance prevention,
diagnosis, treatment, and rehabilitation.
4. Has its own association, the Society for Behavioral Medicine, and its own journal, the
Journal of Behavioral Medicine.
B. Health psychology
1. Can be traced to the APA taskforce that studied the role of psychology in health
research.
2. Was founded by psychologists, some of whom were working in health care settings
but others who were involved in research in various content areas of psychology.
3. Attempts to apply knowledge in psychology to the promotion of health, the
prevention and treatment of disease, and the establishment of health policy.
4. Has its own division of the American Psychological Association, Division 38 and its
own journal, Health Psychology.
6. Discuss how the preparation and work of health psychologists differ from and are similar to
those of other psychologists.
A. The preparation of health psychologists is similar to other psychologists, following the
scientist/practitioner model.
1. Health psychologists receive doctoral degrees in psychology, including a generic core
of courses (experimental design, statistics, biopsychology, social psychology, cognitive
psychology, and individual differences).
2. Many training programs include the clinical components necessary for psychologists
who deliver psychological services.
3. Health psychologists often receive postdoctoral training and internships to enable
them to become more familiar with health care services and to be health care providers.
B. Jobs of health psychologists may be similar to other psychologists or may vary
considerably.
1. Like other research psychologists, health psychologists who conduct research usually
are employed in educational settings where they combine teaching and research.

17
Chapter 1

2. Unlike most research psychologists, health psychology researchers may be employed

in medical centers, teaching medical students and participating in research as part of a
biomedical research team
3. Like other clinical or counseling psychologists, health psychologists who provide
services may work in private practice, in hospitals or clinics, or in health maintenance
organizations (HMOs), where they provide diagnosis and treatment.
4. Unlike most clinical or counseling psychologists, health psychologists who provide
services may work as part of a team that provides services to people who are physically
sick, either as ancillary treatment or as treatment for the physical disorder.
5. Unlike most psychologists, health psychologists are more likely to be involved in
providing preventive services.

18
Another random document with
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 mrs. cleveland

Frankness and self-reliance were, perhaps, the most prominent

characteristics of Abdur Rahman’s nature. At the same time, he was
a genial, strong, clever man of the world, well-informed upon all
subjects of general interest, eloquent, resolute, logical and
possessed of much innate humour and facility in repartee. Always
alive to his own interests, he possessed no small capacity for
intrigue; and his first bid for position in Afghanistan was as the
nominee of the Russians, General Kauffman, the Russian Governor-
General of Turkestan, having arranged that he should be supplied
with 200 breech-loading rifles, 20,000 rounds of ammunition,
accoutrements for 100 horse and 100 footmen and 5000 Bokhara
tillas (35,000 rupees). Yet, when he appeared across the border and
arrived at a secret understanding with the Government of India about
his nomination as Amir, he posed as the champion of his faith and
the liberator of the land from foreign domination, suppressing, in
order to do this, all mention of his agreement with us and of his
relations with Russia. Nevertheless, as soon as his own position was
secure, he curtailed the influence of the mullahs.
It was no part of the Russian scheme that Abdur Rahman should
go to Kabul. They had calculated that, as we were about to retire
from Afghanistan, Abdur Rahman might drive out General Ghulam
Haidar from Turkestan and establish himself as ruler. Later, if
circumstances should permit and the British nominee at Kabul prove
weak or incapable, they expected to strengthen their position there
and, at last, to see all Northern Afghanistan under Russian
occupation. With our acceptance of Abdur Rahman as Amir, he
realised that the interests of himself, his dynasty and his country lay
with us. Resolved to obtain all he could from the British Government,
he was perfectly good humoured and contented when he found that
all his demands could not be granted. He spoke of Russia with
friendliness, and acknowledged his obligations to her for the seven
years of hospitality that had been shown him. He absolutely denied
any agreement with or dependence on her; and, making light of the
circumstances under which he left Tashkent as also the instructions
and assistance he had received, he preferred, with the aid of
England, to reign as an independent sovereign. The results of his
rule reveal an astonishing record of work done, and progress made,
in the short space of twenty years. Amid constant anxiety and
discouragement, surrounded by open enemies and secret traitors,
with robber tribes to subdue, the whole machinery of administration
to create, and with very few servants and officials who could
sympathise with, carry out or even understand his schemes for the
development and civilisation of his country, he yet achieved a signal
and brilliant success, leaving it to his successor to cement the
structure which he had put together with such labour and loving care
or to wreck it altogether.
After addressing a variety of remarks upon the various interests in
Kabul to his guests, Habib Ullah opened a general conversation in
Persian, as that tongue is the language of the Court. Habib Ullah
reads and speaks English, Arabic, Hindustani and Persian, but
considers the employment of English as undignified. At the
beginning of the audience the Amir seemed preoccupied; but as he
had just come from giving orders in connection with the welcome
and entertainment of the Dane Mission, he presently talked of that
event. He began by a graceful allusion to the Viceroy, Lord Curzon,
and a complimentary reference to Lord Kitchener, in
acknowledgment of the great interest these distinguished people
took in the welfare of his state. Gradually he brought the
conversation closer to his subject, likening Afghanistan to the
position of a shield held at arm’s length against the enemies of India.
“If such a shield were thin as parchment,” said Habib Ullah, “a
child could tear it. But if thick and strong were the shield it would
resist all attempts; and it is my object to make this shield strong—so
strong that it cannot be broken,” adding with parting reflection that he
would discuss further the means of strengthening the shield when
the Mission from India had arrived.
At this point in the interview Inayat Ullah Khan, the little prince
who at a later date visited India, entered the chamber. Salaaming to
his father he stood with the pages until given permission to be
seated. Habib Ullah now turned the conversation to his gun accident,
finding in the quick recovery that he had made under the skilful
attention of Major Bird—physician to the late Viceroy and specially
despatched in response to an urgent message from Kabul—a direct
manifestation of the grace of Allah. In order that his guests should be
in a position to inspect the injured limb the Amir rested his hand
upon a table, which he himself drew up. Removing the glove the
effects of the operation became apparent. At the moment that Major
Bird had arrived in Kabul the hand had become very swollen. There
was, also, a great accumulation of pus in the wounds, which it had
been necessary to incise; while the terminal phalanx of the index
finger, and part of the second phalanx of the middle finger of the left
hand, had been removed. At the time of this audience Major Bird had
returned to India. The wounds had healed; and the hand was
perfectly healthy, although the joints were still stiff. The accident,
which has made him look with greater toleration upon the wisdom of
establishing in Kabul a permanent branch of the Indian medical
system, had been caused through the bursting of a sixty guinea,
hammerless, 12-bore, double-barrel gun of English make. The Amir,
on March 28, 1904, was snipe-shooting near the village of Khudadad
and had shot twenty brace, when, as he was firing, the right barrel
burst, a fragment an inch and a half in length being blown out.
Fortunately the palm of the hand was well beneath the barrel, the
injured fingers alone resting on the side—a position which explains
the escape of the other portion of the hand.
Upon the conclusion of their examination of his hand by his
visitors, the reception, which had occupied two hours in duration,
terminated with a concluding remark upon the murder of Mr.
Fleischer, an English-speaking German subject, who had been sent
out from Krupp’s, to superintend the Kabul ordnance yards and
workshops. Mr. Fleischer had remained in Kabul in charge of the
arsenal until, returning to India to meet his wife and family, he was
murdered by the risaldar of the escort that was taking him to Lundi
Khana, the limit of Afghan territory in the direction of India. Habib
Ullah defended the action of the murderer on the ground that, when
a Mahommedan overhears his faith abused, he must kill himself or
the traducer. Mr. Fleischer had not abused the Mahommedan
religion, the foul deed arising out of a jealous intrigue between
Mohammed Sarwar Khan, the official in charge of the Amir’s
factories, and the risaldar, but set afoot by Habib Ullah’s practice of
accepting complaints against foreign workmen without permitting
them to make any explanation on their own behalf. Mr. Martin himself
had suffered through having punished this same official, Mohammed
Sarwar Khan, for gross insolence, and accordingly had left the
Amir’s service. After his departure Mohammed Sarwar Khan plotted
against Mr. Fleischer, finding in the latter’s visit to India an
opportunity well suited to his purpose on account of the Amir’s
hostility to Europeans. Accordingly Mohammed Sarwar Khan
instructed the risaldar to provoke Mr. Fleischer in such a way that
complaints by this worthy pair could be lodged with Habib Ullah
against him.
The actual incident began on the evening of November 6, 1904,
when, near the village of Basawul, a party of Europeans, proceeding
to Kabul from Peshawar, were joined at their encampment for the
night by Mr. Fleischer and his caravan from Kabul. After dinner Mr.
Fleischer discovered that the Europeans from India had not been
provided with farrashes, whose duties it is to attend to the pitching
and striking of tents in camp. As Mr. Fleischer was going in the
morning to Lundi Kotal and would not require his farrashes, he sent
a message to the risaldar to inform him that these men were to
return to Kabul with the European party from India. The risaldar, on
receipt of this message, replied that he would not be responsible for
the tents which the Amir had loaned for the journey if the two
farrashes were withdrawn. Mr. Fleischer then despatched his servant
to tell the man to come to him, which order the risaldar refused to
obey. Subsequently, later in the night, when Mr. Fleischer had gone
back to his own camp, the fellow was again insubordinate. The next
morning, November 7, Mr. Fleischer bade farewell to the Europeans
and, proceeding on his way to India, was shot down a mile from
Lundi Khana by the risaldar. News of the murder was conveyed to
Dakka, the officer of that post going out to meet the risaldar. The
newcomer inquired immediately whether there had been any
witnesses of the crime, and, learning that it had been witnessed by
two muleteers, he suggested that they should be shot too, at the
same time guaranteeing to support any story that the risaldar should
invent. The murderer did not attach any importance to the matter and
declined the proposal, returning to Dakka as the guest of the officer
of that fort.
Within a short time news reached the Governor of Jelalabad, who
sent out to arrest the risaldar, reporting at the same time the deed to
the Amir. To save his own “face” Habib Ullah issued orders that the
murderer should be taken back to the scene of his crime and there
shot, the escort, which he had commanded, together with his family,
being cast into prison. The action of the Amir came as a complete
surprise to the risaldar; before execution he explained that, had he
known that the Amir would have regarded the shooting of a
feringhee with such severity, he would have shot the two witnesses
as well.
 In appreciation of Mr. Fleischer’s services the Amir went through
the farce of announcing to the Government of India his intention of
presenting the widow and her family with a pension. Many months
have passed since then and no payment has been awarded, money
being as difficult to screw out of Afghanistan as gold is from stones.
Nevertheless, Mrs. Fleischer has appealed repeatedly, but without
success, to the consideration of the Government of India and to the
generosity of the Amir.
In spite of his amiability Habib Ullah does not possess a very
secure seat upon his throne, the intrigues of the queen-mother and
the jealousy of his brothers disturbing his position. Nor does he
receive the confidence of his people or reveal sufficient strength of
character to dominate the situation. Afghanistan needs the firm hand
of a man, who is as much a maker as a ruler of men. Habib Ullah is
weak-willed; and, in a country where the authority of the priest is a
law in the land, his subserviency to priestly control and his subjection
to the influence of his brother Nasr Ullah Khan have attracted
universal attention. Nasr Ullah and the Queen Dowager, Bibi Halima,
wife of the late Amir and the mother of Sirdar Mahommed Omar Jar
Khan, are the stormy petrels in the Afghan sea of domestic politics.
Habib Ullah in some measure understands the situation; and,
doubtless, it is out of respect for their dignity that Bibi Halima and
Omar Khan are closely protected by a strong detachment of the
Imperial Bodyguard—so closely, indeed, that they are practically
state prisoners.
 his highness prince nasr ulla khan

It is more difficult for the Amir to assail the position occupied by

Nasr Ullah, who was appointed commander-in-chief of the Afghan
army in the early days of Habib Ullah’s accession. Little attempt
therefore is made by the Amir to curb the masterful will of his brother.
Nasr Ullah Khan, who has become a Hafis or repeater of the Koran,
also held the office of Shahgassi, or Gentleman Usher to the King.
Just before the advent of the Dane Mission at Kabul he was created
an Itwad-ul-Dowlah or Pillar of the State. In his dual capacity he
threw into the scales already settling against the Mission the whole
weight of his influence, ultimately securing its complete discomfiture.
He is not, perhaps, the most reliable prop to the policy and rule of his
brother, since he aspires to the throne for himself; and, there is no
doubt that when opportunity offers, he will make a bid for it. At the
moment neither his plans nor his partisans are prepared, but events
move with such swiftness in Afghanistan that no one can gauge
more than approximately the varying fortunes of the situation.
Serious family quarrels have compelled the Amir to exercise his
authority in the arbitrary way common in Afghanistan. The first step
taken was in 1904, when the Omar Jar was deprived of his
bodyguard, the men being sent back to their regiments. The next
step was to remove him from his office as head of all Government
officials, an appointment in which he had succeeded Nasr Ullah
Kahn in 1902. These proceedings caused much excitement in the
capital and public feeling increased when it became known that the
Bibi Halima had refused to accept the allowance assigned to her for
the upkeep of her household. Matters became further complicated by
an incident which roused the Amir’s anger against the “Queen’s”
faction. Omar Jar ordered the Master of the Horse to send him the
favourite charger of the late Amir. This request was disregarded, and
the unfortunate officer, on being summoned to give an explanation,
was so maltreated by the Sirdar’s retainers that he died from his
injuries. When news of these proceedings reached the ears of the
Amir, the Bibi Halima and her son were directed to leave the palace
where they had resided since the demise of Abdur Rahman, Habib
Ullah finally decreeing that they should be confined to another
residence, where they are practically state prisoners. His Highness is
said to have asked two of the principal mullahs in Kabul to adjudicate
upon the causes of the strained relations existing in his family; but,
although a temporary compromise was established, no permanent
reconciliation was obtained. It is necessary to study carefully the
table of the Amir’s descent[36] to understand the precise position of
affairs existing to-day in Afghanistan.
Even in Afghanistan women wield an influence over the affairs of
the state, and its domestic policy is never without the disturbing
effect of a jealous woman’s interference. Indeed, the sway of the
harem in Court circles at Kabul is as pronounced as the power of the
priests—a condition of affairs that is no small departure from the old
order, when women and priests were relegated to the background.
Since the ascent of the present Amir to the throne there have been
changes in the army, in the state and in the harem. Three wives
have been divorced—a woman of the Mohmund tribe; a woman from
the Helmund country who had only been a few days in Kabul and the
daughter of Saad-ud-Din Khan, Hakim of Herat, the will of the Kabul
priests prevailing upon Habib Ullah to enforce the spirit of the Koran,
which forbids the maintenance of more than four wives. The number
of concubines is unrestricted and the strength of the royal harem in
this respect increases constantly, slaves of prepossessing
appearance—in the service of the queens—being chosen. Their end
is usually disastrous, and the hapless woman who, as a slave,
excites the admiration of the Amir is generally—“removed.” The four
wives who have survived this example of priestly authority are: (1)
the mother of Aman Ullah; (2) Ulia Jancah (the daughter of Yusef
Khan Barakzai, the favourite wife until recently—she is the mother of
a daughter); (3) the daughter of Ibrahim Khan; and (4) the mother of
Inayat Ullah. The child of Yusef Khan, Ulia Jancah, is known in the
intimate circle of the harem as the Hindustani queen. She is a
woman of education, charm and accomplishment. She reads and
writes; as a former pupil of an Indian seminary, she also sings and
plays the piano. She is no admirer of the Afghan ruler, his people, or
the state; and it was the chance expression of this aversion which
brought about her displacement.
the amir’s bodyguard
 pedigree of the amir of afghanistan[37]
Amir Dost Mahommed Khan Barakzai. Born 1774. Finally
overthrew the power of the ruling Saddozai clan on the death of
Shah Shujah, 1829. Died 1863.
Married a daughter of a Shia Rayi of Shalozan in Kuram, sister of
Shah Hussein Mania, father of Shah Jehan of Kuram.
Amir Mahommed Afzul Khan. Died 1867. Married a daughter
of a Popalzai Rayi of Koh-i-Daman, Haka Kabul, sister of
Khwahaja Mahommed Khan, and of Sultan Mahommed Khan
Popalzai.
Amir Abdur Rahman Khan. Born 1844. Refugee in
Russian territory. 1869-79. Recognized as Amir 1880.
Died October 1, 1901.
Married Gulriz, a slave girl from Wakhan.
Amir Habib Ullah Khan. Born at Samarkand,
1872. Succeeded as Amir in 1901.
 Married a stepdaughter of Naib Salar Amir
Mahommed Khan.
Inayat Ullah Khan. Born 1888. (4th
Queen).
Married a stepdaughter of Shahgassi
Mahommed Sarwar.
Aman Ullah Khan. Born 1890. (1st
Queen).
Married a woman of the Mohmund tribe.
(Divorced).
Married a woman from the Helmund country.
(Divorced).
Married a daughter of Saad-ud Din Khan,
Hakim of Herat. (Divorced).
Married a daughter of Sirdar Ibrahim Khan.
(3rd Queen).
Married a daughter of Sirdar Mahommed
Yusef Khan Barakzai. (2nd Queen).
Sirdar Nasr Ullah Khan. Born 1874.
Married Bibi Halima, daughter of Sahibzadeh Alik
Ullah Khan, and grand-daughter, on the maternal
side, of Amir Dost Mahommed Khan.
Sirdar Mahommed Omar Khan. Born 1889.
Married Staro, a Chitrali woman of no important
family.
Sirdar Amin Ullah Khan. Born 1885.
Married a daughter of a Mir of Mazar-i-Sharif.
Sirdar Ghulam Ali Khan. Born 1889.
Amir Mahommed Azim Khan. Born (?). Died 1869. Married an
Armenian of Kabul, a relative of Daniyal Khan.
 Sirdar Mahommed Ishak Khan. Born 1840. A Refugee
in Russian territory.
Married a daughter of Hajii Rahmet Ullah Khan Bamazai
Popalzai.
Amir Shir Ali Khan. Born 1825. Succeeded as Amir 1863.
Died 1879. Married Kamar Jan, sister of Saadet Kahn of
Lalpura.
Mahommed Yakub Khan. Born 1852. Refugee in India
since 1879.
Mahommed Ayub Khan. Born 1856. Refugee, first in
Persia and then in India, since 1881.
Wazir Mahommed. Akbar Kahn.
Sirdar Ghula Haidar.
The woman now filling the position of chief queen is the mother of
Aman Ullah. She has recently given birth to a daughter. At a more
normal season she strikes an interesting contrast with the daughter
of Yusef Khan. She is a woman of ungovernable passions, wilful,
domineering, and capricious—an odd mixture of the termagant and
the shrew. She has killed with her own hands three of her slaves
who had become enceinte through their intercourse with the Amir,
and she chastises personally her erring handmaidens, purposely
disfiguring any whose physical attractiveness may appeal to their
master. Her influence over the Amir, however, is limited. She sings
and dances, but she lacks the subtle craft of the Bibi Halima and the
gentle dignity of the Hindustani queen. The four wives of the Amir
occupy positions which are graduated to a recognised scale. The
first wife, the mother of Aman Ullah, draws an allowance of one lakh
of rupees annually; the second wife, Ulia Jancah, the Hindustani
queen, 80,000 rupees; the third wife, the daughter of Ibrahim, 20,000
rupees; and the fourth wife, mother of Inayat Ullah, 14,000 rupees a
year. The first queen resides in the harem serai of the Shah Ara
palace where the two principal concubines, the mothers of Hayat-
Ullah Khan[38] and Kabir Jan[39] and respectively former Badakshi and
Tokhi slave-girls, are housed. The inmates of the harem are busy
people, occupying themselves in knitting, embroidery and other
feminine pursuits. The chief wife has a sewing machine and with it
makes clothes for her children. The Hindustani Queen, who is of
royal birth, lives in great style. She is an ambitious woman and
wears English dresses although it should be said that they are
costumes in the fashion of thirty years ago. Each of the Amir’s
married wives, as distinct from the concubines, has a separate
house, where she lives with her children.

his highness habib ullah, amir of afghanistan

The Queen Dowager, Bibi Halima, the mother of Sirdar

Mahommed Omar Khan, a woman of engaging personality, at one
time held a position not without close resemblance to those filled by
the Empress Dowager of China and the Lady Om, queen to the
Emperor of Korea. Her intrigues on behalf of her son were over-bold
and she is now confined—her son, contrary to the energetic
character of his mother, taking little interest in his situation. The Bibi
Halima is a woman of considerable beauty, particularly intelligent
and well informed. She is nearly forty-three years of age, and her
sympathies are so distinctly British that her palace is regarded with
as much suspicion as the British agency. The law of succession to
the thrones in Mahommedan countries, apart from the exercise of
opportunity which secures recognition upon the basis that might is
right, entails the throne upon the son of the first woman whom the
ruler may have married. The heir may be younger than sons born to
other women, but, if such a marriage were the first alliance
contracted by his father, the succession is seldom set aside. Abdur
Rahman, however, departed from this custom as the Amirs of
Afghanistan have power to appoint their successors.
Habib Ullah is the offspring of a Wakhan concubine named Gulriz
with whom the Amir Abdur Rahman consorted. Bibi Halima, also the
wife of Abdur Rahman, lays claim to it through her direct descent
from the Amir Dost Mahommed Khan. She is of the Blood Royal
indubitably; and, if she were in possession of her liberty, she would
soon compel her son, Sirdar Mahommed Omar Khan, to take the
field. His chances of success in any rebellion would be as great as
those enjoyed by his half-brother, Nasr Ullah Khan, similarly a son of
Gulriz and full brother to Habib Ullah. The disparity in the ages of
these three sons of Abdur Rahman bears upon the present
situation—Habib Ullah, born 1872, and Nasr Ullah, born 1874, being
many years the senior of Mahommed Omar, who was born at Mazar-
i-Sharif on September 15, 1889. By a strange irony, which may yet
be not without its effect upon the succession to the throne, Inayat
Ullah, the son of Habib Ullah and the lawful heir to the throne, was
born in 1888, his uncle, the son of Bibi Halima and Abdur Rahman,
being only six months younger.
 (Translation.)
[40]The proclamation is addressed: “To the loyal-hearted nobles, to
high and low, to all my subjects of the clans of Hazara.” After
reminding the clansmen at some length that formerly they displayed
some opposition and rebellion towards the State, the edict goes on to
state the terms of the Amir’s clemency, which are as follow:
First. As regards your lands which have till now been given to
Afghans who have left their own districts for yours, I direct that
hereafter your lands which are in your possession and which are
cultivated and constitute your agricultural land are not to be given to
alien immigrants.
Secondly. Persons who have been banished from this God-given
kingdom and have fled to other parts are all hereby permitted and
commanded to return to their own proper homes, and let them come
with confidence. Let all of these absentees as are of good position
(Mir), or the descendants of such, come before me that I may see
them and that their dwelling-place and that their means of living and
residence may be well and appropriately arranged for. Let all ranks of
landlords and tenants be present at their homes. If their land has not
yet been given to aliens, We direct that after this it shall not be given.
Let them hold their own lands in peace and comfort. And to as many
persons as have, previous to this order, transferred their lands to
aliens and have not taken them back, in place of these transferred
lands State lands of culturable quality will be granted from the area
watered by the new canal, so that they may, please God, settle down
in peace and comfort.
We also notify to those who have absconded beyond the frontiers
of this God-given kingdom that if by the last month of this year they
do not return to their homes, we shall not allow their lands to lie
uncultivated. We direct that they shall be given over to alien
cultivators.
This order applies to all clans of the Hazara. But if the men of the
three villages of Sheik Ali, Koh (namely, of Talah, in Barfak), and men
of Chahar Sadah and the clan of Sultan who have absconded from
this God-given State return home, we are pleased to bestow on them
allotments of cultivated land in another place. In these three villages
named above land will not be given to them.
For the rest, for all the inhabitants of my kingdom I pray the
Glorious God to grant a daily increase of peace and prosperity.
 Given on Saturday, the 12th of Ramzan-ul-Mobarik, 1322, Hijreh
(about the 17th of December, 1904).

Ultimately, there is some prospect of a struggle for the throne

taking place between the uncle and his nephew. Each is a young
man; but, although time may not temper their discretion, it does lie
within the power of Habib Ullah to place the rights of his son beyond
the reach of this particular rival candidate. In any case, and it is of
interest to note it, Habib Ullah has gone out of his way to consolidate
the position of his eldest son, Inayat Ullah. This he did by
despatching him on the recent mission to India and appointing him
Governor of Kabul, while Mahommed Omar shares the restricted
liberty of his mother, and Hayat Ullah, born in 1890, the son of a
Badakshi slave-girl and half-brother to Inayat Ullah, the heir-
apparent, has been appointed to Badakshan as Governor of the
province. These facts are in reality only eddies showing the way that
the current runs in Kabul, where from its complex nature the position
may be described as shifting, delicate and treacherous as any
quicksand. None the less the policy of the new Amir has been
markedly benevolent; and his remission of certain taxes, his many
acts of clemency to Afridi fugitives and his invitations[41] to Afghan
refugees of noble or tribal families to return, reveal a great change in
the controlling forces in Afghanistan. It is to us not a matter of
gratification altogether, for it merely shows that the tribal leaders of
noble families have lost their influence, that they can no more sway
factions or parties in the population, and that power in Afghanistan is
being gradually centralised around the Amir in a circle of officials
which is controlled by the mullahs. The invitation to the refugees to
come back is not out of any generosity of feeling; it arises from
pride—and a desire to appear to be indulgent to those who are
helpless and who are now impotent. In fact it is political charity,
intended to spread the good name of the new ruler of Afghanistan in
India, and to impress the British Government. It is a certain indication
too, that, in the event of complications in the future with Afghanistan,
the assistance of dissatisfied Sirdars will be of little value, for, in a
few years if not very soon, the only elements will be the officials, the
bureaucracy and the mullahs. At the same time the power of the
Amir himself has been reduced and transferred to the officials. The
measures of Abdur Rahman prepared the way for this change. He
either killed or frightened out of Afghanistan every rival or every
individual likely to acquire influence. His declaration and boast was
that his God-granted Government ruled for the benefit of the people
and the glory of religion, that he had no object but the good of the
country and no secrets from the people as he had no interests but
theirs to serve. There is not amongst any class of Afghans the
feeling of reverence for the throne which exists in Turkey or in
Persia. The Amir is the highest official of a tribe, that has seized
power; and Afghanistan is gradually evolving a bureaucratic
Government controlled by priestly influence, whose policy will not
always be measured by the interests of the country, but by whatever
interpretations of the “Sheriat” some powerful mullah may conjure
up.
Meanwhile, Afghanistan is acknowledged to be an independent
Government within certain limitations. No Power has any right to
interfere in its administration, although it is obvious that certain
contingencies might alter its position in this respect. In the meantime,
the Government of Afghanistan owes no national debt nor any war
indemnity. The Amir is not hampered by any capitulations with
Foreign Governments; he has no foreign ambassadors in his
capital—although this is more a grievance than a pleasure to him,
since he is anxious to vaunt his independence before the Courts of
Europe.
The relations between Great Britain and Afghanistan as they
stand to-day are fixed by treaties. The British Government
acknowledges the independence of Afghanistan; it accepts
responsibility for its safety and integrity against unprovoked
aggressions, so long as the Amir does not act against the advice of
the British Government in matters affecting his relations with other
countries. Great Britain pays the Amir eighteen lakhs of rupees as an
annual subsidy by virtue of Sir Mortimer Durand’s treaty with the
Amir Abdur Rahman, dated 1893 and confirmed by Sir Louis Dane
with the Amir Habib Ullah, 1904-1905; in addition to which she
permits Afghanistan to import without restriction supplies of war
materials and to maintain a political agent at the Court of the Viceroy
of India.
In return for this understanding with the Imperial Government, the
Amir is bound by his word and treaties to be the friend and ally of
Great Britain; he pledges himself not to communicate with any
Foreign Power without consulting with the Indian Government, and
to accept at Kabul a British Agent, who must always be a
Mahommedan subject and provided solely with a native staff.
The British agent at Kabul holds an absolutely thankless position.
He is shunned of necessity by Europeans in order to avoid giving
rise to political suspicions, and he may see the Amir only in the
public Durbars or by special appointment. To all intents and
purposes he is a prisoner; since, although received in Durbar, he
does not visit any one and seldom ventures into the street. If a
European were seen speaking to the British Agent, or to any one
attached to his staff, he would certainly be packed off at once to the
frontier. No Afghan is allowed to enter the British Agency and no
Englishman has visited the British Agent, since Sir Salter Pyne left
Kabul. Even to be found near the building causes suspicion, as
several Afghans have discovered. Moreover, since in many cases
punishment has not ended merely with imprisonment, it has become
an unwritten law to avoid the British agent and his entourage at any
cost.
The British political agents at Kabul are appointed by the Indian
Foreign Office, who forward to the Amir for his approval the names
of a few Mahommedan officials. One of these candidates is selected,
the term of office being from three to five years. Upon returning to
India he is usually rewarded with the title of Nawab. The Agency staff
consists of two secretaries, one hospital assistant, and about two or
three dozen private servants and bodyguard, all of which must be
natives of India. The British agent attends the public audiences of
the Amir; but, if he has any letters or communications from the
British Government to convey to the Amir, he must ask for an
appointment to deliver them.