FOUNDATIONS:

PSYCHOSOCIAL ASPECTS FOR HEALTH

PROFESSIONALS

Dr. Muhammad Arsyad Subu

Dr. Jacqueline Maria Dias
 Learning Objectives
 Define, health, and psychosocial health
 Describe elements of psychosocial health
 Discuss client-professional relationships
 Identify boundaries of client-professional relationships
 Explain preservation of dignity
 Discuss concepts of healthcare ethics: autonomy, beneficence, nonmaleficence
& justice
 Explain the biomedical model of health and illness
 Describe the biopsychosocial model of health and illness.
 WHAT IS HEALTH?

 Health is a state of complete physical, mental and social well-

being and not merely the absence of disease or infirmity. (World
health Organization-WHO).
 WHAT IS PSYCHOSOCIAL HEALTH?

 Psychosocial health encompasses the mental, emotional, social & spiritual

dimensions.
 It is the result of complex interaction between a person’s history and his/her
thoughts about and interpretations of the past & what the past means to the
present.
ELEMENTS OF PSYCHOSOCIAL HEALTH
PSYCHOSOCIAL HEALTH (Mental Health)

 The Thinking You:

• The “thinking” part of psychosocial health
• Mentally healthy people tend to respond in positive ways
• Irrational thinking may indicate poor mental health.
PSYCHOSOCIAL HEALTH (Emotional Health)

 The Feeling You

• Emotions are complex feelings
o Examples: love, hate, frustration.

 Richard Lazarus notes 4 (four) types:

1. Emotions from harm, loss, threat
2. Emotions from benefits
3. Borderline emotions (hope/compassion)
4. Complex emotion (grief/disappointment).
PSYCHOSOCIAL HEALTH (Social Health)

 Importance of social interactions

 Social bonds
 Social supports
 Prejudices may indicate poor social health
 PSYCHOSOCIAL HEALTH (Spiritual Health)

 An Inner Quest for Well-Being:

• A belief in a unifying force that gives purpose or meaning to life
 Four main themes of spirituality:
1. A feeling of interconnectedness
2. Mindfulness
3. Spirituality as a part of daily life
4. Living in harmony with the community.
 PSYCHOSOCIALLY HEALTHY PEOPLE

 They feel good about themselves

 They feel comfortable with other people
 They control tension and anxiety
 They are able to meet the demands of life.
CLIENT - PROFESSIONAL
RELATIONSHIP
 A PROFESSIONAL & CLIENT RELATIONSHIP

 A professional and client relationship is a relationship between an expert in a

field (health) and a patron who is using their services (clients or patients).
 Model of client - professional relationship:
• Trust
• Compassion
• Open and honest communication
• Respect
• Empathy.
 KEY POINTS:
PROFESSIONAL - CLIENT COMMUNICATION

 Ask about expectations, feelings and concerns

 Show concern for comfort and modesty
 Give an opportunity to express feelings and concerns
 Encourage patients to ask questions
PROFESSIONAL - CLIENT RELATIONSHIP
BOUNDARIES

 Planning social activities with clients

 Having sex with clients
 Having family members or friends as clients
 AREAS WHERE BOUNDARIES MAY
BLUR
 Self disclosure
 Giving or receiving significant gifts
 Dual or overlapping relationships
 Becoming friends
 Physical contact.
PRESERVATION OF DIGNITY
 DEFINING ‘DIGNITY’

 Dignity consists of many overlapping aspects, involving respect, privacy,

autonomy and self-worth (Oxford Dictionary).
 A standard dictionary definition: a state, quality or manner worthy of
esteem or respect; and (by extension) self-respect.
 DIGNITY (cont.)

 Dignity is:
• about being treated as an individual with respect and compassion

• listening and responding to the person as soon as requested

• maintaining confidentiality at all times

• putting the person receiving care at the center of things

• asking what their specific wants and needs

• giving information.
 DIGNITY
 DIGNITY IS:
1. Kindness
2. Respect
3. Compassion
 FORMS OF DIGNITY
1. Human Dignity (external): Physical care and respect for the individual.
 “I was given a room with a bed and linen plus I had people to talk to. This was in sharp

contrast to my first experience, I was locked in an empty room with no bed or linen but just

cold cement to sleep on.

2. Self Dignity (internal): Feeling empowered in the treatment process.

 “Dr. S considered how I felt before she did anything, she listened to my concerns. I always felt

like I was in control of my treatment.

3. Universal Dignity: How society treats those with physical/mental illness.

 World Dignity is about social justice, equality, being respected and being allowed to contribute.
HEALTHCARE ETHICS
 WHAT IS AN ‘ETHICAL ISSUE’?

 When you have to judge what is right or wrong

 Choosing between options
 Deciding whether to do something or do nothing
 Should I or shouldn’t I?
 Weighing up the potential impact of your decisions or actions
 A dilemma – making a difficult choice
 ETHICAL ISSUES IN HEALTH CARE

 We usually think of the these issues

• E.g. definition of life, what is a person, quality of life, prolonging life,
ending life, human rights.
 But day to day ethical issues can involve:
• Respecting people
• Treating people with dignity
• Treating people fairly
• Supporting patient’s choices
 The code is a useful source of ethical principles in health care
 A SOURCE OF IDEAS IN HEALTH CARE ETHICS

 Principles of Biomedical Ethics (Beauchamp & Childress, 2001)

• 4 (four) key principles
• Supplemented by 4 rules
 4 - KEY ETHICAL PRINCIPLES

1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
 1. Autonomy

 Respect a person’s right to make their own decisions

 Teach people to be able to make their own choices
 Support people in their individual choices
 Do not force or coerce people to do things
 ‘Informed Consent’ is an important outcome of this principle
 2. Beneficence (to do good)
 Our actions must aim to ‘benefit’ people – health, welfare, comfort, well-
being, improve a person’s potential, improve quality of life (QoL).
 ‘Benefit’ should be defined by the person themselves. It’s not what we think
that is important.
 Act on behalf of ‘vulnerable’ people to protect their rights
 Prevent harm
 Create a safe and supportive environment
 Help people in crises
 3. Non–maleficence (to do no harm)

 do not to inflict harm on people

 do not cause pain or suffering
 do not incapacitate (prevent from functioning in a normal way).
 do not cause offence
 do not deprive (suffering a severe and damaging lack of basic material
and cultural benefits)
 do not kill
 4. Justice

 Treating people fairly

 Not favouring some individuals/groups over others
 Acting in a non–discriminatory / non-prejudicial way
 Respect for peoples rights
 Respect for the law
 4 (four) - Ethical Rules

 Veracity: truth telling, informed consent, respect for autonomy

 Privacy: a persons right to remain private, to not disclose information
 Confidentiality: only sharing private information on a ‘need to know
basis’
 Fidelity: loyalty, maintaining the duty to care for all no matter who they
are or what they may have done.
 THE BIOMEDICAL MODEL &
BIOPSYCHOSOCIAL MODEL OF
HEALTH AND ILLNESS
 1. THE BIOMEDICAL MODEL
 Main assumptions:
• Psychological disorders are illnesses or diseases affecting the nervous
system
• Abnormal behaviour, thinking and emotion are caused by biological
dysfunctions
• Understanding mental illness involves understanding what went wrong
with the brain
 THE BIOMEDICAL MODEL (cont.)

 Possible causes of abnormal behaviour:

• Biochemistry: an imbalance of certain neurotransmitters or hormones

might cause parts of the brain to malfunction

• Structural damage or abnormality: if the structure of the brain is damaged

or improperly formed then thinking, emotion and behaviour may change.
 THE BIOMEDICAL MODEL (cont.)

 Factors that may affect nervous system functioning:

• Genetics – inherited developmental abnormality
• Toxicity – chemical poisoning from e.g. drugs or environmental toxins
• Infection/disease – causing chemical or structural damage to the brain
• Stress – causing abnormal hormonal effects in the long term.
 An Example:
Brain Abnormality (Structure)
 Schizophrenia:
Brain Abnormality (Structure)
 2. THE BIOPSYCHOSOCIAL MODEL
 A model or approach posits that biological, psychological,
and social-cultural factors, play a significant role in the
context of disease or illness.
1. Biological factors
2. Psychological factors
3. Social- Cultural factors
 CONTEMPORARY THEORIES

Psychological
Biological Feedback Loops Emphasis on
Emphasis on biological psychological factors, i.e.
processes (i.e., early childhood
genetics) experience and self-
concept

Feedback Loops Feedback Loops

Social/Cultural
Emphasis on interpersonal
relationships and social,
cultural environment
 1. BIOLOGICAL FACTORS
 A cause of mental disorders is based on biology of the brain and the nervous
system
 Biological factors: genetics, prenatal damage, infections, exposure to toxins,
brain defects or injuries, & chemical imbalances can effect on a disorder
 Genetic factors, long-term physical health conditions & head injuries or
epilepsy may possibly trigger an episode of physical/mental illness.
 BIOLOGICAL THEORIES

1. Structural Theories • Abnormalities of the brain cause the

disorders

2. Biochemical Theories • Imbalances of neurotransmitters or

hormones, or poor functioning of
receptors cause disorders

3. Genetic Theories • Problems of genes lead to the disorders

 PSYCHOLOGICAL FACTORS

1. Psychodynamic Theories

2. Behavioral Theories

3. Cognitive Theories
1. PSYCHODYNAMIC THEORIES
(Sigmund Freud  1856 –1939)

Id Pleasure principle, primary process

(wish fulfillment)

Ego Reality principle, secondary

process thinking (rational
deliberation)

Superego Introject (internalize) social

standards. Conscience and ego ideal
 2. BEHAVIORAL THEORIES

 Classical Conditioning: a biologically potent stimulus (e.g. food) is paired

with a previously neutral stimulus (e.g. a bell).
 Operant Conditioning: the strength of a behavior is modified by the
behavior's consequences, such as reward or punishment,
 Modeling Learning: individuals develop and continuously adapt choice rules
while interacting with their environment
 Observational Learning: occurs through observing the behavior of others.
 3. COGNITIVE THEORIES
 Causal attributions: are both a symptom and source of prejudice
• A homelessness is attributed to dispositional factors such as personal laziness, poor
character, or lack of ability, prejudice toward a person is likely to persist.
 Control beliefs: are one of a number of determinants of health behavior & health
outcomes.
• A person's health status can be influenced by & can influence his or her control
beliefs.
 Dysfunctional assumptions: are the rules for living, often expressed in terms of “If…
then” statements or “should.
 SOCIOCULTURAL FACTORS

 Focus more on the larger social structures within

which an individual lives
 Relation between a person and his/her society.
 COMMUNITIES & CULTURES
 Illness/disorders have been linked to social, economic &
cultural system:
• Problems in communities or cultures (unemployment
or underemployment, lack of social cohesion & migration)
• Stresses & strains related to socioeconomic
status or social class
• Insecure educational, occupational, or social position
• Socioeconomic deprivation in neighborhoods
• Minority ethnic groups (e.g., immigrants, racism).
 LIFE EXPERIENCE & ENVIRONMENTAL
FACTORS
 Environmental causes are stressors in everyday life.
 Environmental factors include a dysfunctional home
life, poor relationships with others, substance abuse,
not meeting social expectations, low self-esteem &
poverty.
POOR PARENTING, ABUSE & NEGLECT

 Poor parenting: a risk factor for depression & anxiety (MH).

 Separation or bereavement in families, & childhood trauma:
risk factors for psychosis & schizophrenia.
 The long-term effects of neglect are reduced physical &
mental health in a child and throughout adulthood.
 RELATIONSHIPS
 Relationship issues have been linked to the development of
illness/disorders
• Parental divorce
• Early social privation, or lack of ongoing, harmonious,
secure, committed relationships
• Continuous fighting with friends and family
• A dysfunctional family
• Losing a loved one.
THANK YOU