An oral history of health psychology in the UK: Quinn, Chater,Morrison 2020

[Sly Saint]

Thought this might be of interest. It's long.

Abstract
Purpose
An oral history of the development of health psychology in the United Kingdom.

Methods
Standard oral history methods produced interviews with 53 UK health psychologists, averaging 92 min in length. All interviewees entered the field from the 1970s to the 2000s, representing all four countries in the United Kingdom. A reconstructive mode of analysis, along with the few existing sources, was used to create a narrative of the history of health psychology in the United Kingdom. Audio recordings and transcripts will be archived for use by future researchers.

Findings
In the 1970s, medical schools in London recruited psychologists to teach, while also conducting pragmatic research on issues in healthcare. At the same time, some clinical psychologists began to work with physical health conditions in general hospitals. Partly influenced by developments in the United States and Europe, an identity of ‘health psychology’ developed and spread to researchers and practitioners doing work in psychology and health. In the 1980s, the field continued to attract researchers, including social psychologists working with health behaviours and outcomes, and clinical psychologists working in health care settings. During this time, it became formalized as a scientific field with the creation of the BPS Health Psychology Section, courses, and journals. In the 1990s, the field moved towards professional practice, which was controversial with other BPS divisions. However, it continued to grow and develop through the 2000s and 2010s.

Conclusion
Reflections on the development of UK health psychology represent the first historical narrative produced from oral testimony of those who were present at the time.

https://onlinelibrary.wiley.com/doi/10.1111/bjhp.12418

 

[Sly Saint]

A few excerpts:

There was this slow trickle of doctors coming across asking questions like “well, you’re a psychologist, can you tell me why it is that some of my patients that don’t seem to be that ill, are coping so badly”… And these were doctors who could sort of see the bigger picture…. And so I started working with them… To be fair, it wasn’t the easiest environment to be in, it was a very biomedical environment, quite a lot of my more narrow biological colleagues were a bit dismissive of psychology. The students really liked it. (John Weinman)

During the 1970s, clinical psychologists began to work in medical settings such as NHS general hospitals (Bennett, 2015) and applied behaviour therapy to problems of physical illness (Rachman, 1977; Rachman & Phillips, 1975). Early on, much of this work had a mental health focus, such as adjustment, or neuropsychology, often using behaviour therapy/modification, widely used then in British clinical psychology (Marks, 2015; Parry, 2015). But medical staff soon sought advice for non‐psychological health issues that were often behavioural in nature (e.g., medication adherence), and clinical psychologists began to move into patient work that would be seen as health psychology. Many also began to train hospital staff in how to manage some of these cases.

Influences during this period came from the United States, Germany, and the Netherlands. Marie Johnston was an academic psychologist doing health research at Oxford University, who obtained clinical psychology training and in 1977 took up a lectureship at the Royal Free Hospital Medical School in London

The 1980s: The new frontier of applied psychology in the UK
In the 1980s, the socio‐political climate shifted to the right, encouraging greater individual responsibility for health. A 1980 report on social inequality in health emphasized cultural and behavioural factors (Murray, 2018), and attempts at mass behaviour change characterized the UK Government’s response to HIV: ‘Don’t die of ignorance’. Health psychology’s emphasis on individual behaviour and response to illness fitted the zeitgeist of this period.

Practitioners during this period (still clinical psychologists) often rejected a mental health approach and turned to health psychology to provide a body of theory that would be useful for their work. For example, Louise Earll approached Marie Johnston when ‘… I needed to acquire more academic rigour. It was clear that mental health models were not appropriate, the focus then was on abnormalities and deficits, problems and treatments’.

Formalizing health psychology in the 1980s
Informal networks also developed, such as in London the ‘Subcommittee of Psychology Applied to Medicine’ (SPAM). These networks reached beyond the United Kingdom. American psychologists had an influence through correspondence and visits, such as Howard Leventhal and Charles Spielberger, and interactions with European colleagues helped build momentum

Practice in the 1990s was still mainly by clinical psychologists taking up local NHS opportunities where the climate was supportive. From the formation of the DHP in 1997, the first practitioners were trained as health psychologists (rather than as clinical psychologists working in health).

Health psychology research in the 1990s
Researchers continued to build the literature and founded new journals, including in 1996 both the British Journal of Health Psychology and the Journal of Health Psychology. Growth in student places at UK universities created more academic posts for researchers and PhD graduates, including at the new universities created in 1992 from the polytechnics. This growth saw some universities become major centres where health psychology had not previously been represented. By the end of the 1990s, health psychology was more widespread than ever in university departments of psychology, medicine, and health professions. At university psychology departments, health psychology was more often taught to undergraduates (sometimes billed as an application of social psychology). This influenced some of the 1990s generation of psychology graduates to enter postgraduate study specifically to become a health psychologist (rather than another branch of psychology such as social or clinical psychology).

The 2000s: Building a discipline
By the year 2000, health psychology in the United Kingdom had the common features of a science and health profession: a professional body, journals, conferences, textbooks, and training routes. It had subsumed research areas that pre‐dated it, such as stress, coping and disease and the psychology of pain. Methods and viewpoints were becoming more diverse. It sat within a range of departments, in universities and to a lesser extent in healthcare settings. Health psychologists in university posts and MSc Health Psychology courses continued to increase. Practitioners could now be trained as health psychologists without a clinical psychology background. However, many practitioners were clinical psychologists and health psychology practice overlapped with clinical health psychology (Bennett, 2015).

Health psychology and government
The 2000s marked the entry of health psychology into advising government. Arranged and part‐funded by the DHP, Charles Abraham and Susan Michie served a secondment to the UK Government’s Department of Health in 2002–03. They reviewed evidence for policy decisions and advised civil servants, ministerial advisers, and the committee producing the second Wanless report about future provision of NHS services (Wanless, 2004).

The 2010s: Reflections and future directions
By the 2010s, there was a shift from predicting health behaviour using dominant theories from social psychology, towards health behaviour change. This matched the zeitgeist in public discourse on health but the dominance of health behaviour research was noted

Limitations
Just as a single piece of psychological research does not provide unquestioned truth, nor does a history (Goodwin, 2015). Differing historiographical methods may produce different histories (Lubek & Murray, 2018). Indeed, historical scholarship often produces competing interpretations, which may be refined as new sources are explored (Claus & Marriott, 2012).

 

[Trish]

I confess I don't understand the point of health psychology. It seems to be targeted at changing people's behaviour in ways that will improve their health, such as improving compliance with taking medication or lifestyle changes.

I'm not convinced there is evidence that a health psycholgist is best placed to explain to patients with physical illnesses why they should change their behaviour if the health psychologist doesn't have the medical knowledge to back it up. They are reduced to a sort of faith based 'because it's good for you' reasoning which easily tips over into patient blaming and shaming.

 

[Arnie Pye]

Alternative titles

How psychology took over medicine and won.
How biological medicine was disrupted and usurped by psychology
How psychologists persuaded governments that all their citizens were mad liars
How psychologists became a fifth column for insurance companies and governments

I am sure others could come up with a few more.

 

[rvallee]

I confess I don't understand the point of health psychology. It seems to be targeted at changing people's behaviour in ways that will improve their health, such as improving compliance with taking medication or lifestyle changes.

I'm not convinced there is evidence that a health psycholgist is best placed to explain to patients with physical illnesses why they should change their behaviour if the health psychologist doesn't have the medical knowledge to back it up. They are reduced to a sort of faith based 'because it's good for you' reasoning which easily tips over into patient blaming and shaming.

It merely seems to be bringing the worst of alternative medicine within a framework that can be coercive and authoritative but lacks any accountability. More than anything the primary beneficiaries, if not the only beneficiaries, are medical professionals. Everything seems built to reassure them that they are doing their best and sometimes the patients are to blame for being ill. Some patients have limited benefits, but nothing that alternative medicine can't deliver far cheaper. Most of those problems are socioeconomic anyway, nothing medicine can do besides saying so and doing the health economics work.

Poster child for the danger of good intentions gone wrong. These people mean well and yet commit atrocious harm while feeling good about it because they are the primary beneficiaries of this "rousing reassurance". Except they work within a framework that only listens to their own voices, never the patients', so they never see the outcomes they create. The ideas and models are far too simplistic. Economics does the same but acknowledges and emphasizes that caricatures and stereotypes are merely thought experiments, clinical psychology seems to actually believe in the cartoonish caricatures they invent.

I genuinely don't think anything of value would be lost if everything that came out of this field were burned down and lost forever. The intentions are good but that's only good for pavement on the road to hell. The complete absence of accountability in this field guarantees those disastrous outcomes, hindsight will not be kind.