1. Introduction to health Psychology
2. Abnormal psychology
3. Psychological responses to illness 1
4. Stress and health 1
Evidence of reflection on your study/experiences of health psychology as it applies to medicine to date.
SEXUAL ATTITUDE, TEENAGE PREGNANCY, POLICY
Health psychology is the study of the link between psychosocial factors and health. Crucially it requires me to develop my analysis of a patient beyond the traditional biomedical model and develop an ability to identify and assess the potential impact of social and psychological influences.
In our 5th week of this course we were presented with a 15-year-old mother of one requesting a prescription for emergency contraception. This girl has a 6-month-old baby and is now having regular unprotected sex with a 24 year old. I am ashamed to admit that at the time this case was presented to us I found it utterly ridiculous that a girl with apparent extensive social interaction could be so ignorant regarding what I considered well-publicised topics such as contraception. However our PBL tutor soon relayed some of her own experiences regarding the lack of awareness among the general public as regards sexual practices. This girl had “only heard bad things about the pill” and was reluctant to use condoms, as her partner did not like them. This was apparently sufficient reason to run the risk of further pregnancy and STI’s! On further research I can acknowledge there is without doubt a massive deficit in awareness of the risks and consequences associated with unprotected sex within Irish society.
The Catholic Church was the dominant influence on the attitudes and beliefs of Irish society as regards sexual practises until the 1970’s/1980’s. Though the restraining influence of the church on younger generations has all but disappeared sex has remained a taboo subject in formal social situations. Due to declining religiosity pre-marital, casual and homosexual sex has become widely accepted and thus commonplace in Ireland. These factors combined with the decreasing age of the sexually active population logically leads to an increased risk of teenage pregnancies and sexually transmitted infections. The reluctance of societies policy makers to bring sex into the public forum has resulted in an embarrassing deficit of understanding within certain subgroups of the Irish population when it comes to contraception and STI’s. This has also meant that the services currently available in Ireland are insufficient to deal with increased levels of “risky” sexual behaviour.
Contraception in is practically inaccessible when compared with Britain; especially to young people with minimal financial resources. Sex education in schools has been described as “patchy”, “unregulated”, and crucially unmatched to the needs of the target group. Social policy in this country also encourages single parents to stay at home due to lone parent allowance and medical benefits thus encouraging a cycle of dependence and withdrawal from the routine of the general population. Young people with lower levels of education are also more likely to engage in unprotected intercourse, as they are less concerned with the loss of prospective opportunities than people of higher socioeconomic classes. Teenage pregnancy is associated with higher than average rates of poverty, unemployment and poor educational achievements. Policy decision makers must recognise the need to improve the potential for professional achievement in lower socioeconomic groups in order to tackle the ambivalent attitude of this sub group towards teenage pregnancies.
On reflection I recognise the error of my previous incredulous attitude. Sexual practices and awareness is undeniably influenced by psychological and social factors such as education, socio-economic class, age and relationship status. All these elements are somewhat outwith a practitioner’s control when dealing with a patient such as Anne Cooper. I can foresee that tackling influences such as these will be a formidable task when I qualify. For this reason it is crucial I develop an awareness of the impact of environmental factors in governing patients lifestyle choices as I have no doubt it is an issue I will come across again and again particularly where sexual behaviours are concerned.
Another area where the biomedical medical is wholly inadequate is when dealing with a grieving patient. Elizabeth Lenihan was known to her GP as a competent previous medical professional. Following the death of her husband she displayed signs of an abnormal prolonged response to bereavement. On learning of her response I have to admit that in this particular situation I may not have recognised her symptoms to be indicative of an abnormal response and thus requiring intervention. Grief is a highly individualized and unpredictable experience, only 50-60% of people are considered to follow a “normal” response to grief. The Kubler and Ross model of grief outlines five typical stages a person may experience following bereavement; absence of a stage/stages or non-linearity does not define an “abnormal” response. Some of the many core indicators (there is no defined criteria) of a complicated response include emotional numbness, difficulty in redefining oneself and engaging in previously rewarding activities. Ms Lenihan allowed herself and her daughter to develop unhealthy diets and withdrew from her usual routine; consequently the GP diagnosed her with depression.
Though studies have shown the majority of people improve simply with time in this case Ms Lenihan responded well to anti-depressants and reached a stage where she stopped taking them of her own accord. A major learning point for me in this case is the important of grasping the psychology of bereavement. Though there are models for grief such as the 5 stage process mentioned above it is greatly influenced by many factors which must be considered before deciding a patient is not coping as they should and perhaps inappropriately initiating pharmacological treatment. In this instance there are many psychosocial factors present which may certainly have influenced her reaction. Dr Lenihan had essentially lost her purpose – that of caring for her husband, he had also had a prolonged stay in hospital indicating she wasn’t able to cope with him.
She was mostly completely withdrawn from society and also was experiencing feelings of guilt that she wasn’t caring adequately for her daughter. Though she responded well to anti-depressants it is impossible to confirm that the other interventions put in place such as encouraging her to meet with friends and arrange help around the house were not responsible for her improvement. This case also highlighted to me the importance of monitoring for the possible health impacts of grief such as reduced health regulating behaviour, depression and increased suicide risk. Outside of this studies have also shown increased mortality and morbidity from other causes following the death of a spouse, of course this may again be related to the psychological impact of the death.