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Physical Health

Health concerns, even those that are not life threatening, profoundly affect people's emotional, social, sexual, and vocational functioning and cause disruptions in valued life goals and roles. Counseling psychology's core emphasis on enhancing optimal development across the life span is especially helpful when considering the interaction of disease with normal developmental processes, as well as during the long-term course of many chronic diseases and health concerns. The concept of the healthy personality, rather than the medical model of a person with disease or deficits, provides a much-needed perspective in the ongoing development of health counseling psychology. The influence of the famous 17th-century philosopher René Descartes, who believed that the mind and the body were separate entities, has been felt for centuries as Western countries have continued to bifurcate mental and physical health services. Yet it is difficult to talk about mental health issues without addressing issues of physical health. Likewise, chronic illnesses have psychological and psychosocial components. In spite of the interaction between the physical and psychological, both physical and mental health professionals often ignore the connection between these two areas.

The etiology of health problems has been conceptualized using different theoretical models, including the biomédical, psychosocial, and more recently the biopsychosocial models. Many practitioners and scholars view the biomédical model as too closely aligned with a body focus with its emphasis on disease symptoms, medication, and genetics; and the psychosocial model as too closely aligned with a mind focus with its emphasis on mood, behaviors, and relationships. In contrast, the biopsychosocial model attempts to bridge the gap between these two models by eliminating the dichotomy between mind and body that devalues the complexity of factors that contribute to health status.

A Biopsychosocial Model of Health Status

George Engel's biopsychosocial model was the first to systematically consider the effect of psychological and social factors in conjunction with biological factors in predicting health outcomes. Representing a radical departure from viewing health and chronic disease as due primarily to biomédical factors, this model recognized the effect of psychosocial factors such as stress, coping skills, culture, environment, and context that lead to a more complete understanding of both body and mind. More recently, Mary Ann Hoffman and Jeanine Driscoll extended this model by conceptualizing health status as ranging on a continuum from illness to Wellness. Unlike Engel's model, which conceptualizes health as the presence or absence of disease or illness, this concentric model recognizes the reciprocal nature of biopsychosocial factors and views health status, or Wellness, as not wholly defined as being free of disease or disability. Instead, the focus is on the quality of the individual's life because individuals may have symptomatic complaints, but may still perceive they have a high quality of life due to coping mechanisms, social support, or institutional supports.

One piece of evidence for the biopsychosocial model is the high rate of comorbidity or co-occurrence of physical and psychological conditions in clients. Physical conditions can lead to psychological outcomes or can covary with these outcomes. The corollary is true in that mental health issues can have physiological ramifications. In other words, mental health acts as both a precursor and an outcome of physical health problems For example, it is well documented that negative emotions can intensify a range of health threats or diseases that may be influenced by the immune system—most notably, cardiovascular disease. Other research has shown that the effects of depression go beyond the negative effect on quality of life. Individuals who are chronically depressed for at least 6 years have nearly a 90% greater risk of developing cancer within the following 4 years. Eating disorders are largely viewed as a problem with psychosocial origins, but they cause significant physical ramifications. Conversely, anxiety and depression are more often found in those with chronic physical illnesses than in those without physical ailments.

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