452 Health Psychology
the eyes without the head, nor the head without the body,
so neither it is proper to cure the body without the soul.”
Aristotle, in 350 B.C., observed how emotions like joy, fear,
anger, and courage affect the body, thus linking bodily
processes to emotional states (Gentry & Matarazzo, 1981;
Lipsitt, 1999). However, it was the Greek physician
Hippocrates (460–377B.C.), often called the father of modern
medicine, who proposed a humoral theory of illness later ex-
panded by Galen (A.D. 129–199). This was a hydraulic model
that postulated that disease would result from the imbalance
of four bodily fluids or humors—blood, black bile, yellow
bile, and phlegm (Lipowski, 1986). Galen proposed four per-
sonality types based on the predominance of one of the four
humors (choleric, melancholic, sanguine, and phlegmatic);
these types permeated European personality theories for cen-
turies thereafter. In sum, the ancient Greeks believed that
mind and body were part of one system, that a balance be-
tween physical and emotional states was fundamental to
health, and that psychological factors could influence bodily
functions or even cause disease.
Lyons and Petrucelli (1978) describe a Greek legend that
illustrates the role of behavior and balance in health and ill-
ness. According to this myth, Zeus, the chief Olympian god,
brought the healer Asclepius into the heavens because of his
healing abilities. Asclepius became a half-god and had two
famous daughters, Hygeia and Panacea. Hygeia was the god-
dess of health and prevention; she taught the Greeks they
could be healthy if they were moderate in all forms of behav-
ior. Panacea was the goddess of medicine; she represented
the continuous search for treatment of all illnesses (cited by
Maes & Van Elderen, 1998, p. 591). These views were
adopted by Roman physicians and influenced Greek and
Roman healing practices that included medical and psycho-
logical approaches such as exercise, massage, music, a warm
and soothing atmosphere, and the like.
In the Middle Ages, a holistic view of mind–body relation-
ships was reflected in the supernatural view of causality and
treatment, but holism began losing credibility as the separa-
tion between church and state became more evident and med-
ical views of illness emerged. With this separation also came
the belief that mind and body were separate entities, or what
is known as dualism. During the Renaissance, the philoso-
pher Descartes (1596–1650) proposed what is now referred to
as Cartesian dualism: the premise that mind and body are
separate entities and that the explanations for bodily pro-
cesses are to be found in the body itself. By emphasizing the
materialism of the body, Cartesian dualism de-emphasized
the importance of emotions in health (Lipsitt, 1999).
The development of physical medicine consolidated a du-
alistic approach that then became the predominant model for
medical science and practice in much of Western civilization.
The work of the Dutch physician Vesalius in the 1500s
marked the development of science in anatomy and physiol-
ogy, highlighting the importance of the scientific method and
experimentation. In the seventeenth and eighteenth centuries,
Antonie van Leeuwenhoek’s work on microscopy and
Giovanni Morgagni’s advances in autopsy both contributed
to the discrediting of the humoral theory (Kaplan, 1975). In
England, in 1628, William Harvey used the objective scien-
tific method to disprove the humoral theory by identifying
that blood circulates in the body and is propelled by the heart
(Gatchel, 1993).
During the eighteenth century, progress was made in
understanding relationships between physical reactions and
psychological phenomena. Heart rate and temperature were
measured with increased sophistication, and pathways be-
tween bodily secretions and emotional reactions were identi-
fied. Although biomedical reductionism seemed to bury
unitary views of mind–body relationships, the active in-
gredients in the clinical practice of medicine were actually
primarily psychological ones (Matarazzo, 1994). In 1747, a
professor of medicine wrote that “the reason why a sound
body becomes ill, or an ailing body recovers, very often lies
in the mind” (Gaub, cited in Lipowski, 1977, p. 234).
In the nineteenth century, the role of psychological factors
in illness revived, giving rise to a new holistic movement and
paving the way for the psychosomatic medicine movement.
The prominent physician Claude Bernard emphasized the
role of psychological factors in physical illness (Gatchel,
1993), and the psychiatrist Heinroth, in Germany, is said to
have been the first to use the term “psychosomatic” (Lipsitt,
1999). In the United States, Benjamin Rush (1746–1813),
considered the father of American psychiatry, wrote the first
textbook on the treatment of mental illness (Rush, 1812), but
he also asserted that “actions of the mind” could cause many
illnesses. In 1812, he also founded the American Medico-
Psychological Association, which later became the American
Psychiatric Association.
In Europe, the antecessors of the psychodynamic ap-
proach, Austrian physician Franz Mesmer and Parisian neu-
rologist Jean Martin Charcot, reported several instances of
hysterical states in which physical symptoms had no med-
ical explanation and could be induced or removed by
hypnosis. These observations defied the biomedical reduc-
tionism that dominated medical science in the late eigh-
teenth and early nineteenth centuries. However, it was
Freud’s theories about hysterical conversion as the expres-
sion of repressed instinctual impulses that inspired the field
of psychosomatic inquiry, which then blossomed in the fol-
lowing 50 years.