The Power of Belief: tackling psychological and

social determinants of illness, disability, and

economic inactivity".
Professor Mansel ylward !B
"irector, #n$mProvident !entre for Psychosocial and "isability %esearch,
!ardiff #niversity
&
!hair, The 'ales !entre for (ealth
ylwardM)cardiff.ac.$k
www.cf.ac.$k*psych*cpdr*inde+.html
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0oint meeting of British Psychological .ociety
* ssociation of British Psychologists
The Power of Belief:
(ow sho$ld we define belief12
A common-sense, empirical definition: (cave: Cognitive
Psychologists!)
A belief is something that someone holds to be tre!
A non-psychologist"s #or$ing belief abot belief:

Associations stored in the mind

%ained largely throgh e&perience of some internal or e&ternal

stimli #hich predicts a particlar otcome or response over
time'
(tored accmlated associations: a basis for all e&pected
contingencies involving specific behaviors #hich follo# from
certain stimlating conditions
Pragmatic Model of Belief:
"o beliefs infl$ence and drive o$r attit$des and
behavio$rs2

A pragmatic yes!

Confirmation of e&pected relationship bet#een stimli

and predicted otcome strengthens association' (ie:
belief)

Association #ea$ened if predicted otcome(s) does

not occr

)his simplistic approach to belief ac*isition is

nonetheless the premise for
+ ,ehavior modifying techni*es and interventions
+ -olding by e&perience, learning and cltre
+ .dcational interventions
Believing is the most mental thing we do13

4s it the most .5!46 thing we do27

(ccessfl %enes Promote their o#n means

of transmission

)ransgenerational beliefs scceed by the

same mechanisms (memes)/

Accracy of belief promotes transmissional

sccess

0n evoltionary terms: the faclty to transmit

tre beliefs is pivotal to the propagation of
abilities to commnicate

)he accracy of belief is empo#ering'

1 ,ertrand 2ssell, The Analysis of the Mind: 3453
6 7aniel %ilbert, Stumbling on Happiness: 5889
/ 2ichard 7a#$ins, The Selfish Gene, 34:9
Belief 8 Transmission

(cceed if they facilitate their means of

transmission!'

;alse beliefs become sper-replicators if they

enhance commnication

,eliefs tend to be transmitted #hen they do

things that transmit genes'

,ad! genes and false beliefs are sccessflly

transmitted if, on balance, they promote their
o#n means of transmission
)he srvival of inaccrate (false) beliefs:
Belief Transmission and .ociety:

;alse beliefs are propagated in societies if they

promote stability in society'

Corollary: people #ho hold sch beliefs tend to live in

stable societies'
Belief Transmission and .ociety:

<appiness: a sper-replicating false belief=

People desire happiness, ths economies florish only
if people are delded into believing that prodction of
#ealth #ill ma$e them happy1

>ealth may not ma$e s happier bt serves the needs

of the economy ? promotes stable society ?
propagates false belief'

Children bring happiness ? cltral #isdom@ bt tre!=

1 After: Adam (mith' The Theory of Moral Sentiments, 3:A4
(ymptoms and 0llness:
an illstration of the propagation of false beliefs'

(ymptoms and Common <ealth Problems in (ociety

Bbstacles to 2ecovery

,elief abot <ealth and >or$

(tability of (ociety threatened + a pblic health crisis

(ealth, 4llness and Beliefs:
A Clarification of terminology: fndamental health-related
concepts

(ymptoms: (bCective bodily or mental sensations

that reach a#areness
+
,othersome! or of concern to the person!
+
(ome represent clinical e&pression of disease
+ -any are normal and part of life
+ <igh fre*ency and prevalence not associated #ith
recognisable disease1 6

0llness:
+
)he sbCective feeling of being n#ell
+
An internal, personal e&perience

(ic$ness:
+ (ocial stats accorded to ill person by society
+ .&ternal, social phenomenon (individal: society
interactions)/
1 Drsin 344: 6 7eyo et al, 344E
/ Parsons, 34A3 9 -echanic 349E
9
2ecipients of $ey #or$ing age benefits
-
:--,---
;,---,---
;,:--,---
,,---,---
,,:--,---
<,---,---
<,:--,---
;=>= ;=?< ;=?> ;==; ;==: ;=== ,--<
Source: DWP and OS
4B %ecipients 8 "iagnoses
!ardiovasc$lar
;-@
"iseases of the
nervo$s system
<@
4nA$ry
;@
"iseases of the
respiratory
system
,@
5ther conditions
or condition not
specified
;9@
Mental health
99@
M$sc$loskeletal
,/@
4ncapacity8related benefit recipients by diagnosis gro$p, Bovember ,--<
#C 4ncapacity Benefit

F(evere -edical Conditions" G5AH

FCommon <ealth Problems"

- -ental health problems IIH
- -sclos$eletal conditions 5AH
- Cardio-respiratory conditions 38H
Prevalence of s$bAective health complaints in the last
<- days in Bordic ad$lts Dafter, Eriksen et al, ;==?F
Any complaints (bstantial complaints
-en >omen -en >omen
)iredness I9H A9H 3:H 59H
>orry JEH J4H 3JH 3AH
7epressed 55H 5EH AH 38H
<eadache J:H A3H IH 4H
Kec$ pain 5:H I3H 4H 3:H
ArmLsholder pain 5EH JEH 35H 3:H
Mo# bac$ pain J5H J:H 3JH 39H
NA8H reported t#o or more symptoms
Common <ealth Problems: Predomonantly
(bCective <ealth Complaints
<igh prevalence in the general poplation (.ri$sen et al, 344E@
Drsin, 588J, ,arnes et al, 5889)
+ Symptoms: self reported
Dne&plained symptoms in people accessing healthcare:
+ On a!erage " #$% symptoms attributed to organic causes
&'roen(e ) Mangelsdorff* #+,+-
+ .imited ob/ecti!e e!idence of disease* damage or impairment
&Page and Wessely* 0$$1-

2egional (Pain) 7isorders O<adler, 5883P

+
.o2 bac(* upper limb* nec(* etc

-edically ne&plained (ymptoms in Btpatient Clinics:

+ 1$34$ percent 2ithout identifiable disease &5ass* #++$*
Maiden et al* 0$$1
0llness ,ehavior: >hat ill people say and do that
e&press and commnicate their feelings of being
n#ell:

Kot solely dependent on an nderlying health condition

( the limited correlation)

People #ith similar symptoms (illnesses) may or may

not be incapacitated

Poorer *ality of life than those #ith comparable

symptoms cased by disease

Consmption of health care disproportionate'

Common <ealth Problems: disability
and incapacity

<igh prevalence in general poplation

-ost acte episodes settle *ic$ly: most people

remain at #or$ or retrn to #or$'

)here is no permanent impairment

Bnly abot 3H go on to long-term incapacity

)hs:

.ssentially people #ith manageable health problems

given the right spport, opportnities Q encoragement

Chronicity and long-term incapacity are not

inevitable
'hy do some people not recover as e+pected2
.5!46
P.G!(58
B458

,io-psycho-social factors may

aggravate and perpetate
disability

)hey may also act as

obstacles to recovery &
barriers to ret$rn to work
Biopsychosocial Model
.5!46 Cltre
(ocial interactions
)he sic$ role
P.G!(58
0llness behavior
,eliefs, coping strategies
.motions, distress
B458 Kerophysiology
Physiological dysfnction
()isse damage=)
.trengths of BP. Model

Provides a frame#or$ for disability and

rehabilitation

Places health conditionLdisability in

personalLsocial conte&t

Allo#s for interactions bet#een person and

environment

Addresses personalLpsychological isses'

Applicable to #ide range of health problems

Management of common health
problems m$st address obstacles
to recovery.
Halse beliefs play a pivotal role in
propagating and perpet$ating
these illnesses
Hoc$sing on %ecovery: the
Psychosocial dimension

Almost anytime yo tell anyone anything, #e are

attempting to change the #ay their brain #or$s

<o# people thin$ and feel abot their health problems

determine ho# they deal #ith them and their impact

.&tensive clinical evidence that beliefs aggravate and

perpetate illness and disability1 6

)he more sbCective, the more central the role of beliefs /

,eliefs inflence: perceptions Q e&pectations@ emotions

Q coping strategies@ motivation@ ncertainty
1 -aid Q (pans#ic$, 5888' 6 %atchell Q )r$, 5885'/ >addell Q Ayl#ard
4llness, .ickness and 4ncapacity
are Psychosocial rather than
medical problems.
More and better healthcare is
not the answer
.hifting attit$des to health & work
!$rrent: .hift to:
>or$ is a Fris$" and (potentially)
harmfl to physical and mental
health'
>or$ is generally good for physical
and mental health
therefore and
(ic$ness absenceLcertification
Fprotects" the #or$erLpatient from
#or$
2ecognise the ris$s and harm of
long term #or$lessness
'ork :

Benefits:
(ymptom management
2ecovery and 2ehabilitation
(elf-esteem and Confidence
(ocial identity and role
Promoting activities and participation
(ocial inclsions and fnctioning
Rality of Mife
(ealth at 'ork:

The key idea is that work is

healthy

The workplace I environment for

promoting healthJ controlling ill
health

p$blic health iss$e

.$ccessf$l 4nterventions:
Practical .lements of Condition -anagement

Address the main health conditions

Clear #or$ focs, vocational goals, otcome measres

Address biological and psychosocial components

Address individal"s obstacles to 2)>

0ncrease activity and restore fnction

(hift beliefs and behavior sing C,) (tal$ing therapies)

!ondition Management K
.$ccessf$l .trategies:

-a$e sense of yor condition

Bvercome stress and an&iety

Mearn to be assertive

Promote emotional L physical #ellbeing

Miving #ith fatige

Miving #ith pain

I4H patients have primary and frther J4H
secondary mental illness diagnosis
PA)<>AS( )B >B2T P0MB)(

9-E88 ne# Cob entries each month in e&isting

Path2ays areas

7obling of claimants entering #or$

)a$e-p arond A times that e&pected from previos

2)> interventions

.&ceeds threshold for cost-effectiveness

>elfare ,ill :e&tending provision across contry

by 588E
:2edcing by 3 million the nmber
on 0ncapacity ,enefits
:employment rate U E8H #or$ing
poplation
;alse ,eliefs ? 0llness ,ehaviors
(Common <ealth Problems)
>or$
+ 2is$y
+ <armfl
+ Avoid
(ic$ 2ole
+ 7isease basis
+ -edical modelLrehabilitation
+ 2ights
>elfare (tate
+
Dnlimited resorces
+
2ights #ithot responsibility
+
dependency

(ealth !are .ystems L

+ O!erloaded
+ 6nmet e7pectation
+ 8educed public trust
+ on3compliance
+
9onte7t of health care
+
Success of 9)A medicine
.ocial .ec$rity .ystem
+ Proliferating e7penditure
+ Dependency ) chronicity
+ Ageing population
+ :2riting people off;
"estabiliMed .ociety
+
Threatened economy
+
Medical ad!ances outstrip resources
+
6nmet e7pectations
+
Social e7clusion
The "oomsday .cenario:
Halse Beliefs L !ommon (ealth Problems L
5verb$rdened and ill8foc$sed health*.. .ystems
L "estabiliMed .ociety
Meeting the !hallenge:

-aCor Cltral (hift

+
Perception Q management of common health
problems
+
>or$ is generally good for physical and mental
health
+
(ocial integration (fll participation in society)

)ac$ling (ocial ine*alities in health Q regional

deprivation
+
-ltiple disadvantages L failre to compete in Cob
mar$ets
+
Addressing the social gradient

%etting all (ta$eholders onside

At the heart of cltre lies belief
+
5eliefs dri!e beha!iour
+
Modified by e7perience
+
Dispelling the myths
+
Public policy initiati!es
Transforming the c$lt$re depends on shifting
core beliefs abo$t health, illness, sickness
and work
)he (cientific and Conceptal ,asis
of 0ncapacity ,enefits
Nordon 'addell and Mansel ylward
The Power of Belief
Peter (alligan and Mansel ylward
Professor Mansel ylward !B
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