We could start with the dictum, “All diseases are not created equal!” Some health con­ditions or disease states are more homogeneous than others, from one individual’s case to the next, and others are more heterogeneous. Similarly, one individual may process and cope with these disease factors differently than others. We can, however, assess particular factors that differentiate the onset and progression of each disease or health condition. If we conceptualize these factors as identifiable stresses posed by each specific health condition, and the demands that this health condition poses for an individual’s or family’s coping, we can characterize these stress and coping situa­tions from one disease to the next. This process, in most respects, utilizes many ele­ments of Rolland’s psychosocial typology model (1987). The following section (see Figure 1.2) highlights several factors that can be used to conceptualize differences among different diseases and health conditions.

As the biopsychosocial model has become widely accepted as an overarching model with great utility for engendering more comprehensive and effective health care services, multiple models have been created to conceptualize the exact manner in which these biopsychosocial factors interrelate. Although we will not here review all mod­els, we will briefly overview the main ones and present a new model for assessment and treatment planning. Some models have been characterized as more categorical, suggesting that different diseases pose different stressors, and that the difficulties the patient and his or her family face will be predictable by particular aspects of the dis­ease state (Rolland, 1987). In addition, the social ecological model (Bronfenbrenner, 1977; Kazak, 1986) emphasizes that the health condition affects individuals in the patient’s social structure, including family, extended family, friends, community, and society in general, as well as the effect of these social circles on the support and adjustment of the patient directly experiencing the disease. Other models have emphasized that, re­gardless of the specific disease state, there are individual-specific or family-specific factors that impact the individual’s reaction and adjustment to the diagnosis and treat­ment of the disease. Among these are the disability-stress-coping model (Wallander & Varni, 1992), and the transactional stress and coping model (Thompson, Gustaf son, Ham-lett, & Spock, 1992). These models have been characterized as risk and resistance mod­els, or integrative theoretical models (Wallander, Thompson, & Alriksson-Schmidt, 2003). An additional model, similar to the risk and resistance models, is the resiliency model of family stress, adjustment, and adaptation (McCubbin & McCubbin, 1993), which empha­sizes that chronic health conditions demand ongoing adjustment over time, and that a patient’s and family’s adjustment is affected by changes in symptomatology, repre­senting a process rather than a single adaptation.
We will then present a new model, the Model for Integrating Medicine and Psy­chology (MI-MAP), which integrates the categorical and risk-resistance models into a guide for sequential assessment and treatment planning regarding comprehensive health psychology factors.

The traditional biological model of medicine is primarily focused on the assessment and treatment of pathology in biological structure and function, or pathophysiology (Van Egeren & Striepe, 1998). In response, Engel (1977) criticized the over-focus of medicine on biological factors, and proposed the biopsychosocial model. Because the biopsychosocial model incorporates multifactorial explanations for health and bi­directional or reciprocal influences between these factors, and allows for complex direct and indirect effects of biological, psychological, and social factors on health outcomes, it has become the predominant model within health psychology (Belar & Deardorff, 1995; Smith & Nicassio, 1995). It is also progressively becoming accepted among allopathic and osteopathic medical training, nursing, and other therapies.

Although health psychology is a rather recent focus of behavioral science, interest in the interplay between humans’ psychological and physical well-being dates back throughout history and spans many cultures, with written discussion as far back as the fourth century bc (Hippocrates, trans. 1923). Of particular historical significance was the conceptual separation of the mind from the body by René Descartes in the sev­enteenth century (Cummings, O’Donohue, Hayes, & Follette, 2001). However, regard­ing health psychology as a subspecialty of psychology and medicine, it is useful to revisit its development over the past 30 years. If we start slightly earlier in the histori­cal timeline, early attention was paid to the effects of the psyche upon physical func­tioning and physical symptoms as early as Stanley Hall (1904), who emphasized the role of psychology in physical healing. William James (1922) discussed the role of people’s individual processes in approaching work and life stresses, an idea that fore­shadowed the current conceptualization of “coping” (Lazarus & Folkman, 1984). Psy­choanalytic attention to physical health generated the terms psychosomatic and psycho­somatic medicine, indicating that the “psyche,” or mind, interacted with the “soma,” or body. Although not specifically determined by this term, psychosomatic acquired a connotation that implied a directionality of influence. That is, the psyche affected the soma, as in somatoform disorders (DSM-IV-TR, 2000). Medical symptoms were con­ceived of as physical symptoms representing the expression of psychological distress, albeit unintentional and unconscious (Freud, 1916-1917, trans. Strachey, 2000). In­deed, the individual remained partly or wholly unconscious of the psychological etiology that created the physical symptoms. During the early twentieth century, psychodynamic investigations sought to identify particular personality organizations that would be prone to the development of physical disease (Alexander, 1950; Dunbar, 1943). While some research has continued on the “cancer-prone personality” (Eysenck, 2000; Katz & Epstein, 2005), for example, research to support it as an etio-logical factor in the disease is not very convincing (Amelang, Schmidt-Rathjens, & Matthews, 1996; O’Leary, 2006). Most modern conceptualizations have changed; now, they investigate individual factors such as the impact of genetics or lifestyle on health (e.g., tendency to smoke cigarettes, drink alcohol excessively, or eat a particular diet), and stress, or coping dispositions that put individuals at risk for a poorer adjustment once health changes occur. After a reduction in professional investigation of the topic during the mid-twentieth century, focus on the interaction of psychological and phys­ical health was renewed by findings that humans could intentionally control physio­logical activity that was previously considered involuntary (Miller, 1969). These find­ings became the foundation for the creation of biofeedback (Miller, 1978).
The consolidated rebirth of modern health psychology and behavioral medicine occurred in the 1970s. After renewed interest in the 1960s and 1970s, Gary Schwartz and Stephen Weiss organized a meeting of scientists interested in defining behavioral medicine in 1977, and Neal Miller chaired a subsequent meeting to organize clinical and research interests relating to these topics, resulting in a meeting of interested pro­fessionals at the National Academy of Science’s Institute of Medicine. These efforts to define behavioral medicine as a field of clinical study and treatment as well as a pro­fessional endeavor yielded several articles summarizing these defining events and concepts (Schwartz & Weiss, 1977, 1978). Behavioral medicine was defined as “the field concerned with the development of behavioral science knowledge and tech­niques relevant to the understanding of physical health and illness and the applica­tion of this knowledge and techniques to prevention, diagnosis, treatment, and reha­bilitation. Psychosis, neurosis, and substance abuse are included only insofar as they contribute to physical disorders as an end point.” (Schwartz & Weiss, 1978, p. 3). The Society of Behavioral Medicine was subsequently formed, first within the confines of the Association for the Advancement of Behavior Therapy, then as a separate and in­dependent organization (Weiss, 2003, as interviewed in Albright, 2003). This was fol­lowed by disagreement regarding the most appropriate terminology for this pursuit of study and treatment.
Health Psychology has “made substantial contributions to the understanding of healthy behaviors and to the comprehension of the myriad factors that undermine health and often lead to illness” (Taylor, p. 40). The term Health Psychology has been defined as “the aggregate of the specific educational, scientific, and professional con­tributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, the identification of etiologic and diagnostic correlates of health and illness and related dysfunctions, and the analysis and im­provement of the health care system and health policy.” (Matarazzo, 1982, p. 4). This latter definition has been criticized for being too broad and encompassing, and sub-definitions will be needed to characterize the specialties regarding particular domains of academic, clinical, and policy endeavors (Marks, Sykes, & McKinley, 2003). Other definitions, however, have emphasized four differing approaches within health psy­chology: a clinical focus, a public health focus, a community focus, and the approach of critical health psychology (Marks, Murray, Evans, & Willig, 2000).
To briefly summarize the consensus, or lack of consensus, about these terms, we here present all of the titles currently used in the professional context:
The term behavioral medicine is preferred by those who view this context as growing from the field of behavioral science or applied behavior analysis; however, this im­plied theoretical bias has engendered some professionals to use the term health psy­chology. Those who favor the term health psychology perceive it as depicting the application of psychological principles to the study and treatment of physical health without evoking the theoretical position of behaviorism. Coming full circle, however, those who favor the term behavioral medicine feel that this implies a nonpharmaco-logical/nonsurgical focus on physical health by any discipline of study (including such disciplines as medicine, nursing, physical therapy, occupational therapy, nutri­tion, exercise physiology, epidemiology, public health, and social work), and not just psychology (Weiss, 2003, as interviewed in Albright, 2003).
In turn, some clinicians and theorists have criticized health psychology and behav­ioral medicine regarding their inattention to the larger social context and social fac­tors. Family therapists communicated that behavioral medicine and health psychol­ogy pursuits were successful in contributing the “psycho” to the “bio,” as dictated by the biopsychosocial model, but were failing to adequately address the “socio” aspect of the biopsychosocial model. This concern generated the term medical family therapy (Doherty, McDaniel, & Hepworth, 1994; Rolland, 1987), and is consistent with other models within pediatric psychology, such as the social ecological model of health (Bronfenbrenner, 1975; Kazak, 1986), which emphasizes the impact of illness on the social circles surrounding the patient as well as the impact of social family/support on patient adjustment. In the interest of fairness, however, we note that significant at­tention is paid within the health psychology and behavioral medicine literature to so­cial support factors, prevention issues in at-risk populations, and sociopolitical factors (Marks et al., 2000).
For the purpose of clarity throughout this book, we will allow the terms health psy­chology and behavioral medicine to be rather parallel and synonymous, and that these will include the study and treatment of environmental and social factors, as empha­sized by medical family therapy. We concede that there exist different emphases among the use of these terms, but here we emphasize their commonalities: the appli­cations of psychological, family, social, spiritual, and other nonpharmacological fac­tors in the role of physical health, and we use these terms with emphasis on their shared definitions and goals rather than on their differences. It is also important to note that the field of health psychology investigates the role of psychosocial factors in the development of disease, the stressors posed by disease for subsequent psycho­logical adjustment, and the ongoing reciprocal influence of physical and psychosocial factors over time, consistent with the biopsychosocial model.