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Printed in the United States of America

Print Number: 01 Print Year: 2021

Part 1 Foundations of Health Psychology

Chapter 1 Introducing Health Psychology 3
Chapter 2 Conducting Health Research 21
Chapter 3 Seeking and Receiving Health Care 43
Chapter 4 Adhering to Healthy Behavior 65

PART 2 Stress, Pain, and Coping

Chapter 5 Defining, Measuring, and Managing Stress 95
Chapter 6 Understanding Stress, Immunity, and Disease 129
Chapter 7 Understanding and Managing Pain 155
Chapter 8 Considering Alternative Approaches 187

PART 3 Behavior and Chronic Disease

Chapter 9 Behavioral Factors in Cardiovascular Disease 221
Chapter 10 Behavioral Factors in Cancer 251
Chapter 11 Living with Chronic Illness 275

PART 4 Behavioral Health

Chapter 12 Smoking Tobacco 305
Chapter 13 Using Alcohol and Other Drugs 335
Chapter 14 Eating and Weight 367
Chapter 15 Exercising 399

PART 5 Looking Toward the Future

Chapter 16 Future Challenges 427

Glossary 448

References 454

Name Index 523

Subject Index 565

iii

About the Authors xvii Would You BELIEVE...? Prescribing Placebos

May Be Considered Ethical 25
IN SUMMARY 26
2-2 Research Methods in Psychology 26
PART 1 Foundations of Health
Correlational Studies 26
Psychology Cross-Sectional and Longitudinal Studies 27
1 Introducing Health Psychology 3 Experimental Designs 28
Ex Post Facto Designs 29
1-1 The Changing Field of Health 3
CHAPTER

IN SUMMARY 29
Real-World Profile of COVID-19 Pandemic 4
Patterns of Disease and Death 6 2-3 Research Methods in Epidemiology 29
Observational Methods 30
Would You BELIEVE...? College is Good for
Your Health 8 Randomized Controlled Trials 30
Escalating Cost of Medical Care 10 Meta-Analysis 32
What is Health? 10 An Example of Epidemiological Research:
The Alameda County Study 32
Would You BELIEVE...? It Takes More Than a
Virus to Give You a Cold 11 Becoming an Informed Reader of
Health-Related Research on the Internet 33
IN SUMMARY 12
IN SUMMARY 34
1-2 Psychology’s Relevance for Health 13
The Contribution of Psychosomatic Medicine 13 2-4 Determining Causation 34
The Emergence of Behavioral Medicine 14 The Risk Factor Approach 34
The Emergence of Health Psychology 15 Cigarettes and Disease: Is There a Causal
Relationship? 35
IN SUMMARY 16
IN SUMMARY 36
1-3 The Profession of Health Psychology 16
2-5 Research Tools 37
The Training of Health Psychologists 16
The Work of Health Psychologists 16 The Role of Theory in Research 37
The Role of Psychometrics in Research 38
Real-World Profile of Angela Bryan 17
IN SUMMARY 39
IN SUMMARY 18
Questions 39
Questions 18
Suggested Readings 40
Suggested Readings 19

2 Conducting Health Research 21 3 Seeking and Receiving Health

Care 43
CHAPTER
CHAPTER

Check YOUR BELIEFS About Health Research 22

3-1 Seeking Medical Attention 43
2-1 The Placebo in Treatment and Research 22
Check YOUR BELIEFS Regarding Seeking and Receiving
Treatment and the Placebo 22
Health Care 44
Real-World Profile of Sylvester Colligan 23
iv

CHAPTER

Check YOUR BELIEFS Regarding Adhering 5-1 The Nervous System and the
to Healthy Behavior 66 Physiology of Stress 95
What is Adherence? 66
Check HEALTH RISKS Life Events Scale for Students 96
How is Adherence Measured? 66
The Peripheral Nervous System 96
Real-World Profile of Rajiv Kumar 67
Real-World Profile of COVID-19
How Frequent is Nonadherence? 68
Pandemic 97
What are the Barriers to Adherence? 69
The Neuroendocrine System 98
IN SUMMARY 70 Physiology of the Stress Response 101
4-2 What Factors Predict Adherence? 70 IN SUMMARY 103
Disease Severity 70 5-2 Theories of Stress 103
Treatment Characteristics 70
Selye’s View 103
Personal Factors 71
Lazarus’s View 105
Environmental Factors 72
IN SUMMARY 106
Interaction of Factors 74
5-3 Sources of Stress 106
IN SUMMARY 75
Cataclysmic Events 106
4-3 Why and How Do People Adhere
Life Events 108
to Healthy Behaviors? 75
Daily Hassles 108
Continuum Theories of Health Behavior 76

Would You BELIEVE...? Pets May Be Better Questions 152

Support Providers Than People 117 Suggested Readings 152
Personal Coping Strategies 117
IN SUMMARY 119
7 Understanding and
Managing Pain 155
CHAPTER
5-6 Behavioral Interventions for
Managing Stress 119 7-1 Pain and the Nervous System 155
Relaxation Training 119 Check YOUR EXPERIENCES
Regarding Your Most Recent Episode of Pain 156
BECOMING HEALTHIER 120
Cognitive Behavioral Therapy 121
Real-World Profile of Pain 157
The Somatosensory System 157
Emotional Disclosure 122
The Spinal Cord 158
Mindfulness 124
The Brain 158
IN SUMMARY 125
Neurotransmitters and Pain 160
Questions 126 Would You BELIEVE...? Emotional
Suggested Readings 127 and Physical Pain are Mainly the Same
in the Brain 160
6 Understanding Stress, Immunity, The Modulation of Pain 161
and Disease 129
CHAPTER

IN SUMMARY 162
6-1 Physiology of the Immune System 129 7-2 The Meaning of Pain 162
Real-World Profile of Big City Taxi The Definition of Pain 163
Drivers 130 The Experience of Pain 163
Organs of the Immune System 130
7-3 Theories of Pain 166
Function of the Immune System 131
Immune System Disorders 133 IN SUMMARY 169
7-4 Pain Syndromes 169
In Summary 136
Headache Pain 170
6-2 Psychoneuroimmunology 136
Arthritis Pain 171
History of Psychoneuroimmunology 136
Cancer Pain 172
Research in Psychoneuroimmunology 137
Phantom Limb Pain 172
Would You BELIEVE...? Pictures
of Disease are Enough to Activate the IN SUMMARY 173
Immune System 137 7-5 The Measurement of Pain 174
Physical Mechanisms of Influence 139 Self-Reports 174
In Summary 140 Behavioral Assessments 176
Physiological Measures 176
vi

Check Your HEALTH CARE PREFERENCES

About Health Research 188
PART 3 Behavior and Chronic
8-1 Alternative Medical Systems 188
Disease
Real-World Profile of T. R. Reid 189
Traditional Chinese Medicine 189 9 Behavioral Factors in Cardiovascular
Ayurvedic Medicine 190
CHAPTER Disease 221
IN SUMMARY 192 9-1 The Cardiovascular System 221
8-2 Alternative Products and Diets 192 Check Your HEALTH RISKS
Regarding Cardiovascular Disease 222
IN SUMMARY 193
8-3 Manipulative Practices 194 Real-World Profile of Emilia Clarke 223
Chiropractic Treatment 194 The Coronary Arteries 223
Massage 194 Coronary Artery Disease 224
Stroke 226
IN SUMMARY 196
Blood Pressure 227
8-4 Mind–Body Medicine 196
IN SUMMARY 228
Meditation and Yoga 196
9-2 The Changing Rates of Cardiovascular
BECOMING HEALTHIER 197 Disease 230
Qi Gong and Tai Chi 198 Reasons for the Decline in Death Rates 230
Biofeedback 199 Heart Disease Throughout the World 231
Hypnotic Treatment 200
IN SUMMARY 231
Physiology and Mind–Body Medicine 201
9-3 Risk Factors in Cardiovascular
IN SUMMARY 201
Disease 232
8-5 Who Uses Complementary and Inherent Risk Factors 232
Alternative Medicine? 202 Physiological Conditions 234
Culture, Ethnicity, and Gender 202 Behavioral Factors 236
Motivations for Seeking Alternative Treatment 203
Would You BELIEVE...? Chocolate May Help
IN SUMMARY 204 Prevent Heart Disease 237
8-6 How Effective are Alternative Would You BELIEVE...? Nearly All the Risk for
Treatments? 204 Stroke is Due to Modifiable Factors 238
Alternative Treatments for Anxiety, Stress, and Psychosocial Factors 239
Depression 205 IN SUMMARY 242
vii

CHAPTER
IN SUMMARY 248
Real-World Profile of Nick Jonas 276
Questions 248
Impact on the Patient 276
Suggested Readings 249 Impact on the Family 278
10 Behavioral Factors in Cancer 251 IN SUMMARY 279
10-1 What is Cancer? 251 11-2 Living with Alzheimer’s Disease 279
CHAPTER

Check Your Health Risks Regarding Cancer 252 Would You BELIEVE...? Using Your Mind May
Help Prevent Losing Your Mind 281
Real-World Profile of Steve Jobs 253
Helping the Patient 282
10-2 The Changing Rates of Cancer Deaths 253
Helping the Family 283
Cancers with Decreasing Death Rates 254
IN SUMMARY 284
Cancers with Increasing Incidence and Mortality
Rates 255 11-3 Adjusting to Diabetes 284
IN SUMMARY 256
The Physiology of Diabetes 284
The Impact of Diabetes 286
10-3 Cancer Risk Factors Beyond
Health Psychology’s Involvement with Diabetes 287
Personal Control 257
Inherent Risk Factors for Cancer 257 IN SUMMARY 288
Environmental Risk Factors for Cancer 258 11-4 The Impact of Asthma 289
IN SUMMARY 259 The Disease of Asthma 289
Managing Asthma 290
10-4 Behavioral Risk Factors for Cancer 259
Smoking 260 IN SUMMARY 291
Diet 262 11-5 Dealing with HIV and AIDS 292
Alcohol 264 Incidence and Mortality Rates for HIV/AIDS 292
Sedentary Lifestyle 264 Symptoms of HIV and AIDS 294
Ultraviolet Light Exposure 264 The Transmission of HIV 295
Would You BELIEVE...? Cancer Prevention Psychologists’ Role in the HIV Epidemic 296
Prevents More Than Cancer 266 BECOMING HEALTHIER 299
Sexual Behavior 266
IN SUMMARY 299
Psychosocial Risk Factors in Cancer 267
11-6 Facing Death 300
IN SUMMARY 267
Adjusting to Terminal Illness 300
10-5 Living with Cancer 268
Grieving 301
Problems with Medical Treatments for Cancer 268
IN SUMMARY 302
Adjusting to a Diagnosis of Cancer 269
Social Support for Cancer Patients 270 Questions 302
Psychological Interventions for Cancer Patients 270 Suggested Readings 303

viii

CHAPTER
and Today 335

12 Smoking Tobacco 305 13-1 A Brief History of Alcohol

Consumption 335
12-1 Smoking and the Respiratory System 305
CHAPTER

Check Your Health Risks Regarding Alcohol and

Check healtH Risks Regarding Tobacco Use 306 Drug Use 336

Real-World Profile of Famous Former Real-World Profile of Daniel Radcliffe 336

Smokers 306 13-2 The Prevalence of Alcohol Consumption
Functioning of the Respiratory System 306 Today 338
What Components in Smoke Are Dangerous? 309
IN SUMMARY 340
IN SUMMARY 309
13-3 The Effects of Alcohol 340
12-2 A Brief History of Tobacco Use 309
13-4 The Hazards of Alcohol 342
12-3 Choosing to Smoke 310
13-5 The Benefits of Alcohol 344
Who Smokes and Who Does Not? 311
Why Do People Smoke? 313 IN SUMMARY 346
13-6 Why Do People Drink? 347
IN SUMMARY 318
Disease Models 348
12-4 Health Consequences of Tobacco Use 318
Cognitive-Physiological Theories 349
Cigarette Smoking 318
The Social Learning Model 351
Would You BELIEVE...? Smoking is Related to
Mental Illness 320 IN SUMMARY 352

Cigar and Pipe Smoking 321 13-7 Changing Problem Drinking 352
E-cigarettes 321 Change Without Therapy 353
Passive Smoking 322 Treatments Oriented Toward Abstinence 353
Smokeless Tobacco 323 Controlled Drinking 354
The Problem of Relapse 355
IN SUMMARY 323
12-5 Interventions for Reducing IN SUMMARY 355
Smoking Rates 324 13-8 Other Drugs 356
Deterring Smoking 324 Health Effects 356
Quitting Smoking 324 Would You BELIEVE...?
Who Quits and Who Does Not? 326 Brain Damage is Not a Common Risk
Relapse Prevention 327 of Drug Use 357
IN SUMMARY 328 BECOMING HEALTHIER 360

12-6 Effects of Quitting 328 Drug Misuse and Abuse 361

Treatment for Drug Abuse 362
BECOMING HEALTHIER 329
Preventing and Controlling
Quitting and Weight Gain 329 Drug Use 363
Health Benefits of Quitting 331
IN SUMMARY 364
IN SUMMARY 331
Questions 364
Questions 332
Suggested Readings 365
Suggested Readings 333
ix

Cardiovascular Health 404

Check Your Health Risks Early Studies 404
Regarding Eating and Controlling
Later Studies 405
Your Weight 368
Do Women and Men Benefit Equally? 406
Real-World Profile of Danny Cahill 368 Physical Activity and Cholesterol Levels 406
14-2 Factors in Weight Maintenance 370
IN SUMMARY 407
Experimental Starvation 370
15-4 Other Health Benefits
Experimental Overeating 371
of Physical Activity 407
IN SUMMARY 372 Protection Against Cancer 407
14-3 Overeating and Obesity 372 Prevention of Bone Density Loss 408
What is Obesity? 373 Improved Sleep 408
Why are Some People Obese? 375 Control of Diabetes 408
Would You BELIEVE...? You May Need Psychological Benefits of Physical
to Nap Rather Than to Diet 377 Activity 409
How Unhealthy is Obesity? 379 Would You BELIEVE...?
IN SUMMARY 380
It’s Never Too Late—or Too Early 409
14-4 Dieting 382 IN SUMMARY 413

Approaches to Losing Weight 382 Would You BELIEVE...?

Is Dieting a Good Choice? 386 Exercise Can Help You Learn 413
15-5 Hazards of Physical Activity 414
IN SUMMARY 386
Exercise Addiction 414
14-5 Eating Disorders 387
Injuries from Physical Activity 417
Anorexia Nervosa 388
Death During Exercise 418
Bulimia 391
Reducing Exercise Injuries 418
Binge Eating Disorder 393
IN SUMMARY 419
BECOMING HEALTHIER 394
15-6 How Much is Enough but Not Too
IN SUMMARY 396 Much? 419
Questions 396 15-7 Improving Adherence to Physical
Suggested Readings 397 Activity 420

15 Exercising 399 BECOMING HEALTHIER 421

15-1 Types of Physical Activity 399 IN SUMMARY 424

CHAPTER

Check Your Health Risks Regarding Exercise and

Questions 424
Physical Activity 400 Suggested Readings 425
Real-World Profile of Ricky Gervais 400
15-2 Reasons for Exercising 401
Physical Fitness 401
Weight Control 402

16-1 Challenges for Healthier People 427 IN SUMMARY 446

CHAPTER

Real-World Profile of Dwayne and Robyn 428 Questions 447

Increasing the Span of Healthy Life 430 Suggested Readings 447
Reducing Health Disparities 431
Would You BELIEVE...? Health Literacy Can Glossary 448
Improve by “Thinking Outside the Box” 433
References 454
IN SUMMARY 435
16-2 Outlook for Health Psychology 436 Name Index 523
Progress in Health Psychology 436 Subject Index 565
Future Challenges for Health
Care 436
Will Health Psychology Continue to Grow? 441
IN SUMMARY 442

Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Copyright 2022 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
Preface
H
ealth is a far different phenomenon today than What’s New?
it was just a century ago. Most serious diseases
The tenth edition reorganizes several chapters to bet-
and disorders now result from people’s behavior.
ter emphasize the theoretical underpinnings of health
People smoke, eat unhealthily, do not exercise, or cope
behavior. For example, Chapter 4 focuses on adherence
ineffectively with the stresses of modern life. As you will
to healthy behavior and presents both classic and con-
learn in this book, psychology—the science of behav-
temporary theories of health behavior, including recent
ior—is increasingly relevant to understanding phys-
research on the “intention–behavior gap.” Readers of
ical health. Health psychology is the scientific study of
the tenth edition will benefit from the most up-to-date
behaviors relating to health enhancement, disease pre-
review of health behavior theories—and their applica-
vention, safety, and rehabilitation.
tions—on the market. They will also be able to hone in
The first edition of this book, published in the
on key concepts and topics highlighted in the Learning
1980s, was one of the first undergraduate texts to cover
Objectives placed at the beginning of each chapter.
the then-emerging field of health psychology. Now, in
The tenth edition also features new boxes on
this tenth edition, Health Psychology: An Introduction to
important and timely topics such as
Behavior and Health remains a preeminent undergradu-
ate textbook in health psychology. • The Covid-19 Pandemic
• Why is there a controversy about childhood
vaccinations?
The Tenth Edition • Do online social networks influence your health?
• How much of your risk for stroke is due to
This tenth edition retains the core aspects that have behavior? (Answer: nearly all)
kept this book a leader throughout the decades: (1) a • Does drug use cause brain damage?
balance between the science and applications of the • Can sleep deprivation lead to obesity?
field of health psychology and (2) a clear and engaging • Can exercise help you learn?
review of classic and cutting-edge research on behavior
Other new or reorganized topics within the
and health.
chapters include:
The tenth edition of Health Psychology: An Intro-
duction to Behavior and Health has five parts. Part • Several Real-World Profiles, including the
1, which includes the first four chapters, lays a solid COVID-19 pandemic, pain patients, T. R. Reid,
foundation in research and theory for understanding Emilia Clarke, and Nick Jonas.
subsequent chapters and approaches the field by con- • Illustration of the evolving nature of health research
sidering the overarching issues involved in seeking in Chapter 2, through examples of studies on the
medical care and adhering to health care regimens. link between diet and colon cancer.
Part 2 deals with stress, pain, and managing these • New research on the role of stigma in influencing
conditions through conventional and alternative people’s decision to seek medical care, in Chapter 3.
medicine. Part 3 discusses heart disease, cancer, and • The role of optimism and positive mood in coping
other chronic diseases. Part 4 includes chapters on with stress, in Chapter 5.
tobacco use, alcohol, eating and weight, and physi- • Mindfulness as a useful technique for managing
cal activity. Part 5 looks toward future challenges in stress (Chapter 5), managing pain (Chapter 7), and
health psychology and addresses how to apply health as a promising therapy for binge eating disorder
knowledge to one’s life to become healthier. (Chapter 14).

xiii

• Stress and its influence on the length of telomeres, from many opportunities to engage with the material
in Chapter 6. throughout each chapter.
• Marriage as a key factor in predicting survival fol-
lowing cancer diagnosis, in Chapter 10. Check Your Health Risks At the beginning of most
• The use of dignity therapy to address psychosocial chapters, a “Check Your Health Risks” box person-
issues faced by terminal patients, in Chapter 11. alizes material in each chapter. Each box consists of
• The use of smartphone “apps” and fitness trackers several health-related behaviors or attitudes that readers
in promoting physical activity, in Chapter 15. should check before looking at the rest of the chapter.
After checking the items that apply to them and then
becoming familiar with the chapter’s material, readers
What Has Been Retained? will develop a more research-based understanding of
their health risks. A special “Check Your Health Risks”
In this revision, we retained the most popular features
appears inside the front cover of the book. Students
that made this text a leader over the past two dec-
should complete this exercise before they read the
ades. These features include (1) “Real-World Profiles”
book and look for answers as they proceed through the
for each chapter, (2) chapter-opening questions; (3) a
chapters (or check the website for the answers).
“Check Your Health Risks” box in most chapters; (4)
one or more “Would You Believe . . .?” boxes in each Would You Believe . . .? Boxes We keep the popular
chapter; and (5) a “Becoming Healthier” feature in “Would You Believe . . .?” boxes, adding many new ones
many chapters. These features stimulate critical think- and updating those we retained. Each box highlights a
ing, engage readers in the topic, and provide valuable particularly intriguing finding in health research. These
tips to enhance personal well-being. boxes explode preconceived notions, present unusual
findings, and challenge students to take an objective
Real-World Profiles Millions of people—including
look at issues that they may not have evaluated carefully.
celebrities—deal with the issues we describe in this
book. To highlight the human side of health psychology, Becoming Healthier Embedded in most chapters
we open each chapter with a profile of a person in the is a “Becoming Healthier” box with advice on how to
real world. Many of these profiles are of famous peo- use the information in the chapter to enact a healthier
ple, whose health issues may not always be well known. lifestyle. Although some people may not agree with
Their cases provide intriguing examples, such as Barack all these recommendations, each is based on the most
Obama’s attempt to quit smoking, Lance Armstrong’s current research findings. We believe that if you follow
delays in seeking treatment for cancer, Steve Jobs’s fight these guidelines, you will increase your chances of a
with cancer, Halle Berry’s diabetes, Daniel Radcliffe’s long and healthy life.
alcohol abuse, and Ricky Gervais’s efforts to increase
physical activity. We also include a profile of “celebri-
ties” in the world of health psychology, including Dr. Other Changes and Additions
Angela Bryan, Dr. Norman Cousins, and Dr. Rajiv We have made several subtle changes in this edition that
Kumar, to give readers a better sense of the personal we believe make it an even stronger book than its pre-
motivation and activities of those in the health psychol- decessors. More specifically, we
ogy and medical fields. • Replaced old references with more recent ones
Questions and Answers In this text, we adopt a pre- • Reorganized many sections of chapters to improve
view, read, and review method to facilitate student’s the flow of information
learning and recall. Each chapter begins with a series • Added several new tables and figures to aid stu-
of Questions that organize the chapter, preview the dents’ understanding of difficult concepts
material, and enhance active learning. As each chapter • Highlighted the biopsychosocial approach to
unfolds, we reveal the answers through a discussion health psychology, examining issues and data from
of relevant research findings. At the end of each major biological, psychological, and social viewpoints
topic, an In Summary statement recaps the topic. Then, • Drew from the growing body of research from
at the end of the chapter, Answers to the chapter-open- around the world on health to give the book a more
ing questions appear. In this manner, students benefit international perspective

• Recognized and emphasized gender issues when- suggested readings are quite recent, but we also selected
ever appropriate several that have lasting interest. We include only read-
• Retained our emphasis on theories and models ings that are intelligible to the average college student
that strive to explain and predict health-related and that are accessible in most college and university
behaviors libraries.
MindTap® Psychology: We now provide MindTap®
in the tenth edition. MindTap for Health Psychology
Writing Style 10th Edition is the digital learning solution that helps
instructors engage and transform today’s students into
With each edition, we work to improve our connec- critical thinkers. Through paths of dynamic assign-
tion with readers. Although this book explores comments and applications that you can personalize, real-
plex issues and difficult topics, we use clear, concise, time course analytics, and an accessible reader, MindTap
and comprehensible language and an informal, lively helps you turn cookie cutter into cutting edge, apathy
writing style. We write this book for an upper-divi- into engagement, and memorizers into higher-level
sion undergraduate audience, and it should be easily thinkers. As an instructor using MindTap you have at
understood by students with a minimal background in your fingertips the right content and unique set of tools
psychology and biology. Health psychology courses typ- curated specifically for your course all in an interface
ically draw students from a variety of college majors, so designed to improve workflow and save time when
some elementary material in our book may be repeti- planning lessons and course structures. The control to
tive for some students. For other students, this material build and personalize your course is all yours, focusing
will fill in the background they need to comprehend the on the most relevant material while also lowering costs
information within the field of health psychology. for your students. Stay connected and informed in your
Technical terms appear in boldface type, and a course through real-time student tracking that provides
definition usually appears at that point in the text. These the opportunity to adjust the course as needed based on
terms also appear in an end-of-the-book glossary. analytics of interactivity in the course.
Online Instructor’s Manual: We provide an online
instructor’s manual, complete with lecture outlines, dis-
Instructional Aids cussion topics, suggested activities, media tools, and
Besides the glossary at the end of the book, we supply video recommendations.
several other features to help both students and instruc- Online PowerPoints: Microsoft PowerPoint® slides
tors. These include stories of people whose behavior are provided to help you make your lectures more
typifies the topic, frequent summaries within each engaging while effectively reaching your visually ori-
chapter, and annotated suggested readings. ented students. The PowerPoint® slides are updated to
reflect the content and organization of the new edition
of the text.
Within-Chapter Summaries Cengage Learning Testing, powered by Cognero®:
Rather than wait until the end of each chapter to pres- Cengage Learning Testing, Powered by Cognero®, is a
ent a lengthy chapter summary, we place shorter sum- flexible online system that allows you to author, edit,
maries at key points within each chapter. In general, and manage test bank content. You can create multiple
these summaries correspond to each major topic in a test versions in an instant and deliver tests from your
chapter. We believe these shorter, frequent summaries LMS in your classroom.
keep readers on track and promote a better understand-
ing of the chapter’s content.
Acknowledgments
Annotated Suggested Readings We would like to thank the people at Cengage for their
At the end of each chapter are three or four annotated assistance: Laura Ross, Product Director, Cazzie Reyes,
suggested readings that students may wish to examine. Product Team Manager, Jessica Witzcak, Product Assis-
We chose these readings for their capacity to shed addi- tant, and Deanna Ettinger, Intellectual Property Man-
tional light on major topics in a chapter. Most of these ager. Special thanks go to Jacqueline Czel our Content

Manager and to Sangeetha Vijayanand who led us He made contributions that helped to shape the book
through the production at Lumina. and provided generous, patient, live-in, expert com-
We are also indebted to several reviewers who read puter consultation and tech support that proved essen-
all or parts of the manuscript for this and earlier edi- tial in the preparation of the manuscript.
tions. We are grateful for the valuable comments of the Linda also acknowledges the huge debt to Jess Feist
following reviewers: and his contributions to this book. Jess was last able to
work on the sixth edition, and he died in February 2015.
Sangeeta Singg, Angelo State University
His work and words remain as a guide and inspiration
Edward Fernandes, Barton College for her and for John; this book would not have existed
Ryan May, Marietta College without him.
Erin Wood, Catawba College John thanks all his past undergraduate students for
making health psychology such a thrill to teach. This
Linda notes that authors typically thank their book is dedicated to them and to the future generation
spouses for being understanding, supportive, and sacri- of health psychology students.
ficing, and her spouse, Barry Humphus, is no exception.

L
inda Brannon is a pro- interest in personality theory to his authorship of The-
fessor in the Depar t- ories of Personality, coauthored with his son Greg Feist.
ment of Psychology at Linda’s interest in gender and gender issues led her to
McNeese State University in publish Gender: Psychological Perspectives, which is in
Lake Charles, Louisiana. Linda its seventh edition.
joined the faculty at McNeese

J
after receiving her doctorate ohn A. Updegraff is a pro-
in human experimental psy- fessor of social and health
chology from the University of psychology in the Depart-
Texas at Austin. ment of Psychological Sciences
at Kent State University in

J
ess Feist was Professor Kent, Ohio. John received his
Emeritus at McNeese State PhD in social psychology at
University. He joined the University of California, Los
faculty after receiving his doc- Angeles, under the mentorship
torate in counseling from the of pioneering health psycholo-
University of Kansas and stayed gist Shelley Taylor. John then
at McNeese until he retired in completed a postdoctoral fellowship at University of
2005. He died in 2015. California, Irvine, prior to joining the faculty at Kent
In the early 1980s, Linda State.
and Jess became interested in John is an expert in the areas of health behavior,
the developing field of health health communication, stress, and coping, and is the
psychology, which led to their coauthoring the first edi- recipient of multiple research grants from the National
tion of this book. They watched the field of health psy- Institutes of Health. His research appears in the field’s
chology emerge and grow, and the subsequent editions top journals.
of the book reflect that growth and development. John stays healthy by running the roads and trails
Their interests converge in health psychology but near his home. John is also known for subjecting stu-
diverge in other areas of psychology. Jess carried his dents and colleagues to his singing and guitar playing
(go ahead, look him up on YouTube).

xvii

LEARNING OBJECTIVES
After studying this chapter, you will be able to…

1-1 Recognize how the major causes of 1-4 Trace the expanding role of psychology
death have changed over the last in understanding physical health, from
century its roots in psychosomatic medicine and
behavioral medicine to its current role in
1-2 Understand how factors such as age, the field of health psychology
ethnicity, and income relate now to the
risk of disease and death 1-5 Familiarize yourself with the profession
of health psychology, including how
1-3 Contrast the biomedical model with the health psychologists are trained and the
biopsychosocial model of health varied types of work that they do

●● Psychology’s Relevance for

Health
●● The Profession of Health 1-1 The Changing Field of
Psychology Health
QUESTIONS LEARNING OBJECTIVES
This chapter focuses on three basic
1-1 Recognize how the major causes of death have
changed over the last century
questions:
1. How have views of health 1-2 Understand how factors such as age, ethnicity, and
income relate now to the risk of disease and death
changed?
2. How did psychology become 1-3 Contrast the biomedical model with the biopsy-
chosocial model of health
involved in health care?

“W
3. What type of training do health e are now living well enough and long enough
psychologists receive, and what to slowly fall apart” (Sapolsky, 1998, p. 2).
kinds of work do they do? The field of health psychology developed
relatively recently—the 1970s, to be exact—to address the chal-
lenges presented by the changing field of health and health care.
A century ago, the average life expectancy in the United States
was approximately 50 years of age, far shorter than it is now.
When people in the United States died, they died largely from
infectious diseases such as pneumonia, tuberculosis, diarrhea,
and enteritis (see Figure 1.1). These conditions resulted from
contact with impure drinking water, contaminated foods, or
sick people. People might seek medical care only after they
became ill, but medicine had few cures to offer. The duration
of most diseases—such as typhoid fever, pneumonia, and diph-
theria—was short; a person either died or got well in a matter of
weeks. People felt limited responsibility for contracting a conta-
gious disease because such a disease was not controllable.
Life and death are now dramatically different than they
were a century ago. Life expectancy in the United States is
nearly 80 years of age, with more Americans now than ever liv-
ing past their 100th birthday. Over 30 countries boast even lon-
ger life expectancies than the United States, with Japan boasting
the longest at 84 years of age. Public sanitation for most citizens

Real-World Profile of COVID-19 Pandemic

This is an image of a SARS-CoV-2 virus. It is tiny, only 100 nanometers in diameter.

Alissa Eckert, MS; Dan Higgins, MAMS/CDC

(Centers for Disease Control and Prevention)
It would take 1,000 of these, lined up side to side, to make a speck that could be
seen by even the sharpest of human eyes.
Yet this virus was the cause of the global COVID-19 pandemic, an unprece-
dented public health crisis. In the first year of its emergence, COVID-19 resulted
in over nearly 2 million deaths, economic collapses, school and business clo-
sures, unemployment, and a fundamental shift in how humans interact with one
another. How could a virus so small have such a devastating impact?
The SARS-CoV-2 virus cannot reproduce on its own; it requires a host, such
as a human, to spread. As such, the SARS-CoV-2 virus is a biological disease-
causing agent, but its spread is due to human behavior. It is passed from person to person mainly through
close, interpersonal contact with an infected person. People’s behavior, in turn, is shaped by psychological,
social, and cultural factors, including their beliefs about risk and severity of infection, adherence to preven-
tive measures, their perceptions of what others around them do, and the cultural environment in which they
live. For example, some countries such as Singapore, Taiwan, and South Korea endorsed immediate and strict
social policies to contain the potential spread of the virus. Other countries such as Sweden did not, at least
immediately. Even within countries such as the United States, people’s behaviors varied widely from state to
state, as did the infection rates between communities.
Among those infected by SARS-CoV-2, the potential for severe illness or death also depends on factors
influenced by behavior. Older adults are at greatest risk, as well as people with underlying chronic conditions
such as diabetes, cancer, chronic obstructive pulmonary disease, and obesity. As you will learn in this book, the
development and management of these medical conditions are influenced, to some degree, by people’s past
and current behavior. The immune system’s ability to fight off an infection, too, can be diminished due to stress,
sleep loss, depression, and loneliness; rates of such experiences and conditions increased during the COVID-19
pandemic. Some ethnic groups were at greater risk of illness than others, with these disparities due likely to a
combination of environmental, economic, behavioral, and social factors.
When vaccines and cures are available for COVID-19, behavior remains important. People will need to choose
to obtain vaccinations or adhere to treatments. These behaviors, again, are shaped by psychological, social, and
cultural factors, including beliefs about effectiveness or support from health care providers and family.
The COVID-19 pandemic, like many other health issues we will review in this book, is more than simply a
matter of biology, but a matter of behavior as well. For this reason, the field of health psychology emerged and has
adopted a biopsychosocial model of health, which we introduce in this chapter. The biopsychosocial model
accounts for the complex ways that biology, behavior, beliefs, emotions, the social environment, and culture all
interact to either increase our risk of illness or help us remain healthy. The rest of this book will cover many issues
that are relevant to the COVID-19 pandemic, including how research contributes to our knowledge of behavioral
factors in health (Chapter 2), when and why people seek medical care (Chapter 3), why people do not always
engage in healthy behaviors (Chapter 4), stress and its role in disease (Chapters 5 and 6), and how behavior relates
to health and chronic illness (Chapters 9 through 15). As you read the pages ahead, you will see many examples of
the central premise of health psychology: While illness is based in biology, our behavior matters.

Leading causes of death, 1900

Pneumonia 11.8%

Tuberculosis 11.3%
Diarrhea and
8.3%
enteritis
Heart disease 6.2%

Liver disease 5.2%

Injuries 4.2%

Cancer 3.7%

Senility 2.9%

Diphtheria 2.3%

0 5 10 15 20 25 30 35 40 45
1900 Percentage of deaths

Leading causes of death, 2017

Heart disease 23%

Cancer 21.3%
Unintentional
injuries 6.0%
Chronic lower
5.7%
respiratory disease
Stroke 5.2%
Alzheimer’s
disease 4.3%

Diabetes mellitus 3.0%

Influenza and
2.0%
pneumonia
Kidney disease 1.8%

Suicide 1.7%

0 5 10 15 20 25 30 35 40 45
2017 Percentage of deaths

FIGURE 1.1 Leading causes of death, United States, 1900 and 2013.
Source: Healthy people, 2010, 2000, by U.S. Department of Health and Human Services, Washington, DC: U.S. Government
Printing Office; “Deaths: Final Data for 2017,” 2019, by Heron, M., National Vital Statistics Reports, 68(6), Table C.

of industrialized nations is vastly better than it was a cen- United States and account for a greater proportion of
tury ago. Vaccines and treatments exist for many infec- deaths than infectious diseases ever did. Chronic diseases
tious diseases. However, improvements in the prevention develop and then persist or recur, affecting people over
and treatment of infectious diseases allowed for a differ- long periods of time. Every year, over 2 million people in
ent class of disease to emerge as today’s killers: chronic the United States die from chronic diseases, but over 130
diseases. Heart disease, cancer, and stroke—all chronic million people—almost one out of every two adults—live
diseases—are now the leading causes of mortality in the with at least one chronic disease.

Furthermore, most deaths today are attributable kidney disease, septicemia (blood infection), liver dis-
to diseases associated with lifestyle and behavior. Heart ease, hypertension, and Parkinson’s disease. For many
disease, cancer, stroke, chronic lower respiratory dis- of these recently increasing causes, behavior is a less
eases (including emphysema and chronic bronchitis), important component than for those causes that have
unintentional injuries, and diabetes are all due in part decreased. However, the rising death rates due to Alzhei-
to cigarette smoking, alcohol abuse, unhealthy eating, mer’s and Parkinson’s reflect another important trend in
stress, and a sedentary lifestyle. Because today’s major health and health care: an increasingly older population.
killers arise in part due to lifestyle and behavior, peo-
ple have a great deal more control over their health than Age Obviously, older people are more likely to die than
they did in the past. However, many people do not exer- younger ones, but the causes of death vary among age
cise this control, so unhealthy behavior is an important groups. Thus, the ranking of causes of death for the entire
public health problem. Indeed, unhealthy behavior con- population may not reflect any specific age group and
tributes to the escalating costs of health care. may lead people to misperceive the risk for some ages. For
In this chapter, we describe the changing patterns of example, cardiovascular disease (which includes heart
disease and disability and the increasing costs of health disease and stroke) and cancer account for over 50% of
care. We also discuss how these trends change the very all deaths in the United States, but they are not the leading
definition of health and require a broader view of health cause of death for young people. For individuals between
than in the past. This broad view of health is the biopsy- 1 and 24 years of age, unintentional injuries are the lead-
chosocial model, a view adopted by health psychologists. ing cause of death, and violent deaths from suicide and
homicide rank high on the list as well (National Center
for Health Statistics [NCHS], 2018). Taken together,
Patterns of Disease and Death injuries, suicides, and homicide account for over half of
The 20th century brought about major changes in the deaths during these younger years. As Figure 1.2 reveals,
patterns of disease and death in the United States, includ- other causes of death account for much smaller percent-
ing a shift in the leading causes of death. Infectious dis- ages of deaths among adolescents and young adults than
eases were the leading causes of death in 1900, but over unintentional injuries, homicide, and suicide.
the next several decades, chronic diseases—such as heart For adults 45 and older, the picture is quite dif-
disease, cancer, and stroke—became the leading killers. ferent. Cardiovascular disease and cancer become the
Only with the COVID-19 pandemic beginning in 2020 leading causes of death, accounting for nearly half of
has an infectious disease been a leading cause of death deaths. As people age, they become more likely to die,
in this century. In 2020, COVID-19 was the third most so the causes of death for older people dominate the
common cause of death in the United States, after heart overall figures. However, younger people show very dif-
disease and cancer. When the COVID-19 pandemic sub- ferent patterns of mortality.
sides, chronic diseases will remain as the leading causes
of mortality in the United States. Ethnicity, Income, and Disease Question 2 from the
During the first few years of the 21st century, deaths quiz inside the front cover asks if the United States is
from some chronic diseases—those related to unhealthy among the top 10 nations in the world in terms of life
lifestyles and behaviors—began to decrease. These include expectancy. It is not even close. It ranks 34th among all
heart disease, cancer, and stroke, which all were respon- nations (World Health Organization [WHO], 2018c).
sible for a smaller proportion of deaths in 2010 than in Within the United States, ethnicity is also a factor in life
1990. Why have deaths from these diseases decreased in expectancy, and the leading causes of death also vary
the last few decades? We will discuss this in greater detail among ethnic groups. Table 1.1 shows the ranking of
in Chapter 9, but one major reason is that fewer people the leading causes of death for four ethnic groups in the
in the United States now smoke cigarettes than in the United States. No two groups have identical profiles of
past. This change in behavior contributed to some of the causes, and some causes do not appear on the list for
decline in deaths due to heart disease; improvements in each group, highlighting the influence of ethnicity on
health care also contributed to this decline. mortality.
Death rates due to unintentional injuries, suicide, If African Americans and European Americans
and homicide have increased in recent years. Signif- in the United States were considered to be different
icant increases also occurred in Alzheimer’s disease, nations, European America would rank higher in life

25.1%
Ages 65 and over 20.7%
2.7%

20.8% Unintentional
28.4% injury (accident)
45–64 years old
3.1% Suicide
8.8% Homicide

10.1% Cancer
10.4%
Heart disease
25–44 years old 6.3%
10.9%
34.6%

2.9%
5.1%
10–24 years old 14.4%
19.2%
40.6%

0 5 10 15 20 25 30 35 40 45 50
Percentage of deaths

FIGURE 1.2 Leading causes of death among individuals aged 10–24, 25–44,
45–64, and 65+, United States, 2017.
Source: “Deaths: Final Data for 2017,” 2019, by Heron, M., National Vital Statistics Reports, 68(6), Figure 2.

TABLE 1.1 Leading Causes of Death for Four Ethnic Groups in the United States, 2017

European Hispanic African Asian

Americans Americans Americans Americans
Heart disease 1 2 1 2
Cancer 2 1 2 1
Chronic lower respiratory disease 3 8 6 8
Unintentional injuries 4 3 3 4
Stroke 5 4 4 3
Alzheimer’s disease 6 6 9 6
Diabetes 7 5 5 5
Pneumonia & influenza 8 11 12 7
Suicide 9 9 16 11
Kidney disease 10 10 8 9
Chronic liver disease 11 7 14 14
Septicemia 12 13 10 12
Hypertension 14 14 11 10
Homicide 20 12 7 18
Source: “Deaths: Leading Causes for 2017,” 2019, by M. Heron, National Vital Statistics Reports, 68(6), Table D.

expectancy than African America—38th place and 80th The association between income level and health
place, respectively (NCHS, 2021; WHO, 2018c). Thus, is so strong that it appears not only at the poverty level
European Americans have a longer life expectancy than but also at higher income levels. That is, very wealthy
African Americans, but neither should expect to live as people have better health than people who are just,
long as people in Japan, Canada, Iceland, Australia, the well, wealthy. Why should very wealthy people be
United Kingdom, Italy, France, Hong Kong, Israel, and healthier than other wealthy people? One possibil-
many other countries. ity comes from the relation of income to educational
Hispanics have socioeconomic disadvantages level, which, in turn, relates to occupation, social class,
like those of African Americans (U.S. Census Bureau and ethnicity. The higher the educational level, the less
[USCB], 2011), including poverty and low educational likely people are to engage in unhealthy behaviors such
level. About 10% of European Americans live below the as smoking, eating high-fat foods, and maintaining a
poverty level, whereas 32% of African Americans and sedentary lifestyle (see Would You Believe . . .? box).
26% of Hispanic Americans do (USCB, 2011). Euro- Another possibility is the perception of social status.
pean Americans also have educational advantages: 86% People’s perception of their social standing may differ
receive high school diplomas, compared with only 81% from their status as indexed by educational, occupa-
of African Americans and 59% of Hispanic Ameri- tional, and income level; remarkably, this perception
cans. These socioeconomic disadvantages translate into relates to health status more strongly than objective
health disadvantages (Crimmins et al., 2007; Smith & measures (Operario, Adler, & Williams, 2004). Thus,
Bradshaw, 2006). That is, poverty and low educational the relationships between health and ethnicity are
level both relate to health problems and lower life intertwined with the relationships between health,
expectancies. Thus, some of the ethnic differences in income, education, and social class.
health are due to socioeconomic differences.
Access to health insurance and medical care is not Changes in Life Expectancy During the 20th century,
the only factor that makes poverty a health risk. Indeed, life expectancy rose dramatically in the United States
the health risks associated with poverty begin before birth. and other industrialized nations. In 1900, life expec-
Even with the expansion of prenatal care by Medicaid, tancy was 47.3 years, whereas today it is almost 78 years
poor mothers, especially teen mothers, are more likely to (NCHS, 2021). In other words, infants born today can
deliver low-birth-weight babies, who are more likely than expect, on average, to live more than a generation longer
normal-birth-weight infants to die (NCHS, 2021). Also, than their great-great-grandparents born at the begin-
pregnant women living below the poverty line are more ning of the 20th century.
likely than other pregnant women to be physically abused What accounts for the 30-year increase in life expec-
and to deliver babies who suffer the consequences of pre- tancy during the 20th century? Question 3 from the quiz
natal child abuse (Zelenko et al., 2000). inside the front cover asks if advances in medical care

Would You
College Is Good for Your Health
BELIEVE...?
Would you believe that attend- have been to college have lower death to college offers much more protec-
ing college could be good for your rates than those who have not. This tion. For example, people with less
health? You may find that difficult advantage applies to both women and than a high school education die at
to believe, as college seems to add men and to infectious diseases, chronic a rate of 575 per 100,000; those with
stress, exposure to alcohol or drugs, diseases, and unintentional injuries a high school degree die at a rate
and demands that make it difficult to (NCHS, 2015). Better-educated people of 509 per 100,000; but people who
maintain a healthy diet, exercise, and report fewer daily symptoms and less attend college have a death rate of
sleep. How could going to college stress than less educated people (Grzy- only 214 per 100,000 (Miniño et al.,
possibly be healthy? wacz et al., 2004). 2011). The benefits of education for
The health benefits of college Even a high school education health and longevity apply to peo-
appear after graduation. People who provides health benefits; but going ple around the world. For example,

a study of older people in Japan with similar education, providing good health and long life. For exam-
(Fujino et al., 2005) found that low an environment with good health- ple, people with a college education
educational level increased the risk related knowledge and attitudes are less likely than others to smoke
of dying. A large-scale study of the (Øystein, 2008). Income and occu- or use illicit drugs (Johnston et al.,
Dutch population (Hoeymans, van pation may also contribute (Batty 2007), and they are more likely to eat
Lindert, & Westert, 2005) also found et al., 2008); people who attend col- a low-fat diet and to exercise.
that education was related to a lege, especially those who graduate, Thus, people who attend col-
wide range of health measures and have better jobs and higher average lege acquire many resources that are
health-related behaviors. incomes than those who do not and reflected in their lower death rate—
What factors contribute to this thus are more likely to have better income potential, health knowledge,
health advantage for people with access to health care. In addition, more health-conscious spouses and
more education? Part of that advan- educated people are more likely to friends, attitudes about the impor-
tage may be intelligence, which be informed consumers of health tance of health, and positive health
predicts both health and longevity care, gathering information on their habits. This strong link between edu-
(Gottfredson & Deary, 2004). In addi- diseases and potential treatments. cation and health is one clear exam-
tion, people who are well educated Education is also associated with a ple of how good health is more than
tend to live with and around people variety of habits that contribute to simply a matter of biology.

were responsible for this increase. The answer is “False”; birthday, these deaths lower the population’s average life
other factors have been more important than medical expectancy much more than do the deaths of middle-
care of sick people. The single most important contrib- aged or older people. As Figure 1.3 shows, infant death
utor to the increase in life expectancy is the lowering rates declined dramatically between 1900 and 1990, but
of infant mortality. When infants die before their first little decrease has occurred since that time.

170
160 162
150
140
Infant mortality (deaths per 1000)

130 132
120
110
100
90 92
80
70 69
60
55
50
40 33
30 26
20
20 12.6 9.2
10 6.9 6.15 5.79
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2017

Year

FIGURE 1.3 Decline in infant mortality in the United States, 1900–2013.

Source: Data from Historical statistics of the United States: Colonial times to 1970, 1975 by U.S. Bureau of the Census,
Washington, DC: U.S. Government Printing Office, p. 60; “Deaths: Final Data for 2013,” 2016, by Xu, J., Murphy, S. L.,
Kochanek, K. D., & Bastian, B. A., National Vital Statistics Reports, 64(2), Table B; “Recent Declines in Infant Mortality in
the United States, 2005–2011,” National Center for Health Statistics, Number 120, 2013.

The prevention of disease also contributes to the condition, and they account for 86% of the dollars spent
recent increase in life expectancy. Widespread vaccination on health care (Gerteis et al., 2014). People with chronic
and safer drinking water and milk supplies all reduce infec- conditions account for 88% of prescriptions written,
tious disease, which increases life expectancy. A healthier 72% of physician visits, and 76% of hospital stays. Even
lifestyle also contributes to increased life expectancy, as though today’s aging population is experiencing better
does more efficient disposal of sewage and better nutrition. health than past generations, their increasing numbers
In contrast, advances in medical care—such as antibiotics will continue to increase medical costs.
and new surgical technology, efficient paramedic teams, One strategy for curbing mounting medical costs is
and more skilled intensive care personnel—play a surpris- to limit services, but another approach requires a greater
ingly minor role in increasing adults’ life expectancy. emphasis on the early detection of disease, changes to a
healthier lifestyle, and behaviors that help prevent disease.
For example, early detection of high blood pressure, high
Escalating Cost of Medical Care serum cholesterol, and other precursors of heart disease
The second major change within the field of health is allow these conditions to be controlled, thereby decreas-
the escalating cost of medical care. In the United States, ing the risk of serious disease or death. Screening peo-
medical costs have increased at a much faster rate than ple for risks is preferable to remedial treatment because
inflation, and currently the United States spends the most chronic diseases are quite difficult to cure and living with
of all countries on health care. Between 1960 and 2008, chronic disease decreases quality of life. Avoiding disease
medical costs in the United States represented an increas- by adopting a healthy lifestyle is even more preferable to
ingly larger proportion of the gross domestic product treating diseases or screening for risks. Staying healthy is
(GDP). Since 1995, the increases have slowed, but med- typically less costly than becoming sick and then getting
ical care costs as a percentage of the GDP are over 16% well. Thus, preventing diseases through a healthy lifestyle,
(Organisation for Economic Co-operation and Develop- detecting symptoms early, and reducing health risks are
ment [OECD], 2019). Considered on a per person basis, all part of a changing philosophy within the health care
the total yearly cost of health care in the United States field. As you will learn in this book, health psychologists
increased from $1,067 per person in 1970 to $9,105 in contribute to each of these aims.
2017 (NCHS, 2019), which is a jump of more than 850%!
These costs, of course, have some relationship to
increased life expectancy: As people live to middle and What is Health?
old age, they tend to develop chronic diseases that require “Once again, the patient as a human being with worries,
extended (and often expensive) medical treatment. fears, hopes, and despairs, as an indivisible whole and
Nearly half of people in the United States have a chronic not merely the bearer of organs—of a diseased liver or
kali9/E+/Getty Images

Technology in medicine is one reason for escalating medical costs.

stomach—is becoming the legitimate object of medical biopsychosocial model has at least two advantages over
interest,” says Franz Alexander (1950, p. 17), one of the the older biomedical model. First, it incorporates not
founders of the field of psychosomatic medicine. only biological conditions but also psychological and
What does it mean to be “healthy”? Question 1 from social factors. Second, it views health as a positive con-
the quiz at the beginning of the book asks if health is dition. The biopsychosocial model can also account for
merely the absence of disease. But is health more complex? some surprising findings about who gets sick and who
Is health the presence of some positive condition rather stays healthy (see the Would You Believe . . .? box). Thus,
than merely the absence of a negative one? Is health simply the biopsychosocial model has not only all the power of
a state of the physical body, or should health also consider the older biomedical model but also the ability to address
one’s beliefs, environment, and behaviors as well? problems that the biomedical model has failed to solve.
The biomedical model, which defines health as the According to the biopsychosocial view, health is
absence of disease, has been the traditional view of West- much more than the absence of disease. A person who
ern medicine (Papas, Belar, & Rozensky, 2004). This view has no disease condition is not sick; but this person may
conceptualizes disease solely as a biological process that not be healthy either. A person may have unhealthy
is a result of exposure to a specific pathogen, a disease- lifestyle habits or poor social support, cope poorly with
causing organism. This view spurred the development of high amounts of stress, or avoid medical care when it is
drugs and medical technology oriented toward removing warranted; all of these factors increase the risk of future
the pathogens and curing disease. The focus is on dis- disease. Because health is multidimensional, all aspects
ease, which is traceable to a specific agent. Removing the of living—biological, psychological, and social—must
pathogen restores health. be considered. This view diverges from the traditional
The biomedical model of disease is compatible with Western conceptualization, but as Table 1.2 shows,
infectious diseases that were the leading causes of death other cultures have held different views.
100 years ago. Throughout the 20th century, adherence Consistent with this broader view, the World Health
to the biomedical model allowed medicine to conquer or Organization (WHO) wrote into the preamble of its con-
control many of the diseases that once ravaged humanity. stitution a modern, Western definition: “Health is a state
However, when chronic illnesses began to replace infec- of complete physical, mental, and social well-being, and
tious diseases as the leading causes of death, the biomedi- not merely the absence of disease or infirmity.” This defi-
cal model became insufficient (Stone, 1987). nition clearly affirms that health is a positive state and
An alternative model of health exists now, one that not just the absence of pathogens. Feeling good is differ-
advocates a more comprehensive approach to medicine. ent from not feeling bad, and research in neuroscience
This alternative model is the biopsychosocial model, has confirmed the difference (Zautra, 2003). The human
which includes biological, psychological, and social brain responds in distinctly different patterns to positive
influences. This model holds that many diseases result feelings and negative feelings. Furthermore, this broader
from a combination of factors such as genetics, physiol- definition of health can account for the importance of
ogy, social support, personal control, stress, compliance, preventive behavior in physical health. For example, a
personality, poverty, ethnic background, and cultural healthy person is not merely somebody without a disease
beliefs. We discuss each of these factors in subsequent or a disability but also somebody who behaves in a way
chapters. For now, it is important to recognize that the that is likely to maintain that state in the future.

Would You
It Takes More Than a Virus to Give You a Cold
BELIEVE...?
One of the dirtiest jobs that an aspir- search of used, mucous-filled tissues. to rummage for snot—they want an
ing health psychologist could have When such tissues are found, the objective measure of how severely
is as a research assistant in Sheldon assistants unfold them, locate the their participants caught the com-
Cohen’s laboratory at Carnegie Mel- gooey treasures within, and pains- mon cold.
lon University. Cohen’s assistants sift takingly weigh their discoveries. Sheldon Cohen and his research
through study participants’ trash in These assistants have good reason team investigate the psychological

and social factors that predict the to predict who gets the cold and who experiences (Cohen, Tyrrell, & Smith,
likelihood that a person will suc- remains healthy. 1991), have better sleep habits (Cohen
cumb to infection. Healthy partic- Cohen’s findings expose the inad- et al., 2009), typically experience more
ipants in Cohen’s studies receive a equacy of the biomedical approach to positive emotion (Cohen et al., 2006),
virus through a nasal squirt and are understanding infection. Even though are more sociable (Cohen et al., 2003),
then quarantined in a “cold research everybody in his studies gets exposed and have more diverse social net-
laboratory”—actually, a hotel room— to the same pathogen in exactly the works (Cohen et al., 1997).
for one week. Participants also answer same manner, only some participants Thus, it takes more than just
several questionnaires about psy- get sick. Importantly, the people who exposure to a virus to succumb to
chological and social factors such resist infection share similar psycho- a cold or flu bug; exposure to the
as recent stress, typical positive and logical and social characteristics. Com- pathogen interacts with psycholog-
negative emotions, and the size and pared with people who get sick, those ical and social factors to produce ill-
quality of their social networks. Cohen who remain healthy are less likely ness. Only the biopsychosocial model
and his team use these questionnaires to have dealt with recent stressful can account for these influences.

TABLE 1.2 Definitions of Health Held by Various Cultures

Culture Time Period Health Is . . .

Prehistoric 10,000 bce Endangered by spirits that enter the body from outside
Babylonians and Assyrians 1800–700 bce Endangered by the gods, who send disease as a
punishment
Ancient Hebrews 1000–300 bce A gift from God; disease is a punishment from God
Ancient Greeks 500 bce A holistic unity of body and spirit
Ancient China Between 800 and A state of physical and spiritual harmony with nature
200 bce
Native Americans 1000 bce–present Total harmony with nature and the ability to survive under
difficult conditions
Galen in ancient Rome 130–200 ce The absence of pathogens, such as bad air or body fluids,
that cause disease
Early Christians 300–600 ce Not as important as disease, which is a sign that one is
chosen by God
Descartes in France 1596–1650 A condition of the mechanical body, which is separate from
the mind
Western Africans 1600–1800 Harmony achieved through interactions with other people
and objects in the world
Virchow in Germany Late 1800s Endangered by microscopic organisms that invade cells,
producing disease
Freud in Austria Late 1800s Influenced by emotions and the mind
World Health Organization 1946 “A state of complete physical, mental, and social
well-being”

diseases as the leading causes of death and disability.

IN SUMMARY These chronic diseases include heart disease, stroke,
In the past century, four major trends changed the field cancer, emphysema, and adult-onset diabetes, all of
of health care. One trend is the changing pattern of dis- which have causes that include individual behavior.
ease and death in industrialized nations, including the The increase in chronic disease contributed to
United States. Chronic diseases now replace infectious a second trend: the escalating cost of medical care.

Cleo. Yet you know an instance of this in two grave divines, men of fame
and great merit, of whom each would think himself very much injured,
should his virtue be called in question.

Hor. When men have an opportunity, under pretence of zeal for religion, or
the public good, to vent their passion, they take great liberties. What was
the quarrel?

Cleo. De lana caprina.

Hor. A trifle. I cannot guess yet.

Cleo. About the metre of the comic poets among the ancients.

Hor. I know what you mean now; the manner of scanding and chanting
those verses.

Cleo. Can you think of any thing belonging to literature, of less importance,
or more useless?

Hor. Not readily.

Cleo. Yet the great contest between them, you see, is which of them
understands it best, and has known it the longest. This instance, I think,
hints to us how highly improbable it is, though men should act from no
better principles than envy, avarice, and ambition, that when learning is
once established, any part of it, even the most unprofitable, should ever be
neglected in such a large opulent nation as ours is; where there are so many
places of honour, and great revenues to be disposed of among scholars.

Hor. But since men are fit to serve in most places with so little capacity, as
you insinuate, why should they give themselves that unnecessary trouble of
studying hard, and acquiring more learning than there is occasion for?
Cleo. I thought I had answered that already; a great many, because they take
delight in study and knowledge.

Hor. But there are men that labour at it with so much application, as to
impair their healths, and actually to kill themselves with the fatigue of it.

Cleo. Not so many as there are that injure their healths, and actually kill
themselves with hard drinking, which is the most unreasonable pleasure of
the two, and a much greater fatigue. But I do not deny that there are men
who take pains to qualify themselves in order to serve their country; what I
insist upon is, that the number of those who do the same thing to serve
themselves with little regard to their country, is infinitely greater. Mr.
Hutcheson, who wrote the Inquiry into the Original of our Ideas of Beauty
and Virtue, seems to be very expert at weighing and measuring the
quantities of affection, benevolence, &c. I wish that curious metaphysician
would give himself the trouble, at his leisure, to weigh two things
separately: First, the real love men have for their country, abstracted from
selfishness. Secondly, the ambition they have of being thought to act from
that love, though they feel none. I wish, I say, that this ingenious gentleman
would once weigh these two asunder; and afterwards, having taken in
impartially all he could find of either, in this or any other nation, show us in
his demonstrative way, what proportion the quantities bore to each other.—
Quisque sibi commissus est, says Seneca; and certainly, it is not the care of
others, but the care of itself, which nature has trusted and charged every
individual creature with. When men exert themselves in an extraordinary
manner, they generally do it to be the better for it themselves; to excel, to be
talked of, and to be preferred to others, that follow the same business, or
court the same favours.

Hor. Do you think it more probable, that men of parts and learning should
be preferred, than others of less capacity?

Cleo. Cæteris paribus, I do.

Hor. Then you must allow that there is virtue at least in those who have the
disposal of places.
Cleo. I do not say there is not; but there is likewise glory and real honour
accruing to patrons for advancing men of merit; and if a person who has a
good living in his gift, bestows it upon a very able man, every body
applauds him, and every parishioner is counted to be particularly obliged to
him. A vain man does not love to have his choice disapproved of, and
exclaimed against by all the world, any more than a virtuous man; and the
love of applause, which is innate to our species, would alone be sufficient to
make the generality of men, and even the greatest part of the most vicious,
always choose the most worthy, out of any number of candidates; if they
knew the truth, and no stronger motive arising from consanguinity,
friendship, interest, or something else, was to interfere with the principle I
named.

Hor. But, methinks, according to your system, those should be soonest

preferred that can best coax and flatter.

Cleo. Among the learned there are persons of art and address, that can mind
their studies without neglecting the the world: these are the men that know
how to ingratiate themselves with persons of quality; employing to the best
advantage all their parts and industry for that purpose. Do but look into the
lives and the deportment of such eminent men, as we have been speaking
of, and you will soon discover the end and advantages they seem to propose
to themselves from their hard study and severe lucubrations. When you see
men in holy orders, without call or necessity, hovering about the courts of
princes; when you see them continually addressing and scraping
acquaintance with the favourites; when you hear them exclaim against the
luxury of the age, and complain of the necessity they are under of
complying with it; and at the same time you see, that they are forward, nay
eager and take pains with satisfaction, in the way of living, to imitate the
beau monde, as far as it is in their power: that no sooner they are in
possession of one preferment, but they are ready, and actually soliciting for
another, more gainful and more reputable; and that on all emergencies,
wealth, power, honour and superiority are the things they grasp at, and take
delight in; when, I say, you see these things, this concurrence of evidences,
is it any longer difficult to guess at, or rather is there room to doubt of the
principles they act from, or the tendency of their labours?
Hor. I have little to say to priests, and do not look for virtue from that
quarter.

Cleo. Yet you will find as much of it among divines, as you will among any
other class of men; but every where less in reality, than there is in
appearance. Nobody would be thought insincere, or to prevaricate; but there
are few men, though they are so honest as to own what they would have,
that will acquaint us with the true reason why they would have it: therefore
the disagreement between the words and actions of men is at no time more
conspicuous, than when we would learn from them their sentiments,
concerning the real worth of things. Virtue, is without doubt, the most
valuable treasure which man can be possessed of; it has every body’s good
word; but where is the country in which it is heartily embraced, præmia si
tollas? Money, on the other hand, is deservedly called the root of all evil:
there has not been a moralist nor a satirist of note, that has not had a fling at
it; yet what pains are taken, and what hazards are run to acquire it, under
various pretences of designing to do good with it! As for my part, I verily
believe, that as an accessary cause, it has done more mischief in the world
than any one thing besides: yet it is impossible to name another, that is so
absolutely necessary to the order, economy, and the very existence of the
civil society; for as this is entirely built upon the variety of our wants, so the
whole superstructure is made up of the reciprocal services which men do to
each other. How to get these services performed by others, when we have
occasion for them, is the grand and almost constant solicitude in life of
every individual person. To expect that others should serve us for nothing,
is unreasonable; therefore all commerce that men can have together, must
be a continual bartering of one thing for another. The feller who transfers
the property of a thing, has his own interest as much at heart as the buyer
who purchases that property: and, if you want or like a thing, the owner of
it, whatever stock or provision he may have of the same, or how greatly
soever you may stand in need of it, will never part with it, but for a
consideration which he likes better than he does the thing you want. Which
way shall I persuade a man to serve me, when the service I can repay him
in, is such as he does not want or care for? Nobody who is at peace, and has
no contention with any of the society, will do any thing for a lawyer; and a
physician can purchase nothing of a man, whose whole family is in perfect
health. Money obviates and takes away all those difficulties, by being an
acceptable reward for all the services men can do to one another.

Hor. But all men valuing themselves above their worth, every body will
over-rate his labour. Would not this follow from your system?

Cleo. It certainly would, and does. But what is to be admired is, that the
larger the numbers are in a society, the more extensive they have rendered
the variety of their desires, and the more operose the gratification of them is
become among them by custom; the less mischievous is the consequence of
that evil, where they have the use of money: whereas, without it, the smaller
the number was of a society, and the more strictly the members of it, in
supplying their wants, would confine themselves to those only that were
necessary for their subsistence, the more easy it would be for them to agree
about the reciprocal services I spoke of. But to procure all the comforts of
life, and what is called temporal happiness, in a large polite nation, would
be every whit as practicable without speech, as it would be without money,
or an equivalent to be used instead of it. Where this is not wanting, and due
care is taken of it by the legislature, it will always be the standard, which
the worth of every thing will be weighed by. There are great blessings that
arise from necessity; and that every body is obliged to eat and drink, is the
cement of civil society. Let men set what high value they please upon
themselves, that labour which most people are capable of doing, will ever
be the cheapest. Nothing can be dear of which there is great plenty, how
beneficial soever it may be to man; and scarcity enhances the price of things
much oftener than the usefulness of them. Hence it is evident why those arts
and sciences will always be the most lucrative, that cannot be attained to,
but in great length of time, by tedious study and close application; or else
require a particular genius, not often to be met with. It is likewise evident,
to whose lot, in all societies, the hard and dirty labour, which nobody would
meddle with, if he could help it, will ever fall: but you have seen enough of
this in the Fable of the Bees.

Hor. I have so, and one remarkable saying I have read there on this subject,
which I shall never forget. “The poor,” says the author, “have nothing to stir
them up to labour, but their wants, which it is wisdom to relieve, but folly to
cure.”

Cleo. I believe the maxim to be just, and that it is not less calculated for the
real advantage of the poor, than it appears to be for the benefit of the rich.
For, among the labouring people, those will ever be the least wretched as to
themselves, as well as most useful to the public, that being meanly born and
bred, submit to the station they are in with cheerfulness; and contented, that
their children should succeed them in the same low condition, inure them
from their infancy to labour and submission, as well as the cheapest diet
and apparel; when, on the contrary, that sort of them will always be the least
serviceable to others, and themselves the most unhappy, who, dissatisfied
with their labour, are always grumbling and repining at the meanness of
their condition; and, under pretence of having a great regard for the welfare
of their children, recommend the education of them to the charity of others;
and you shall always find, that of this latter class of poor, the greatest part
are idle sottish people, that, leading dissolute lives themselves, are
neglectful to their families, and only want, as far as it is in their power, to
shake off that burden of providing for their brats from their own shoulders.

Hor. I am no advocate for charity schools; yet I think it is barbarous, that

the children of the labouring poor, should be for ever pinned down, they,
and all their posterity, to that slavish condition; and that those who are
meanly born, what parts or genius soever they might be of, should be
hindered and debarred from raising themselves higher.

Cleo. So should I think it barbarous, if what you speak of was done any
where, or proposed to be done. But there is no degree of men in
Christendom that are pinned down, they and their posterity, to slavery for
ever. Among the very lowest sort, there are fortunate men in every country;
and we daily see persons, that without education, or friends, by their own
industry and application, raise themselves from nothing to mediocrity, and
sometimes above it, if once they come rightly to love money and take
delight in saving it: and this happens more often to people of common and
mean capacities, than it does to those of brighter parts. But there is a
prodigious difference between debarring the children of the poor from ever
rising higher in the world, and refusing to force education upon thousands
of them promiscuously, when they should be more usefully employed. As
some of the rich must come to be poor, so some of the poor will come to be
rich in the common course of things. But that universal benevolence, that
should every where industriously lift up the indigent labourer from his
meanness, would not be less injurious to the whole kingdom than a
tyrannical power, that should, without a cause, cast down the wealthy from
their ease and affluence. Let us suppose, that the hard and dirty labour
throughout the nation requires three millions of hands, and that every
branch of it is performed by the children of the poor. Illiterate, and such as
had little or no education themselves; it is evident, that if a tenth part of
these children, by force and design, were to be exempt from the lowest
drudgery, either there must be so much work left undone, as would demand
three hundred thousand people; or the defect, occasioned by the numbers
taken off, must be supplied by the children of others, that had been better
bred.

Hor. So that what is done at first out of charity to some, may, at long run,
prove to be cruelty to others.

Cleo. And will depend upon it. In the compound of all nations, the different
degrees of men ought to bear a certain proportion to each other, as to
numbers, in order to render the whole a well proportioned mixture. And as
this due proportion is the result and natural consequence of the difference
there is in the qualifications of men, and the vicissitudes that happen among
them, so it is never better attained to, or preserved, than when nobody
meddles with it. Hence we may learn, how the short-sighted wisdom of
perhaps well-meaning people, may rob us of a felicity that would flow
spontaneously from the nature of every large society, if none were to divert
or interrupt the stream.

Hor. I do not care to enter into these abstruse matters; what have you further
to say in praise of money?

Cleo. I have no design to speak either for or against it; but be it good or bad,
the power and dominion of it are both of vast extent, and the influence of it
upon mankind has never been stronger or more general in any empire, state,
or kingdom, than in the most knowing and politest ages, when they were in
their greatest grandeur and prosperity; and when arts and sciences were the
most flourishing in them: Therefore, the invention of money seems to me to
be a thing more skilfully adapted to the whole bent of our nature, than any
other or human contrivance. There is no greater remedy against sloth or
stubbornness; and with astonishment I have beheld the readiness and
alacrity with which it often makes the proudest men pay homage to their
inferiors: It purchases all services, and cancels all debts; nay, it does more,
for when a person is employed in his occupation, and he who sets him to
work, a good paymaster, how laborious, how difficult or irksome soever the
service be, the obligation is always reckoned to lie upon him who performs
it.

Hor. Do not you think, that many eminent men in the learned professions
would dissent from you in this?

Cleo. I know very well, that none ought to do it, if ever they courted
business, or hunted after employment.

Hor. All you have said is true among mercenary people; but upon noble
minds that despise lucre, honour has far greater efficacy than money.

Cleo. The highest titles, and the most illustrious births, are no security
against covetousness; and persons of the first quality, that are actually
generous and munificent are often as greedy after gain, when it is worth
their while, as the most sordid mechanics are for trifles: The year twenty
has taught us, how difficult it is to find out those noble minds that despise
lucre, when there is a prospect of getting vastly. Besides, nothing is more
universally charming than money; it suits with every station, the high, the
low, the wealthy, and the poor: whereas, honour has little influence on the
mean, slaving people, and rarely affects any of the vulgar; but if it does,
money will almost every where purchase honour; nay, riches of themselves
are an honour to all those who know how to use them fashionably. Honour,
on the contrary, wants riches for its support; without them it is a dead
weight that oppresses its owner; and titles of honour, joined to a necessitous
condition, are a greater burden together than the same degree of poverty is
alone: for the higher a man’s quality is, the more considerable are his wants
in life; but the more money he has, the better he is able to supply the
greatest extravagancy of them. Lucre is the best restorative in the world, in
a literal sense, and works upon the spirits mechanically; for it is not only a
spur that excites men to labour, and makes them in love with it, but it
likewise gives relief in weariness, and actually supports men in all fatigues
and difficulties. A labourer of any sort, who is paid in proportion to his
diligence, can do more work than another who is paid by the day or the
week, and has standing wages.

Hor. Do not you think, then, that there are men in laborious offices, who,
for a fixed salary, discharge their duties with diligence and assiduity?

Cleo. Yes, many; but there is no place or employment in which there are
required or expected, that continual attendance and uncommon severity of
application, that some men harass and punish themselves with by choice,
when every fresh trouble meets with a new recompence; and you never saw
men so entirely devote themselves to their calling, and pursue business with
that eagerness, dispatch, and perseverance in any office of preferment, in
which the yearly income is certain and unalterable, as they often do in those
professions where the reward continually accompanies the labour, and the
fee immediately either precedes the service they do to others, as it is with
the lawyers, or follows it, as it is with the physicians. I am sure you have
hinted at this in our first conversation yourself.

Hor. Here is the castle before us.

Cleo. Which I suppose you are not sorry for.

Hor. Indeed I am, and would have been glad to have heard you speak of
kings and other sovereigns with the same candour, as well as freedom, with
which you have treated prime ministers, and their envious adversaries.
When I see a man entirely impartial, I shall always do him that justice, as to
think, that if he is not in the right in what he says, at least he aims at truth.
The more I examine your sentiments, by what I see in the world, the more I
am obliged to come into them; and all this morning I have said nothing in
opposition to you, but to be better informed, and to give you an opportunity
to explain yourself more amply. I am your convert, and shall henceforth
look upon the Fable of the Bees very differently from what I did; for
though, in the Characteristics, the language and the diction are better, the
system of man’s sociableness is more lovely and more plausible, and things
are set off with more art and learning; yet in the other there is certainly
more truth, and nature is more faithfully copied in it almost every where.

Cleo. I wish you would read them both once more, and, after that, I believe
you will say that you never saw two authors who seem to have wrote with
more different views. My friend, the author of the Fable, to engage and
keep his readers in good humour, seems to be very merry, and to do
something else, whilst he detects the corruption of our nature; and having
shown man to himself in various lights, he points indirectly at the necessity,
not only of revelation and believing, but likewise of the practice of
Christianity manifestly to be seen in mens lives.

Hor. I have not observed that: Which way has he done it indirectly?

Cleo. By exposing, on the one hand, the vanity of the world, and the most
polite enjoyments of it; and, on the other, the insufficiency of human reason
and heathen virtue to procure real felicity: for I cannot see what other
meaning a man could have by doing this in a Christian country, and among
people that all pretend to seek after happiness.

Hor. And what say you of Lord Shaftsbury?

Cleo. First, I agree with you that he was a man of erudition, and a very
polite writer; he has displayed a copious imagination, and a fine turn of
thinking, in courtly language and nervous expressions: But, as on the one
hand, it must be confessed, that his sentiments on liberty and humanity are
noble and sublime, and that there is nothing trite or vulgar in the
Characteristics; so, on the other, it cannot be denied, that the ideas he had
formed of the goodness and excellency of our nature, were as romantic and
chimerical as they are beautiful and amiable; that he laboured hard to unite
two contraries that can never be reconciled together, innocence of manners,
and worldly greatness; that to compass this end, he favoured deism, and,
under pretence of lashing priestcraft and superstition, attacked the Bible
itself; and, lastly, that by ridiculing many passages of Holy Writ, he seems
to have endeavoured to sap the foundation of all revealed religion, with
design of establishing Heathen virtue on the ruins of Christianity.

FINIS.
INDEX.
Abelard, page 334.

Absurd, nothing is thought so that we have been used to, 367.

Absurdities in sacred matters not incompatible with politeness and worldly wisdom, 413,
414, 415, 422.

Acclamations made at church, 369.

Accomplishments. The foundation of them is laid in our youth, 508.

Acknowledgment due to ancestors, 202.

Active, stirring man. The difference between such a one, and an easy indolent man in the
same circumstances, 338 to 346.

Adam. All men are his descendants, 402.

Was not predestinated to fall, 429.
A miraculous production, 485.

Administration, the civil, how it ought to be contrived, 495.

What men it requires, ibid.
Most branches of it seem to be more difficult than they are, 496.
Is wisely divided into several branches, ibid.
Is a ship that never lies at anchor, 504.

Affections of the mind mechanically influence the body, 376.

Affectionate scheme, 441.

Would have been inconsistent with the present plan, 442.
When it might take place, 447.

Age, the golden, fabulous, 483.

Inconsistent with human nature, 452.
Air and Space, no objects of sight, 207.

Alexander the Great. The recompence he had in view, 20.

Proved from his own mouth, ibid.
Another demonstration of his frailty, 212.

Alexander Severus, his absurd worship, 414.

America, what the conquest of it has cost, 115.

Americans. The disadvantage they laboured under, 492.

May be very ancient, ibid.

Ananas, the, or pine-apple, excels all other fruit, 400.

To whom we owe the cultivation of it in England, 401.

Anaxagoras, the only man in antiquity that really despised riches and honour, 341.

Anger defined, 119.

Conquered by fear, ibid. and 122.
The operation of strong liquors imitates that of anger, 126.
Anger described, 386.
The origin of it in nature, ibid.
What creatures have most anger, ibid.
The natural way of venting anger is by fighting, 474.

Animal Economy. Man contributes nothing to it, 477.

Animals, all, of the same species intelligible to one another, 466.

Antagonists, the, of prime ministers, 500, 501.

Are seldom better than the ministers themselves, 504.

Apology, an, for several passages in the book, 137, 138.

An apology for recommending ignorance, 182.

Applause, always grateful, 369.

The charms of it, 271.
Arts and Sciences. What encourages them, 509.
Which will always be the most lucrative, 514.

Atheism has hid its martyrs, 128.

Atheism and Superstition of the same origin, 487.

What people are most in danger of atheism, ibid.
Atheism may be abhorred by men of little religion, 266.

Atheists may be men of good morals, 488.

Avarice, 52.
The reason why it is generally hated, ibid.
Why the society stands in need of it, 53.
Is equally necessary with prodigality, ibid.
What ought to be deemed as such, 266.

Author of the Fable of the Bees, the, desires not to conceal any thing that has been said
against him, 261.
The reason of his silence, ibid.
How far only he defends his book, 262.
Has called it an inconsiderable trifle, and a rhapsody, ibid.
Was unjustly censured for confessing his vanity, 263.
How far he is answerable for what Horatio says, 275.
His fears of what will happen, ibid.
The report of his having burnt his book, 276.
The preparatory contrivance this report was built upon, ibid. and 277.

Authors compared to architects, 480.

Ought to be upon the same footing with their critics, 261.
When most foolishly employed, 262.

Beards, the various modes concerning them, 208.

Bears brought forth chiefly in cold countries, 430.

Bear-Gardens not inferior to operas, as to the real virtue of the companies that frequent
either, 301.
Beau Monde censured 333.
What has always employed the wishes of them, 365.
Are every where the judges and refiners of language, 471, 472.
A character of a considerable part of the beau monde throughout Christendom, 266.
The indulgence of the beau monde censured, ibid.
Their easy compliance with ceremonies in divine worship, 267.
Exceptions from the generality of them, ib.

Bees, in, society is natural, in man artificial, 393, 394.

Beggars, their policy, 158, 159.

What sort of people complain of them most, ibid.

Behaviour of modest women, 31.

Of a bride and bridegroom, 33.
Of undisciplined soldiers, 123.
Of a fine gentleman at his own table, 307.
Abroad, ibid.
To his tenants, 308.
To his servants, 309.
To tradesmen, 310.
Of an indolent man of no fortune, 338.
Of an active man in the same circumstances, 339.
Of men meanly born, 479.
Of savages, 354, 355.
Of the ill-bred vulgar, 466.
Of different parties, 504, 505.

Belief, when we deserve it, 90.

Believing. The necessity of it, 488.

Benefits that accrue from the worst of people, 42 to 48.

Blessing, a, there is nothing created that is always so, 356.

The children of the poor one of the greatest blessings, 446.

Blessings, prejudicial, 136.

Bodies, our, visibly contrived not to last, 435.

Brain, the, compared to a spring watch, 377.

The economy of it unknown, 378.
Conjectures on the use of it, 380.
Of infants compared to a slate and a sampler, 381.
The labour of the brain, 383.
The brain more accurate in women than it is in men, ibid.

Brandy Shops, the qualifications required to keep them, 45.

Breeding, good, a definition of it, 36.

A discourse on it, ibid. to 38.

Brewing and baking luxurious inventions, 98.

Britain, Great, wants ignorance, 189, 203.

Brutes, have privileges and instincts which men have not, 467.

Bustle, the, to be made in the world to procure a scarlet or crimson cloth, 228.

Cardinals, the most valuable accomplishments among, 496, 297.

Care, what ought to employ our first, 351.

Carthaginians. Their abominable worship, 414.

Castrati. See Eunuchs.

Castration, the effects of it upon the voice, 333.

Cat-calls, 371.

Cato, his character, 213.

His self-denial. 264.

Centaurs, sphinxes, and dragons. Their origin, 426.

Chance. What it is, 448, 449.

Chancellor, the Lord, of Great Britain. What he should be, 495.
His post requires greater qualifications than any other, 498.

Charity. A definition of it, 155.

Is often counterfeited by our passions, 156, 158, 160.
The compliments paid to all the appearances of charity, ibid.
Abuses of charity, 161, 162, 164.
Often counterfeited, 345.
The world hates those who detect the counterfeits, ibid.
An instance of an unjust pretence to charity, ibid.

Charity children have no opportunity to learn good manners, 166.

Why they are pleasing to the eye, 175.

Charity schools are admired to distraction, 165.

What is said in behalf of them, ibid.
Not capable to prevent thefts and robberies, ibid.
The cause of our fondness for those schools, 171.
A description of the first rise and subsequent steps that are made to erect a charity school,
ibid. to 175.
The joy they give, 175.
They are an inexhaustible fund for tittle-tattle, ib. and 176.
The charms of them to the multitude, 176.
The different views partymen have in wishing well to them, 194, 195.
More labour and eloquence are laid out upon them than on any other duty, ib.
The comfort the wicked find in liking them, 177.
The true motives of the bustle made about them, ibid.
Arguments against charity schools, showing them to be destructive to the public, 178 to
203.
A perpetual nursery for them, 188.

Chastity, the worlds opinion about it, 267.

Children. What makes them mannerly, 166.

What all delight in, 174.
Labour the proper province of the children of the poor, 187.
What they are indebted for to parents, 420.
Whether people marry with design of having them, 422.
The children of savages when sociable, 404.

Children of the poor, one of the greatest blessings, 446.

What their lot always will be, 315, 316.

Christianity, the essentials of, never to be talked of among the beau monde, 267.

Church, going to it of the utmost necessity to the poor, 193.

Cicero, his character, 384.

He imitated Plato, 264.

Cid. The six famous lines of it censured, 476.

Cities, great flourishing, the work of Providence, 493.

What is requisite to govern them, ibid, and 494.

Claim, the unjust, men lay to every thing that is laudable, 410, 411.

Classes. The two classes men are divided into, 14.

Cleomenes begs of Horatio to accept of the Fable of the Bees, and read it, 299.
Is denied, ibid.
Thinking Horatio displeased, breaks off the discourse, 301, 302.
But Horatio owning himself in the wrong, is persuaded to go on, 312.
Shows himself not uncharitable or censorious, 314.
Gives reasons why well accomplished persons may be ignorant of the principles they act
from, 315.
Explores duelling; demonstrates the laws of honour to be clashing with the laws of God,
from 318 to 333.
Shows the false pretences that are made to virtue, from 337 to 349.
His maxim of inquiring into the rise of arts and inventions, 352.
Gives his conjectures concerning the origin of politeness, from 353 to 364.
Shows the inconsistency of the affectionate scheme with the world as it is, from 442 to
448.
Proves his assertions concerning the nature of man, from the tendency of all laws,
especially the ten commandments, from 453 to 466.
Gives his opinion concerning the different designs Lord Shaftsbury and his friend have
wrote with, 519.
His character, 270, &c.
His censuring of his own actions, 272.
His aversion to contempt, 273.

Clergy, pride concealed them, 72.

Their value for the comforts of life, 88.
A deceitful plea of theirs, 89.
What brings them into contempt, ibid.
The same illustrated by example, 90.
The clergy, when poor, expose themselves by matrimony, 91.

Clergyman, the social, 292.

Why many clergymen are angry with the Fable of the Bees, 333.

Clothes, the use of them, 68.

Combabus, 334.

Comforts of life, various as the conditions of men vary, 57.

Commandments, the ten, are a strong proof of the principle of selfishness and instinct of
sovereignty in human nature, 456.
All of them have their political uses, 464.
What is implied in the ninth commandment, 457.
What may be inferred from the sixth, ibid.
The two first point at our natural blindness and ignorance of the true Deity, 459.
The purport of the third discussed, 460.
The fifth explained, 462, 463.
The usefulness of the fourth in worldly affairs, 464.

Company, good, 214.

The love of it not the cause of man’s sociableness, 213.
Solitude to be preferred to some company, 216.
Love of company no virtue, ibid.
The reason why man loves it, 391.
Compassion. A story of a child to raise compassion, 156.
See Pity.

Compliments, which are Gothic, 368.

Not begun among equals, ibid.
Lose their dignity, 369.

Conclaves, a character of, 369.

Conclusion of the Remarks, 150 to 154.

Confidence reposed in prime ministers, 502, 503.

Confucius, 489.

Conjectures on the origin of politeness, 409, 414.

On the first motives that could make savages associates, 425, 426.
This conjecture not clashing with any of the Divine attributes, 435, 448.

Consciousness, what it consists in, 385.

Constitution of the body. What it consists in, 126.

Constitution, the, 497.

Wisdom of that of Great Britain, ibid. and 498.
Is chiefly to be taken care of in all countries, 504.

Constructions, the kind, of the beau monde, 263, 269.

Are hurtful to the practice of Christianity, 270.

Content, the bane of industry, 3, 9, 10, 144.

A definition of content, 146.
Is a precarious virtue, ibid.
An instance of it, 148.
Content more opposite to industry than laziness, ibid.

Contracts never lasting among savages, 452.

Conversation between a mercer and a lady his customer, 223 to 226.

Corneille cited, 476.
Defended, 477.

Covetousness. What people are not taxed with it by the beau monde, 269.

Counsellor, the social, 292.

Courage, natural, 321.

Proceeds from anger, 121.
Spurious and artificial courage, 122.
Natural courage, good for nothing in war, 123.
Stratagems to create courage, 124, 125, 129.
May be procured by discipline, 490.
How pride is mistaken for courage, 124.
A definition of artificial courage, 125.
Why it does not appear in dangers where honour is not concerned, 329.

Courtiers, their business, 500.

Courts of Princes. What procures men admittance there, 480.

Creatures, how some to be talked of that never had any existence, 426.

Creatures, living, compared to the engine that raises water by fire, 380.
The production of their numbers in every species proportioned to the consumption of them,
439.
This is very conspicuous in whales, ibid.

Cruelty, not greater in a wolf that eats a man, than it is in a man who eats a chicken, 435.

Custom, the force of it, 99.

Customers, the different ways of drawing them, 225.

Danger, the, from wild beasts, the first inducements to make savages associate, 425, 426.
The effects of it upon man’s fear, ibid. 427.
Objections to this conjecture, 425, 429, 430, 434, 436, 447, 448.
This danger is what our species will never be entirely exempt from upon earth, 450.
Death, not always the thing we fear most, 124.
Interest of money after death, 163.
It is death and not the manner of dying, to which our aversion is universal, 436, 437.

Debate, a, about pride, and what sort of people are most affected with it, 305, 306.
About money to servants, 309, 310.
About the principles a fine gentleman may act from, 312, 313.
About which it is that inclines men most to be religious, fear, or gratitude, from 410 to 416.
About the first step to society, 425, 426.

Decencies and conveniencies have a large signification, 148.

Deism, modern, what has increased it in this kingdom, 488.

No greater tie than atheism, ibid.

Deity, notions worthy of the, 393, 408, 418, 441, 444, 448.
The same, unworthy, 417, 418, 443, 444.

Descartes, his opinion refuted, 105.

Description, a, of the pleasures of the voluptuous, 399, 400.

Of the killing of a bullock, 105.

Dialogues, the reputation that has been gained by writing them, 265.
Why they are in disrepute, ibid.

Dice, spoken to illustrate what chance is, 449.

Discourse, a, on the social virtues according to Lord Shaftsbury, from 288 to 302.
On duelling, natural and artificial courage, from 318 to 333.
On the different effects the same passions have on men of different tempers, from 338 to
341.
On pride, and the various effects and symptoms of it, from 347 to 352.
On the origin of politeness, 352, to 364.
On compliments, tokens of respect, laughing, &c. from 366 to 377.
On the faculty of thinking, from 377 to 386.
On the sociableness of man, from 386 to 403.
On the first motive that could make savages associate, from 425 to 451.
On the second step to society, and the necessity of written laws, from 451 to 465.
On language, from 466 to 488.
On diverse subjects relating to our nature and the origin of things, from 477 to 491.
On government, capacities, and the motives of study, on ministers, partiality, and the power
of money, to the end.

Distiller, a, what is required to make an eminent one, 40.

Divines, what it is we are obliged to for the great numbers of them, 184.

Docility depends upon the pliableness of the parts, 390.

Lost if neglected in youth, 396.
The superior docility in man, in a great measure owing to his remaining young longer than
other creatures, 397.

Dominion, the desire of, all men are born with it, 406.
Seen in the claim of parents to their children, ibid.

Dress, the only thing by which men are judged of at courts, 480.

Drunkenness, how it is judged of, 268.

Dryades and Hama-Dryades, 410.

Duelling, proceeds not from false notions of honour, 130.

The benefit of it to society, 131.
The custom of it not to be abolished, ibid.
How to prevent it, ibid.
Men of honour would be laughed at if they scrupled it, because it is a sin, 319.
What considerations are slighted for it, 332.

Duellists, their concern chiefly owing to their struggles between the fear of shame and the
fear of death, 326.
Seem to act by enchantment, 327.

Dutch, the, not frugal from principle, 108.

Their calamities under Philip II. of Spain, ibid.
Their other disadvantages, 109.
How they differ from us, ibid.
Their profuseness, 111.
Their policy in encouraging the extravagancies of sailors, ibid.

Dying, the means of, are all equally the contrivance of nature, 436.
It is as much requisite to die as to be born, ibid.
Several ways of dying are necessary, 443.

Earth, the, our species would have overstocked it, if there never had been war, 443.

Education, observations concerning it, 19, 23.

(a refined) teaches no humility, 305.
The most effectual means to succeed in the education of children, 315.
Teaches to conceal, and not to conquer the passions, 305, 337.
The best proof for the necessity of a good education, 476.
People may be miserable only for want of education, 482.
The necessity of a Christian education, 488, 489.
A gentleman’s education destructive to Christian humility, 272.

Effendi, Mahomet, died for atheism, 128.

Eggs in fish not impregnated by the male as in other oviparous animals, 438.
The use of this, ibid.

Elements, the, are all our enemies, 219.

Emulation, mankind divided into two classes for emulations sake, 14.
The emulation of school-boys not derived from virtue, 75.

Englishmen do not covet Spartan greatness, 150.

Enthusiasm, the force of it, 149.

Envy, 73.
A definition of it, ibid.
The various symptoms of it, 74, 75.
Envy conspicuous in wild beasts, 75.
An argument to show that envy is rivetted in our nature, ibid.
The use of envy in painters, 76.
Envy has reformed more bad husbands than preaching, ibid.
An instance of envy, 77.
Nobody is without, ibid.
Cato’s envy to Cæsar, 213.
Envy accounted for, 386.

Epicurus. The pleas and apologies of Epicurus, 140, 141.

The doctrine of Epicurus exploded, 485, 486.

Essay, an, on charity and charity schools, 155.

Evil, both moral and natural the solid basis of society, 237.
The cause of it more inquired into than that of good, 441.

Eunuchs overvalued, 33, 34.

No part of the creation, ibid.

Examination of one’s self, 302, 316, 330, 272.

Exchequer, the wise regulations of it, 496.

In all the business belonging to it, the constitution does nine parts in ten, ibid.

Exclaim, why all nations cry Oh! when they exclaim, 374.

Experience of greater use in procuring good laws than genius, 491.

Fable, the, or what is supposed to have occasioned the first dialogue, 273, 274.

Fable of the Bees, the first part of the, quoted, 326, 332, 436,
spoke against, 280, 301, 332, 336,
defended, 293, 332.—
What view the book ought to be seen in, 333.
The treatment it has had illustrated by a simile, 333.
Vice is no more encouraged in it than robbing is in the Beggar’s Opera, 263.

Fall, the, of man not predestinated, 429.

Fame, what the thirst after fame consists in, 20.

Fathers of the church delighted in acclamations whilst they are preaching, 269.
Fear, not to be conquered by reason, 118.
A definition of fear, ibid.
The necessity of fear in the society, 122.
Fear of death, when the strongest, 211.
Fear the only thing man brings into the world with him towards religion, 408.
The Epicurean axiom that fear made the gods exploded, ibid. and 409.

Fees, the power of them upon lawyers and physicians, 293.

Fish, a visible provision made by nature for their extraordinary numbers, 437.
The vast consumption of them, 438, 439.

Flatterers of our species. Why they confound what is acquired with what is natural, 478.

Flattery, no man proof against it, 18, 316.

The various arts of it, 20, 21.
The beginning of it in society, 363.
Becomes less barefaced as politeness increases, 369.

Flesh of animals, to eat it is a cruel piece of luxury, 99, 100.

Flies, 440.

Folly of infants, 424.

Fools, learned, where to be met with, 383.

Footmen, the faults they are generally guilty of in England, 189, 190, 191.
What it is that spoils them, 191.
A society of them, 192.

Frailties palmed upon the world for virtues, 338.

Friendship, never lasting without discontent on both sides, 337.

Fright, a, pride of no use in it, 126.

The effects it had upon us, ibid.

Frowning described, 373.

Frugality, a definition of it, 105.
What frugality will always depend upon, 106.
What his made the Dutch frugal, 110.
A discourse on frugality, ibid. to 113.—
The impossibility of forcing people to be frugal without necessity, 113.
The frugality of the Spartans, 133.
The influence of it on trade, ibid.
When it is no virtue, 338, 339.

Fulvia, the reason why no character is given of her, 273.

Gamesters, the reason why they conceal their gettings before the losers, 39 to 41.

Gassendus is the example the author has followed in his dialogues, 274.

Genius, many things are ascribed to genius and penetration that are owing to time and
experience, 361.
Has the least share in making laws, 493.

Gentleman, a fine, drawn, and the picture approved of by Horatio, from 306 to 311.
Why there are not many such, from 306 to 315.

Gestures made from the same motive in infants and orators, 469.
The abuse of them, 470.
To make use of them more natural than to speak without, ibid.

Gift, a great, of a late physician examined into, 105 to 164.

Glory, the love of, in men of resolution and perseverance, may, without other help, produce
all the accomplishments men can be possessed of, 312, 313, 314.
A trial to know whether a fine gentleman acts from principles of virtue and religion, or
from vain glory, 317, 318.
When only the love of glory can be commendable, 324.
The eager pursuit of worldly glory inconsistent with Christianity, 269.

Golden age not fit for society, 11, 220.

Governing. Nothing requires greater knowledge than the art of it, 491, 492.
Is built on the knowledge of human nature, 493.
Government, the rise of it, 222.
What is the best form of it, is yet undecided, 394.
Is in bees the work of nature, 393, 394.
None can subsist without laws, 377.
What the best forms of it are subject to, 491.

Government, the, of a large city. What sort of wisdom it requires, 493.

Compared to the knitting frames, 494.
To a musical clock, ibid.
Once put into good order it may go right, though there should not be a wise man in it, 494.

Governor, the charms of the word to mean people, 173.

Governors of charity schools, ibid.
The praises given them, 175.

Grammar schools, how to be managed, 211.

Gratitude, man’s, examined into, as the cause of Divine worship, 411, 413, 414.

Grumbling. See Hive.

Happiness on earth like the philosopher’s stone, 388.

Hardships are not such when men are used to them, 199.

Hats, the various modes of them, 208.

Heroes, their great views, 20.

What they differ in from coward is corporeal, 126.
Of antiquity, chiefly famed for subduing wild beasts, 426.

Hive, Grumbling Hive, 1.

Their glorious condition, ibid. 2.
Their knavery, 2. to 4.
Their murmurings, 6.
Jupiter makes them honest, ibid.
Their conversion and the effects of it upon trade, 7 to 11.
The moral, 11.
Honesty, the effects of it on trade, 9, 132, 133, 134, 139.
Where the most of it is to be found, 165, 166.

Honour, the genuine signification of it, 27.

The figurative sense of it, 116.
Rubs of honour, ibid. 117.
Principles of honour, how raised, 123.
The standard of honour, 130.
A new standard of it, ibid.
The latter much easier than the first, ibid.
Honour opposite to religion, 132.
The great allowances of honour, ibid.
Why there are so many men of real honour, ibid.
The principles of it extolled, 299, 300, 318.
The same condemned, ibid.
Is a chimerical tyrant, 322.
Is the result of pride, but the same cause produces not always the same effect, 325.
Is acquired, and therefore no passion belonging to any one’s nature, 326.
Is not compatible with the Christian religion, 329.
In women more difficult to be preserved than in men, 349.
Is not founded upon any principle of virtue or religion, ibid.
The signification of the word whimsical, ibid.

Hope, a definition of it, 78.

The absurdity of the words certain hope, 79.

Horatio refuses to accept of the Fable of the Bees, 299.

Is taxed with maintaining the theory of what he cannot prove to be practicable, ibid.
Owns that the discourse of Cleomenes had made an impression on him, 302.
Mistakes Cleomenes and grows angry, 303, 304.
Interrupts him, 305.
Finds fault again with Cleomenes wrongfully, and seems displeased, 310.
Sees his error, begs pardon, and desires Cleomenes to go on, 311.
Takes upon him to be the fine gentleman’s advocate, 317.
Labours hard to justify the necessity of duelling, 318, 319, 322.
—Shows the intolerable consequences of affronts not resented, 322, 323.
Accepts of the Fable of the Bees, 331.
Why he dislikes it, 336.
Having considered on the origin of politeness, pays a visit to Cleomenes, 367.
Invites him to dinner, 399.
Cannot reconcile the account of savages with the Bible, 401.
Proposes mutual affection as a means to make men associate, 441.
Allows of the conjecture about the first step towards society, 449.
Comes into the sentiments of Cleomenes, 518.
His character, 270, 271.

Horses, not tamed by nature, 454.

What is called vicious in them, 455.

Hospitals, the necessity of them, 164.

A caution against the increase of them, ibid. 165.

Humility, Christian, no virtue more scarce, 272.

Hunger and lust the great motives that stir up courage in brutes, 118, 119.
The influence these appetites have upon ourselves, 120, 121.

Hutcheson, Mr., a favour asked him, 511.

Hypocrisy, to deceive by counterfeiting, 297.

Of some divines, 333.
Four are never guilty of it, 338.
Detected in the pretences to content in poverty, 339, 340.
When owned, 345.

Idiots, not affected with pride, 376.

Made by loss of memory, 385.

Idolatry, all the extravagancies of it pointed out in the second commandment, 459.
Of the Mexicans, 460.

Ignorance, a necessary ingredient in the mixture of society, 55, 179.

Reasons for it, ibid.
Punishments the author has to fear for recommending ignorance, 181, 182.
Great Britain wants it to be happy, 203.
Of the true Deity is the cause of superstition, 408.

Imaginary, rewards for self-denial, 14.

Immortality, the, of the soul, a doctrine older than Christianity, 138.

Why so generally received, ibid.

Indolence not to be confounded with laziness, 343.

Indolent easy man, an, the difference between him and an active stirring man in the same
circumstances, 338 to 345.

Industry, differs from diligence, 148.

Infants, the management of them, 380.

Why they ought to be talked to, 381, 390.
Imagine every thing to think and feel, 409.
This folly humoured in them, 410.
Their crying given them to move pity, 467.
Vent their anger by instinct, 473.

Innes, the Rev. Dr. quoted, 276.

His sentiments on charity, 277.

Innocence, state of, described, 220.

Prejudicial to society, 221.

Insects, would overrun the earth in two years time if none were destroyed, 439.

Interest teaches men the use of their limbs, 360.

Savages to love and infants to suck, neither of them thinking on the design of nature, 422.
All men are born with an instinct of sovereignty, 456, 457.

Invention, of ships, 361, 362.

What sort of people are best at invention, 363.
No stability in the works of human invention, 394.
Invisible Cause, an, how savages come to fear it, 408.
The perplexity it gives to men ignorant of the true Deity, 411, 412.
The wildest parents would communicate the fear of it to their children, 412.
The consequence of different opinions about it, 413, 414.

Jealousy, a compound, 78.

No jealousy without love, 82.

Jews, knew truths which the politest nations were ignorant of, 1500 years after, 421.

Judges, who are fit to be, 495.

Judgment, sound, what it consists in, 383.

Women are as capable of acquiring it as men, ibid. 384.

Justice, and Injustice. What notions a savage of the first class would have of it, 403.

Justice, the administration of it impracticable without written laws, 377.

Juvenal, quoted on superstition, 460.

Knowledge, does not make men religious, 165, 166, 170, 193.
Knowledge beyond their labour is prejudicial to the poor, 179, 180.
Neither knowledge nor politeness belong to a man’s nature, 480.

Knowing, à priori, belongs to God only, 393.

King, a, his happiness compared to that of a peasant, 198, 199.

Labour, the usefulness of dividing and subdividing it, 465.

Lampredius, quoted, 414.

Languages, that of the eyes is understood by the whole species, 497.

Is too significant, 468.
How language might come into the world from two savages, ibid.
Signs and gestures would not cease after the invention of speech, 469.
A conjecture on the strength and beauty of the English language, 471.
The reason of it, ibid. 472.
Whether French or English be more fit to persuade in, 475.
The same things are not beautiful in both languages, ibid.
The intention of opprobrious language, 477.
Is an equivalent for fighting, 474.

Latin, not necessary to write and spell English, 185.

To whom it is prejudicial, 186.

Laughter, conjectures on the rationale of that action, 371, 372.

Laws, sumptuary, useless to opulent kingdoms, 153.

All laws point at some defect or frailty belonging to human nature, 455, 456.
The necessity of written laws, 455.
The Israelites had laws before they knew Moses, 456.
What the wisest of human laws owing to, 491.
Laws in all countries restrains the usurpation of parents, 406.
Laws of honour are pretended to be superior to all other, 318.
Are clashing with the laws of God, 319.
Whether there are false laws of honour, 326.

Lawgivers, what they have chiefly to consider,454.

Lawyers, when fit to be judges, 495.

Laziness, a definition of it, 144.

People often call others lazy, because they are so themselves, ibid.
A story of a porter wrongfully suspected of laziness, 145, 146.

Leaping, cunning displayed in it, 360.

Learned fools, where to be met with, 383.

Learning, methods to promote and increase it, 182 to 187.

How all sorts of it are kept up, and looked into in flourishing nations, 508, 509.
How the most useful parts of it may be neglected for the most trifling, 510.
An instance of it, ibid.

Letters, the invention of them, the third step to society, 453.

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