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Health Psychology: An Introduction to Behavior and

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Linda Brannon

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HEALTH Psychology

An Introduction to Behavior and Health NINTH

CHECK YOUR HEALTH KNOWLEDGE

Decide if each of the following statements is true or false.

True False 1. Good health is the absence of disease.

True False 2. The United States ranks in the top 10 countries in the world in terms of life expectancy.

True False 3. The 30-year increase in life expectancy that occurred in the United States during the 20th century was due mostly to technological improvements in medical care.

True False 4. Stress is a leading cause of disease.

True False 5. People who maintain their weight within the ranges on the height-weight charts have lower death rates than people who are heavier or thinner.

True False 6. A few major “breakthrough” studies are the source of most health information.

True False 7. Smoking is a major cause of death in the United States.

True False 8. How a person copes with stress is more important than the number of stressors in that person’s life.

True False 9. More smokers will die of heart disease than from cancer.

True False 10. If two factors are strongly related, then one causes the other.

True False 11. High cholesterol is one of the best predictors of risk for cardiovascular disease.

True False 12. People who are physically active are usually healthier than those who lead sedentary lives.

True False 13. Breast cancer is the leading cause of cancer death among women.

True False 14. Fat around the waist is more dangerous to health than fat around the hips and thighs.

True False 15. The experience of stress makes people more vulnerable to infection.

True False 16. Alternative treatments such as acupuncture and meditation can be effective treatments for chronic pain.

True False 17. Alcohol is an important contributor to both intentional and unintentional injuries.

True False 18. “No pain, no gain” is true for receiving health benefits from exercise.

True False 19. The lower a person’s cholesterol, the lower his or her risk of dying.

True False 20. Eating a high-protein diet is a healthy choice.

True False 21. Totally eliminating alcohol from one’s life is a healthy choice.

True False 22. People who experience chronic pain have underlying psychological disorders that are the real basis of their pain problem.

True False 23. Only viruses and germs trigger activation of the immune system.

True False 24. African Americans are more likely than European Americans to develop and to die of heart disease.

True False 25. Both positive and negative events may produce stress.

True False 26. Psychologists have found that lack of willpower is the primary reason why smokers cannot quit.

True False 27. Sugar pills (placebos) can boost the effectiveness of both psychological and medical treatments.

True False 28. People with a minor illness are about as likely as people with a serious illness to seek medical treatment.

True False 29. People who live with a smoker have about the same risk for cancer and heart disease as do cigarette smokers.

True False 30. Sick people who have a lot of friends usually live longer than sick people who have no close friends.

The answers to these questions appear on the back endpapers. You can also find an answer key on the website for this book: www.cengagebrain.com.

HealtH Psychology

a n Introduction to Behavior and Health

linda Brannon

McNeese State University

John a. Updegraff

Kent State University

Jess Feist

Health Psychology: An Introduction to Behavior and Health, Ninth Edition

Linda Brannon, John A. Updegraff, and Jess Feist

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b RI ef co N te N t S

PART 1 Foundations of Health Psychology

Chapter 1 Introducing Health Psychology 1

Chapter 2 Conducting Health Research 17

Chapter 3 Seeking and Receiving Health Care 37

Chapter 4 Adhering to Healthy Behavior 57

PART 2 Stress, Pain, and Coping

Chapter 5 Defining, Measuring, and Managing Stress 85

Chapter 6 Understanding Stress, Immunity, and Disease 119

Chapter 7 Understanding and Managing Pain 143

Chapter 8 Considering Alternative Approaches 173

PART 3 Behavior and Chronic Disease

Chapter 9 Behavioral Factors in Cardiovascular Disease 205

Chapter 10 Behavioral Factors in Cancer 235

Chapter 11 Living with Chronic Illness 257

PART 4 Behavioral Health

Chapter 12 Smoking Tobacco 285

Chapter 13 Using Alcohol and Other Drugs 313

Chapter 14 Eating and Weight 343

Chapter 15 Exercising 373

PART 5 Looking Toward the Future

Chapter 16 Future Challenges 399

Glossary 421 References 427 Name Index 487 Subject Index 519

Preface xiii

About the Authors xvii

PART 1 Foundations of Health Psychology

1 CHAPTER Introducing Health Psychology 1

Real-World Profile of Angela Bryan 2

The Changing Field of Health 3

Patterns of Disease and Death 3

Would You BE l IEVE...? College Is Good for Your Health 7

Escalating Cost of Medical Care 8

What Is Health? 9

Would You BE l IEVE...? It Takes More Than a Virus to Give You a Cold 10

IN SUMMARY 11

Psychology’s Relevance for Health 12

The Contribution of Psychosomatic Medicine 12

The Emergence of Behavioral Medicine 13

The Emergence of Health Psychology 13

IN SUMMARY 14

The Profession of Health Psychology 14

The Training of Health Psychologists 14

The Work of Health Psychologists 15

IN SUMMARY 15

Answers 16

PART 2 Stress, Pain, and Coping

5 CHAPTER Defining, Measuring, and Managing Stress 85

Ch EC k You R h EA lTh R IS k S 86

Real-World Profile of Hope Solo 86

The Nervous System and the Physiology of Stress 87

The Peripheral Nervous System 87

The Neuroendocrine System 89 Physiology of the Stress Response 92

IN SUMMARY 93

Theories of Stress 93

Selye’s View 93

Lazarus’s View 95

IN SUMMARY 96

Sources of Stress 96

Cataclysmic Events 96

Life Events 97

Daily Hassles 98

Would You BE l IEVE...? Vacations Relieve Work Stress … But not for Long 101

IN SUMMARY 101

Measurement of Stress 102

Methods of Measurement 102

IN SUMMARY 103

6 CHAPTER

Coping with Stress 104

Personal Resources That Influence

Coping 104

Would You BE l IEVE...? Pets May Be Better Support Providers Than People 106

Personal Coping Strategies 107

IN SUMMARY 108

Behavioral Interventions for Managing

Stress 109

Relaxation Training 109

Becoming He A lTH ie R 110

Cognitive Behavioral Therapy 110

Emotional Disclosure 112

Mindfulness 114

IN SUMMARY 115

Answers 116

CHAPTER

Ch EC k You R Ex PERIE n CES 144

Real-World Profile of Aron Ralston 145

Pain and the Nervous System 145

The Somatosensory System 146

The Spinal Cord 146

The Brain 146

Neurotransmitters and Pain 148

Would You BE l IEVE...? Emotional and Physical Pain Are Mainly the Same in the Brain 148

The Modulation of Pain 149

IN SUMMARY 150

The Meaning of Pain 150

Definition of Pain 150

The Experience of Pain 151

Theories of Pain 154

IN SUMMARY 156

Pain Syndromes 157

Headache Pain 157

Low Back Pain 158

Arthritis Pain 158

Cancer Pain 159

Phantom Limb Pain 160

IN SUMMARY 160

The Measurement of Pain 161

Self-Reports 161

Behavioral Assessments 162

Physiological Measures 163

IN SUMMARY 163

Managing Pain 164

Medical Approaches to Managing Pain 164

Behavioral Techniques for Managing Pain 166

IN SUMMARY 170

Answers 170

8 CHAPTER

Considering Alternative Approaches 173

Ch EC k You R h EA lTh C ARE PREFERE n CES 174

Real-World Profile of norman Cousins 174

Alternative Medical Systems 175

Traditional Chinese Medicine 175

Ayurvedic Medicine 177

IN SUMMARY 178

Alternative Products and Diets 178

IN SUMMARY 179

Manipulative Practices 179

Chiropractic Treatment 179

Massage 180

IN SUMMARY 181

Mind–Body Medicine 181

Meditation and Yoga 182

Becoming He A lTH ie R 183

Qi Gong and Tai Chi 183

Biofeedback 185

Hypnotic Treatment 185

Physiology and Mind–Body Medicine 186

IN SUMMARY 186

Who Uses Complementary and Alternative Medicine? 187

Culture, Ethnicity, and Gender 187

Motivations for Seeking Alternative Treatment 188

IN SUMMARY 189

How Effective Are Alternative Treatments? 189

Alternative Treatments for Anxiety, Stress, and Depression 190

Alternative Treatments for Pain 191

Would You BE l IEVE...? Humans Are not the only ones Who Benefit from Acupuncture 193

Alternative Treatments for Other Conditions 194

Limitations of Alternative Therapies 198

Integrative Medicine 200

IN SUMMARY 201

Answers 202

PART 3 Behavior and Chronic Disease

9 CHAPTER

Behavioral Factors in Cardiovascular Disease 205

Ch EC k You R h EA lT h RIS k S 206

Real-World Profile of President Bill Clinton 207

The Cardiovascular System 207

The Coronary Arteries 208

Coronary Artery Disease 208

Stroke 211

Blood Pressure 212

IN SUMMARY 212

The Changing Rates of Cardiovascular Disease 214

Reasons for the Decline in Death Rates 214 Heart Disease Throughout the World 215

IN SUMMARY 215

Risk Factors in Cardiovascular Disease 215

Inherent Risk Factors 216

Physiological Conditions 218 Behavioral Factors 220

Would You BE l IEVE...? Chocolate May Help Prevent Heart Disease 221

Would You BE l IEVE...? nearly All the Risk for Stroke Is Due to Modifiable Factors 222

Psychosocial Factors 222

IN SUMMARY 226

Reducing Cardiovascular Risks 226 Before Diagnosis: Preventing First Heart Attacks 227

Becoming He A lTH ie R 230

After Diagnosis: Rehabilitating Cardiac Patients 230

IN SUMMARY 232

Answers 232

10 CHAPTER

Behavioral Factors in Cancer 235

Ch EC k You R h EA lTh R IS k S 236

Real-World Profile of Steve Jobs 236

What Is Cancer? 237

The Changing Rates of Cancer Deaths 237

Cancers with Decreasing Death Rates 238

Cancers with Increasing Incidence and Mortality Rates 240

IN SUMMARY 240

Cancer Risk Factors Beyond Personal Control 241

Inherent Risk Factors for Cancer 241

Environmental Risk Factors for Cancer 242

IN SUMMARY 243

Behavioral Risk Factors for Cancer 243

Smoking 243

Diet 246

Alcohol 247

Sedentary Lifestyle 248

Ultraviolet Light Exposure 249

Would You BE l IEVE...? Cancer Prevention

Prevents More Than Cancer 250

Sexual Behavior 251

Psychosocial Risk Factors in Cancer 251

IN SUMMARY 252

Living with Cancer 252

Problems with Medical Treatments for Cancer 252

Adjusting to a Diagnosis of Cancer 253

Social Support for Cancer Patients 254

Psychological Interventions for Cancer Patients 254

IN SUMMARY 255

Answers 255

14 CHAPTER

Eating and Weight 343

Ch EC k You R h EA lTh R IS k S 344

Real-World Profile of Danny Cahill 344

The Digestive System 344 Factors in Weight Maintenance 346

Experimental Starvation 347

Experimental Overeating 348

IN SUMMARY 348

Overeating and Obesity 348 What Is Obesity? 349

Why Are Some People Obese? 351

Would You BE l IEVE...? You May need a nap Rather Than a Diet 353 How Unhealthy Is Obesity? 355

IN SUMMARY 356

Dieting 357

Approaches to Losing Weight 358 Is Dieting a Good Choice? 361

IN SUMMARY 362

Eating Disorders 362

Anorexia Nervosa 363

Bulimia 366

Binge Eating Disorder 368

Becoming He A lTH ie R 369

IN SUMMARY 371

Answers 371

15 CHAPTER Exercising

373

Ch EC k You R h EA lTh R IS k S 374

Real-World Profile of Ricky Gervais 374

Types of Physical Activity 375

Reasons for Exercising 375

Physical Fitness 376

Weight Control 376

IN SUMMARY 378

Physical Activity and Cardiovascular

Health 378

Early Studies 378

Later Studies 379

Do Women and Men Benefit Equally? 380

Physical Activity and Cholesterol Levels 380

IN SUMMARY 381

Other Health Benefits of Physical Activity 381

Protection Against Cancer 381

Prevention of Bone Density Loss 382

Control of Diabetes 382

Psychological Benefits of Physical Activity 382

Would You BE l IEVE...? It’s never Too Late—or Too Early 383

Would You BE l IEVE...? Exercise Can Help You Learn 387

IN SUMMARY 387

Hazards of Physical Activity 387

Exercise Addiction 390

Injuries from Physical Activity 390

Death During Exercise 391

Reducing Exercise Injuries 392

IN SUMMARY 392

How Much Is Enough But Not Too Much? 393

Becoming He A lTH ie R 394

Improving Adherence to Physical Activity 394

IN SUMMARY 397

Answers 397

PART 5 Looking Toward the Future

16 CHAPTER Future Challenges 399

Real-World Profile of Dwayne and Robyn 400

Challenges for Healthier People 401

Increasing the Span of Healthy Life 402

Reducing Health Disparities 403

Would You BE l IEVE...? Health Literacy Can Improve by “Thinking outside the Box” 405

IN SUMMARY 407

Outlook for Health Psychology 407

Progress in Health Psychology 407

Future Challenges for Health Care 408

Will Health Psychology Continue to Grow? 413

IN SUMMARY 413

Making Health Psychology Personal 414

Understanding Your Risks 414 What Can You Do to Cultivate a Healthy Lifestyle? 416

IN SUMMARY 418

Answers 418

P R eface

Health is a far different phenomenon today than it was just a century ago. Most serious diseases and disorders now result from people’s behavior. People smoke, eat unhealthily, do not exercise, or cope ineffectively with the stresses of modern life. As you will learn in this book, psychology—the science of behavior—is increasingly relevant to understanding physical health. Health psychology is the scientific study of behaviors that relate to health enhancement, disease prevention, safety, and rehabilitation.

The first edition of this book, published in the 1980s, was one of the first undergraduate texts to cover the then-emerging field of health psychology. Now in this ninth edition, Health Psychology: An Introduction to Behavior and Health remains a preeminent undergraduate textbook in health psychology.

The Ninth Edition

This ninth edition retains the core aspects that have kept this book a leader throughout the decades: (1) a balance between the science and applications of the field of health psychology and (2) a clear and engaging review of classic and cutting-edge research on behavior and health.

The ninth edition of Health Psychology: An Introduction to Behavior and Health has five parts. Part 1, which includes the first four chapters, lays a solid foundation in research and theory for understanding subsequent chapters and approaches the field by considering the overarching issues involved in seeking medical care and adhering to health care regimens. Part 2 deals with stress, pain, and the management of these conditions through conventional and alternative medicine. Part 3 discusses heart disease, cancer, and other chronic diseases. Part 4 includes chapters on tobacco use, drinking alcohol, eating and weight, and physical activity. Part 5 looks toward future challenges in health psychology and addresses how to apply health knowledge to one’s life to become healthier.

What’s New?

The ninth edition reorganizes several chapters to better emphasize the theoretical underpinnings of health behavior. For example, Chapter 4 focuses on adherence to healthy behavior and presents both classic and contemporary theories of health behavior, including recent research on the “intention–behavior gap.” Readers of the ninth edition will benefit from the most up-to-date review of health behavior theories—and their applications— on the market.

The ninth edition also features new boxes on important and timely topics such as

• Why is there a controversy about childhood vaccinations?

• Do online social networks influence your health?

• Could acupuncture benefit animals as well as humans?

• How much of your risk for stroke is due to behavior? (Answer: nearly all)

• Does drug use cause brain damage?

• Can sleep deprivation lead to obesity?

• Can exercise help you learn?

Other new or reorganized topics within the chapters include:

• Several new Real-World Profiles, including Hope Solo, Ricky Gervais, Danny Cahill, Rajiv Kumar, and big city taxi drivers.

• Illustration of the evolving nature of health research in Chapter 2, through examples of studies on the link between diet and colon cancer.

• New research on the role of stigma in influencing people’s decision to seek medical care, in Chapter 3.

• The role of optimism and positive mood in coping with stress, in Chapter 5.

• Mindfulness as a useful technique for managing stress (Chapter 5), managing pain (Chapter 7), and as a promising therapy for binge eating disorder (Chapter 14).

• Stress and its influence on the length of telomeres, in Chapter 6.

• Marriage as a key factor in predicting survival following cancer diagnosis, in Chapter 10.

• The use of dignity therapy as a means to address psychosocial issues faced by terminal patients, in Chapter 11.

• The use of smartphone “apps” and fitness trackers in promoting physical activity, in Chapter 15.

What Has Been Retained?

In this revision, we retained the most popular features that made this text a leader over the past two decades. These features include (1) “Real-World Profiles” for each chapter, (2) chapter-opening questions, (3) a “Check Your Health Risks” box in most chapters, (4) one or more “Would You Believe …?” boxes in each chapter, and (5) a “Becoming Healthier” feature in many chapters. These features stimulate critical thinking, engage readers in the topic, and provide valuable tips to enhance personal well-being.

Real-World Profiles Millions of people—including celebrities—deal with the issues we describe in this book. To highlight the human side of health psychology, we open each chapter with a profile of a person in the real world. Many of these profiles are of famous people, whose health issues may not always be well-known. Their cases provide intriguing examples, such as Barack Obama’s attempt to quit smoking, Lance Armstrong’s delays in seeking treatment for cancer, Steve Jobs’ fight with cancer, Halle Berry’s diabetes, Charlie Sheen’s substance abuse, and Ricky Gervais’ efforts to increase physical activity. We also include a profile of “celebrities” in the world of health psychology, including Dr. Angela Bryan, Dr. Norman Cousins, and Dr. Rajiv Kumar, to give readers a better sense of the personal motivation and activities of those in the health psychology and medical fields.

Questions and Answers In this text, we adopt a preview, read, and review method to facilitate student’s learning and recall. Each chapter begins with a series of Questions that organize the chapter, preview the material, and enhance active learning. As each chapter unfolds, we reveal the answers through a discussion of relevant research findings. At the end of each major topic, an In Summary statement recaps the topic. Then, at the end of the chapter, Answers to the chapteropening questions appear. In this manner, students

benefit from many opportunities to engage with the material throughout each chapter.

Check Your Health Risks At the beginning of most chapters, a “Check Your Health Risks” box personalizes material in that chapter. Each box consists of several health-related behaviors or attitudes that readers 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 will develop a more research-based understanding of their health risks. A special “Check Your Health Risks” appears inside the front cover of the book. Students should complete this exercise before they read the book and look for answers as they proceed through the chapters (or check the website for the answers).

Would You Believe …? Boxes We keep the popular “Would You Believe …?” boxes, adding many new ones and updating those we retained. Each box highlights a particularly intriguing finding in health research. These boxes explode preconceived notions, present unusual findings, and challenge students to take an objective look at issues that they may have not have evaluated carefully.

Becoming Healthier Embedded in most chapters is a “Becoming Healthier” box with advice on how to use the information in the chapter to enact a healthier lifestyle. Although some people may not agree with all of these recommendations, each is based on the most current research findings. We believe that if you follow these guidelines, you will increase your chances of a long and healthy life.

Other Changes and Additions

We have made a number of subtle changes in this edition that we believe make it an even stronger book than its predecessors. More specifically, we

• Replaced old references with more recent ones

• Reorganized many sections of chapters to improve the flow of information

• Added several new tables and figures to aid students’ understanding of difficult concepts

• Highlighted the biopsychosocial approach to health psychology, examining issues and data from a biological, psychological, and social viewpoint

• Drew from the growing body of research from around the world on health to give the book a more international perspective

• Recognized and emphasized gender issues whenever appropriate

• Retained our emphasis on theories and models that strive to explain and predict health-related behaviors

Writing Style

With each edition, we work to improve our connection with readers. Although this book explores complex issues and difficult topics, we use clear, concise, and comprehensible language and an informal, lively writing style. We write this book for an upper-division undergraduate audience, and it should be easily understood by students with a minimal background in psychology and biology. Health psychology courses typically draw students from a variety of college majors, so some elementary material in our book may be repetitive for some students. For other students, this material will fill in the background they need to comprehend the information within the field of health psychology.

Technical terms appear in boldface type, and a definition usually appears at that point in the text. These terms also appear in an end-of-book glossary.

Instructional Aids

Besides the glossary at the end of the book, we supply several other features to help both students and instructors. These include stories of people whose behavior typifies the topic, frequent summaries within each chapter, and annotated suggested readings.

Within-Chapter Summaries

Rather than wait until the end of each chapter to present a lengthy chapter summary, we place shorter summaries at key points within each chapter. In general, these summaries correspond to each major topic in a chapter. We believe these shorter, frequent summaries keep readers on track and promote a better understanding of the chapter’s content.

Annotated Suggested Readings

At the end of each chapter are three or four annotated suggested readings that students may wish to examine. We chose these readings for their capacity to shed additional light on major topics in a chapter. Most of these

suggested readings are quite recent, but we also selected several that have lasting interest. We include only readings that are intelligible to the average college student and that are accessible in most college and university libraries.

MindTap® Psychology: We now provide MindTap® in the 9th edition. MindTap for Health Psychology 9th Edition is the digital learning solution that helps instructors engage and transform today’s students into critical thinkers. Through paths of dynamic assignments and applications that you can personalize, real-time course analytics, and an accessible reader, MindTap helps you turn cookie cutter into cutting edge, apathy into engagement, and memorizers into higher-level thinkers. As an instructor using MindTap you have at your fingertips the right content and unique set of tools curated specifically for your course all in an interface designed to improve workflow and save time when planning lessons and course structure. The control to build and personalize your course is all yours, focusing on the most relevant material while also lowering costs for your students. Stay connected and informed in your course through real-time student tracking that provides the opportunity to adjust the course as needed based on analytics of interactivity in the course.

Online Instructor’s Manual: We provide an online instructor’s manual, complete with lecture outlines, discussion topics, suggested activities, media tools, and video recommendations.

Online PowerPoints: Microsoft PowerPoint® slides are provided to help you make your lectures more engaging while effectively reaching your visually oriented students. The PowerPoint® slides are updated to reflect the content and organization of the new edition of the text.

Cengage Learning Testing, powered by Cognero®: Cengage Learning Testing, Powered by Cognero®, is a flexible online system that allows you to author, edit, and manage test bank content. You can create multiple test versions in an instant and deliver tests from your LMS in your classroom.

Acknowledgments

We would like to thank the people at Cengage Learning for their assistance: Marta-Lee Perriard, Product Director, Star Burruto, Product Team Manager, Katie Chen, Product Assistant, and Reba Frederics, Intellectual Property Manager. Special thanks go to Linda Man, our

Content Developer and to Joseph Malcolm who led us through the production at Lumina.

We are also indebted to a number of reviewers who read all or parts of the manuscript for this and earlier editions. We are grateful for the valuable comments of the following reviewers:

Sangeeta Singg, Angelo State University

Edward Fernandes, Barton College

Ryan May, Marietta College

Erin Wood, Catawba College

Linda notes that authors typically thank their spouses for being understanding, supportive, and sacrificing, and her spouse, Barry Humphus, is no exception. He made contributions that helped to shape the book and provided generous, patient,

live-in, expert computer consultation and tech support that proved essential in the preparation of the manuscript.

Linda also acknowledges the huge debt to Jess Feist and his contributions to this book. Jess was last able to work on the sixth edition, and he died in February, 2015. His work and words remain as a guide and inspiration for her and for John; this book would not have existed without him.

John also thanks his wife, Alanna, for her support throughout the process and his two children for always asking about the book, even though they rarely comprehended what he told them about it. John thanks all of his past undergraduate students for making health psychology such a thrill to teach. This book is dedicated to them and to the future generation of health psychology students.

a bout the autho RS

Linda Brannon is a professor in the Department of Psychology at McNeese State University in Lake Charles, Louisiana. Linda joined the faculty at McNeese after receiving her doctorate in human experimental psychology from the University of Texas at Austin.

Jess Feist was Professor Emeritus at McNeese State University. He joined the faculty after receiving his doctorate in counseling from the University of Kansas and stayed at McNeese until he retired in 2005. He died in 2015.

In the early 1980s, Linda and Jess became interested in the developing field of health psychology, which led to their coauthoring the first edition of this book. They watched the field of health psychology emerge and grow, and the subsequent editions of the book reflect that growth and development. Their interests converge in the area of health psychology but diverge in other areas of psychology.

Jess carried his interest in personality theory to his authorship of Theories of Personality, coauthored with his son Greg Feist. Linda’s interest in gender and gender issues led her to publish Gender: Psychological Perspectives, which is in its seventh edition.

John A. Updegraff is a professor of social and health psychology in the Department of Psychological Sciences at Kent State University in Kent, Ohio. John received his PhD in social psychology at University of California, Los Angeles, under the mentorship of pioneering health psychologist Shelley Taylor. John then completed a postdoctoral fellowship at University of California, Irvine, prior to joining the faculty at Kent State.

John is an expert in the areas of health behavior, health communication, stress, and coping, and is the recipient of multiple research grants from the National Institutes of Health. His research appears in the field’s top journals.

John stays healthy by running the roads and trails near his home. John is also known for subjecting students and colleagues to his singing and guitar playing (go ahead, look him up on YouTube).

CHAPTER 1

Introducing Health Psychology

CHAPTER OUTLINE

■ Real-World Profile of Angela Bryan

■ The Changing Field of Health

■ Psychology’s Relevance for Health

■ The Profession of Health Psychology

QUESTIONS

This chapter focuses on three basic questions:

1. How have views of health changed?

2. How did psychology become involved in health care?

3. What type of training do health psychologists receive, and what kinds of work do they do?

Real-World Profile of ANGELA BRYAN

Health psychology is a relatively new and fascinating field of psychology. Health psychologists examine how people’s lifestyles influence their physical health. In this book, you will learn about the diverse topics, findings, and people who make up this field.

First, let’s introduce you to Angela Bryan, a health psychologist from the University of Colorado Boulder. Angela develops interventions that promote healthy behavior such as safe sex and physical activity. Angela has won several awards for her work, including recognition that one of her interventions is among the few that work in reducing risky sexual behavior among adolescents (“Safe on the Outs”; Centers for Disease Control and Prevention [CDC], 2011b).

As an adolescent, Angela thought of herself as a “rebel” (Aiken, 2006), perhaps an unlikely start for someone who now develops ways to help people to maintain a healthy lifestyle. It was not until college that Angela discovered her passion for health psychology. She took a course in social psychology, which explored how people make judgments about others. Angela quickly saw the relevance for understanding safe sex behavior. At this time, the HIV/AIDS epidemic was peaking in the United States, and condom use was one action people could take to prevent the spread of HIV. Yet, people often resisted proposing condoms to a partner, due to concerns such as “What will a partner think of me if I say that a condom is needed?” Angela sought out a professor to supervise a research project on perceptions of condom use in an initial sexual encounter.

Angela continued this work as a PhD student and developed a program to promote condom use among college women. In this program, Angela taught women skills for proposing and using condoms. This work was not always easy. She recalls, “I would walk through the residence halls on my way to deliver my intervention, with a basket of condoms in one arm and a basket of zucchinis in the other. I can’t imagine what others thought I was doing!”

Later, she expanded her work to populations at greater risk for HIV, including incarcerated adolescents, intravenous drug users, HIV+ individuals, and truck drivers in India. She also developed an interest in promoting physical activity.

In all her work, Angela uses the biopsychosocial model, which you will learn about in this chapter. Specifically, she identifies the biological, psychological, and social factors that influence health behaviors such as condom use. Angela’s interventions address each of these factors.

Angela’s work is both challenging and rewarding. She works on a daily basis with community agencies, clinical psychologists, neuroscientists, and exercise physiologists. She uses solid research methods to evaluate the success of her interventions. More recently, she has started to examine the genetic factors that determine whether a person will respond to a physical activity intervention.

Although she views many aspects of her work as rewarding, one aspect is especially worthwhile: “When the interventions work!” she says. “If we can get one kid to use a condom or one person with a chronic illness to exercise, that is meaningful.”

In this book, you will learn about the theories, methods, and discoveries of health psychologists such as Angela Bryan. As you read, keep in mind this piece of advice from Angela: “Think broadly and optimistically about health. A health psychologist’s work is difficult, but it can make a difference.”

Courtesy Angela Bryan

The Changing Field of Health

“We are now living well enough and long enough to slowly fall apart” (Sapolsky, 1998, p. 2).

The field of health psychology developed relatively recently—the 1970s, to be exact—to address the challenges 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 diphtheria—was short; a person either died or got well in a matter of weeks. People felt very limited responsibility for contracting a contagious disease because such 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 living past their 100th birthday. Over 30 countries boast even longer life expectancy than the United States, with Japan boasting the longest life expectancy at 84 years of age. Public sanitation for most citizens of industrialized nations is vastly better than it was a century ago. Vaccines and treatments exist for many infectious diseases. However, improvements in the prevention and treatment of infectious diseases allowed for a different class of disease to emerge as today’s killers: chronic diseases. Heart disease, cancer, and stroke—all chronic diseases—are now the leading causes of mortality in the United States and account for a greater proportion of deaths than infectious diseases ever did. Chronic diseases develop and then persist or recur, affecting people over long periods of time. Every year, over 2 million people in the United States die from chronic diseases, but over 130 million people—almost one out of every two adults—live with at least one chronic disease.

Furthermore, most deaths today are attributable to diseases associated with lifestyle and behavior. Heart disease, cancer, stroke, chronic lower respiratory diseases (including emphysema and chronic bronchitis), unintentional injuries, and diabetes are all due in part to cigarette smoking, alcohol abuse, unhealthy eating, stress,

and a sedentary lifestyle. Because the major killers today arise in part due to lifestyle and behavior, people have a great deal more control over their health than they did in the past. However, many people do not exercise this control, so unhealthy behavior is an important public health problem. Indeed, unhealthy behavior contributes to the escalating costs of health care.

In this chapter, we describe the changing patterns of disease and disability and the increasing costs of health care. We also discuss how these trends change the very definition of what health is and require a broader view of health than in the past. This broad view of health is the biopsychosocial model, a view adopted by health psychologists such as Angela Bryan.

Patterns of Disease and Death

The 20th century brought about major changes in the patterns of disease and death in the United States, including a shift in the leading causes of death. Infectious diseases were leading causes of death in 1900, but over the next several decades, chronic diseases such as heart disease, cancer, and stroke became the leading killers.

During the first few years of the 21st century, deaths from some chronic diseases—those related to unhealthy lifestyles and behaviors—began to decrease. These diseases include heart disease, cancer, and stroke, which all were responsible for a smaller proportion of deaths in 2010 than in 1990. Why have deaths from these diseases decreased in the last few decades? We will discuss this in greater detail in Chapter 9, but one major reason is that fewer people in the United States now smoke cigarettes than in the past. This change in behavior contributed to some of the decline in deaths due to heart disease; improvements in health care also contributed to this decline.

Death rates due to unintentional injuries, suicide, and homicide have increased in recent years (Kung, Hoyert, Xu, & Murphy, 2008). Significant increases also occurred in Alzheimer’s disease, kidney disease, septicemia (blood infection), liver disease, hypertension, and Parkinson’s disease. For many of these causes of death that have recently increased, behavior is a less important component than for those causes that have decreased. However, the rising death rates due to Alzheimer’s and Parkinson’s disease reflect another important trend in health and health care: an increasingly older population.

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 2013,” 2016, by Xu, J., Murphy, S. L., Kochanek, K. D., & Bastian, B. A., National Vital Statistics Reports, 64(2), Table B.

Age Obviously, older people are more likely to die than younger ones, but the causes of death vary among age groups. Thus, the ranking of causes of death for the entire population may not reflect any specific age group and may lead people to misperceive the risk for some ages. For example, cardiovascular disease (which includes heart disease and stroke) and cancer account for over 50% of all deaths in the United States, but they are not the leading cause of death for young people. For individuals between 1 and 44 years of age, unintentional

injuries are the leading cause of death, and violent deaths from suicide and homicide rank high on the list as well (National Center for Health Statistics [NCHS], 2016a). Unintentional injuries account for 30% of the deaths in this age group, suicide for almost 12%, and homicide for about 8%. As Figure 1.2 reveals, other causes of death account for much smaller percentages of deaths among adolescents and young adults than unintentional injuries, homicide, and suicide.

For adults 45 to 64 years old, the picture is quite different. Cardiovascular disease and cancer become the leading causes of death. As people age, they become more likely to die, so the causes of death for older people dominate the overall figures for causes of death. However, younger people show very different patterns of mortality.

Ethnicity, Income, and Disease Question 2 from the quiz inside the front cover asks if the United States is among the top 10 nations in the world in terms of life

expectancy. It is not even close; it ranks 34th among all nations (World Health Organization [WHO], 2015c). Within the United States, ethnicity is also a factor in life expectancy, and the leading causes of death also vary among ethnic groups. Table 1.1 shows the ranking of the 10 leading causes of death for four ethnic groups in the United States. No two groups have identical profiles of causes of death, and some causes do not appear on the list for each group, highlighting the influence of ethnicity on mortality.

If African Americans and European Americans in the United States were considered to be different nations, European America would rank higher in life expectancy than African America—34th place and 68th place, respectively (NCHS, 2016; WHO, 2015c). Thus, European Americans have a longer life expectancy than African Americans, but neither should expect to live as long as people in Japan, Canada, Iceland, Australia, the United Kingdom, Italy, France, Hong Kong, Israel, and many other countries.

FIGURE 1.2 leading causes of death among individuals aged 5–14, 15–24, and 25–44, united states, 2013.

Source: “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.

*Not among the 10 leading causes of death for this ethnic group.

Source: “Deaths: Leading causes for 2013,” 2016, by M. Heron, National Vital Statistics Reports, 65(2), Tables D and E.

Hispanics have socioeconomic disadvantages similar to those of African Americans (U.S. Census Bureau [USCB], 2011), including poverty and low educational level. About 10% of European Americans live below the poverty level, whereas 32% of African Americans and 26% of Hispanic Americans do (USCB, 2011). European Americans also have educational advantages: 86% receive high school diplomas, compared with only 81% of African Americans and 59% of Hispanic Americans. These socioeconomic disadvantages translate into health disadvantages (Crimmins, Ki Kim, Alley, Karlamangla, & Seeman, 2007; Smith & Bradshaw, 2006). That is, poverty and low educational level both relate to health problems and lower life expectancy. Thus, some of the ethnic differences in health are due to socioeconomic differences.

Access to health insurance and medical care are not the only factors that make poverty a health risk. Indeed, the health risks associated with poverty begin before birth. Even with the expansion of prenatal care by Medicaid, poor mothers, especially teen mothers, are more likely to deliver low-birth-weight babies, who are more likely than normal-birth-weight infants to die (NCHS, 2016). Also, pregnant women living below the poverty line are more likely than other pregnant women to be physically abused and to deliver babies who suffer the

consequences of prenatal child abuse (Zelenko, Lock, Kraemer, & Steiner, 2000).

The association between income level and health is so strong that it appears not only at the poverty level but also at higher income levels. That is, very wealthy people have better health than people who are just, well, wealthy. Why should very wealthy people be healthier than other wealthy people? One possibility comes from the relation of income to educational level, which, in turn, relates to occupation, social class, and ethnicity. The higher the educational level, the less likely people are to engage in unhealthy behaviors such as smoking, eating a high-fat diet, and maintaining a sedentary lifestyle (see Would You Believe ...? box). Another possibility is the perception of social status. People’s perception of their social standing may differ from their status as

by educational, occupational, and income level, and remarkably, this perception relates to health status more strongly than objective measures (Operario, Adler, & Williams, 2004). Thus, the relationships between health and ethnicity are intertwined with the relationships between health, income, education, and social class.

Changes in Life Expectancy During the 20th century, life

Would You BELIEVE...? College Is Good for Your Health

Would you believe that attending college could be good for your health? You may find that difficult to believe, as college seems to add stress, exposure to alcohol or drugs, and demands that make it difficult to maintain a healthy diet, exercise, and sleep. How could going to college possibly be healthy?

The health benefits of college appear after graduation. People who have been to college have lower death rates than those who have not. This advantage applies to both women and men and to infectious diseases, chronic diseases, and unintentional injuries (NCHS, 2015). Better educated people report fewer daily symptoms and less stress than less educated people (Grzywacz, Almeida, Neupert, & Ettner, 2004).

Even a high school education provides health benefits, but going to college offers much more protection. For example, people with less than a high school education die at a rate of 575 per 100,000; those with a high school degree die at a rate of 509

per 100,000; but people who attend college have a death rate of only 214 per 100,000 (Miniño, Murphy, Xu, & Kochanek, 2011). The benefits of education for health and longevity apply to people around the world. For example, a study of older people in Japan (Fujino et al., 2005) found that low educational level increased the risk of dying. A large-scale study of the Dutch population (Hoeymans, van Lindert, & Westert, 2005) also found that education was related to a wide range of health measures and health-related behaviors. What factors contribute to this health advantage for people with more education? Part of that advantage may be intelligence, which predicts both health and longevity (Gottfredson & Deary, 2004). In addition, people who are well educated tend to live with and around people with similar education, providing an environment with good healthrelated knowledge and attitudes (Øystein, 2008). Income and occupation may also contribute (Batty et al., 2008); people who attend

and other industrialized nations. In 1900, life expectancy was 47.3 years, whereas today it is almost 79 years (NCHS, 2016). In other words, infants born today can expect, on average, to live more than a generation longer than their great-great-grandparents born at the beginning of the 20th century.

What accounts for the 30-year increase in life expectancy during the 20th century? Question 3 from the quiz inside the front cover asks if advances in medical care were responsible for this increase. The answer is “False”; other factors have been more important than medical care of sick people. The single most important contributor to the increase in life expectancy is the lowering of infant mortality. When infants die before their first birthday, these deaths lower the population’s

college, especially those who graduate, have better jobs and higher average incomes than those who do not, and thus are more likely to have better access to health care. In addition, educated people are more likely to be informed consumers of health care, gathering information on their diseases and potential treatments. Education is also associated with a variety of habits that contribute to good health and long life. For example, people with a college education are less likely than others to smoke or use illicit drugs (Johnston, O’Malley, Bachman, & Schulenberg, 2007), and they are more likely to eat a low-fat diet and to exercise.

Thus, people who attend college acquire many resources that are reflected in their lower death rate— income potential, health knowledge, more health-conscious spouses and friends, attitudes about the importance of health, and positive health habits. This strong link between education and health is one clear example of how good health is more than simply a matter of biology.

average life expectancy much more than do the deaths of middle-aged or older people. As Figure 1.3 shows, infant death rates declined dramatically between 1900 and 1990, but little decrease has occurred since that time. Prevention of disease also contributes to the recent increase in life expectancy. Widespread vaccination and safer drinking water and milk supplies all reduce infectious disease, which increases life expectancy. A healthier lifestyle also contributes to increased life expectancy, as does more efficient disposal of sewage and better nutrition. In contrast, advances in medical care—such as antibiotics and new surgical technology, efficient paramedic teams, and more skilled intensive care personnel—play a surprisingly minor role in increasing adults’ life expectancy.

20102013

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.

Escalating Cost of Medical Care

The second major change within the field of health is the escalating cost of medical care. In the United States, medical costs have increased at a much faster rate than inflation, and currently the United States spends the most of all countries on health care. Between 1960 and 2008, medical costs in the United States represented a larger and larger proportion of the gross domestic product (GDP). Since 1995, the increases have slowed, but medical care costs as a percentage of the GDP are over 16% (Organisation for Economic Co-operation and Development [OECD], 2015). Considered on a per person basis, the total yearly cost of health care in the United States increased from $1,067 per person in 1970 to $7,826 in 2013 (NCHS, 2015), a jump of more than 700%!

These costs, of course, have some relationship to increased life expectancy: As people live to middle and old age, they tend to develop chronic diseases that require extended (and often expensive) medical treatment. Nearly half of people in the United States have a chronic condition (Ward, Schiller, & Goodman, 2012),

and they account for 86% of the dollars spent on health care (Gerteis et al., 2014). People with chronic conditions account for 88% of prescriptions written, 72% of physician visits, and 76% of hospital stays. Even though today’s aging population is experiencing better health than past generations, their increasing numbers will continue to increase medical costs.

One strategy for curbing mounting medical costs is to limit services, but another approach requires a greater emphasis on the early detection of disease and on changes to a healthier lifestyle and to behaviors that help prevent disease. For example, early detection of high blood pressure, high serum cholesterol, and other precursors of heart disease allow these conditions to be controlled, thereby decreasing the risk of serious disease or death. Screening people for risk is preferable to remedial treatment because chronic diseases are quite difficult to cure and living with chronic disease decreases quality of life. Avoiding disease by adopting a healthy lifestyle is even more preferable to treating diseases or screening for risks. Staying healthy is typically

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Bishop and Knight of the Poor, and the divided cloak and sword are his special symbols. The Memorial Day for St. Martin is kept on November 11.

The Chapel of St. Martin of Tours (15 on plan), designed by Messrs. Cram & Ferguson, is in early 13th century Gothic Architecture; about the same size as the Chapel of St. Ambrose; and cost about $150,000. Its interior walls are faced with light colored Bedford, Ind. limestone. The lower half of the walls is occupied by Gothic arcatures, in the trefoiled arches of which are fleurs de lis. Under the fleurs de lis, in mediaeval text, runs the inscription:

(Left side:) “They that ǁ be wise ǁ shall shine ǁ as the bright- ǁ ness of ǁ the firm- ǁ ament ǁ and they ǁ that turn ǁ many to ǁ righteous-ǁ ness as the ǁ stars forever ǁ and ever ǁ (Right side:) The Peace ǁ of God which ǁ passeth ǁ all under- ǁ standing ǁ shall keep ǁ your hearts ǁ and minds ǁ through ǁ Christ ǁ Jesus ”

A little above the arcature is a border of roses. The upper half of the side walls presents a unique feature in a sort of triforium gallery built in the thickness of the wall. The pavement of Knoxville, Tenn. pink marble is bordered with black Belgian marble. The simple marble Altar in the form of a table resting on red marble pillars has no reredos. The Seven Windows, three in the Sanctuary and four in the clerestory, by Mr Charles Connick of Boston, Mass., are of grisaille[37] work in geometrical designs, the Sanctuary windows being inset with pictorial medallions in painted mosaic glass in the mediaeval style. In the central window over the Altar the medallions depict scenes in the life of St. Martin as follows, beginning at the bottom and reading upward: In the left-hand light (1) St. Martin receives sword and enters army; (2) divides his cloak with the beggar; (3) has vision of Christ wearing the severed cloak which he had given to the beggar; and (4) is baptized. In the middle light, (1) He converts the robber; (2) revives the dead man; (3) is affectionately welcomed on his return to Tours; and (4) destroys the heathen temple. In the righthand light, (1) He intercedes with Count Avitianus for the release of prisoners; (2) pleads for Priscillian’s life; (3) dies; and (4) the ship bearing his body is mysteriously propelled. In the middle light of the window at the left of the Altar are scenes in the life of St. Louis: (1) His coronation; (2) his release of prisoners at Paris; (3) his ministration to sick soldiers during the first Crusade; and (4) his departure on the second Crusade. In the middle light of the window at the right of the Altar are scenes in the life of Joan of Arc: (1) Her vision; (2) the capture of Orleans; (3) the coronation of Charles VII.; and (4) her martyrdom at the stake. In the circular lights at the top of the seven windows are the following coats-of-arms (left to right): (1) On a blue field, three golden fleurs de lis above a white wreath of oak and laurel with red fruit, representing the City of Rheims.[38] (2) On a blue field sprinkled with golden fleurs de lis, the Mother and Child, representing the Cathedral of Notre Dame in Paris. (3) Seven horizontal bars, alternately blue and gold, being the arms of Bertrand d’Eschaux, Archbishop of Tours. (4) On a blue field, a white Latin cross with trefoiled ends, being the arms of the Chapter of Poitiers. (5) On a blue cloak surrounded by red, a white sword, cross-hilt upward, emblematic of St. Martin. (6) On a blue field sprinkled with golden fleurs de lis, a red Greek cross, representing

the Archdiocese of Rheims.[39] (7) On a blue field, three golden fleurs de lis under a white “label” or mark of cadency of eldest son,[40] being the royal arms of the Dukes of Orleans. A Statue of Joan of Arc, expressing her spiritual character, by Miss Anna Vaughn Hyatt, was placed in this chapel in 1922. It was given by Mr. J. Sanford Saltus through Dr. George F. Kunz, President of the Joan of Arc Statue Committee which erected the equestrian statue of the Maid by the same sculptress in Riverside Drive. Near it are two rough stones from the Chateau de Rouen in which the Maid was imprisoned at the time of her trial and from which she was led to the stake. The wrought-iron Screen of beautiful tracery at the entrance, designed in the office of Messrs. Cram & Ferguson and made by Messrs. F Krasser & Co., of Boston, is a particularly lovely example of this form of art. While not copied from any existing mediaeval prototype, it shows the influence of the wrought-iron work of the Romanesque and early Gothic periods of France. The shell ornament in the section below the cornice is symbolical of St. Martin as a pilgrim, while the finials and cresting, blossoming with roses, signify the flowering of the Christian religion. In the frieze are four panels depicting four scenes which are described in a quaintly lettered inscription in the moulding above:

“S Martin shares cloak with Beggar ǁ Our Lord appears in cloak to S Martin ǁ S Martin receives holy baptism ǁ Saint Martin journeys to Rome.”

An inscription on the wall of the chapel reads:

Coats of Arms in Windows of Chapel of St. Martin of Tours.

“The Chapel of ǁ Saint Martin of Tours ǁ Consecrated 1918 ǁ To the worship of ǁ Almighty God ǁ and in Loving Memory of ǁ William P. Furniss ǁ and His Wife ǁ Sophia Furniss ǁ and their Daughter ǁ Sophia R C Furniss ”

In another panel is this inscription:

“To the ǁ Glory of God ǁ and in Loving Memory of ǁ Clementina Furniss ǁby Whose Gift ǁ this Chapel ǁ was Erected ǁ and ǁ Margaret Elizabeth Zimmerman ǁ Daughters of ǁ William P Furniss ǁ and his wife ǁ Sophia Furniss ”

The Chapel of St. Saviour

S S, the name of this chapel, means Holy Saviour, the word Saint being used in its primary sense as an adjective, derived from the Latin “sanctus.”

The Memorial Day for St. Saviour is kept on December 25.

The Chapel of St. Saviour (16 on plan,) is the easternmost of the seven Chapels of Tongues and forms the eastern extremity of the Cathedral. Among the languages in which services are held in this chapel are Japanese and Chinese. When the royal Abyssinian Commission to the United States Government was formally received at the Cathedral on July 24, 1919, its members knelt at this altar. The chapel is in the English Decorated Gothic style of Architecture after designs by Messrs. Heins & LaFarge. It is 56 feet long and 30½ feet wide, seats 150 persons, and cost about $200,000. Its interior walls are of Minnesota dolomite, around the base of which runs a foundation course of red jasper with green serpentine moulding like those which run around the Choir The pavement is of stone from Hauteville, France, with a mosaic border The Sanctuary steps are of pink marble from Georgia. The Altar, made by Messrs. Batterson & Eislie and carved by Mr Schwartz, is of snow-white Carrara marble. Its face and front corners are adorned by the figures of six angels singing “Holy, Holy, Holy.” Carved on the face of the retable is the crown of thorns, supported by two cherubs. The Reredos is of polished red Siena marble, bordered with Venetian mosaic. The Chair and Prayer Desk of black walnut at the left side of the Sanctuary have an interesting history recited on a brass tablet on the desk as follows:

“The first use of ǁ this chair and prayer desk was made by ǁ the Most Reverend Randall Thomas Davidson, D D , ǁ Archbishop of Canterbury ǁ in the Crypt of the Cathedral of St John the Divine ǁ on Wednesday morning, September 28th, A D 1904 ǁ at the celebration of the Holy Communion at which ǁ His Grace was the celebrant and which preceded the ǁ opening of the One hundred and twenty-first Convention ǁ of the Diocese of New York, being also the first opening ǁ of the Diocesan Synod Hall ”

The East Window, a glorious work in stained glass by Mr. Hardman of Birmingham, Eng., completely fills the end of the chapel. Its central light is occupied by a representation of the Transfiguration (Mat. xvii. 1-3). In the middle of the scene is the radiant Saviour, with Moses (left) holding the Ten Commandments, and Elias

(right) holding the receptacle of the scrolls, representing respectively the Law and the Prophets.[41] Surrounding the group are angels; and below it are the three Disciples who were with Jesus on the mount: St. Peter (left) looking up, St. James (middle) covering his eyes, and St. John, the beardless Disciple (right), shading his face. In the left side light, above, is Moses putting off his shoes on the holy ground before the burning bush from which the angel of the Lord appears (Ex. iii. 5); and below, Moses raising the brazen serpent for healing (Num. xxi. 9). The serpent, seen indistinctly coiled around the pole, is by artistic license represented in green. In the right side light, above, is the angel appearing to Elijah (I. Kings xix. 5-8); and below, Elijah’s sacrifice miraculously consumed by the fire of the Lord (I. Kings xviii. 30-38). In niches on either side of the window are the following Statues of Bishops, saints and scholars of the Eastern church: Left. Right.

St. Polycarp b. 69 d. 155

Bishop of Smyrna

St. Athanasius b. 296 d. 373 Primate of Egypt

Origen

b. 185 d. 253

Great eastern scholar

St. Gregory Nazianzen

b. 330 d. 389 Bishop of Nazianzus

St. Chrysostom b. 347 d. 407 Archbp. of Constantinople

St. Basil

b. 329 d. 379 Bishop of Caesarea

St. Clement of Alexandria b. circ. 150 d. 213-220

Celebrated Church Father

St. Ignatius

b. circ. 50 d. 107 Bishop of Antioch

In a niche in the upper part of the north wall is a statue of St. Peter with key; and in a corresponding niche in the south wall one of St. Paul with sword. Turning toward the entrance to the chapel, one sees in niches between the clustered columns at the sides of the great archway in array of angels, five on each side, one above the other, corresponding to as many on the Ambulatory side,—twenty in all— representing the Heavenly Choir. These lovely figures are worthy of more than passing notice. All the statuary is by Mr. Gutzon Borglum. The four Lamp Standards of Carrara marble surmounted by alabaster bowls standing in the four corners of the chapel, and carved in relief with many symbolical details, were made by Messrs. E. F Caldwell & Co. and carved by Messrs. F Ruggeri and P Giuntini of New York. The elaborate wrought iron Screen, made by the Wm. H. Jackson Co. of New York, at the entrance, is in the Italian style after one in Orvieto, Italy It is embellished in its upper part by two golden angels holding a wreath at the foot of the cross. Looking

outward through the screen, one sees the back of the High Altar of the Cathedral. On one of the walls of the chapel is inscribed:

“This Chapel is Erected to ǁ the Glory of God ǁ and in Loving Memory of ǁ Bessie Morgan Belmont ǁ by her Husband ǁ August Belmont ”

The Chapel of St. Columba

S C was born in County Donegal, Ireland, in 521, of royal blood. After study and religious work in Ireland, he set out in 563 with twelve disciples and planted upon the Island of Iona, on the west coast of Scotland, which he received from his kinsman Conal, King of Scots, a monastery which, from the 6th to the 8th centuries, was second to hardly any other in Great Britain. From it was conducted a wonderful missionary work in Scotland, Ireland, the north of England, and small adjacent islands. Many miracles are attributed to him, and he was accredited with power to subdue not only wild tribes of men but also the beasts of the wilderness (see p. 32). He died in 597, and his body was buried at Iona, which is regarded as one of the great shrines of Christianity in Great Britain. The Memorial Day for St. Columba is kept on June 9.

The Chapel of St. Columba, (17 on plan), designed by Messrs. Heins & LaFarge, is in the Norman style of Architecture It is 50 feet long and 27 wide, seats 100 persons, and cost about $150,000. The interior walls are of Minnesota dolomite, separated from a base course of polished Mohegan granite by a moulding of yellow Verona marble. The pavement is a fine grained gray stone from Illinois. The semicircular arched window heads, and particularly the six large cylindrical pillars diversified by spiral and diaper patterns, convey the idea of the Norman style which one sees exemplified on a larger scale in Durham Cathedral and other churches of that period in England. The vaulting over the Sanctuary is lined with gold mosaic, upon which appear black and white Celtic crosses. The lectern, communion rail, Glastonbury chairs, and other wood work of the Sanctuary were designed by Mr. Charles R. Lamb and made by J. & R. Lamb of New York. They are carved in low relief with ornament expressive of English Gothic feeling. The lectern shows a composition of three figures: Christ in the center, between John the Baptist, his Forerunner, and St. John the Divine, namesake of the Cathedral, who closes the biblical record with the Book of Revelation. The Altar, of cream colored Italian marble, is in the form of a table supported by marble pillars. It has no Reredos. The Sanctuary Windows, three in number, were made by Messrs. Clayton & Bell of London. In the central light of the window above the Altar is represented the baptism of Christ by John the Baptist, and in the side lights are St. John with cup (left), and St. Paul with sword, (right.) In the bottom of the three lights are the four symbols previously explained (p. 74), namely, the ΙΗϹ, the Alpha, the Omega, and the Chi Rho. The windows on either side of the middle window are in grisaille, copied from the famous lancet windows called the Five Sisters in the North Transept of York Cathedral, although these windows have only two lights each

instead of five. The six wonderfully graceful seven-branched Candelabra, after Donatello, were brought from Italy by Mr George Gordon King. Turning toward the entrance, in which is a wrought iron Screen in the Spanish style, designed by Mr Samuel Yellen and made by the Industrial Ornamental Iron Works of Philadelphia, Penn., one sees an extremely interesting feature in the Statues by Mr Gutzon Borglum of representatives of the successive stages of the development of Christianity in England, which stand in the niches between the clustered columns at the sides of the great entrance archway [42]

The figures, five on each side, one above the other, and corresponding to as many on the Ambulatory side,—twenty in all,—are in the following relative positions, it being understood that the left side as seen from the chapel is the same as the right side as seen from the Ambulatory.

Seen from Chapel.

Left.

St. Aidan

Bishop of Northumbrians ac. 635 d. 651

St. Anselm

Archbishop of Canterbury ac. 1093 d. 1109

Thomas Cranmer

Archbishop of Canterbury b. 1489 d. 1556

Joseph Butler

Bishop of Durham b. 1692 d. 1752

John Keble

leader in Oxford movement b. 1792 d. 1866

Left.

St. Alban

promartyr of Britain d. circ. 304

Right.

St. Augustine

Archbishop of Canterbury ac. 597 d. 604

King Alfred King of Wessex b. 849 d. 901

William of Wykeham

Bishop of Winchester ac. 1367 d. 1405

Jeremy Taylor

Bishop of 3 Irish sees b. 1613 d. 1667

Reginald Heber

Bishop of Calcutta b. 1783 d. 1826

Seen from Ambulatory

Right.

Theodore of Tarsus

Archbishop of Canterbury ac. 668 d. 690

The Venerable Bede Stephen Langton

chronicler and priest b. 673 d. 735

John Wyckliffe morning-star of Reformation b. 1325 d. 1384

Richard Hooker Anglican theologian b. 1554 d. 1600

John Wesley evangelical revivalist b. 1703 d. 1791

Archbishop of Canterbury b. 1150 d. 1228

Matthew Parker Archbishop of Canterbury b. 1504 d. 1575

George Berkeley Bishop of Cloyne, etc. b. 1684 d. 1753

Frederic Denison Maurice preacher and leader b. 1805 d. 1872

The Cathedral has in its possession a Stone from the Cathedral, or Church of St. Mary (dating from the 13th-16th centuries) on the Island of Iona, which may fittingly be placed in this chapel at some future time.

Upon the wall of the chapel is inscribed:

“Chapel ǁ of ǁ Saint Columba ǁ To the Glory of God ǁ and ǁ in Loving Memory of ǁ Mary Leroy King ǁ The Gift of Her Mother ǁ Mary Augusta King ǁ Consecrated ǁ April 27th, 1911.”

The Chapel of St. Boniface

S. B, whose original name was Winifred, was born in Devonshire, England, about the year 680. He entered a Benedictine monastery at the age of 13, learned rhetoric, history and theology, and became a priest at the age of 30. At a time when England and Ireland were sending missionaries to the heathen parts of Europe, Winifred was authorized by Pope Gregory II. to preach the Gospel to the tribes of Germany, and he is called the Apostle of Germany. While engaged in this work, Gregory made him a Bishop and gave him the name of Bonifacius, or Boniface, which means Doer of Good. The Bishoprics of Ratisbon, Erfurt, Paderborn, Wurzburg, Eichstadt, Salzburg, and several others, owe their establishment to his efforts. In 746 he was made Archbishop of Mainz. In 755, while carrying on his work in Dokkum, in West Friesland, he and his congregation of converts there were slain by a mob of armed heathen. His remains are buried in the famous abbey of Fulda, which he founded. In art, he is depicted holding a book pierced by a sword, referring to the manner of his death. The Memorial Day for St. Boniface is kept on June 5.

The Chapel of St. Boniface, (18 on plan), designed by Mr. Henry Vaughan, is a very pure specimen of English Gothic Architecture of the 14th century. It is about 48½ feet long and 28 wide, seats about 100 persons, and cost about $175,000. The

interior walls are of Indiana limestone; the pavement of pink marble from Knoxville, Tenn., with heavy black border of Belgian marble; and the steps to the Sanctuary also of pink Knoxville marble The Altar is of gray marble from the same source. In the three ornate panels on its face are the monogram IHS (see p. 74), the floriated Greek cross (see note below), and the Greek cross form of the Chi Rho (p. 74). The richly carved Reredos has three canopied niches, in the central one of which is represented the Adoration of the Magi. In each of the side niches is an angel with scroll. In the recesses of the windows on either side of the Altar are carved clergy stalls of dark oak, with wainscoting of the same wood as high as the window sills. There are six stained glass Windows, three in the Sanctuary and three smaller ones in the clerestory. Each has three lights. In the middle light of the central window above the Altar Christ is represented as the Great Teacher. His robe is sprinkled with the IHS monogram (p. 74) and in His nimbus appear the ends of a floriated cross.[43] Above His head are two angels, and above them the dove, symbolizing the Holy Spirit. Below the figure of Christ is a scene representing Him teaching the multitude. In the left side light is St. Boniface with mitre, archiepiscopal staff,[44] and Bible pierced with sword; and below him a scene representing him hewing down an oak in Geismar accounted sacred by the idolators. In the right side light is St. Paul with sword; and below him a scene representing him preaching to the men of Athens. In the left window of the Sanctuary are three figures with scenes below as follows (left to right): St. Birinus, Bishop of Dorchester, holding a monstrance, and (below) St. Birinus baptizing King Cynegils of the West Saxons; St. Augustine of Canterbury with archiepiscopal staff, holding a tablet representing the crucifixion, and (below) St. Augustine announcing the Word of Life to King Ethelbert; and St. Felix, Bishop of Dunwich, with crozier and torch, and (below) St. Felix receiving the blessing of the Archbishop of Canterbury In the right Sanctuary window, similarly, are: St. Chad, Bishop of Lichfield, holding crozier and model of Lichfield Cathedral, [45] and (below) St. Chad listening to the songs of angels; St. Columba in monastic garb with crozier and with monastery (Iona) at his feet, and (below) St. Columba converting the Picts; and St. Aidan with crozier, and (below) St. Aidan instructing the youthful St. Chad and others. In the west clerestory window are: St. Patrick with crozier ornamented with shamrocks; St. Gregory of Rome with papal staff, holding an open music book displaying the Sursum Corda (referring to him as founder of the Gregorian music), with Pere Marquette below; and St. Martin of Tours with crozier and Bible. In the east wall are two clerestory windows. In the left hand window of the two are: St. Cyprian, Archbishop of Carthage, holding his staff and his best known book concerning Church Unity, or the universal church; St. Ambrose, Bishop of Milan, with crozier and open book displaying the words “Te Deum Laudamus” (we praise Thee, O God,) and pen in hand, with the missionary Robert Hunt below; and St. Augustine, Bishop of Hippo Mundia, with crozier. In the right hand clerestory window in the east wall are: St. Cyril, Patriarch of Alexandria, with book and staff; St. John Chrysostom, Bishop of Constantinople, with staff, chalice and Book of Homilies, with the missionary John Robinson below; and St. Ignatius, Bishop of Antioch, holding a palm. The windows were made by Messrs. C.

E. Kempe & Co. of London. In two canopied niches in the west wall are Statues of Thomas a Becket (left) and St. Boniface (right); and in a niche in the east wall is one of Erasmus. Three wrought iron Lamps are suspended by iron chains from the ceiling; and at the entrance is a handsome wrought iron Screen adorned with escutcheons bearing the ihc monogram and surmounted by a floriated cross before explained. On one of the walls is inscribed:

“The Chapel of St Boniface ǁ Consecrated ǁ February 29, 1916 ǁ Erected to ǁ the Glory of God ǁ by ǁ George Sullivan Bowdoin ǁ and His Wife ǁ Julia Grinnell Bowdoin ǁ and Their Children ǁ Temple Bowdoin ǁ Fanny Hamilton Kingsford ǁ Edith Grinnell Bowdoin ”

Story of the Dove Of Peace During the last year of the World War, an incident interesting in itself and illustrative of the origin of the legends and traditions which often grow up around cathedrals, occurred in connection with the chapel bearing the name of the Apostle of Germany. In the spring of 1918, some weeks after the great German drive of March 21 had begun and before the beginning of the counter-offensive of the second battle of the Marne in July, the large stained glass window in the clerestory of the Choir above the entrance to the Chapel of St. Boniface arrived from England. All the ventilation openings in the Cathedral windows are screened to exclude birds, which, however interesting in their natural habitats, are a practical nuisance in the Cathedral. When the stained glass window above mentioned arrived, the temporary window filling the space above the entrance to the chapel was removed for its installation. While the window was thus open, and at a period in the war when the issue trembled in the balance and the world fairly held its breath in fearful expectation of the event, a white dove,—very generally recognized as a symbol or harbinger of Peace—flew into the Cathedral over this chapel. On the following Sunday it soared around in the great dome of the Crossing and in the Choir, alighting in the most interesting places. When Dean Robbins ascended the stairs of the great marble pulpit, he found the dove perched on the edge of the pulpit directly before him. The dove then flew down and alighted on the back of a vacant chair between two occupied chairs in the midst of the congregation on the south side of the Crossing, and there remained quietly during the sermon. When the ushers started toward the Altar with the offertory, the bird soared across the congregation and alighted on the hat of a woman dressed in mourning who was sitting near the middle aisle, its snow white plumage contrasting strikingly with the sombre attire of the bereaved woman who seemed not to be disturbed by what perhaps she regarded as a happy omen. In a moment the dove flew to another part of the Crossing. It remained in the Cathedral a few days longer; and then one day, went out through an open door. Soon after this occurrence, the Allies facing the Marne salient, including the Americans at Chateau Thierry, began the great counter-movement which finally brought peace.[46] It was at least an interesting coincidence that this white dove came into the Cathedral over this chapel, at the very crisis of the war, and that almost immediately thereafter began that series of determining events which led the Germans to make overtures for Peace.

The Chapel of St. Ansgarius

S A, or St. Ansgar, was born in Picardy in 801. With his co-laborer Autbert he went to preach Christianity to the northmen of Sleswick. In spite of much persecution, he was so successful that in 831 the Pope established an archbishopric in Hamburg, (afterwards transferred to Bremen,) and Ansgarius was appointed first Archbishop. He made several missionary tours in Denmark, Sweden and other parts of the north, and died at Bremen in 865. He is called the Apostle of the North. The Memorial Day for St. Ansgarius is kept on February 3.

The Chapel of St. Ansgarius (19 on plan), designed by Mr. Henry Vaughan, architect of the Chapel of St. James, is in the same style of Architecture, 14th century Gothic, and about the same size, being 66 feet long and 41 wide, with a seating capacity of 250. It differs, however, from the Chapel of St. James in plan, the bay east of the turret stairs being here thrown into the Ambulatory, while in the Chapel of St. James it is included as a sort of transept; and the north side of the Chapel of St. Ansgarius being divided into only two bays, while the south side of the Chapel of St. James is divided into three. On account of the amount of work required to secure a firm foundation, the Chapel of St. Ansgarius cost about $225,000, making it the most expensive of the seven Chapels of Tongues.

Niche in St Ansgarius Chapel made of old Cathedral Stones

The interior walls are of Indiana limestone; and the pavement of pink Knoxville, Tenn., marble and mottled Vermont marble. The Altar is of gray Knoxville marble. On its front is carved the Madonna of the Chair on the left of which, from the spectator’s standpoint, is St. Michael with sword and on the right St. Gabriel with lilies. In the middle of the sculptured Reredos, (above) is represented Christ holding the globe (symbol of sovereignty), and (below) the baptism of Christ by John the Baptist.

On the left of the figures are St. Ansgarius with crozier (above) and Gustavus Adolphus with sword (below), while on the right are St. Olaf with crown and scepter (above) and Luther in gown with book (below). The Altar and Reredos were given by Mrs. Julia Grinnell Bowdoin. In the left (northern) wall of the Sanctuary is a niche made of stones from Worcester and Ely Cathedrals, England. On the upper surface of the stone bracket forming the shelf of the niche is carved “Ely 1320.” The stones from the Lady Chapel of Worcester Cathedral were given to the Cathedral of St. John the Divine by Canon George William Douglas of New York who procured them from Canon J. M. Wilson, Archdeacon of Worcester.[47] On the stones on either side of the recess is carved:

“These Stones from ǁ the Cathedral ǁ of Christ and ǁ St. Mary the Virgin ǁ Worcester, England, ǁ are Memorials to ǁ William Reed ǁ Huntington ǁ Sometime Rector ǁ of All Saints ǁ in Worcester ǁ Massachusetts ”

Three small Windows of two lights each in the Sanctuary contain (from left to right) representations of: (1) St. Willibrod with mitre, archiepiscopal staff, and model of cathedral; and St. Lucian with crown, scepter and sword; (2) St. Ansgarius with mitre and crozier; and King Olaf with crown and scepter; and (3) above the Reredos, St. Eric with crown and scepter; and St. Wilifred with mitre and archiepiscopal staff. The window spaces at the right of the latter are walled up because they are blanketed by the adjacent chapel. In the two bays of the north aisle are two noble stained glass windows, each having five lights and each light depicting two scenes. In the left hand or western window, the upper tier of scenes is chiefly devoted to Old Testament subjects as follows (left to right): Adam and Eve (Gen. ii. 7-25); the visit of the three angels to Abraham bearing the promise of the birth of Isaac (Gen. xviii. 2-22); St. Michael fighting the dragon with a cross-shaped spear (Rev. xii. 7); Abraham offering to sacrifice Isaac (Gen. xxii. 9-13); and Jacob’s dream of the ladder (Gen. xxviii. 12). In the lower tier are five scenes prophetic of the birth of the Forerunner of Christ and of Christ himself: The angel’s visit to Zacharias to foretell the birth of John the Baptist (Luke i. 13); the annunciation to the Virgin Mary of the coming birth of Christ (Luke i. 28); St. Gabriel with lilies as Angel of the Annunciation (Luke i. 28); the angels’ visit to the shepherds (Luke ii. 812); and the angel’s visit to Joseph, husband of Mary, to foretell the birth of Christ (Mat. i. 20). The right hand or eastern window depicts Acts of the Apostles. In its upper tier are: St. Peter preaching to the Disciples (Acts i. 15); St. Peter healing the lame man (Acts iii. 2-8); St. Peter with key; the stoning of St. Stephen (Acts vii. 59); and St. Philip baptizing the eunuch (Acts viii. 26-38); and in the lower tier: St. Peter

raising Tabitha (Acts ix. 40); the conversion of St. Paul’s jailer at Philippi (Acts xvi. 23-31); St. Paul with sword; St. Paul laying hands on the Disciples (Acts xix. 6); and St. Paul before Felix (Acts xxiv. 24-25). All the windows are by Messrs. C. E. Kempe & Co. of London. In two high niches in the south wall are Statues of Eric, King of Sweden (left) and Canute, King of the English, Danes and Norwegians (right;) and in a niche at the west end of the north aisle is a statue of King Eskiel, all crowned. On the Ambulatory side of the entrance bay are two statues: John the Baptist (above) and St. Ansgarius with crozier and mitre, holding a small cathedral (below). The sculptures are by Mr John Evans of Boston. In a bay of the chapel temporarily rests a symbolic group executed in Caen stone by Miss Malvina Hoffman of New York, entitled The Sacrifice. It is intended for Harvard University at Cambridge, Mass., as a memorial of Robert Bacon, sometime U. S. Ambassador to France and a Trustee of the University, and of the Harvard men who lost their lives in the World War. It represents a dead Crusader, such as those who went from Cambridge, Eng., in the 12th century, and gave their lives for an ideal, lying upon a cross with his head pillowed in a woman’s lap. According to the traditional position of the feet of the Crusader, he was one of those who never reached Jerusalem, those who did so being traditionally represented with their feet crossed. The woman may typify Alma Mater as well as those women who gave their best to a great cause and made their lonely grief their glory. The two figures symbolize mutual sacrifice. This chapel has an independent Organ played from a movable console on the floor. The chapel, which is the gift of many persons, was dedicated on April 3, 1918. On one of the walls is inscribed:

THE SACRIFICE

“The Chapel of Saint Ansgarius ǁ Consecrated April 3, 1918 ǁ to the Worship of ǁ Almighty God ǁ and in Loving Memory of ǁ William Reed Huntington ǁ for 25 Years Rector of Grace Church ǁ and for 22 Years Trustee of this Cathedral.”

The Corner Stone of the Cathedral, which was laid by Bishop Henry C. Potter on St. John’s Day, December 27, 1892, is imbedded in the northwestern pier of the Chapel of St. Ansgarius and is only partly visible in the chamber under the chapel. It is a block of gray Quincy granite, 4 feet 4 inches square and 2 feet 4½ inches thick. Upon the angle of the visible corner are inscribed a Greek cross and “I. H. S. St. John’s Day, Decem. XXVII, A. D. 1892.” It contains, among other things, a fragment of a Spanish Brick from Hispaniola (Hayti) which was given to the Cathedral by Mr. Malcolm McLean, Senior Warden of St. Andrew’s Church, New York City, and upon which is a silver plate inscribed:

“From the Ruin of the First Christian Church in the New World where the First Church was Erected by Christopher Columbus, 1493 Isabella, Hispaniola ”[48]

The Crypt

The Crypt, located beneath the Choir, is closed, pending work on other parts of the Cathedral. And on account of the consequent dampness, the delicate furnishings were removed in September, 1916, and entrusted to the care of Mr. Louis C. Tiffany, who designed them, and who has placed them temporarily in the private chapel on his large country estate at Laurelton, L. I. The Crypt has a seating capacity of 500, and the first services in the Cathedral were held in it from January 8, 1899, until the Choir and Crossing were opened on April 19, 1911. In its furnished state, it contains an Altar, Reredos, font, lectern, and five stained glass windows which were exhibited by Mr. Tiffany at the World’s Fair at Chicago in 1893 and which were called collectively the Tiffany Chapel The top and retable of the Altar are of Carrara marble, while the front and sides are adorned with medallions of mother of pearl, four smaller discs containing emblems of the four Evangelists, a central shield set with sapphires, topazes and mother of pearl, and 150,000 pieces of glass mosaic. The Reredos is of iridescent glass mosaic, as are the twelve Pillars back of the Altar symbolizing the twelve Apostles. The general effect is Byzantine. The Altar, Reredos, font, lectern and windows were given by Mrs. Celia Hermione Wallace in memory of her son. The following interments have been made in the Crypt: The Very Rev. William M. Grosvenor, D.D., Dean of the Cathedral, December 13, 1916; the Right Rev David H. Greer, D.D., eighth Bishop of New York, May 23, 1919; and the Right Rev. Charles S. Burch, D.D., ninth Bishop of New York, December 23, 1920.

Summary Dimensions

Following are the principal dimensions of the Cathedral. As cathedrals are compared in size by their areas, the Cathedral of St. John the Divine will rank, after St. Peter’s at Rome and Seville Cathedral, the third largest in the world.

West Front (including buttresses)

and Aisles (exterior)

of Nave

Nave Vaults (above floor)

Vaults (above floor)

Vault (above floor)

Area of Cathedral

Bishops of New York

Following is a list of the Bishops of New York since the erection of the Diocese:

First: The Right Rev Samuel Provoost, D.D.; born February 24, 1742; Bishop of New York 1787-1815; died September 6, 1815.

Second: The Right Rev Benjamin Moore; born November 5, 1748; Assistant Bishop 1801-1815; Bishop of New York 1815-1816; died February 29, 1816.

Third: The Right Rev John Henry Hobart, D.D.; born September 14, 1775; Assistant Bishop 1811-1816; Bishop of New York 1816-1830; died September 12, 1830.

Fourth: The Right Rev Benjamin Tredwell Onderdonk; born July 15, 1791; Bishop of New York, active 1830-1845, inactive 1845-1861; died April 30, 1861.

Fifth: The Right Rev Jonathan Mayhew Wainwright, D.D., D.C.L.; born February 24, 1792; Provisional Bishop 1852-1854; died September 21, 1854.

Sixth: The Right Rev Horatio Potter, D.D., D.C.L., Oxon.; born February 9, 1802; Provisional Bishop 1854-1861; Bishop of New York 1861-1887; died January 2, 1887.

Seventh: The Right Rev Henry Codman Potter, D.D., LL.D.; born May 25, 1834; Assistant Bishop 1883-1887; Bishop of New York 1887-1908; died July 21, 1908.

Eighth: The Right Rev. David Hummell Greer, D.D., S.T.D., LL.D.; born March 20, 1844; Bishop Coadjutor 1904-1908; Bishop of New York 19081919; died May 19, 1919.

Ninth: The Right Rev. Charles Sumner Burch, D.D., L.H.D., LL.D.; born June 30, 1855; Bishop Suffragan 1911-1919; Bishop of New York 1919-1920; died December 20, 1920.

Tenth: The Right Rev. William Thomas Manning, D.D., LL.D., D.C.L.; born May 12, 1866; Bishop of New York 1921.

Part Three Other Buildings, Etc.

The Bishop’s House

The Bishop’s House (A. on plan) is in French Gothic architecture of the chateau type, with lofty roof and high dormer windows, and is built of Germantown micaceous schist. It is designed to be connected with the Cathedral by cloisters, and is connected with the Deanery by a vaulted porch above which is to be built the Bishop’s private chapel. The extreme outside dimensions of the Bishop’s House are 77 by 126 feet, including the porch. The architects were Messrs. Cram & Ferguson.[49] The occupants of the house have been Bishop Greer from the time of its opening in 1914 until his death May 19, 1919; Bishop Burch from his installation October 28, 1919, until his death December 20, 1920; and Bishop Manning since his consecration on May 11, 1921.

The Deanery

The Deanery (B. on plan) adjoins the Bishop’s House as above mentioned. It is by the same architect, is in the same style but of a more domestic type, forms a part of the same architectural composition, and is built of the same kind of stone. It is not so lofty a structure as the Bishop’s House, but has many interesting details, particularly on the southern façade. Its extreme outside measurements are about 79 by 93 feet. The late Dean Grosvenor occupied the Deanery from the time of its erection until his death December 9, 1916, and was succeeded by Dean Robbins in June, 1917. A tablet in the porch is inscribed:

“The Deanery ǁ erected in ǁ Faithful Remembrance ǁ of ǁ Clinton Ogilvie ǁ 18381900 ǁ by his wife ǁ Helen Slade Ogilvie ǁ A. D. 1913.”

THE BISHOP’S HOUSE

The Choir School

The Choir School (C. on Plan) has a special interest for everyone who goes to the Cathedral, for here are educated and trained the boys who sing in the Cathedral services. The school was founded by Bishop H. C. Potter in 1901 and was formerly located in the Old Synod House. The present building, erected in 1912 and built of the same kind of stone as the Bishop’s House and Deanery, is in the English Collegiate Gothic style of architecture; is three stories high, and has extreme outside dimensions of 83 by 150 feet. Messrs. Walter Cook and Winthrop A. Welch were the architects. The building contains offices, a general school room which is equipped with apparatus for both stereopticon and moving pictures, a choir rehearsal room with stalls, individual rooms for vocal and instrumental practice, a fine large common room with open fire-place for reading and social intercourse, dining room, kitchen, dormitories, a big gymnasium, a sick room to which a boy is transferred upon the first sign of any illness, etc. Accommodations are provided for 40 resident scholars and 20 day scholars. Their musical training is under the personal

direction of the organist and Master of the Choristers, and their general education under the direction of the Head Master and staff of under-masters. A sympathetic House Mother looks out for the personal wants of the boys and directs the domestic service; and competent physicians and trained nurses are in attendance when necessary Boys are admitted to the school at the age of 9 and remain until their voices change, which is usually between the ages of 13 and 14. They come from all parts of the United States and possessions, two boys recently having come from Alaska. An applicant is first received on probation, and if he manifests a good character and disposition, and gives promise of a good voice, he is accepted as a chorister Until they become full choristers, vested with cassock and cotta, probationers sit in separate choir stalls in the Cathedral services and wear only their black student gowns. During their residence at the school, the boys are under strict but gentle discipline and have the finest education and musical training that can be given them. Their board, education and musical training are free, in return for which they give their services as choristers. When they leave the school, they are followed by the interest of the Cathedral organizations which endeavor to secure scholarships for their higher education. The men of the choir, of whom there are about 20, do not reside at the Choir School. The usual number of choristers, men and boys, in the Cathedral services is about 60, except during the summer vacation when the number is somewhat reduced. There is probably no finer choir school in the world, and the Cathedral music is the highest expression of this form of musical art in this country

Health psychology: an introduction to behavior and health linda brannon - Quickly download the ebook

Health Psychology: An Introduction to Behavior and

Health

Linda Brannon

Introduction to public health Schneider

An Introduction to Community Public Health 9th Edition

Nutrition for Health and Health Care (MindTap Course List) 7th Edition Linda Kelly Debruyne

HEALTH Psychology

An Introduction to Behavior and Health NINTH

CHECK YOUR HEALTH KNOWLEDGE

HealtH Psychology

a n Introduction to Behavior and Health

b RI ef co N te N t S

PART 1 Foundations of Health Psychology

PART 2 Stress, Pain, and Coping

PART 3 Behavior and Chronic Disease

PART 4 Behavioral Health

PART 5 Looking Toward the Future

PART 1 Foundations of Health Psychology

PART 2 Stress, Pain, and Coping

6

CHAPTER

CHAPTER

8 CHAPTER

Considering Alternative Approaches 173

PART 3 Behavior and Chronic Disease

9 CHAPTER

10

CHAPTER

14 CHAPTER

15 CHAPTER Exercising

PART 5 Looking Toward the Future

P R eface

The Ninth Edition

What’s New?

What Has Been Retained?

Other Changes and Additions

Writing Style

Instructional Aids

Within-Chapter Summaries

Annotated Suggested Readings

Acknowledgments

a bout the autho RS

CHAPTER 1

Introducing Health Psychology

CHAPTER OUTLINE

QUESTIONS

Real-World Profile of ANGELA BRYAN

The Changing Field of Health

Patterns of Disease and Death

Would You BELIEVE...? College Is Good for Your Health

Escalating Cost of Medical Care

The Chapel of St. Saviour

The Chapel of St. Columba

The Chapel of St. Boniface

The Chapel of St. Ansgarius

THE SACRIFICE

The Crypt

Summary Dimensions

Bishops of New York

Part Three Other Buildings, Etc.

The Bishop’s House

The Deanery

THE BISHOP’S HOUSE

The Choir School

THE DEANERY