Introduction
Sarah Riley; Kathryn McGuigan; Eleanor Brittain; Gareth Terry; Aorangi Kora; Siobhán Healy-Cullen; Clifford van Ommen; and Don Baken
Nau mai haere mai—come on in, you have been warmly welcomed to this book—and with it, to a community of scholars, students, activists, policy makers, and many others who are interested in critical health psychology. In this section, we introduce you to what we mean by critical health psychology, why we wrote this book, and what we hope it will offer you.
What is critical health psychology?
Health psychology is a subfield of psychology that focuses on producing and applying psychological knowledge to:
- promote and maintain physical health
- prevent illness
- enhance treatments for people who are ill
- support of disabled people[1]
- improve healthcare systems and health policies.
Critical health psychology offers a distinctive approach to addressing these goals. In reviewing a range of critical health psychology literature for this book, we posit five “pou” that often underpin this work. “Pou” is a Māori (the Indigenous people of Aotearoa New Zealand) word. It refers to carved wooden poles or posts that can serve as boundary markers and support structures integral to the building of Marae, a traditional house and centre for Māori activities. The pou support the Marae, and for that reason this term is sometimes adopted by institutions to refer to the central values supporting the work that is done within them. We borrow from these ideas to offer five pou for critical health psychology. These pou explicitly, or implicitly, shape the chapters in this book. We outline them in the textbox below.
Key takeaways: The five pou for critical health psychology
- valuing theoretical and conceptual thinking
- challenging taken-for-granted understandings
- paying attention to issues of power and equity
- moving beyond the individualism that characterises much of (Western) psychology
- considering knowledge as produced in social context.
(1) Valuing theoretical and conceptual thinking. This pou encourages us to put theory and theoretical concepts at the centre of our work. Theories provide a framework for understanding and interpreting an issue. They provide a structured explanation of a phenomenon, allowing us to better understand, or make predictions about human behaviour. A theoretical framework thus offers a lens through which to examine an issue. Critical health psychologists often draw on theoretical frameworks that enable rich conceptual thinking, including bodies of philosophical thought. Putting theory explicitly at the centre of our work helps us think deeply about complex issues, encouraging us to engage in critical reflection on both the explicit and implicit concepts that we use in health psychology.
(2) Challenging taken-for-granted understandings. A key process in critical reflection is looking at what we take for granted. Taken-for-granted knowledge refers to ideas we rarely recognise or explain because we experience them as obvious, normal, and natural – a bit like how we imagine a fish with water. This means it takes effort and techniques to notice taken-for-granted knowledge. Critical health psychologists often use reflective practices to help them notice the kind of taken-for-granted knowledge underpinning their work, from which they can explore the advantages and disadvantages of this way of thinking, and start to imagine more enabling or equitable alternatives.
Michel Foucault’s experience of recognising taken-for-granted knowledge
In the preface of his book The order of things: The archaeology of the human sciences, philosopher and cultural historian Michel Foucault recounts how reading a book describing what he considered to be an amusing Chinese categorisation of animals prompted a realisation: his own categories of thinking were not normal or natural, but simply another, equally arbitrary, socially constructed system of thought.[2]
“This passage quotes a ‘certain Chinese encyclopaedia’ in which it is written that ‘animals are divided into: (a) belonging to the Emperor, (b) embalmed, (c) tame, (d) suckling pigs, (e) sirens, (f) fabulous, (g) stray dogs, (h) included in the present classification, (i) frenzied, (j) innumerable, (k) drawn with a very fine camelhair brush, (l) et cetera, (m) having just broken the water pitcher, (n) that from a long way off look like flies’. In the wonderment of this taxonomy, the thing we apprehend in one great leap, the thing that, by means of the fable, is demonstrated as the exotic charm of another system of thought, is the limitation of our own, the stark impossibility of thinking that” (Foucault, 1970, p. xv).
(3) Considering knowledge as produced in context. In focusing on how people in specific social contexts make sense of themselves, each other, and their wider world, critical health psychology offers a different orientation to the universalising approach often evident in psychological research, which seeks to identify generalisable patterns across contexts. Instead, a foundational element of critical health psychology is that we take seriously evidence showing a diversity of meaning and practice in people across time and place. For example, if someone stopped you on the street to ask you where you feel love in your body, most people would report feeling it somewhere near their heart, that somehow love originates there. But that has not always been the case historically, and it is not the case across contemporary cultures. Those of you who touch your heart centre if asked to say where your feelings are might be surprised to know that in Shakespearian England it was the liver. In Māori culture, the liver (ate) is still associated with deep emotions and feelings. For example, the phrase “Kai whea te tau o taku ate?” translates to “Where is my soul mate?”.
The above example shows how different ideas circulate in different contexts, which in turn shape how people can make sense of themselves.[3] From this basis, critical health psychologists often study: (1) the ideas that are circulating in a particular context; (2) the wider socio-historic, economic, political, and material elements that enable these ideas to make sense to people in that context; and (3) the implications these ideas have for what people can say, think, feel, and do – and how this in turn impacts people’s health, wellbeing, and treatment outcomes.
(4) Paying attention to issues of power and equity. The ideas that people use to make sense of themselves and their health are connected to power. Power shapes what ideas are valued or agreed-upon in any given social context. Thus, we cannot separate power from meaning-making. And how we make sense of something, in turn, shapes where resources get directed. A focus on power also means that even though psychology is about understanding people’s thoughts, feelings, and behaviour, critical health psychologists also pay attention to structural and systemic factors that shape health. Relatedly, we advocate for policies and practices that address these factors, aligning with a social justice approach to health that seeks to address health inequities.
(5) Moving beyond individualism. Recognising the importance of the social context also moves us away from the individualism that often characterises psychology. Our concern with individualism is that when we centre the individual, the person and their social context are positioned as separate, if interacting, elements. This conceptual split between the person and their social context flies in the face of cross-cultural research and important theories suggesting that people are produced through, not just influenced by, their context (Burkitt, 1991; 2008). Individualistic psychology can also have embedded, taken-for-granted values that foreground autonomy and problematise dependency. This is despite how people are inherently dependent on each other and their environment, and can experience great joy and pleasure in feeling mutually connected. Critical health scholars argue that individualism often limits the ability of psychology to explain how and why people think, feel, and behave in the ways they do, because it fails to conceptualise the human experience as situated and relational.
Another concern we have with individualistic psychology is that it typically fails to theorise power, and so reproduces it. For example, individualistic Western, White, (often middle-class) perspectives are presented as universal norms or ideals, despite research suggesting these are the least representative of human populations (Henrich et al., 2010; Sanches de Oliveira & Baggs, 2023). Relatedly, when psychologists, researchers, and/or policy makers take an individualised approach to health, they align with existing powerful systems that shift responsibility for health onto individuals while downplaying state responsibilities for creating conditions that make good health more likely. Critical health psychology thus invites us to consider the application of psychological knowledge beyond behaviour change and “fixing” the individual, and towards community-led, societal, political, and environmental solutions that may have more substantial and lasting effects.
These five pou provide guiding principles for critical health psychology. In this book we take you on a journey to explore how we can better understand health when applying this framework. We acknowledge that some of the ideas we share may be new to readers, and warn you that when our taken-for-granted understandings are challenged, we can feel confused, anxious, or even angry. Learning theories suggest that if you encounter such difficult feelings, it helps to recognise they are part of your learning journey and reflect on where they come from. Our hope is that, ultimately, you will find the ideas in this book energising.
Indigenous scholarship
Our social context is Aotearoa New Zealand, a country whose institutions are accountable to Te Tiriti o Waitangi, a treaty between rangatira Māori (tribal chiefs) and British settlers that was signed in 1840. One outcome of Te Tiriti is that Aotearoa New Zealand may be considered a bicultural country, where Māori and non-Māori cultures are recognised, and partnerships expected (Dam, 2017; also see Brittain & Kora Chapter 1.1, and Fraser & Walker Chapter 3.1, this volume; and Hayward (2012) for a critique of biculturalism). You will therefore find both Indigenous and Western scholarship represented in this book, with some chapters more focused on Māori scholarship, others more strongly positioned within Western scholarship, but all showcasing important contributions to critical health psychology.
Our first chapter, “Hauora” (Brittain & Kora Chapter 1.1), is written by Māori scholars and introduces te ao Māori (Māori worldviews) as it pertains to health. We intend this chapter to be of interest for both Māori and non-Māori, and part of the foundation for learning critical health psychology in Aotearoa New Zealand. It should also be of interest to an international readership. Māori have distinct and unique ways of being and thinking in the world that are holistic, relational, and spiritual; recognising the interconnectedness between all things. These worldviews and assumptions, including the place of humans within the world, are critical to understanding Māori health and wellbeing, and for expanding health psychology more generally, especially in the context of climate change, which requires us to recognise our relational co-existence (Jones, 2019).
Other chapters in this book are informed by the awa whiria (braided river) analogy, in which Māori and Western traditions of knowledge are imagined as a braided river—typical in Aotearoa New Zealand—made up of a network of river channels that come together and diverge as they flow. As an analogy, awa whiria represents the weaving together of different knowledge systems, the valuing of diverse knowledge and shared understanding, and the usefulness of considering both the distinctions and connections between these knowledge systems (Clifford & Arahanga-Doyle, 2024; Martel et al., 2022). Te awa whiria illustrates how these world views may come together at times, yet remain quite distinct, each retaining its own integral value. We have also included research on Pacific people’s understanding of health and illness, although our engagement with this scholarship remains limited.
Most of us are not Indigenous and since we draw on international, English language research, Western frameworks remain central in this book overall. This book is therefore not a decolonising psychology project; as a team, we do not have the capacity to offer that. Instead, we see our book as a small step towards such a project.
Why we wrote this book
Our motivation for producing this book was to create a significant resource that offers accessible and comprehensive coverage of critical health psychology. The readership we have in mind is postgraduate students; as well as students in their final years of undergraduate study, scholars interested in learning more about critical health psychology, and people who are lifelong learners. We write for those based in Aotearoa New Zealand, where we are writing from, and those located elsewhere. Our focus has been on people studying psychology, but this book will also appeal to readers located in a range of disciplines and subdisciplines where people and health are of interest.
Our students regularly tell us they have learnt to see the world differently, and feel empowered from being on our courses. Here are examples of what our students say:
I feel like I’m not only receiving an education to get me a degree, but one that is expanding my horizons, challenging my worldviews, and making me more ready to be a successful psychologist
This course has changed me not only as an academic/upcoming psychologist but as a person too. I know I’m a better person after this course than when I first walked in!
When I first plunged back into postgraduate studies, I had no idea it would lead me here – to new perspectives that have unravelled not only my previous academic understandings, but also, understandings of myself, my identity, my intentions, and the world around me. From the confines of traditional, biomedical conceptions of mainstream psychology, to the emancipatory horizons of critical health psychology. Blog post by Bella van Hattum.
We want to continue to support our students to undertake study that will allow them to feel empowered and excited by their learning—and to extend this possibility to many other students. Our aim is to provide our readers with a foundation for engaging with the world, especially for those who go on to work in health, community, policy, and therapeutic settings. More broadly, we are offering people a range of tools to negotiate a world where health and wellbeing dominate so much of public discussion and private identity.
There is an appetite for teaching and learning about critical health psychology. The community of people interested in critical health psychology is significant, as evident in the membership of the International Society of Critical Health Psychology, which at time of writing comprises over 1,000 people spanning the Global South and North. This means that across the world, people are teaching, researching, learning, and thinking with and about critical health psychology. Although there are resources that enable this work, these are limited; they are either dated, less comprehensive, or behind a paywall that reduces people’s ability to share and discuss these ideas. In receiving a grant from the Open Education Resources (OER) Collective, managed by Massey University Library staff, we have been able to break through that barrier and offer a unique resource that can be read by anyone with Internet access or a printed copy.
The Massey University health psychology team is uniquely placed to make this contribution. We are the custodians of a Masters programme with a 30-year history of shaping the field. This calls on us to be ambitious in continuing the vision of those who built the programme and who have seeded the ground for critical health psychology to grow across both Aotearoa New Zealand and internationally. Speaking to this ambition, our aim has been to provide a textbook that can take the reader through the foundations, approaches, and applications of critical health psychology by showcasing cutting-edge scholarship from Aotearoa New Zealand and internationally in an accessible and well-structured format, with real-life, relatable examples throughout. And we have tested it on our students:
I really enjoyed this textbook, as not only was it simple to follow and easy to read, but it felt relatable and real. A lot of the theories had real world examples and used real people and cultures to elaborate on this, and made me think of my own life and the people in it… I also enjoyed reading the historical context of Māori, the colonisation they have faced, and how it is still seen in today’s structural systems.
Although we are delighted with this, and other, feedback (see peer review statement for our review process and external review comments), it does not mean that every decision we made was the right one, or that this is the perfect textbook. Our ambition has been to do the best that we can, with the resources we have, and as the people we are. We have sought consultation at every step of the way, reaching out to many people in our wider community who have supported us to do this work, for which we are deeply grateful (see contributors and acknowledgements).
Positionality
This book is rooted in a belief that knowledge is never neutral, and that how we see the world is shaped by where we come from. It is therefore important to acknowledge some of the positions we write from. As a concept, ‘positionality’ helps us recognise that our social locations and personal experiences shape our identities, vantage points, and perspectives, and these in turn shape the kind of work we do, including our attempts to write a critical health psychology book.
Positionalities are fluid, relational, and embedded in complex power dynamics. Researchers and educators who recognise the importance of positionality often draw on intersectional theory to consider how our racialised, gendered, and embodied positions, as well as our disability, sexuality, class and socio-economic status interconnect to shape how we understand ourselves and may be understood by others (e.g., CTLT (nd); Collins & Bilge, 2020; Crenshaw, 1989; Collins 2000; Misawa, 2010).
Reflexivity involves considering such elements without producing a hollow “shopping list” (Folkes, 2023, p. 1301), and there is a body of work to help with this (e.g., Bolam & Chamberlain, 2003; Lumsden, 2019; also see Fraser & Walker Chapter 3.1). Building on Wilkinson (1988), Braun and Clarke (2021), for example, suggest considering personal, functional, and disciplinary levels of reflectivity that include our values; positions of privilege and marginality; methodological, theoretical, philosophical, political, or disciplinary assumptions or commitments; and our hopes, expectations, anxieties, and fears for our work. Although there are multiple ways to do reflexivity, the aim is to help consider the complex relationships between the knowledge producer and the production of knowledge and recognise that values are important because they shape our work. Therefore, in our position statements below, we describe some elements of who we are, and how these have shaped our values and scholarship.
Position statements
Sarah: British born, I lived in several countries as a child, and as an adult, in Northern Ireland, England, Scotland, Wales, and now, Aotearoa New Zealand. My early childhood experiences were of living in both working and middle-class contexts, which years later a friend said had made me a social scientist because I had learnt to “see culture”. From an early age, I was sensitive to gender inequity, and feminism gave me the words to make sense of those feelings. A confronting moment of my White privilege occurred when a Southeast Asian friend was told to get off the library photocopier so I could use it. The development of discourse analysis in psychology introduced me to theories of power and meaning making, and these ideas resonated and became a career long focus (you can hear some of my key influences on Dave Nicoll’s ParaDoxa substack). Studying a PhD in a pre-ebook era meant that I had to go to the library, where, when there weren’t many psychology books on the subject, I turned the corner and read sociology and anthropology. This started a career of doing trans-disciplinary research, and I have enjoyed being part of many generative interdisciplinary collaborations. In 2019, I joined the Health Psychology Masters programme at Massey, a flagship programme both for the University and – in my previous experience – a beacon for those doing critical psychology elsewhere. On this programme, I have taught and supervised students in critical health psychology and qualitative research methods, and the first section of this book maps onto one of those courses. I have been subtly shaped by the opportunity to live and work in Aotearoa New Zealand, and am on a journey to better understand te ao Māori (Māori worldviews).
Kathryn: I am a cis-gender heterosexual Pākehā woman. I grew up in rural South Canterbury and attended Otago University in the early 90s. I came to critical health psychology at Massey University as a mature student and found my home within this area. I am married with three daughters. The youngest is autistic and has a range of mental health issues. She continues to inspire my research interests and my desire to create inclusive spaces within tertiary spaces and in the wider world. My positionality is as an ally – an ally for diversity, inclusion, and respect for difference regardless of ethnicity, gender, learning style, or ability.
Elle: I belong to the iwi Ngāti Kahungunu ki te Wairoa, Ngāti Rākaipaaka, and Rongomaiwahine. My maternal whānau are from the villages of Nūhaka and Te Whakakī in the Hawke’s Bay, where I spent my early years. In Te Whakakī, our ancestral maunga is Ōrangi, our awa is Te Ewe, and our marae is Whakakī. In Nūhaka, our ancestral maunga is Moumoukai, our awa is Waitirohia ki Nūhaka, and our marae is Kahungunu. My father is a White Australian, born and raised in Tasmania. I have three sisters, and I am a wahine Māori. Growing up I knew our whenua (land) intimately and I felt connected to where we come from and our wider whānau, I did not realise until my late teens that this was not the experience of all Māori. During my upbringing our family was working-class; my parents valued education and had high expectations that my sisters and I would seek tertiary qualifications. I often reflect on the ways education was also highly valued by my maternal grandparents, and I view these kinds of expectations within my whānau as a privilege. I am clear that I am Māori first, and a practitioner second; a scholar, researcher, educator, and clinical psychologist. My research and teaching are mainly situated within the Centre for Indigenous Psychologies at Massey University, focusing on Māori and Indigenous psychologies and wellbeing. In my doctoral research, I explored narratives of wairua as related to psychological distress, healing, and recovery for Māori. My clinical practice has primarily been with adults who experience mental distress and substance use harms. I am committed to developing understandings about Māori psychological experiences, and addressing issues affecting Māori communities to contribute to meaningful change.
Gareth (he/him, they/them): I grew up in a working-class Pākehā home in Tāmaki Makaurau (Auckland), Aotearoa New Zealand. I have lived most of my life in the shadow of Maungakiekie (one of Auckland’s volcanic cones). My family is of English and Irish ancestry, with most of my mother’s side arriving in the late 19th Century from Kent in England and Cork in Ireland, and my father’s side coming from Kent in the early 20th Century. I am a cisgender man, in a long-term heterosexual relationship, identify as childfree, and live with a chronic autoimmune condition that sometimes locates me at the edges of disability. Although I grew up in a context infused by racism, misogyny, and heterosexism, I benefitted from key people throughout my life who were willing to give me important privilege-checking nudges. It wasn’t until a late start at university that I began to build on these nudges with the language to develop critical consciousness. An undergraduate critical psychology course at the University of Auckland changed my planned direction from clinical to critical psychology and then to critical health psychology. My research is informed by social justice values, and an investment in seeing change to a status quo defined by inequity and unhelpful individualism. This has meant exploring the social production of masculinities, reproductive justice, the involvement of Pākehā in Māori-centred research, and disability and access. I take seriously the opportunities to grow in my identity and actions as Tangata Tiriti, and in other forms of allyship. I joined the Health Psychology programme at Te Kunenga ki Pūrehuroa/Massey University in 2023.
Aorangi: I am a wahine Māori PhD student who descends from multiple iwi (tribes) around Aotearoa, including Rangitāne, Ngāti Kauwhata, Te Whakatōhea, Ngāti Porou, Rongowhakaata, and Kai Tahu. I am the second eldest of four children, and a single mother to two. I have had the privilege of growing up strongly grounded by my whānau, my culture, my reo, and my tūrangawaewae. I was born in Ōpōtiki, a small town in the Eastern Bay of Plenty rich in whānau (family), culture, beaches, and rivers. Ten minutes out of town is my marae, Ōpape, which sits on the top of a hill overlooking my moana Ōpape, my awa Ōpepe, my maunga Tarakeha, and the urupā where my ancestors lie. My teen and adult years have predominantly been spent closer to my other tūrangawaewae, Aorangi marae, which lies just out of a small rural town, Feilding. While going to university wasn’t common in my pāpā’s whānau, it was normalised in my mum’s whānau, who over the years have dedicated their careers to Māori health and education, both in practice and through the academy. The legacies of my tūpuna and my connection to my ancestral lands instil in me a distinctly Māori worldview and the values of education, whānau, te reo Māori (the Māori language), collective wellbeing, and tūrangawaewae. Motherhood and getting older have increased my awareness of the inequities, injustices, and mamae being experienced by our people, and I grew equally hōhā with society’s expectations and stereotypes of Māori, especially wāhine. I returned to study psychology at Massey University where I gained a Master of Science in Health Psychology, and am now pursuing a PhD. Alongside study, I have worked in various teaching and research roles within the Centre for Indigenous Psychologies at Massey University. Over the years it became apparent to me that Māori “mental health” is not an isolated issue that can be fixed with therapy. It is a manifestation of a web of underlying biological, psychological, social, political, cultural and historical factors; mostly stemming from White supremacy and colonisation. My passions and research are therefore centred on kaupapa Māori perspectives of Māori wellbeing and aspirations, and exploring the social, political, and cultural contexts within which Māori health is understood and experienced. (Please hover your cursor over the Māori words for an English translation).
Siobhán (she/her): I was born in Canada and spent the first four years of my life there before returning to Ireland with my Irish mother. I grew up in Kilkenny, a small town in the southeast of Ireland. I was born “out of wedlock”, and raised in a middle-class “blended” family, a fact that mattered in the cultural and religious context of that time and place. Growing up in a Catholic community, and attending a public Catholic school system, shaped my early awareness of the quiet politics of shame and respectability. Now, from my position as a White, cisgender, heterosexual woman, I am interested in feminist, social justice-oriented approaches to research that challenge narrow or pathologising framings of sex/uality and health. I came through a conventional psychology education that left me disillusioned with its often-reductive lens on human experience. It wasn’t until arriving at Massey University, Aotearoa New Zealand, that I found a disciplinary home in critical health psychology. In moving from a postcolonial republic with a history of cultural erasure to a settler-colonial state still deeply marked by the ongoing impacts of colonisation, I’ve been continually challenged to reflect on the responsibilities that come with being a Tauiwi (immigrant), living and working on Māori land. One of the most meaningful parts of that journey has been learning from Māori relational values: deep connections to whenua (land), to those around us, and to those who came before. These values, alongside my connections across Ireland, Aotearoa New Zealand, and Canada, continue to colour how I think about community, identity, belonging, and the complicated pull of place.
Clifford: I was born in apartheid-era South Africa, my parents having immigrated from the Netherlands in the mid-1950s with my brothers and sisters. My parents had survived the Nazi occupation of the Netherlands during the Second World War and these traumatic experiences left their mark across them and their children. I grew up in Benoni, a former mining town east of Johannesburg, and was educated in a whites-only Christian education system. Racism, sexism, homophobia, and physical violence were common elements of this scene and there was little space for someone who seemed to move through the world differently. Fortunately, I had the refuge of a large family, a community of Dutch aunties and uncles, and a second family of English migrants. University provided me with a space for critical thought and reflection, an undergraduate course in critical psychology being an important spark, and I appreciated the sense of freedom and wonder this provided. I witnessed anti-apartheid activists and leaders of immense courage and integrity, who provided an important yardstick. The democratic election in 1994 demonstrated that emancipatory social change is possible but also that the struggle for social justice is interminable. Moving to Aotearoa well over a decade ago I found a new home, and value a country where many seek to challenge the deep traces left by colonialism and neoliberalism whilst celebrating difference and indigeneity, recognising the deep well of hope, strength and creativity this provides.
Don: I was fortunate enough to do a special topic in health psychology with Professor Kerry Chamberlain and then a health psychology PhD with Professor Christine Stephens. Following that, I trained to be a clinical psychologist and have worked most of that career focusing in psycho-oncology. Members of my family have chronic illnesses that significantly affect their lives so I have some understanding of caring for people with chronic illness and also the limits of our systems to ‘fix’ these problems. This has also helped me understand some of the impacts of economics, beliefs, personal interests, and social influence on the generation of knowledge and the provision of healthcare. My work as a clinical psychologist in psycho-oncology provided a different angle as I supported people to make a difference in their own lives. I’ve always believed there are two sets of knowledge in the room, which work together to achieve the client’s goal. During this time, I have seen that health professionals are clever, generous, and hardworking people who do their best in overburdened systems. I have worked with them and consumers to seek to improve these systems and the experience of consumers where we can.
Approach of the book
We have sought to provide an accessible and interesting resource, that showcases some of the best of critical health psychology and takes you through key ideas and research that relate to this subfield. In so doing, our hope has been to provide a comprehensive textbook that offers an in-depth exploration of the foundations, approaches, and applications of critical health psychology. Accordingly, we have divided this book into three parts:
- Part One describes the theoretical foundations that underpin critical health psychology and shows how these help us understand people’s experiences of illness and treatment.
- Part Two examines a range of approaches in critical health psychology as they relate to health and illness.
- Part Three explores how critical health psychology can be applied in practice.
Pedagogical features
The book has a range of pedagogical features. Its online format enables us to hyperlink between sections in the book. Words in the glossary are also hyperlinked where they are used—if you hover your cursor over them, the glossary definition will appear in a pop-up box. The glossary words include terminology related to critical health psychology as well as English translations for te reo Māori (Māori language).
The book uses a variety of text boxes designed to support your learning, including examples, key takeaways, discussion points or activities, and links to videos. Each chapter also ends with a “Want to know more?” section, which recommends resources you can read, listen to, or watch, to make these ideas come alive. Practical activities to help you test your knowledge, such as interactive multiple-choice questions, are also embedded.
Scope
As noted above, health psychology is the application of psychology to health issues. These health issues tend to be physical health issues, based on the argument that if we want people to have better physical health outcomes, we need to think about their psychology. For example, if we want people to adhere to their physiotherapy exercise regimes, we should probably consider the psychology behind what makes people do them. The focus on physical health also distinguishes health psychology from other fields such as medical sociology and anthropology (Stam, 2015), and from other branches of psychology (e.g., clinical psychology with its focus on mental health).
These distinctions are useful, especially when they prime us to understand that different (sub/)disciplines can offer different perspectives on the same issue. Equally, it is important to recognise that physical and mental health issues are deeply interconnected, and that these boundaries are arbitrary in the sense they are conceptual distinctions created by humans. In terms of the scope of the book, this means that in general we focus on physical health issues, but bring in mental health issues where we think relevant.
Open access
This book is released as an open access textbook, or open educational resource (OER). It is free for anyone with online access to read, download, save, print, or share. OERs aim to reduce the financial burdens on students and remove barriers to education, aligning with our pou of paying attention to issues of power and equity.
The book’s open license, CC BY-NC 4.0 (Creative Commons Attribution Noncommercial 4.0 International), also allows adaptation. This means that you can adapt the content for your own learning or teaching context, so that it works for you. The BY section of the license means that if you do adapt the book, you need to attribute the book to us and indicate the changes you have made, normally at the end of the document you create. Please see below for how to cite or attribute this book.
How to cite the book as a textbook:
Riley, S., McGuigan, K., Brittain, E., Terry, G., Kora, A., Healy-Cullen, S., van Ommen, C., & Baken, D. (Eds.). (2025). Critical health psychology: Foundations, approaches and applications. Massey University. https://oercollective.caul.edu.au/critical-health-psychology
How to attribute the book if adapting or using content:
Critical health psychology: Foundations, approaches and applications by Riley, S., McGuigan, K., Brittain, E., Terry, G., Kora, A., Healy-Cullen, S., van Ommen, C., & Baken, D. (Eds.) is licensed under a Creative Commons Attribution Noncommercial 4.0 (CC BY-NC 4.0) Licence by Massey University
Terminology
We also want to mention some broader discussions we had about terminology.
Mainstream psychology: We chose to use the term “mainstream psychology” when talking about the kind of individualist, often socio-cognitive psychology that dominates English-language psychology. We use this term because it emphasises how these ideas are centred in psychology (Toomela, 2014). It is also a term used in other critical health psychology literature. For example, in their discussion of critical health psychology, Horrocks and Johnson (2014, p. 176) explain:
Mainstream health psychology and approaches to health behavioural change assume a particular ontology of personhood that […] centres on the idea that people are driven and cognitively motivated as individuals; and their health beliefs and attitudes are framed as the favoured mechanisms to target in order to bring about behaviour change.
As we have started to unpack in our discussion of pou above, and will continue to do so in the book, these ideas contrast significantly with a “critical psychology” that centres meaning making, power, the social context, and desires for psychology to develop more socially grounded and relational understandings.
Practices: Critical health psychologists tend to use the word “practices” rather than “behaviour” when talking about things that people do. Rather than locating behaviour as an outcome of individual decisions, the word “practices” recognises that our behaviours are shaped by a range of social and relational elements, such as social norms, expectations, power relations, and the contexts in which we live and interact with others.
Global South, Global North, & Western: “Global South” and “Global North” are terms used to describe shared characteristics of a range of countries. Global South countries are mostly in the southern hemisphere and have socio-economic and political characteristics that produce multiple health inequities, including those resulting from colonisation. Global North countries tend to be in the northern hemisphere and are characterised as post-industrial nations with significant influence in the global economy. These terms highlight geographical divisions in power and inequity.
Although these terms are linked to broad geographical regions, many countries in these North/South categorisations do not map onto where they are in the Earth’s hemispheres. This is just one of many critiques of this terminology (e.g., da Silva, 2021; Dados & Connell, 2012; and Palomino, 2019). However, we have used it when we want to talk broadly about countries with similar socioeconomic characteristics, when it makes sense to do so in relation to health issues.
Similarly, despite various critiques of the word “Western”, sometimes we find it useful as shorthand for talking about a shared perspective or worldview, and associated social norms and customs that draw from historical European civilisations and which connect to contemporary Anglo-American cultures. When discussing our use of these terms, we decided to use them where we felt they were useful to explain the ideas we wanted to talk about, while recognising they are problematic. We have also capitalised the words “Western”, “Black”, and “White” to show that these are politicised terminology and not taken-for-granted descriptions of the world as it is.
Want to know more?
As with all words that do a lot of “heavy lifting”, the above terms have interesting histories. If you want to know more about them, you could:
Read:
Kwame Anthony Appiah’s (2016) Long Read article for the Guardian newspaper, “There is no such thing as western civilisation”. https://www.theguardian.com/world/2016/nov/09/western-civilisation-appiah-reith-lecture
Cyma Hibri’s (2023) Article for The Conversation, “Orientalism: Edward Said’s groundbreaking book explained”. https://theconversation.com/orientalism-edward-saids-groundbreaking-book-explained-197429
Watch:
Western Values Explained by Mr Beat
The Global North versus South divide (explained in three minutes), The Helpful Professor Explains!
People working in health psychology: This is a book about health psychology, aimed at people – especially students – interested in health psychology. Some students studying health psychology go on to become registered psychologists, and many will apply health psychology in a range of roles, including research and policy development. The term “people working in health psychology” thus describes the range of people who apply knowledge of psychology in relation to health. In the interests of parsimony, we sometimes shorten “people working in health psychology” to terms like “health psychologists”. However, we highlight that in many countries, only those people who are registered psychologists and approved by an appropriate governing body (e.g., the New Zealand Psychologist Board; the UK Health and Care Professionals Council, and so forth), can call themselves a “Health Psychologist”. Addressing these issues when considering the application of critical health psychology, Part Three also uses the term “practitioners of critical health psychology”.
People, patient, service user, customer, client: There are multiple ways in which we can describe people who use health services, each of which connects to a range of debates. For example, in mental health contexts “service users” tends to be the preferred term, while people using services for physical health issues are more likely to consider themselves “patients”. Psychologists generally use the term “client” to describe the people they are treating. In the New Zealand healthcare system, people are often called “consumers”, to highlight that they are using services and should be accorded consumer rights. In other countries, this market-oriented language might seem inappropriate for healthcare. Because of this variation, we have used different terms we felt most appropriate to the context about which we were writing. When in doubt, to emphasise their (and our) common humanity, we have used the term “people”.
How to use this book
We have tried to be true to our principle of knowledge being produced within social context by writing from our social context, while also creating a book that can be read by, and be of value to, people outside of Aotearoa New Zealand.
Part One and Part Two support two postgraduate courses/modules in critical health psychology at Massey University, while the chapters in Part Three contribute readings to two Massey University courses related to professional psychology and work–integrated learning. Readers outside of Massey are invited to use this book in a similar way, or differently, so that it works for your context. You might selectively choose chapters that are most relevant for your learning or teaching, or produce a new course or module through a novel combination of chapters, or by building a course around the chapters in one part of the book. The whole book could form a course – or be read for personal study. Regardless of how you use it, our sincere hope is that the book provides you with the confidence and resources to enjoy learning and teaching critical health psychology. We hope it facilitates your journey in supporting, or becoming, the next generation of critical health psychologists.
Ngā mihi nui/with best wishes from
Sarah, Kathryn, Elle, Gareth, Aorangi, Siobhán, Clifford, and Don.
Want to know more?
Study at Massey University: Massey’s Master of Science (MSc) endorsement in Health Psychology programme has a proud 30-year history of leading the field in critical health psychology. Founded by internationally recognised scholars, it continues to attract top academics and students passionate about enhancing health and impacting healthcare systems and communities. You can find out more, including student testimonials, at: https://sites.google.com/view/chp-practicum/home
You can apply to study at: https://www.massey.ac.nz/study/all-qualifications-and-degrees/master-of-science-PMSCN/psychology-health-psychology-PMSCN1SPSHP2/
You can also join the critical health psychology community by becoming a member of the International Society for Critical Health Psychology (it’s free) at https://ischp.net/subscribe/
References
Bolam, B., & Chamberlain, K. (2003). Professionalization and reflexivity in critical health psychology practice. Journal of Health Psychology, 8(2), 215–218. https://doi.org/10.1177/1359105303008002661
Burkitt, I. (1991). Social selves: Theories of the social formation of personality. Sage.
Burkitt, I. (2008). Social selves: Theories of self and society. Sage.
Centre for Teaching, Learning and Technology. (n.d.). Positionality & intersectionality. The University of British Columbia. https://indigenousinitiatives.ctlt.ubc.ca/classroom-climate/positionality-and-intersectionality
Clifford, C., & Arahanga-Doyle, H. (2024). He Awa Whiria in psychology: Health, clinical practice and tertiary education. In A. Macfarlane, M. Derby & S. Macfarlane (Eds.), He Awa Whiria: Braiding the knowledge streams in research, policy and practice. Canterbury University Press. https://oercollective.caul.edu.au/braiding-knowledge-research-policy-practice/chapter/he-awa-whiria-in-psychology-health-clinical-practice-and-tertiary-education/
Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.). Routledge.
Collins, P. H., & Bilge, S. (2020). Intersectionality (2nd ed.). John Wiley.
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1, 139–167.
da Silva, J. T. (2021). Rethinking the use of the term ‘Global South’ in academic publishing. European Science Editing, 47, e67829. https://ese.arphahub.com/article/67829/download/pdf/
Dados, N., & Connell, R. (2012). The global south. Contexts, 11(1), 12–13. https://doi.org/10.1177/1536504212436479
Dam, L. (2017). Love and politics: Rethinking biculturalism and multiculturalism in Aotearoa/New Zealand. In Z. L. Rocha & M. Webber (Eds.), Mana Tangatarua: Mixed heritages, ethnic identity and biculturalism in Aotearoa/New Zealand (pp. 135–150). Routledge.
Folkes, L. (2023). Moving beyond ‘shopping list’ positionality: Using kitchen table reflexivity and in/visible tools to develop reflexive qualitative research. Qualitative Research, 23(5), 1301–1318. https://doi.org/10.1177/14687941221098922
Foucault, M. (1970). The order of things: An archaeology of the human sciences. Pantheon Books.
Hayward, J. (2012). Biculturalism – Continuing debates. Te Ara – the encyclopedia of New Zealand. http://www.TeAra.govt.nz/en/biculturalism/page-3
Henrich, J., Heine, S. J., & Norenzayan, A. (2010). The weirdest people in the world? Behavioral and Brain Sciences, 33(2–3), 61–83. https://doi.org/10.1017/S0140525X0999152X
Jones, R. (2019). Climate change and Indigenous health promotion. Global Health Promotion, 26(3), 73–81. https://doi.org/10.1177/1757975919829713
Lumsden, K. (2019). Reflexivity: Theory, method, and practice. Routledge.
Martel, R., Shepherd, M., & Goodyear-Smith, F. (2022). He awa whiria—A “Braided River”: An indigenous Māori approach to mixed methods research. Journal of Mixed Methods Research, 16(1), 17–33. https://doi.org/10.1177/1558689820984028
Misawa, M. (2010). Queer race pedagogy for educators in higher education: Dealing with power dynamics and positionality of LGBTQ students of color. The International Journal of Critical Pedagogy, 3(1), 26. https://libjournal.uncg.edu/index.php/ijcp/article/viewFile/68/53
Murray, M. (2015). Introducing critical health psychology. In M. Murray (Ed.), Critical health psychology (2nd ed., pp. 1–12). Palgrave Macmillan.
Palomino, P. (2019). On the disadvantages of “Global south” for Latin American Studies. Journal of World Philosophies, 4(2), 22–39. https://scholarworks.iu.edu/iupjournals/index.php/jwp/article/view/3113
Sanches de Oliveira, G., & Baggs, E. (2023). Psychology’s WEIRD problems. Cambridge University Press.
Toomela, A. (2014). Mainstream psychology. In Teo, T. (Ed.), Encyclopedia of critical psychology. Springer.
Wilkinson, S. (1988). The role of reflexivity in feminist psychology. Women’s Studies International Forum, 11(5), 493–502. https://doi.org/10.1016/0277-5395(88)90024-6
- We have elected to use the phrasing “disabled people” in alignment with the New Zealand Disability Strategy, which foregrounds the interaction with the inaccessible environment as creating disability, rather than being located with the person. ↵
- The truth of this list has not been verified, and Foucault calls it a ‘fable’, but he went on to use this idea to demonstrate, through an analysis of historical documentations, how taken-for-granted ways of sense-making—or “the ordering of things”—significantly changes over time in Western culture in a fractured, arbitrary, and not necessarily progressive way. ↵
- Although this is a useful example for showing how different peoples, across cultures or across time, can understand themselves differently, we also note that Māori have unique ways of feeling and expressing emotions that are ontologically embedded in Māori connections to the collective, to the land, and to the spiritual realm, which mean like-for-like translations such as ‘liver’ and ‘ate’ fail to recognise the complex, unique cultural meanings represented in these words (Hokowhitu, 2014). ↵
Extended Māori kinship group, tribe, nation; a large group of people descended from a common ancestor and associated with a distinct territory, usually comprised of a number of hapū (subtribes).
Family, extended family.
Mountain.
A Māori word for river.
A gathering place for Māori made up of a communal complex of buildings and grounds belonging to a particular hapū (sub-tribe). The marae includes the courtyard, wharenui (meeting house), wharekai (dining hall), and sometimes other grounds and buildings.
Māori woman/women.
Describes the spiritual and unseen; central to a Māori worldview about reality and human life; the ultimate reality of existence for Māori (Marsden, 1992). Reference: Marsden, M. (1992). God, man and universe: A Māori view. In M. King (Ed.), Te ao hurihuri aspects of Māoritanga (pp. 117–137). Reed Publishing.
Language; see Te reo Māori.
A place to stand or belong, a place where one has rights of residence and belonging through kinship and whakapapa.
Ocean.
Cemetery, burial grounds.
Ancestors.
Pain, suffering, wound, trauma.
To be bored/boring, annoying/annoyed, to be fed up with.
A Māori approach embedded in Māori knowledges and worldviews.
Carved wooden poles or posts that can serve as boundary markers and support structures integral to the building of Marae, a gathering place for Māori made up of a communal complex of buildings and grounds belonging to a particular hapū (sub-tribe). The pou support the Marae meeting house, and for that reason this term is sometimes adopted by institutions to refer to the central values supporting the work that is done within them.
To introduce the foundations of critical health psychology, we described five pou (pillars or central values), namely, (1) valuing theoretical/conceptual thinking, (2) challenging taken-for-granted understandings, (3) paying attention to issues of power and equity, (4) moving beyond individualist psychology, and (5) considering knowledge as produced in context.
