Download ILLNESS BEHAVIOR

Dr Nesif Al-Hemiary
MBChB – FICMS(Psych.)
ARCPsych.(UK)
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The term illness behavior describes patients'
reactions to the experience of being sick.
Aspects of illness behavior have sometimes been
termed the sick role, the role that society ascribes
to people when they are ill.
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The concept of illness behavior was largely defined
and adopted during the second half of the
twentieth century.
Broadly speaking, it is any behavior undertaken by
an individual who feels ill to relieve that
experience or to better define the meaning of the
illness experience.
There are many different types of illness behavior
that have been studied.
Some individuals who experience physical or
mental symptoms turn to the medical care system
for help; others may turn to self-help strategies;
while others may decide to dismiss the symptoms
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Why hasn’t he consulted sooner?
What made him consult now?
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Headache?
Backache?
Abdominal pain?
Sore throat?
Pain in chest?
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Familiarity
Duration, frequency & intensity
Perceived severity
◦ fear may delay consulting (eg Smith 2005)
◦ if symptoms perceived as mild patients may be
concerned about wasting the doctor’s time…. “I was
lucky, I didn’t have to go to my GP because I
collapsed in church”
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Visibility
Source of embarrassment
◦ Related to examination of private parts of the body
eg rectum (Smith 2005)
◦ 34% men & 58% women reported a sexual problem
but only 10% of men and 21% of women sought help
Mercer et al, (2003) BMJ, 327, 426-427
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Gender
◦ men more reluctant to consult (sign of weakness?)
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Patient beliefs and mood
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depression can be barrier to consultation
stress can increase reporting of symptoms
internal control
knowledge eg help seeking for URTI
Cues
◦ eg information, media etc
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Convenience of clinic/hospital
◦ Distance from home, waiting hours etc
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Past experience of consultation
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Gender of doctor
◦ doctor’s skills, empathy
◦ Men anxious about intimate examinations by male
doctors
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Social and cultural context
◦ Family norms about consultation
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Legimisation of sick role
◦ Sick role carries rights eg exception from social
responsibility (not everyone able or willing to give up
occupational or family duties)
◦ Sick role also carries responsibilities eg expected to
seek medical help and must want to get well.
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The sick role is a concept arising from the work of
the important American sociologist Talcott Parsons
(1902–1979)
Thus Parsons was concerned with understanding how
the sick person related to the whole social system,
and what the person's function is in that system.
Ultimately, the sick role and sick-role behavior could
be seen as the logical extension of illness behavior to
complete integration into the medical care system.
Parsons' argument is that sick-role behavior accepts
the symptomatology and diagnosis of the established
medical care system, and thus allows the individual to
take on behaviors compliant with the expectations of
the medical system.
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Basically, Parsons defined the "sick role" as
having four chief characteristics:
First, the sick person is freed or exempt from
carrying out normal social roles. The more severe
the illness, the more one is freed from normal
social roles. Everyone in society experiences this;
for example, a minor chest cold "allows" one to
be excused from small obligations such as
attending a social gathering. By contrast, a major
heart attack "allows" considerable time away from
work and social obligations.
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Second, people in the sick role are not directly
responsible for their plight.
Third, the sick person needs to try to get well.
The sick role is regarded as a temporary stage of
deviance that should not be prolonged if at all
possible.
Finally, in the sick role the sick person or patient
must seek competent help and cooperate with
medical care to get well.
This conceptual schema implies many reciprocal
relations between the sick person (the patient),
and the healer (the physician). Thus the function
of the physician is one of social control.
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The sick role can include being excused from
responsibilities and the expectation of wanting to
obtain help to get well.
Illness behavior and the sick role are affected by
people's previous experiences with illness and by
their cultural beliefs about disease.
The influence of culture on reporting and
manifestation of symptoms must be evaluated.
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For some disorders, this varies little among
cultures, whereas for others, the cultural mores
may strongly shape the way the patient presents
the condition.
The relation of illness to family processes, class
status, and ethnic identity is also important.
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The attitudes of peoples and cultures about
dependency and helplessness greatly influence
whether and how a person asks for help, as do
such psychological factors as personality type and
the personal meaning the person attributes to
being ill.
Some people experience illness as overwhelming
loss; others see in the same illness a challenge
they must overcome or a punishment they deserve.
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Prior illness episodes, especially illnesses of
standard severity (childbirth, renal stones, surgery)
Cultural degree of stoicism
Cultural beliefs concerning the specific problem
Personal meaning of or beliefs about the specific
problem
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Particular questions to ask to elicit the patient's
explanatory model:
What do you call your problem? What name does it
have?
What do you think caused your problem?
Why do you think it started when it did?
What does your sickness do to you?
5. What do you fear most about your sickness?
6. What are the chief problems that your sickness
has caused you?
7. What are the most important results you hope to
receive from treatment?
8. What have you done so far to treat your illness?
clinical
Intrapsychic
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Lowered self image ’ loss ’
grief
Threat to homeostasis ’
fear ‘
Failure of (self) care ’
helplessness,
hopelessness
Sense of loss of control ’
shame (guilt)’
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Anxiety or depression.
Denial and anxiety.
Depression , bargaining
and blaming.
Regression
Isolation
Dependency
Anger
Acceptance
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People unconsciously use defense mechanisms to
protect themselves from realities that cause
conflict and anxiety.
The patient’s use of defense mechanisms can act
as a barrier to the physician in obtaining
information and in gaining patient’s compliance.
Two of the most common defense mechanisms
used by people when they are ill are denial and
regression.
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In denial a patient unconsciously refuses to admit
to being ill or to acknowledge the severity of the
illness.
This can be helpful initially because it can protect
the individual from the physical and emotional
consequences of intense fear.
However ,denial can be destructive in the long term
if it hinders the patient from seeking treatment.
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The patient reverts to a more child-like pattern of
behavior that may involve a desire for more
attention and time from the physician.
This can make it more difficult for the physician to
interact with and treat the patient effectively.
It can make the patient more dependent and less
able to take decisions regarding his/her illness.