Illness and Behaviour

Illness and behaviour • Disease: an objective, pathological process, a deviation from a biological norm • Illness: a subjective feeling of being unwell, an internal, personal experience • Sickness: a social role, status, negotiated role in society • Includes thoughts and emotions that determine actions • Dynamic – changes over course of time (and progression/healing of illness) • Social component (how friends and relatives react influence how the ill person reacts) • Comes from learned behaviour (family in early childhood) – “family scripts” on how to behave • Illness behaviour varies and is related more to the person than to his/her state of health 20 • Influencing factors: o Age (U-shaped curve) o Sex (female) o Ethnicity o Religion/worldview o Personality o Social class (lower) o Geography o Structure of health system o Interpersonal problems o Perception of the nature and severity of illness • Impact of socioeconomic status: o Lower socioeconomic status, more burden of disease o Lower SES more likely to delay seeking care o Lower SES face more barriers to care o Lower SES visit the Dr more often but get fewer longer consults, although chronic disease and preventive care needs o suggest they should receive more care • Social triggers to seek professional help: o Perceived interference with vocational or physical activity o Perceived interference with social relations o Interpersonal crisis o Temporalizing of symptomatology (if I’m not better by ...) o Pressure from family and friends. Women make 70% of health decisions Stages of illness experience 1. Symptom Experience 2. Assumption of sick role 3. Medical care contact 4. Dependent patient role 5. Recovery and rehabilitation Parson’s model of the sick role – four postulates 6. The person is not responsible for assuming the sick role. 7. The sick person is exempted from carrying out some or all of normal social duties (e.g. work, family). 8. The sick person must try and get well – the sick role is only a temporary phase. 9. In order to get well, the sick person needs to seek and submit to appropriate medical care 21 The sick role: expectations of the doctor Critique of Parson’s model • Society has moved on from the 1950s • Paternalistic Vs Patient-centred consultations • Assumes ideal patient and doctor • Chronic disease model: the chronically ill go in and out of the sick role, depending on periods of aggravation and complications of their disease. They are now the experts, not the doctor • Self-inflicted illness: doesn’t fit either • Different cultures and worldviews have different sick roles Abnormal illness behaviour • The persistence of a maladaptive mode of perceiving, evaluating and acting in relation to one’s own state of health, despite that a doctor has offered a reasonably lucid and accurate explanation of the nature of the illness and the appropriate course of management to be followed, ... based on a thorough examination and assessment ... and taking into account the patient’s age, educational and sociocultural background. • Abnormal illness behaviour might manifest as: o Adopting the sick role unnecessarily o Rejecting the sick role inappropriately • Malingering: Intentional production of false of grossly exaggerated physical or psychological symptoms. The motivation for the behaviour involves external incentives. (E.g. CTP, work cover) • Factitious disorder: Intentional production or feigning of physical or psychological signs or symptoms. The motivation for the behaviour is to assume the sick role. External incentives for the behaviour are absent. (E.g. Munchausen syndrome.) • Somatoform disorders: a group of psychological disorders that manifest with unexplained physical symptoms 🡪 hypochondriasis, somatisation disorder, conversion disorder, body dysmorphic disorder