Dr Tabassum Alvi
Assistant Professor
Psychiatry/Behavioural Sciences
Majmaah University

At the end of the session the student should be able to:
• Recognize the sick role of the patient
• Explain the treatment seeking behavior
• Describe the placebo effect on treatment
• Discuss the role of somatization in illness behavior

‘A state which fulfills requirements of relevant reference group for admission of sick role’
Doctors decide for the sick role of the patients

‘The way in which individual experience, perceive, evaluate and respond to their own health status.’
• Wide variety of ways people responded to symptoms(carelessly or too intrusively)
• It is a disturbance of body and has social meanings and impact
– i.e. it is partially the result of disease but is also determined by social and cultural factors
• Sometimes a distinction is made between disease (medical definition) and illness (lay person’s perception)
– Can be sick but no symptoms
– Can feel ill but no disease/condition

• Only small numbers of people with symptoms decide to consult GPs (many self-medicate).
• People often discuss symptoms with others before the discuss them with their doctor (‘lay referral’)
• Patient experiencing symptoms would receive an advice from a close relative before being referred to progressively more remote and expert people
Lay referral network (Friedson, 1960)

• Normal Appropriate and adaptive
• Abnormal Atypical and abnormal

Parson viewed:
Sickness as response to social pressures and avoidance of social responsibilities.
• 3 Obligations
• 3 Privileges

• Accept role as undesirable
• Recognize an obligation to cooperate with others so as to achieve health.
• Utilize the series of those regarding by society as competent to diagnosis and treatment of illness

• Person is not responsible for his state
• Person is accepted as someone require care
• Person is entitled exemption from normal obligations, taking into account age/nature of disability.

Disease: Actual physical pathology.
Illness: Feeling thoughts and subjective experience accompanied the disease.

Promotes individual health
• Social control of occupancy of status ‘sick’
– Doctor as gatekeeper (legitimates illness and occupancy of sick role)
– Privileges dependent on duties
Promotes health of society
– Controls number of people opting out of normal roles
& responsibilities
– Returns sick people to health

• WHO classification - International Classification of
Impairment, Disability & Handicap (ICIDH)
– Impairment (any loss or abnormality of psychological, physiological or anatomical function)
– Disability (any restriction or lack - resulting from impairment - of ability to perform an activity in the manner or within the range of activity considered to be normal for a human being )
– Handicap (a disadvantage for a given individual that limits or prevents fulfillment of a role that is normal for that individual

• Difficult to apply the sick role theory to chronic illness
– Permanent state
– The requirement is to enhance functioning and not encourage dependency
• Physicians’ social functions extend far beyond the policy of sick role and process.
Friedson 1960

Inappropriate/maladaptive mode of experiencing, evaluating or acting in relation to ones own state of health despite the fact the doctors has offered accurate and reasonably lucid information.

• Patients does not get along with their doctors simple because that is the nature of their sickness.
• Painful women
• Waste of hours
• Arguing for procedures and tests for no reason
• They go to quacks.

• Proliferation of non specific syndromes and diagnosis in terms of symptom rather then physical etiology (chronic pain)
• Example: Hysteria, somatization
• It has serious implications on economic and physical health of society.
• Multidisciplinary approach

• Extremely difficult task for doctor following medical model to diagnose.
• Estimation of restriction and limitation is provided by non medical experts
( Example; lawyers)
• Clinician duty is to change patients perception of his/her illness.
• It varies from person to person.

• Health or care seeking behaviour has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy.
• Health seeking behaviour is preceded by a decision making process that is further governed by individual and/or household behaviour, community norms and expectations as well as provider related characteristics and behaviors.
• The interplay of these factors are central in the final choice of care seeking options.

• Health or care seeking behaviour has been defined as any action undertaken by individuals who perceive themselves to have a health problem or to be ill for the purpose of finding an appropriate remedy.
• Health seeking behaviour is preceded by a decision making process that is further governed by individual and/or household behaviour, community norms and expectations as well as provider related characteristics and behaviors.
• The interplay of these factors are central in the final choice of care seeking options.

• Client based factors, provider-based factors, caretaker perceptions; social and demographic factors, cost, social networks and biological signs and symptoms work synergistically to produce a pattern of health seeking behaviour.
• Health care seeking model will involve recognition of symptoms, perceived nature of illness, followed initially by appropriate home care and monitoring. This may necessitate seeking care at the health facility, medication and compliance.
• Treatment failure may require a return to the health facility or an alternative care provider( sequential pattern behaviour of illness )

Refers to an improvement in symptoms as a result of
medical treatment with an inactive substance or
medical procedure.
– Patient recovers without genuine medicalintervention
– Attributed to belief in the effectiveness of treatment
– Belief mediates healing of symptoms
• Explain how the placebo effect works
?

Quoted as saying: “Anything is possible when you put your mind to it.”
Do you agree with this statement? Why or why not?

• The power of positive thinking is not a new subject.
• The Talmud, the ancient compendium of rabbinical thought, states that:
• "Where there is hope, there is life."
• And hope is positive expectation
• Study of the placebo effect is usually dated to the pioneering paper published in 1955 on "The Powerful Placebo" by the anesthesiologist Henry K. Beecher (1904-1976). Beecher concluded that, across the 26 studies he analyzed, an average of 32% of patients responded to placebo.

• The placebo effect is believed to reduce pain in two different ways.
•
One way is by the placebo initiating the release of endorphins which are natural pain killers produced by the brain.
• The other way is the placebo changing the patient's perception of pain. "A person might reinterpret a sharp pain as uncomfortable tingling .“
• Placebo analgesia is more likely to work the more severe the pain.
•
Most research reports average reduction for a group of people, but this can be lower (some people do not respond).
• Another measure is the ability to endure pain.

• People who receive a placebo may also experience negative effects.
• They are like side effects with a medication and may include, for example nausea, diarrhea and constipation .
• A negative placebo effect has been called the nocebo effect.

• Recent classification focus more on symptoms with relative underlying neglect of psychopathology.
• There are experiential ,perceptual and cognitive behavioral aspects of somatization.
• Somatosensory amplification.
• Multiple causal attributions.(organic/underlying anxiety and depression)
• Somatization is associated with high utilization of health care.

• Somatization and illness behavior co exist and their inter relationship is complex.
• People with somatization are often observe to exhibit illness behaviour.
• Exact cause and effect relationship is not fully established.