Illness and sick-role behaviour
Presented by Assist .Prof
Dr Sirwan K Ali
2012-2013
Disease
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What is Disease?
The biological process that doctors use
to explain and understand illness
Illness and Disease
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The process of diagnosing disease is
central to medical education. This
becomes the doctor’s agenda
However in at least 25% of GP
consultations, no disease specific
diagnosis is available
We must understand then what the
illness means to the patient – the
patient’s agenda
Illness
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What is Illness?
Definitions vary and patients and
doctors will disagree!
The patients experience of a physical or
psychological disturbance
Illness Behaviour
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Symptoms of Illness may be differently
perceived, evaluated and acted upon
by different kinds of people.
This is sometimes called “Illness
Behaviour”
Illness Behavior
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Illness behavior is described as the state
when the individual feels ill and behaves
in a particular way
Illness is a psychological concept:
– It has different meanings for different people
– It’s based upon an individual’s personal
evaluation of his/her bodily state and
ability to function
Illness behaviour
The concept of illness behaviour was defined and
adopted during the second half of the twentieth
century.
It is any behaviour undertaken by an individual
who feels ill to relieve that experience.
Illness behaviour is usually mediated by strong
subjective interpretations of the meaning of
symptoms.
Many social and psychological factors intervene
and determine the type of illness behaviour
expressed in the individual.
Disease versus ill/illness behaviour:
 Disease is physical malfunctioning of the body.
 Illness is subjective perception of whether one is
sick or not. Possible to have a disease and not
feel ill, e.g., undetected diabetes. Also possible
to feel ill without any detectable disease, e.g.,
hypochondriasis.
How do people determine when
they’re ill?

Illness is a condition of pronounced deviation
from the normal healthy state
Illness is a subjective experience
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When do patients report illness?
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– When they’re unable to engage in day-to-day
activities
– When they have decreased energy
– When they feel pain, nausea, fatigue
– When they just don’t feel well
(DiMattteo & Martin, 2002)
Illness
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Often it is difficult to decide objectively
whether someone is ill or not
Some suggest using scales that define
illness based on a total score of symptoms
However, illness is a relative concept,
and is often functionally based
Symptoms
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Illness is recognized because of the
presence of symptoms, either physical or
mental
People respond to symptoms in a variety
of ways including dismissing, ignoring,
denying, and/or maximizing their
symptoms
If we experience unusual symptoms,
which are severe enough, we may feel
that we are ill and then behave in certain
ways
Why symptoms lead to medical visits
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Intensity
Duration
Change in presentation
Family history
Previous experience
Unfamiliarity
Perceived threat
Loss of control
Illness behavior involves
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Much of it is a result or associated with the
recognized disease .
Some are generated by the fear of disease
or the positive rewards and support
provided for a person in the sick role .
Some times a person may adopt the sick
role and illness behavior without having
illness or may show illness behavior which is
out of proportion to the degree of illness.
Behaving normally in the presence of
undiagnosed illness .
Physical and mental experience of
illness
David Mechanic (1995):
• Biological predispositions.
• The nature of symptomatology.
• Learned patterns of response.
• Attributional predispositions.
• Situational influences, and the organization and incentives
characteristics of the health care system that affect access.
• Responsiveness and availability of secondary benefit.
Is disease real or is it in the mind?
Types of illness behaviour
 Individuals who experience physical or mental
symptoms turn to the medical care system for help.
 Others may turn to self-help strategies.
 Some individuals may decide to dismiss the
symptoms.
 In every day life, illness behaviour may be a mixture
of behavioural decisions.
Factors influence illness behaviour
Age and gender in illness behaviour; is far
greater in women.
Ethnicity, education
Family structure and social network
Healthcare coverage and insurance
Socioeconomic status; with lower-class
individuals most likely to delay seeking health
care even with sever symptoms
The Sick Role
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The sick role – any activity undertaken
for the purpose of getting well by those
who consider themselves ill
This is a social role
A patient who enters the sick role has
both rights and obligations
There are positives and negatives to the
sick role
The Sick Role
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Advantages
– Exempt from many
daily activities
– Able to rest and be
taken care of
– Social support
– Workers
compensation,
disability
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Disadvantages
– Behaviors are
scrutinized
– Others may view
behaviors as
illegitimate attempt to
gain advantages
– Confusion,
discomfort, decreased
functioning, and
distress
The Sick Role
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People are not expected to let themselves
better by effort, and the illness is not
considered to be their fault
However, the symptoms must be
recognized by others
Sick people are expected to want to get
better
They are also expected to seek
professional help if needed and to comply
with health recommendations
The Sick Role
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The (societal) obligations:
– The person’s symptoms must
correspond with a diagnosis
recognized by society
– There must be overt symptoms before
others will recognize the illness
– The patient must accept the sick role, and
is expected to take steps to get well
The Sick Role—more (societal) obligations
– Sick people are expected to remain
optimistic and cheerful and not display
distress
– Not everyone is willing to act sick and
some people may conceal their symptoms
to avoid becoming dependent
The Sick Role
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Most believe being ill is temporary and in
most cases, this is true
Chronic diseases bring about different
responsibilities and the person cannot stay
in the sick role forever
Most people have symptoms of one sort or
another at any one time, but whether or
not they enter the sick role may be only
loosely related to the severity or
persistence of symptoms
Chief characteristics
Parsons defined the sick-role as having four
characteristics
First; the sick person is freed or exempt from
carrying out normal social roles. The more sever
the illness, the more one is freed from social
roles.
Second; people in the sick-role are not directly
responsible for their plight.
Chief characteristics
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.
Fourth; the sick person or patient must seek
competent help and cooperate with medical
care to get well
Thank you