Illness behavior
 Generally, health-related behavior of healthy people and those who
try to maintain their health are considered as behaviors related to
primary prevention of disease.
 Such behaviors are intended to reduce susceptibility to disease, as
well as to reduce the effects of chronic diseases when they occur
in the individual
 Secondary prevention of disease is more closely related to the
control of a disease that an individual has or that is incipient in the
individual. This type of prevention is most closely tied to illness
behavior.
 Tertiary prevention is generally seen as direct towards reducing the
impact and progression of symptomatic disease in the individual.
This type of prevention is highly related to the concept of sick-role
behavior
 In general, illness and sick-role behavior are viewed as
characteristic of individuals and as concepts derived from
sociological and socio-psychological theories.
Illness behavior and sick role
 The term illness behavior describes patient's reactions to the
experience of being sick.
 Aspect of illness behavior have sometimes been termed the sick
role, the that society ascribed to people when they are ill
 The concept of illness behavior was largely defined and adopted
during the second half of the twentieth century
 Broadly speaking, it is any behavior undertaking 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
 In everyday life, illness behavior may be a mixture of behavioral
decisions.
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 For example, an individual faced with recurring symptoms of joint
pain may turn to complementary or alternative medicine for relief.
 However ,sudden, sharp, debilitating symptoms may lead one
directly to a hospital emergency room.
 In any event, illness behavior is usually mediated by strong
subjective interpretation of the meaning of symptoms
 As with any
type of human behavior, many social and
psychological factors intervene and determine the type of illness
behavior held by individuals and health care practitioners
 The differing world views of patients and practitioners are now
seen as highly relevant to illness behavior.
 The medical practitioner and the individual experiencing symptoms
go through very different appraised of the meaning of the
symptoms
 Increasingly in the literature there is the recognition of the strong
relationship between the physical and mental experience of
symptoms and the meaning of that experience for illness behavior
 David mechanic, a pioneer in the study of illness behavior, best
summarizes the current perspective on
illness behavior: illness behavior arise from complex causes,
including biological predisposition , the nature of symptomatology,
learned patterns of response, attributional predispositions,
situational influences, and the organization and incentives
characteristic of the health care system that effect access,
responsiveness and the availability of secondary benefits.
sick-role behavior
 The sick role is a concept arising from the work of the important
American sociologist Talcott Parsons (1902-1979). Parsons was a
structural functionalist who argued that social practices should be
seen in terms of their function in maintaining order or structure in
society .
 Thus person 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 risk-role behavior could be seen as
the logical extension of illness behavior to complete integration
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into medical care system . parson's 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.
 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 "allow" one to be excused from
small obligation such as attending a social gathering. By contrast,
a major heart attack "allows" considerable time away from work
and social obligations.
Second
People in the sick role are not directly responsible for their plight
Third
The sick person need 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 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.
 The sick role 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.
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 The influence of culture on reporting and manifestation of
symptoms must be evaluated
 For some disorders, this varies little among cultures,
whereas for others, the cultural mores may strongly shape
the way patient presents the condition
 The relation of illness to family processes, class status, and
ethnic identity is also important.
 The attitudes of people and cultures about dependency and
helplessness greatly influence whether and how a person
asks for help, so 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.
Assessment of illness behavior
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o Prior illness episodes, especially illness of standard severity
(childbirth , renal stones, surgery)
o Cultural degree of stoicism
o Cultural beliefs concerning the specific problem
o Personal meaning of or beliefs about the specific problem.
Particular question 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?
What do you fear most about your sickness?
What are the chief problems that your sickness has cause you?
What are the most important results you hope to receive from
treatment?
What have you done so far to treat your illness?
Predicable reaction to illness
Intrapsychic
Lowered self image ' loss' grief
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Threat to homeostasis ' fear '
Failure of (self) care, helplessness, hopelessness
Sense of loss of control ' shame (guilt) '
Clinical
Anxiety or depression
Denial and anxiety
Depression, bargaining and blaming
Regression, isolation, dependency, anger, acceptance
Defense mechanisms in illness
 People unconsciously use defense mechanism 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
Denial
 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
Regression
 The patient reverts to a more child-like pattern of behavior that
may involve a desire for more attention and time from the
physician
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 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
decision regarding his/her illness
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