Illness and sick-role Illness and sick-role behaviourbehaviour

Presented by Assist .ProfPresented by Assist .Prof

Dr Sirwan K AliDr Sirwan K Ali

2012-20132012-2013

DiseaseDisease

What is Disease?What is Disease?

The biological process that doctors The biological process that doctors use to explain and understand use to explain and understand illnessillness

Illness and DiseaseIllness and Disease

The process of diagnosing disease The process of diagnosing disease is central to medical education. is central to medical education. This becomes the doctor’s agendaThis becomes the doctor’s agenda

However in at least 25% of GP However in at least 25% of GP consultations, no disease specific consultations, no disease specific diagnosis is availablediagnosis is available

We must understand then what the We must understand then what the illness means to the patient – the illness means to the patient – the patient’s agendapatient’s agenda

IllnessIllness

What is Illness?What is Illness?

Definitions vary and patients and Definitions vary and patients and doctors will disagree!doctors will disagree!

The patients experience of a The patients experience of a physical or psychological physical or psychological disturbancedisturbance

Illness BehaviourIllness Behaviour

Symptoms of Illness may be Symptoms of Illness may be differently perceived, evaluated differently perceived, evaluated and acted upon by different kinds and acted upon by different kinds of people.of people.

This is sometimes called “Illness This is sometimes called “Illness Behaviour”Behaviour”

Illness BehaviorIllness Behavior Illness behavior is described as the Illness behavior is described as the

state when the individual state when the individual feels illfeels ill and and behavesbehaves in a particular way in a particular way

Illness is a Illness is a psychologicalpsychological concept: concept:– It has different meanings for different It has different meanings for different

peoplepeople– It’s based upon an individual’s It’s based upon an individual’s personal personal

evaluation of his/her bodily state evaluation of his/her bodily state and ability to functionand 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 How do people determine when they’re illthey’re ill?? IllnessIllness is a condition of pronounced is a condition of pronounced

deviation from the normal healthy statedeviation from the normal healthy state Illness is a subjective experienceIllness is a subjective experience

When do patients report illness?When do patients report illness?– When they’re unable to engage in day-to-day When they’re unable to engage in day-to-day

activitiesactivities– When they have decreased energyWhen they have decreased energy– When they feel pain, nausea, fatigueWhen they feel pain, nausea, fatigue– When they just don’t feel wellWhen they just don’t feel well

(DiMattteo & Martin, 2002)(DiMattteo & Martin, 2002)

IllnessIllness

Often it is difficult to decide Often it is difficult to decide objectively whether someone is ill or objectively whether someone is ill or notnot

Some suggest using scales that Some suggest using scales that define illness based on a total score define illness based on a total score of symptomsof symptoms

However, However, illness is a relative illness is a relative conceptconcept, and is , and is often functionally often functionally basedbased

SymptomsSymptoms Illness is recognized because of the Illness is recognized because of the

presence of presence of symptoms, symptoms, either either physical or mentalphysical or mental

People respond to symptoms in a People respond to symptoms in a variety of ways including dismissing, variety of ways including dismissing, ignoring, denying, and/or maximizing ignoring, denying, and/or maximizing their symptomstheir symptoms

If we experience unusual symptoms, If we experience unusual symptoms, which are severe enough, we may feel which are severe enough, we may feel that we are ill and then behave in that we are ill and then behave in certain ways certain ways

Why symptoms lead to medical visits

IntensityIntensity DurationDuration Change in presentationChange in presentation Family historyFamily history Previous experiencePrevious experience UnfamiliarityUnfamiliarity Perceived threatPerceived threat Loss of controlLoss of control

Illness behavior involvesIllness behavior involves

Much of it is a result or associated with the Much of it is a result or associated with the recognized disease .recognized disease .

Some are generated by the fear of disease Some are generated by the fear of disease or the positive rewards and support or the positive rewards and support provided for a person in the sick role .provided for a person in the sick role .

Some times a person may adopt the sick Some times a person may adopt the sick role and illness behavior without having role and illness behavior without having illness or may show illness behavior which illness or may show illness behavior which is out of proportion to the degree of illness.is out of proportion to the degree of illness.

Behaving normally in the presence of Behaving normally in the presence of undiagnosed illness .undiagnosed illness .

Physical and mental experience of illnessDavid 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 mindIs 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 RoleThe Sick Role The The sick rolesick role – any activity – any activity

undertaken for the purpose of undertaken for the purpose of getting well by those who consider getting well by those who consider themselves illthemselves ill

This is a social roleThis is a social role A patient who enters the sick role A patient who enters the sick role

has both rights and obligationshas both rights and obligations There are positives and negatives to There are positives and negatives to

the sick rolethe sick role

The Sick RoleThe Sick Role

AdvantagesAdvantages– Exempt from many Exempt from many

daily activities daily activities – Able to rest and be Able to rest and be

taken care oftaken care of– Social supportSocial support– Workers Workers

compensation, compensation, disabilitydisability

DisadvantagesDisadvantages– Behaviors are Behaviors are

scrutinizedscrutinized– Others may view Others may view

behaviors as behaviors as illegitimate attempt illegitimate attempt to gain advantagesto gain advantages

– Confusion, Confusion, discomfort, discomfort, decreased decreased functioning, and functioning, and distressdistress

The Sick RoleThe Sick Role People are not expected to let People are not expected to let

themselves better by effort, and the themselves better by effort, and the illness is not considered to be their faultillness is not considered to be their fault

However, the symptoms However, the symptoms must be must be recognized by othersrecognized by others

Sick people are expected to want to get Sick people are expected to want to get better better

They are also expected to seek They are also expected to seek professional help if needed and to professional help if needed and to comply with health recommendationscomply with health recommendations

The Sick RoleThe Sick Role

The (societal) obligations:The (societal) obligations:– The person’s The person’s symptoms must symptoms must

correspond with a diagnosis correspond with a diagnosis recognized by societyrecognized by society

– There must be There must be overt symptomsovert symptoms before others will recognize the before others will recognize the illnessillness

– The patient must accept the sick role, The patient must accept the sick role, and is expected to and is expected to take steps to get take steps to get wellwell

The Sick Role—more (societal) obligationsThe Sick Role—more (societal) obligations

– Sick people are expected to remain Sick people are expected to remain optimistic and cheerful and not optimistic and cheerful and not display distressdisplay distress

– Not everyone is willing to act sick and Not everyone is willing to act sick and some people may conceal their some people may conceal their symptoms to avoid becoming symptoms to avoid becoming dependentdependent

The Sick RoleThe Sick Role Most believe being ill is temporary and Most believe being ill is temporary and

in most cases, this is truein most cases, this is true Chronic diseases bring about different Chronic diseases bring about different

responsibilities and the person cannot responsibilities and the person cannot stay in the sick role foreverstay in the sick role forever

Most people have symptoms of one Most people have symptoms of one sort or another at any one time, but sort or another at any one time, but whether or not they enter the sick role whether or not they enter the sick role may be only loosely related to the may be only loosely related to the severity or persistence of symptomsseverity 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 youThank you