PREVENTION: DIFFERENCES BETWEEN HEALTH AND ILLNESS BEHAVIOUR

April 2009
M	T	W	T	F	S	S
« Mar		May »
	1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30

The large differences in health and illness behaviour between groups and cultures suggest that it must be learned. Research shows that Jews and Italians claim that their mothers were over-protective and over-concerned about their children’s health and participation in sports and that they were constantly warned to avoid colds, fights and other threatening situations. Perhaps this kind of upbringing fosters a type of personality which is particularly concerned and even anxious about illness.

First-born and only children are more likely to want the company of another person when they face stress in adult life-probably because they are so much more psychologically dependent than later-born children. This is interesting in the light of studies which show that early-born children use more medical services than do later-borns (in whatever size of family).

We have already seen that psychological manoeuvres that are going on, usually quite unconsciously, are much more complex. Illness behaviour is part of a well-defined social pattern and we all have our views of how doctors (them) and patients (us) behave. I firmly believe, to paraphrase Shakespeare, that, ‘All the world’s a surgery and all the doctors and patients merely role-players.’ It is my view that many of those going to their doctors are quite unconsciously playing a role-the sick role. Studies suggest that only about four out of ten people going to a general practitioner have anything physically wrong with them and that about 80 per cent of all ailments are self-limiting. So what are we all playing at?

Illness behaviour (adopting the sick role) is a very effective way of being relieved from social expectations, and is an excuse for failure, a way of obtaining privileges and sympathy, and so on. For those who have few social ties, poor support and feel isolated, the medical system is a well-recognized and comfortable way of obtaining at least some of these. Thirty or more years ago perceptive doctors realized that what their patients came to them for was often quite unimportant but what it did was to establish a relationship with the doctor who would then confirm them in the sickness role. Doctors need people like this to make them feel wanted so that they, the doctors, can live out their role as health-givers. Unfortunately, many doctors do not understand this role-playing and as a result go along with their patients’ endless demands for medical care. This results in numerous return visits, many if not most of which would be unnecessary if the patient’s real problems and motivations had been perceived and adequately dealt with by the doctor at the first consultation.

Just as certain people unconsciously retreat into the sickness role because it is a release from unpleasant or unacceptable situations, others sacrifice their health to ambition, expediency or the good of others. Young parents overwork in the full knowledge of what they are doing, sometimes also going without things ‘because of the children’ and so on. The health of general practitioners is perhaps a good example. British GPs have alarmingly high rates of alcoholism, drug abuse, broken marriages, coronary artery disease and suicide, yet they presumably know all the answers. To some extent at least, they are choosing to sacrifice their own health in favour of that of their patients.

But closely allied to all this illness and sickness behaviour is society’s concept of what is normal, and how it defines ill health. Mental illness for example, has been seen, at different times over the centuries, as demonic power, witchcraft and madness. The labels, the treatments and the social attitudes are all different and yet the ‘reality’ of the illness in question may well have been the same. Alcoholism is another example. When does social drinking become an illness? Sexual deviations and hypochondriasis or malingering are especially difficult to define yet somewhere along the line is a point beyond which sufferers could be said to be ‘ill’. Certainly fashions and fads are all-important when trying to define behaviour of any kind, let alone illness behaviour. Forty years ago oral sex was a ‘perversion’-today it is a fashionable pursuit that raises few eyebrows. Today we accept the fact that 30 per cent of the population has backache-it is ‘nor-mal’-and that thousands are killed on the roads every year. In developing countries parasitic diseases, infectious diseases, civil war or poverty may be similarly accepted as ‘normal’.

*12/72/5*

Share and Enjoy: