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NATIONAL OPEN UNIVERSITY OF NIGERIA FACULTY OF HEALTH SCIENCES COURSE CODE: NSC 301 COURSE TITLE: HUMAN BEHAVIOUR IN HEALTH AND ILLNESS NSC 301 HUMAN BEHAVIOUR IN HEALTH AND ILLNESS Course Code NSC301 Course Title Human...

NATIONAL OPEN UNIVERSITY OF NIGERIA FACULTY OF HEALTH SCIENCES COURSE CODE: NSC 301 COURSE TITLE: HUMAN BEHAVIOUR IN HEALTH AND ILLNESS NSC 301 HUMAN BEHAVIOUR IN HEALTH AND ILLNESS Course Code NSC301 Course Title Human Behaviour in Health and Illness Course Developer Jane-Frances Agbu National Open University of Nigeria Victoria Island, Lagos Course Writer Jane-Frances Agbu National Open University of Nigeria, Victoria Island, Lagos Course Coordinator Kayode, S. Olubiyi National Open University of Nigeria, Victoria Island, Lagos Programme Leader Prof Mba O. Okoronkwo Dean, School of Health Sciences NOUN ii NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS NATIONAL OPEN UNIVERSITY OF NIGERIA © 2020 by NOUN Press National Open University of Nigeria Headquarters University Village Plot 91, Cadastral Zone Nnamdi Azikiwe Expressway Jabi, Abuja Lagos Office 14/16 Ahmadu Bello Way Victoria Island, Lagos E-mail: [email protected] e-mail: [email protected] URL: www.noun.edu.ng ISBN 978-978-058-040-7 Printed: 2020 iii NSC 301 HUMAN BEHAVIOUR IN HEALTH AND ILLNESS TABLE OF CONTENT PAGE Module 1 Defining Concepts: Human Behaviour, Disease and Illness……… 1 Unit 1 Behaviour: Basic Concepts………….. 1-7 Unit 2 Conceptualizing Health and Disease… 8-16 Unit 3 Conceptualizing Illness……………… 17-26 Module 2 Conceptualizing Health/Illness Dichotomies and Determinants…… 27 Unit 1 Health and Illness and the mind – Body Relationship…………………. 27-32 Unit 2 Acute Illness versus Chronic Illness… 33-41 Unit 3 Culture and Socio-Demographic Determinants of Health and Illness……………………………….. 42-47 Module 3 Conceptualizing Health Behaviour 48 and Models Unit 1 What is Health Behaviour?.................. 48-55 Unit 2 Changing Patterns of Health and Illness………………………………… 56-60 Unit 3 Theoretical Approaches to Health and Illness Behaviour………………... 61-68 Module 4 Attitude Change and Specific Health Behaviour Problems………. 69 Unit 1 Preventive Health Behaviour………... 69-74 Unit 2 Attitude Change and Health Promotion……………………………. 75-81 Unit 3 Addressing Specific Health Behaviour Problems.…………………………….. 82-94 Module 5 Conceptualizing Illness Behaviour… 95 Unit 1 Defining Illness Behaviour…………... 95-101 Unit 2 Symptom Experience………………… 102-108 Unit 3 The Sick Role………………………… 109-117 iv NSC 301 HUMAN BEHAVIOUR IN HEALTH AND ILLNESS Module 6 Dependent Patient Role/ Recovery And Rehabilitation…………………………… 118 Unit 1 Healing Options…………………………. 118-125 Unit 2 Doctor/Patient Interaction………………. 126-132 Unit 3 Delay or Overuse of Medical Care…….... 133-138 Unit 4 Recovery – Rehabilitation………………. 139-145 v NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS MODULE 1 DEFINING CONCEPTS: HUMAN BEHAVIOUR AND MODELS Unit 1 Behaviour: Basic Concepts Unit 2 Conceptualizing Health and Disease Unit 3 Conceptualizing Illness UNIT 1 BEHAVIOUR: BASIC CONCEPTS CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Defining Behaviour 3.2 Principles of Behaviour 3.2.1 Stimulus and Response 3.2.2 Innate and learned Behaviour 3.2.3 Reflex Behaviour 3.3 Defining Human Behaviour 3.4 Features of Human Behaviour 4.0 Conclusion 5.0 Summary 6.0 Tutor Marked Assignment 7.0 References/Further Readings 1.0 INTRODUCTION Welcome to NSC 301 (Human Behaviour in Health and Illness ). For a better appreciation of this course, we shall start from the most basic term , ‗human behaviour ‘. Some may argue why bother defining behaviour since it appears very obvious and simple. However , this assumption may be wrong, especially in trying to assess the underlying factors influencing behaviour. This unit therefore hopes to systematically analyze the term ‗behaviour ‘ and specifically , ‗human behaviour‘ 2.0 OBJECTIVES At the end of this unit, you should be able to:  Define ‗behaviour‘ in a more general term  Discuss principles of behaviour  Define human behaviour 1 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS  Identify features of human behaviour  Identify distinctions between human and animal behaviour 3.0 MAIN CONTENT 3.1 Defining Behaviour  The term behaviour generally refers to the actions or reactions of a person or animal or plant in response to external or internal stimuli.  Behaviour is also viewed as an external change or activity exhibited by an organism.  It is also a manner in which something functions or operates.  Behaviour can also be viewed as the way a person, animal, a plant or chemical behaves or functions in a particular situation. (Wikipedia - The Free Encyclopedia, 2007) The above definitions are pointers that plants as well as animals (including humans), display behaviour patterns which can also be observed and measured. 3.2 Principles of Behaviour The following are therefore basic principles guiding behaviour. 3.2.1 Stimulus and Response A stimulus is any phenomenon that directly influences the activity or growth of a living organism. Phenomenon, meaning any observable fact or event, is a broad term and appropriately so, since stimuli can be of so many varieties. Chemicals, heat, light, pressure, and gravity can all serve as stimuli, as indeed can any environmental change. In some cases an internal environment can act as a stimulus. A good example is when an animal reaches the age of courtship and mating and responds automatically to changes in its body. All creatures, even humans, are capable of automatic responses to stimuli. When a person inhales dust, pepper, or something to which he or she is allergic, a sneeze follows. The person may suppress the sneeze (which is not a good practice, since it puts a strain on blood vessels in the head), but this does not stop the body from responding automatically to the irritating stimulus by initiating a sneeze. (Nebraska Behavioural Biology Group, 2007). 2 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.2.2 Innate and Learned Behaviour In general, behaviour can be categorized as either innate (inborn) or learned, but the distinction is frequently unclear. In many cases it is safe to say that behaviour present at birth is innate, but this does not mean that behaviour that manifests later in life is learned. Behaviour is considered innate when it is present and complete without any experience. At the age of about four weeks, human babies, even blind ones, smile spontaneously at a pleasing stimulus. Like all innate behaviour, babies‘ smiling is stereotyped, or always the same, and therefore quite predictable. Lower animals that lack a well-developed nervous system rely on innate behaviour. Higher animals, on the other hand, use both innate and learned behaviour. A fish is born knowing how to swim, whereas a human or a giraffe must learn how to walk (Black, 1996). 3.2.3 Reflex Behaviour An excellent example of an innate animal behaviour, and one in which humans also take part, is the reflex. A reflex is a simple, inborn, automatic response to a stimulus by a part of an organism‘s body. The simplest model of reflex action involves a receptor and sensory neuron and an effector organ. Such a mechanism is at work, for instance, when certain varieties of coelenterate (a phylum that includes jellyfish) withdraw their tentacles. More complex reflexes require processing inter-neurons between the sensory and motor neurons as well as specialized receptors. These neurons send signals across the body, or to various parts of the body, as, for example, when food in the mouth stimulates the salivary glands to produce saliva or when a hand is pulled away rapidly from a hot object. Reflexes help animals respond quickly to a stimulus, thus protecting them from harm. By contrast, learned behaviour results from experience and enables animals to adjust to new situations. If an animal exhibits a behaviour at birth, it is a near certainty that it is innate and not learned. Sometimes later in life, however, a behaviour may appear to be learned when, in fact, it is a form of innate behaviour that has undergone improvement as the organism matures. For example, chickens become more adept at pecking as they get older, but this does not mean that pecking is a learned behaviour; on the contrary, it is innate. The improvement in pecking aim is not the result of learning and correction of errors but rather is due to a natural 3 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS maturing of muscles and eyes and the coordination between them (Nebraska Behavioural Biology Group, 2007) SELF ASSESSMENT EXERCISE i. Define Behaviour ii. Identify the principles of Behaviour Answer to Exercise i. The term behaviour generally refers to the actions or reactions of a person or animal or plant in response to external or internal stimuli. Behaviour is also viewed as an external change or activity exhibited by an organism. Behaviour can also be viewed as the way a person, animal, a plant or chemical behaves or functions in a particular situation. ii. Principles of behaviour are: 1. Stimulus and Response: 2. Innate and Learned Behaviour 3. Reflex Behaviour I hope you enjoyed this exercise. Please always remember that these guiding principles aid a better understanding of the concept of behaviour. Thus, if you understand them now, you will have little problem conceptualizing human behaviour and more specifically, health and illness behaviour. Now let us turn to the concept of human behaviour. 3.3 Defining Human Behaviour Now, let us attempt to provide more specific definition of behaviour, i.e., human behaviour. Remember, this course is about human behaviour in health and illness. However, the dimensions of behaviour provided earlier are also very useful for a proper grasp of the term human behaviour.  Human Behaviour could therefore be broadly defined as manner of acting or controlling oneself  It could be viewed as an observable demonstration of capability, skill, or characteristics.  Human behaviour could also be viewed as an especially definitive expression of capability, in that it is a set of actions that presumably, can be observed, taught, learned and measured (Wikipedia- The free Encyclopedia, 2007). 4 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS These definitions therefore portray human behaviour as observable demonstration of skills and characteristics as well as definitive expression of such characteristics. This then indicates that human behaviour is not mechanistic but rather definitive, controlled and flexible. What then are the features of human behaviour. 3.4 Features of Human Behaviour Let us now briefly discuss the features of human behaviour. Human behaviour could therefore present the following features: Verbal – this means that human behaviour requires a language to express feelings and emotions. Lower animal also use a form of language to express feelings and emotions but human language appears to be more conscious and definitive. Verbal expression also stimulates good doctor/patient relationship and helps in better diagnosis of illnesses. Nonverbal – this means human behaviour which is independent of a formal language. This type of behaviour can sometimes be observed through body languages and facial gesture. Conscious – this refers to a state of being aware of a stimulus or event. For example, a hungry or sick person is very likely to be aware of the state, which in turn triggers behaviours necessary for that particular stimulus. It is thus expected that an individual eats when hungry or visits the health professional when sick. Unconscious – this is an opposite of consciousness. Here a person is unaware of a stimulus or event. Interestingly, certain body languages that people exhibit could be categorized here. For example, an anxious person may be unaware to the fact that he or she is exhibiting certain behaviours like: tapping the foot, biting the fingers, sweating, etc. Also, a complete state of unconsciousness is best described while sleeping, if not rudely woken by a loud sound. Overt – this form of human behaviour is open, observable and possibly measured. Good examples are a; child crying when in need or a sick person engaging in certain health habits (eating healthy, exercising), to feel better. Covert – here, behaviour is closed, hidden and not readily observable. Certain cultural practices could trigger this type of behavioural pattern. A very interesting example is the belief that men are generally not supposed to cry because they are the stronger sex. They are expected to be brave and bear grief ‗like men‘, though they may cry in the safety of 5 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS their homes. Here, behaviour is covert because such emotions are not readily observed. Voluntary – here, behaviour is performed willingly and controlled, and not forced. The adage that ‗you can take a horse to the stream but you cannot force it to drink‘ also applies to human behaviour. For example, a student must be willing to learn, and when forced could lead to school drop-out or exam malpractices. Involuntary – this refers to actions or behaviour, performed suddenly without an ability to be controlled. For example, a sudden sharp pain could trigger a corresponding uncontrollable response like jerking or screaming. Normal – normal behaviour refers to typical, expected or ordinary activities that generally conform to a given norm and dictate of a society. For example, it is normal for a child to wet the bed or generally behave like a child but such behaviour could be frowned at when they are exhibited by an adult. Abnormal – abnormal behaviour refers to those activities that are different from the usual or expected. Thus, they are seen to be a deviation from the norm. 4.0 CONCLUSION Now, you all will agree with me that the concept ‗Behaviour‘ is not as easy as it sounds. Perhaps, we have come to appreciate other technical aspects of behaviour and human behaviour, which appear simple and complex at the same time. I hope that the concepts introduced in this unit, such as stimulus and response, innate and learned behaviour etc. are not very difficult to assimilate. Try applying them to everyday activities and you will realize that they are much simpler than they appear. 5.0 SUMMARY In this unit, you have learnt the definitions as well as the characteristics of behaviour. We also attempted specific conceptualization of human behaviour as well as its associated features. The information provided in this unit should therefore aid an in-depth understanding of the distinction between human and animal behaviours (Lower animals). We hope you enjoyed this unit. Now, let us attempt the questions below. 6 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 6.0 TUTOR MARKED ASSIGNMENT 1. Define human behaviour 2. Identify and Discus the features of human behaviour 7.0 REFERENCES/FURTHER READINGS Behavior Resources on the Internet. Nebraska Behavioral Biology Group (Website).. Site visited on 10th April, 2007 Black, J.G. (1996). Microbiology. Principles and Applications. Third Edition. Prentice Hall. Upper Saddle River, New Jersey. pp. 392- 412 Dugatkin, Lee Alan. (1999). Cheating Monkeys and Citizen Bees: The Nature of Cooperation in animals and human. New York: Free Press. Hauser, M. D. (2000). Wild Minds: What Animals Really Think. New York: Henry Holt Pavlov, I. P. (1927). Conditions Reflex. Translated by G. V. Anrap. London: Oxford. Skinner, B. F. (1938). The behaviour of organisms. NY: Appleton Century Crofts. The Oxford Advanced Learner’s Dictionary, (2000). 6th Edition. Wehmeier, S. & Ashby, M. (Eds). Oxford: Oxford Univ. Press. Thorndike, E. L. (1898). Animal intelligence: An experimental study of the associative process in animals. Psychological Monographs, 2:8. Behaviour – Wikipedia, the free Encyclopedia. Retrieved from http://en.wikipedia.org/wiki/behaviour. Page last modified on 14th March 2007. Site visited on 17th March 2007. 7 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS UNIT 2 CONCEPTUALIZING HEALTH AND DISEASE CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 What is Health 3.2 Components of health 3.2.1 Holistic Dimension 3.2.2 Positive Dimension 3.2.3 Negative Dimension 3.3 Defining Disease 3.4 Syndromes and Disease 3.5 Transmission of Disease 3.6 Social Significance of Disease 4.0 Conclusion 5.0 Summary 6.0 Tutor marked Assignment 7.0 References/Further Readings 1.0 INTRODUCTION Granted that we are all well, we are likely to assume we do not need to take any special actions to keep healthy. We are unlikely to think of ourselves as ill when we have minor discomfort caused by colds or headaches, or when we feel tired or depressed. However, we all, knowingly or unknowingly, have different concepts of health that guide our behaviours. This unit, therefore, seeks to review the WHO definition of health as well as different concepts of health and disease. 2.0 OBJECTIVES At the end of this unit, you should be able to:  Summarize the WHO perspective of health.  Distinguish between holistic, positive and negative concepts of health  Define Disease  Determine Syndrome and Disease  Determine transmission of Disease  Ascertain social significance of Disease 3.0 MAIN CONTENT 8 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.1 What Is Health The Constitution of WHO, in conformity with the Charter of the United Nations declares that the following principles are basic to the happiness, harmonious relations and security of all people: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic and social isolation. The health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individual states. The achievement of any State in the protection of health is of value to all. Unequal development in different countries in promotion of health, control of disease, especially communicable disease, is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active cooperation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. SELF ASSESSMENT EXERCISE 1 Give a summary of the WHO perspective of Health. Answer to Exercise Have you done that? Well done. Now, let us see if it tallies with the answer provided below 9 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS The Constitution of WHO, in conformity with the Charter of the United Nations declares that the following principles are basic to the happiness, harmonious relations and security of all people: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political, belief, economic and social isolation. Also, the health of all people is fundamental to the attainment of peace and security and is dependent upon the fullest cooperation of individual states. The achievement of any State in the protection of health is of value to all. Unequal development in different countries in promotion of health, control of disease, especially communicable disease, is a common danger. Healthy development of the child is of basic importance; the ability to live harmoniously in a changing total environment is essential to such development. The extension to all people of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health. Informed opinion and active cooperation on the part of the public are of the utmost importance in the improvement of the health of the people. Governments have a responsibility for the health of their people which can be fulfilled only by the provision of adequate health and social measures. Now let us take a look at the three components of health known as holistic, positive and negative concepts of health. 3.2 Components of Health A researcher once asked a sample of participants, ‗Is your health good, average or poor?‘ When a respondent gave the answer ‘good‘, the researcher asked, ‗When you say your health is good, what do you mean?‘ The answers could be extracted from these three dimensions of health. They are:  A holistic dimension  A positive dimension  A negative dimension You might also be wondering whether there is any advantage or disadvantage in holding one or other of these views. Below are explanations to the three perceptual dimensions of health as well as the advantages and disadvantages. 10 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.2.1 A Holistic Dimension Of Health A Holistic Concept of health is the belief that being healthy means being without any physical disorders or diseases and being emotionally comfortable. For example, a person who feels anxious or who has low self-esteem would, according to this concept, may not be well. Likewise, a person with malaria or chickenpox is likely to label himself/herself ill. Generally, People with this view are likely to label themselves as ill when they experience a wide range of unpleasant feelings, not just physical discomfort or pain. Advantage Of Holistic Dimension Of Health  One advantage of having the holistic concept is that it tends to make people sensitive about their health. This can be an advantage because it can help them to notice symptoms more quickly than other people. They notice when something does not feel right and pay more attention to their bodies.  It can spur people to eat healthy and live healthy. Disadvantage Of Holistic Dimension Of Health  It can lead to oversensitivity to signs and symptoms of illness. Thus, oversensitivity can lead people to believe that they are ill when they are not.  It can lead to unnecessary worry and result in people wasting their Doctor‘s time. 3.2.2 A Positive Dimension Of Health A positive dimension of health is the belief that being healthy is a state achieved only by continuous effort. People with this belief take active steps to maintain their health for example, through their choice of food, by taking exercise and other activities they believe will keep them well. Such people are likely to feel responsible for their own health. They will take credit for the continued absence of disease and blame themselves if they develop symptoms. According to this view, people who do not take action to maintain their own health (for example, by ‗healthy eating‘) cannot be healthy — even if, at any one time, there is nothing wrong with them (Cockerham, 2003). Advantages Of Positive Dimension Of Health  One result of having a positive concept of health is that people tend to take plenty of exercise, avoid smoking and excessive 11 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS intake of alcohol, and eat a balanced diet. This is likely to be advantageous to them.  Another advantage is that if such people become ill, they are likely to adopt attitudes and behaviour that contribute to getting better. There is some evidence that the chances of surviving cancer are influenced by the attitude of the patient. People who believe they can recover and avoid feeling defeated by their illness tend to do better than those who believe that they are doomed to die.  People with positive dimensions to health tend to be active rather than passive in relation to their own health. Disadvantage Of Positive Dimensions Of Health  One disadvantage of this concept is that, by taking responsibility for their own health, people might blame themselves for their illnesses and feel guilty when they become ill. 3.2.3 A Negative Dimension Of Health A negative dimension of health is the view that being healthy is the absence of illness — for example, not having any symptoms of disease, pain or distress. People with this view are likely to believe that good health is normal and to take it for granted. Advantage Of Negative Dimension Of Health  A person with this perspective may be less anxious about his/health. Disadvantage Of Negative Dimension Of Health  A person with negative health concept believes that being healthy is by chance, while those with positive concepts take active steps to stay well.  He/she may think less of healthy habits as well as measures to live healthy.  He/she may engage in self medication because good health is taken for granted. SELF ASSESSMENT EXERCISE 2 Read the following replies from different people on the question ‗Are you healthy‘? And decide which dimension of health best fits each answer. 12 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Answer A: ‗There‘s nothing wrong with me, as far as I know.‘ Answer B: ‗I look after myself, stay fit and that sort of thing.‘ Answer C: ‗I feel well balanced. My body and my mind are working well together.‘ Now try to decide which concept of health is closest to the way you think about your health. Answer to Exercise A Negative dimension of health B Positive dimension of health C Holistic dimension 3.3 Defining Disease When we think of physical infirmities that we have had, we most often think in terms of what is wrong with our bodies biologically; for instance, a virus producing disease such as chicken pox or the flu, or a failure of the body to produce needed substances such as insulin in diabetes, or an abnormal growth as in cancer. In other words, we usually think in terms of some type of disease. Pathology is the study of diseases. The subject of systematic classification of diseases is referred to as nosology. The broader body of knowledge about human diseases and their treatments is medicine. Many similar (and a few of the same) conditions or processes can affect animals (wild or domestic). The study of diseases affecting animals is veterinary medicine. Definition 1 A disease is a change away from a normal state of health to an abnormal state in which health is diminished Definition 2 Disease is also a medical condition. It is an abnormality of the body or mind that causes discomfort, dysfunction, distress, or death to the person afflicted or those in contact with the person. Sometimes the term is used broadly to include injuries, disabilities, disorders, syndromes, infections, symptoms, deviant behaviours, and atypical variations of structure and function, while in other contexts these may be considered distinguishable categories. Definition 3 Cole (1970), defined disease as specific kinds of biological reactions to some kind of injury or change affecting the internal environment of the body. 13 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Disease thus alters the normal functioning of the body and creates a lot of anxiety for the sick person. It is also a universal phenomenon, constitutes a threat to survival and disrupts socio-economic life of people. Definition 4 In biology, disease refers to any abnormal condition of an organism that impairs function. The term disease is also, often used metaphorically for disordered, dysfunctional, or distressing conditions of other things, as in disease of society. 3.4 Syndromes and Disease Medical usage sometimes distinguishes a disease, which has a known specific cause or causes (called its etiology), from a syndrome, which is a collection of signs or symptoms that occur together. However, many conditions have been identified, yet continue to be referred to as ―syndromes‖. Furthermore, numerous conditions of unknown etiology are referred to as ―diseases‖ in many contexts (Taylor, 2006). 3.5 Transmission of Disease Some diseases, such as influenza, are contagious or infectious, and can be transmitted by any of a variety of mechanisms, including aerosols produced by coughs and sneezes, by bites of insects or other carriers of the disease, from contaminated water or food, etc. Other diseases, such as cancer and heart disease are not considered to be due to infection, although micro-organisms may play a role, and cannot be spread from person to person. 3.6 Social Significance of Disease The identification of a condition as a disease, rather than as simply a variation of human structure or function, can have significant social or economic implications. The controversial recognitions of diseases of post-traumatic stress disorder, also known as ―Soldier‘s heart,‖ ―shell shock,‖ and ―combat fatigue‖; repetitive motion injury or repetitive stress injury (RSI); and Gulf War syndrome has had a number of positive and negative effects on the financial and other responsibilities of governments, corporations and institutions towards individuals, as well as on the individuals themselves. The social implication of viewing aging as a disease could be profound, though this classification is not yet widespread (Taylor. 2006). 14 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS A condition may be considered to be a disease in some cultures or eras but not in others. Oppositional-defiant disorder, attention-deficit hyperactivity disorder, and, increasingly, obesity are conditions considered to be diseases in the United States and Canada today, but were not so-considered decades ago and are not so-considered in some other countries. Also, malaria, HIV/AIDS, childhood diseases like polio etc, seem to be top priority in the sub Saharan African countries. Lepers are also a group of afflicted individuals who were historically shunned and the term ―leper‖ still evokes social stigma. Fear of disease can still be a widespread social phenomenon, though not all diseases evoke extreme social stigma. 4.0 CONCLUSION When thinking about your own health, you might have realized that you use more than one of the three concepts of health, or perhaps you use all three. Do not be surprised by this. The fact that there are different perceptual dimensions of health does not mean that your attitude to health necessarily belongs to just one of them. You will probably find that you apply one concept in some situations and others on different occasions. 5.0 SUMMARY We have been able to define health as well as identify different components of health. We have also learnt different definitions of disease, as well as syndromes, transmission and social significance of disease. I hope you find them quite interesting and insightful. 6.0 TUTOR MARKED ASSIGNMENT 1. Define Disease 2. Identify and briefly describe the 3 components of health. Identify the advantages and disadvantages of each component. 7.0 REFERENCES/FURTHER READINGS Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston: Allyn and Bacon Black, J.G. (1996). Microbiology. Principles and Applications, 392-412. Third Edition. New Jersey: Prentice Hall. Upper Saddle River Brown L, (1993). The new shorter English dictionary. Oxford: Clarendon Press. 15 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Cockerham, W. C. (2003). Medical Sociology. 9th Edition. NY: Prentice Hall. Cole, R. M. (1970), Sociology of Medicine. New York: McGraw-Hill Book Co. Kendell, R. E. (1975), The role of diagnosis in Psychiatry. Oxford: Blackwell Scientific Pub: Marinker M. Why make people patients? Journal of Medical Ethics 1975:I:81–4. Szasz, T. S. (1987). Insanity – The idea and its Consequences. New York: John Wiley and Sons: Taylor, S. E. (2006). Health Psychology (6th Edition). Los Angeles: McGraw Hill. The British Journal of Psychiatry (2001) 178: 490-49 © 2001 The Royal College of Psychiatrists United Nations. (1995) Basic Facts. Geneva: United Nations. WHO. (1994a) Basic Documents. Geneva: WHO. 16 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS UNIT 3 CONCEPTUALIZING ILLNESS CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Defining Illness 3.2 Perspectives of Illness 3.2.1 Illness as subjective sensation of illness 3.2.2 Illness as observable symptom of disease 3.2.3 Illness as disorder or malfunction 3.3 How concepts of Illness overlap 3.4 How concepts of illness do not overlap 3.5 Distinction between disease and illness 3.6 Illness Dynamics 3.6.1 Major Components of Illness Dynamics 4.0 Conclusion 5.0 Summary 6.0 Tutor marked Assignment 7.0 References/Further Readings 1.0 INTRODUCTION All of us have had experiences of getting sick and feelings of discomfort associated with it. It may be something as mild as cold, headache, fainting spell, or as serious and long lasting as chronic life-threatening disease such as cancer, diabetes, HIV/AIDS, etc. Illness is certainly a universal human experience, irrespective of age, gender, religious belief or socio-cultural differences. What then is illness? This unit tries to introduce the definition and different dimensions of illness. First we will try to provide several definitions of illness. 2.0 OBJECTIVES At the end of this unit, you should be able to:  Provide an in-dept definition of illness.  Determine perspectives of illness  Determine how concepts of illness overlap  Determine how concepts of illness do not overlap  Distinguish between disease and illness  Illustrate components of illness dynamics 3.0 MAIN CONTENT 17 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.1 Definition of Illness Illness has several definitions. Two of them are of the way the word was used up to the 18th century—to mean either "wickedness, depravity, immorality", or "unpleasantness, disagreeableness, hurtfulness". These older meanings reflect the fact that the word "ill" is a contracted form of "evil". Another meaning, dating from the 19th century, is the modern one: "Illness; the state of being ill". The dictionary defines "ill" in this third sense as "a disease, a sickness". Looking up "sickness" we find "The condition of being sick or ill; illness, ill health"; and under "sick" (a Germanic word whose ultimate origin is unknown) we find "affected by illness, unwell, ailing... not in a healthy state", and, of course, "having an inclination to vomit". There is a rather unhelpful circularity about these dictionary definitions. But dictionaries of the English language usually only aim to tell us the origins of words and how they have been used historically. They do not aim at the much more contestable goal of conceptual clarity. For that we have to look elsewhere. In this case, let us look at how disease, illness and sickness have been elucidated first by a medical practitioner, who ought to know something about the subject; and then, after noting some popular and literary definitions, by a philosopher, who ought to know something about conceptual clarity. It might be thought that so fundamental a concept in medical science, ‗illness‘ would have been the subject of broad agreement and succinct definition, but this appears to be very far from the truth indeed (Szasz, 1987). Definitions of illness have changed regularly throughout the history of medicine in response to fashion and a variety of other factors. The present situation is in part complicated because many of these historical definitions co-exist with their more recent counterparts (Cockerham, 2003; Taylor, 2006). For example, the definition of illness as a syndrome, or coherent cluster of symptoms is credited to the seventeenth-century physician Sydenham. His definition, which does not rely on the notion of pathogens or pathological process, is still current, being used alongside the more modern, but logically quite different definition of illness, as that of bacterial infection. There are, of course, still more recent definitions; all are useful and all more or less appropriate according to circumstances. Definition 1: Bishop (1994) defined Illness as the experience of suffering and discomfort, which may or may not be related to objective physical pathology. 18 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Definition 2: Barondness (1979); Jennings, (1986), defined illness as an experience of discomfort and suffering. Advances in science and technology have greatly improved our ability to detect disease and, more than any other factor, have influenced the views of both lay people and professionals in their understanding of illness (Kendel, 1975). For this reason, definitions of illness, with the exception of mental illness which is sometimes defined ambiguously, are biased towards a structural or physiological view, making the assumption that the core of illness consists of organic dysfunction or ‗disease‘. Definition 3: Illness is also defined as a state or condition of suffering as the result of a disease or sickness. This definition is thus based on the modern scientific view that an illness is an abnormal biological affliction or mental disorder with a cause, a characteristic train of symptoms, and a method of treatment (Cockerham, 2003). Definition 4: Illness is also the individual‘s perception and labeling of a set of physical and emotional experiences. This definition, therefore, highlights the role of cognition on illness perception (Cockerham, 2003). Definition 5: Illness, although often used to mean disease, can also refer to a person‘s perception of their health, regardless of whether they in fact have a disease (Weiss and Lonnquist, 2005) As you will rightly agree the above perspectives to illness leave one in little doubt about the concept. Now let us try our hands on this simple exercise. SELF ASSESSMENT EXERCISE 1 i. Define Illness ii. Can the 18th century conception of illness be applicable in contemporary time? Answer To Exercise i. Illness is defined as an experience of discomfort and suffering (Barondness, 1979; Jennings, 1986). Illness is also defined as a state or condition of suffering as the result of a disease or sickness (Cockerham, 2003). Illness, although often used to 19 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS mean disease, can also refer to person‘s perception of their health, regardless of whether they in fact have a disease (Weiss and Lonnquist, 2005). ii. Illness has several conceptions. One of them is of the way the word was used up to the 18th century—to mean either "wickedness, depravity, immorality", or "unpleasantness, disagreeableness, hurtfulness". These older meanings reflect the fact that the word "ill" is a contracted form of "evil". Contemporary views of illness are that of scientific and medical approaches, but few observations indicate that illness could be perceived as a state of immorality and wickedness. These views are likely to have spiritual undertones to them. 3.2 Perspectives of Illness Now let us introduce another aspect of illness experience that could further aid our understanding of the concept. We can call them perspectives of illness. They are:  Illness as subjective sensation  Illness as a set of symptoms or disease  Illness as a disorder or a malfunction of a body tissue, organ or system 3.2.1 Illness as the Subjective Sensation A subjective sensation of illness means feeling ill. People might feel ill when they have some disease symptoms; they might also feel ill when no symptoms are present. By this definition, illness exists when people decide that they feel ill or describe themselves as being ill. People who are very anxious about, or sensitive towards, their health are likely to think of themselves as ill even when symptoms are very mild or absent. Other people may also refuse to think of themselves as ill even when there are obvious signs that something is wrong (Taylor, 2006). 3.2.2 Illness As Observable Symptoms Of Disease Disease refers to a diagnosable problem, which might be physiological (a physical disorder) or psychiatric (a mental disorder). This view of illness is objective, i.e. illness is something for which there is likely to be publicly available evidence — for example, two people with medical knowledge agreeing that a patient has a disease. Also, when people become ill they usually develop symptoms. A symptom is something that is noticeable to the affected person (e.g. itching or pain). It might be noticeable to other people too (e.g. a rash or a lump). Soon after developing symptoms, people begin to think of themselves as ill and 20 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS decide to take some action. This might be to buy some medication or to visit their doctor. The physician might then confirm that the person is ill and diagnose the disease. However, there are sometimes situations in which this pattern is not followed. For example, people might think of themselves as ill but a doctor or a hospital consultant might be unable to detect any disorder. Sometimes, people might have a disease but not notice any symptoms, or might notice symptoms but not think of themselves as ill. For example, a person might catch a cold, but ignore it and carry on as normal. It might surprise you that there are several different opinions about what is meant by being healthy and also a range of views about what is meant by being ill (Bishop, 1994). 3.2.3 Illness As A Disorder Or Malfunction The term ‗disorder‘ refers to some malfunction of a body tissue, organ or system. This concept is based on the idea that body systems can go wrong. This definition is the one that the writer of a medical textbook is likely to have in mind (Cockerham, 2003). 3.3 How Concepts of Illness Overlap Students can have difficulty in telling the difference between the three concepts of illness. This is partly because they sometimes overlap. For example, ‗illness as subjective sensation‘ can overlap with ‗illness as having symptoms of disease‘. This is because some of the symptoms of illness (e.g. pain and tiredness) are themselves subjective sensations. This overlap is most noticeable with mental disorders. Unlike physical illnesses, mental disorders often have no symptoms that are detectable through observation, blood tests, scans, and so on. For example, a person suffering from depression is likely to have no observable symptoms apart from complaining of overwhelming feelings of misery and helplessness. In this case, ‗illness as a subjective sensation‘ is the same as ‗illness as disease symptoms‘. In other situations it is easier to tell the difference. For example, a person with a skin rash (observable disease symptom) might not think of himself or herself as ill (subjective sensation), particularly if the rash is not accompanied by pain. The concept of ‗illness as disease symptoms‘ can also overlap with ‗illness as a disorder or malfunction‘. This is usually the case when the symptoms correspond very closely to the malfunction. For example, a person with a lung disorder such as pneumonia will experience difficulty in breathing. 21 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.4 When Concepts of Illness Do Not Overlap However, in other situations these concepts of illness can be distinct. For example, a person could experience symptoms, such as sneezing and a runny nose that are not caused by malfunction of any body tissue, organ or system. Rather, those symptoms are the result of ineffective functioning of the immune system to overcome a cold virus. In this case, ‗illness as disease symptoms‘ is distinct from ‗illness as disorder or malfunction‘. A contrasting example is that a person can have a serious malfunction of body tissue (such as a tumour growing on the spleen) but not feel ill. Some symptoms like tumours in some parts of the body, including the abdomen and brain, can grow for many months before they are noticed. This is because there are few sense organs in these parts of the body. Symptoms are unlikely to be felt until the tumour is pressing on surrounding tissue that has more sense organs. So the sufferer might remain healthy with no sign of illness until it gets critical. Another situation in which ‗illness as symptoms of disease‘ and ‗illness as malfunction‘ do not overlap is when the symptoms could be the result of a range of malfunctions. For example, a person feels constantly tired and out of breath. A blood test reveals that the person is anaemic (has too few red blood cells). The symptoms of tiredness, shortness of breath and anaemia do not arise from any particular disorder or malfunction. The anaemia could be caused in several ways — for example, by a disorder of the bone marrow, by internal bleeding or by a dietary deficiency. Only by further tests and investigations could a specific disorder or malfunction be detected. However, in most people who are seriously ill, these three aspects of illness occur together. People will think of themselves as ill, they will notice symptoms (e.g. partial paralysis) and they will have an organ malfunction (e.g. a stroke or bleed into the brain). SELF ASSESSMENT EXERCISE 2 Have you enjoyed your readings? Now let us attempt this. A researcher asked a sample of people the question, ‗What does ―illness‖ mean to you?‘ Read the following replies from different people and decide which concept of illness best fits each answer. The three concepts of illness you should use are:  Illness as a subjective sensation of illness  Illness as disease symptoms  Illness as disorder or malfunction 22 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Answer A: ‗It means having things like heart disease or something blocking your intestines.‘ Answer B: ‗All sorts of things. You know sickness and diarrhea, unbearable pain, lumps growing on your skin. ‗ Answer C: ‗It‘s when you don‘t feel well. Answer to Exercise A Illness as a disorder B Illness as disease symptom C Illness as subjective sensation I hope you enjoyed this exercise. Now let us focus on the distinctions between disease and illness. 3.5 Distinction between Illness and Disease Professor Marshall Marinker, a general practitioner, suggested over twenty years ago a helpful way of distinguishing between disease and illness. He characterizes these "two modes of unhealth as follows. "Disease... is a pathological process, most often physical as in throat infection, or cancer of the bronchus, sometimes undetermined in origin, as in some mental illnesses. Thus, disease can be thought of as the presence of pathology, which can occur with or without subjective feelings of being unwell or social recognition of that state. The quality which identifies disease is some deviation from a biological norm. There is an objectivity about disease which doctors are able to see, touch, measure, and smell. Diseases are valued as the central facts in the medical view. "Illness... is a feeling, an experience of un-wellness which is entirely personal, interior to the person or the patient. Thus, it is a subjective state of un-wellness, with certain individual differences in coping mechanisms. Often it accompanies disease, but the disease may be undeclared, as in the early stages of cancer or tuberculosis or diabetes. Sometimes illness exists where no disease can be found. A person without any disease may feel unhealthy and believe he/she has an illness. Another person may feel healthy and believe he/she does not have an illness even though he/she may have a disease such as dangerously high blood pressure which may lead to a fatal heart attack or categorized as subjective, with certain individual differences in coping mechanisms. Alternatively, a person may have a disease and not feel ill. For example, Hypertension is called the silent killer because it 23 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS can exist for a long time without being detected. Many cancers can also exist and develop for weeks, months or even years without being detected (Weiss and Lonnquist, 2005). 3.6 Illness Dynamics The relationship among one‘s biological status (e.g., genetic constitution and physical pathology), emotional makeup, and the supports and stresses of a social matrix (confluence of biologic, psychologic, and social aspects), represents the patient‘s understanding of a specific disease during a particular period of life. Illness dynamics incline one to assess all illness-related information in light of singular values, wishes, needs, and fears, ultimately causing the patient to perceive, assess, and defend against the loss of health in a highly subjective manner. This may significantly affect the patient‘s ability to cope with the disease. 3.6.1 Major Components of Illness Dynamics Biological  Nature, severity, and time course of disease  Affected organ, system, body part, or body function  Baseline physiological functioning and physical resilience  Genetic endowment Psychological  Maturity of ego functioning and object relationships  Personality type  Stage in the lifecycle  Interpersonal aspects of the therapeutic relationship (e.g., countertransferance of healthcare providers)  Previous psychiatric history  Effect of past history on attitudes toward treatment (e.g., postoperative complications) Social  Dynamics of family relationships  Family attitudes toward illness  Level of interpersonal functioning (e.g., educational and occupational achievements; ability to form and maintain friendships)  Cultural attitudes 24 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 4.0 CONCLUSION Illness definition is indeed not as easy as it appears because of its dynamic nature. As a subjective experience, illness is influenced not only by the person‘s biological state but also by cultural and social factors, situational variables, stress, personality, and concepts held by the person about the nature of disease. Thus illness represents a true interaction between the physical, social and the psychological. 5.0 SUMMARY We have systematically defined illness. We also went further to analyze the three perspectives of illness as well as the distinction between illness and disease. Lastly, we looked at the dynamics of illness. I hope you found this unit helpful. Now let us try this exercise. 6.0 TUTOR MARKED ASSIGNMENT 1. Distinguish between illness and disease 2. Identify the major components of illness dynamics. 7.0 REFERENCES/FURTHER READINGS Barrondness, J. A. (1979). Disease and illness: A crucial distinction. American Journal of Medicine, 66, 375-376. Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston: Allyn and Bacon. Brown L, ed. (1993). The new shorter English dictionary. Oxford: Clarendon Press. Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall. Jennings, D. (1986). The confusion between disease and illness in clinical medicine. Canadian Medical Association Journal, 135, 865-870. Kendell, R. E. (1975), The role of diagnosis in Psychiatry. Oxford: Blackwell Scientific Pub: Marinker, M. (1975). Why make people patients? Journal of Medical Ethics, 1:81-84. 25 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Szasz, T. S. (1987). Insanity – The idea and its Consequences. New York: John Wiley and Sons. Taylor, S. (2006). Health Psychology (6th edition). Los Angeles: McGraw Hill. Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and Illness, (5th edition). Safari book online. Retrieved from http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th March 2007. 26 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS MODULE 2 CONCEPTUALIZING HEALTH/ILLNESS DICHOTOMIES AND DETERMINANTS Unit 1 Health and Illness and the Mind – Body Relationship Unit 2 Acute Illness versus Chronic Illness Unit 3 Culture and Socio-Demographic Determinants of Health and Illness UNIT 1 HEALTH AND ILLNESS AND THE MIND – BODY RELATIONSHIP CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Illness and the Mind-Body Relationship: A Brief History 3.1.1 Illness and the Mind-Body Relationship: The Middle Ages 3.1.2 Illness and the Mind-Body Relationship: The Modern Era 4.0 Conclusion 5.0 Summary 6.0 Tutor Marked Assignment 7.0 References/Further Readings 1.0 INTRODUCTION The relationship between the mind and the body has long been a controversial topic. Are experiences, such as illness experiences purely mental, physical, or an interaction between the mental and physical? This unit therefore seeks to provide answers to these. 2.0 OBJECTIVES At the end of this unit, you should be able to:  Illustrate historical perspective of illness and the mind – body relationship.  Identify the perspectives of illness and the mind-body relationship in the middle ages.  Illustrate the conception of illness and the mind-body relationship in the modern era. 27 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.0 MAIN CONTENT 3.1 Illness and the Mind and Body Relationship: A Brief History As Gentry and Matarazzo (1981) pointed out, the view that there are delicate interrelationships, such as the dry mouth and racing heart associated with fear and anger, or the headache triggered by emotional stress, can be found in ancient literature documents from Babylonia and Greece. The Greeks were among the earliest civilizations to identify the role of bodily functioning in health and illness. Rather than ascribing illness to evil spirit, they developed a humoral theory of illness that was first proposed by Hippocrates in 377 B.C., and later expanded by Galen (A.D. 129). According to this view, disease arises when the four circulating fluids of the body – blood, black bile, yellow bile and phlegm – are out of balance. An excess of yellow bile was linked to a choleric temperament. It was assumed that this yellow bile prompted an individual to become chronically angry and irritable, hence the word choleric (angry), which literally means bile. An excess of black bile was considered to cause a person to be chronically sad or melancholic, hence the term melancholy, which literally means black bile. The sanguine or optimistic temperament, characterized by calm, listless personality attributes, was seen as being due to an excess of bodily humor phlegm (Gatchel, et al, 1997). Of course, this humoral view of personality and illness was long ago abandoned, along with a number of other pre-scientific notions. On a historical level, however, it points out how physical or biological factors have been seen through the ages as significantly interacting with and affecting the personality or psychological characteristics of an individual (Gatchel, et al, 1997). The function of treatment is to restore the balance among the humors. Specific personality types were thus believed to be associated with bodily temperaments in which one of the four humors predominated. In essence, then, the Greeks ascribed disease states to bodily factors, but also believed that these factors could also have an impact on the mind (Taylor, 2006). SELF ASSESSMENT EXERCISE Describe the pre-historic conception of illness and the mind-body relationship 28 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Answer to Exercise The Greeks were among the earliest civilizations to identify the role of bodily functioning in health and illness. Rather than ascribing illness to evil spirit, they developed a humoral theory of illness that was first proposed by Hippocrates in 377 B.C., and later expanded by Galen (A.D. 129). According to this view, disease arises when the four circulating fluids of the body – blood, black bile, yellow bile and phlegm – are out of balance. For example, an excess of yellow bile was linked to a choleric temperament. Thus, the function of treatment is to restore the balance among the humors. In essence, then, the Greeks ascribed disease states to bodily factors, but also believed that these factors could also have an impact on the mind 3.1.1 Illness and the Mind-Body Relationship - The Middle Ages Mysticism and demonology dominated concepts of illness in the middle- ages, while afflicted persons were seen as receivers of God‘s punishment for evil doing. Cure often consisted of driving out evil by tutoring the body. Later, this ―therapy‖ was replaced by penance through prayers and good works. Throughout this time, the church was seen as the guardian of medical knowledge; as a result medical practices took on religious overtones, including religiously based but unscientific generalizations about the body-mind illness relationship. 3.1.2 Illness And The Mind-Body Relationship – The Modern Era Beginning in the Renaissance and continuing up to the present day, great strides have been made in the technological basis of medical practices. Most notable among these were Anton Vaan Leeuwenhoek‘s (1632- 1723) work in microscopy and Gionanni Morgagni‘s (1682-1771) contributions to autopsy, both of which laid the groundwork for the rejection of the humoral theory of illness. The humoral approach was finally put to rest by the theory of cellular pathology, which maintains that all disease is disease of the cell rather than a matter of fluid imbalance (Kaplan, 1975).As a result of such advances, medicine looked more and more to the medical laboratory and bodily factors, rather than to the mind, as a basis for medical progress. This view however began to change with the rise of modern psychology, particularly with Sigmund Freud‘s (1856-1936) early work on conversion hysteria. According to Freud, specific unconscious conflicts can produce particular physical disturbances that symbolize the repressed psychological conflicts. In conversion hysteria, the patient 29 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS converts the conflict into a symptom via the voluntary nervous system; he or she becomes relative free of the anxiety the conflict would otherwise produce. The conversion hysteria literature is full of intriguing but biologically impossible disturbances, such as glove anaesthesia (in which the hand, but not the other parts of the arm, loses sensation) in response to highly stressful events. Other problems include sudden loss of speech, hearing or sight; tremors; muscular paralysis, etc, have also been interpreted as forms of conversion hysteria. True conversion hysterias are now less frequent than they were in Freud‘s time (Taylor, 2006) Nonetheless, the idea that specific illnesses are produced by individual‘s internal conflicts was perpetuated by the works of Flanders Dunbar (Dunbar, 1943), and Franz Alexander (Alexander, 1950). Unlike Freud, these researchers linked patterns of personality rather than single specific conflict to specific illnesses. For example, Alexander developed a profile of the ulcer prone personality as someone whose disorder was caused primarily by excessive needs for dependency and love. A more important departure from Freud concerned the physiological mechanism postulated to account for the link between conflict and disorder. Whereas, Freud believed that conversion reactions occurred via the voluntary nervous system with no necessary physiological changes, Dunbar and Alexander argued that conflicts produce anxiety that becomes unconscious and takes a physiological toll on the body via the autonomic nervous system. The continuous physiological changes eventually produce an actual organic disturbance. In the case of ulcer patient, for example, repressed emotions resulting from frustration dependency and love-seeking needs were said to increase the secretion of acid in the stomach, eventually eroding the stomach lining and producing ulcer (Alexanader, 1950). Dunbar and Alexander‘s work however helped shape the emerging field of psychosomatic medicine (Taylor, 2006) 4.0 CONCLUSION There indeed exist a delicate relationship between mind and body on illness experiences. Observations have shown the delicate relationship between stress, personality and physical complaints like headache or even cancer. The Greeks were therefore one of the first civilization to identify the role of bodily functioning to illness. Thus, rather than ascribing illness to evil spirit, as previously thought, or even as currently thought sometimes, illness was ascribed to imbalance in bodily fluids. Also, a further assessment of mind-body relationship gave rise to the psychosomatic movement, which was of course, without its criticism. 30 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 5.0 SUMMARY Wow, I‘m sure you find this unit very insightful, like the previous ones. In this unit, we have been able to trace the historical perspective of mind-body relationship as well as different perceptions of illness, pre and post the modern era. Now let us attempt the following exercise. 6.0 TUTOR MARKED ASSIGNMENT Identify the pre and post historic views of illness and the mind body relationship. 7.0 REFERENCES/FURTHER READINGS American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th Ed) (DSM-IV). Washington, DC: APA. Alexander, F. (1950). Psychosomatic Medicine. New York: Norton. Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall Dunbar, F. (1943). Psychosomatic diagnosis. New York: Hoeber Engel, B. T. (1986). Psychosomatic medicine, behavioural medicine, just plainmedicine. Psychosomatic medicine, 48, 466-47. Gatchel, R. J., Baum, A. and Krantz, D. S. (1997). An Introduction to Health Psychology (3rd edition). NY: McGraw Hill. Gentry, W. D. and Matarazzo, J. D. (1981). Medical Psychology: Three decades of growth and development. In L. A. Bradely and C. K. Prokop (Eds). Medical Psychology: Contributions to behavioural medicine. New York: Academic Press. Kaplan, H. I. (1975). Current psychodynamic concepts in psychosomatic medicine. In R.O. Pasnau (Ed.), Consultation-Liaison Psychiatry. New York: Grune & Stratton Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw Hill. World Health Organization (1992) International Statistical Classification of Diseases and Related Health Problems. Geneva: WHO. 31 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS UNIT 2 ACUTE VERSUS CHRONIC ILLNESS CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Defining Acute Illness 3.1.1 Types of Acute Illness 3.2 Defining Chronic Illness 3.2.2 Types of Chronic Illness 3.3 Distinction between Chronic and Acute Illnesses 3.4 Chronic Illness and Hospitalization 4.0 Conclusion 5.0 Summary 6.0 Tutor Marked Assignment 7.0 References/Further Readings 1.0 INTRODUCTION As you must have noted, we provided information on illness and the mind-body relationship in the previous unit. Of course, these are very necessary information as they help for better appreciation of this course. However, in this unit, we will analyze acute versus chronic illness. Observations indicate that we cannot understand human behaviour in health and illness without looking at these basic terms. So, we are going to look at acute versus chronic illness as well as the diseases categorized under each. Happy reading! 2.0 OBJECTIVES At the end of this unit, you should be able to:  Define acute illness  Enumerate types of acute illness  Define chronic illness  Determine types of chronic illness  Ascertain differences between acute and chronic illness  Determine the influence of chronic illness on hospitalization 3.0 MAIN CONTENT 32 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.1 Defining Acute Illness Acute illness is by definition a self-limiting disease which is mostly characterized by the symptoms having a rapid onset. These symptoms are fairly intense and resolve in short period of time as either cure or death in the patient. 3.1.1 Types of Acute Illness We commonly know these acute diseases as:  Colds  Flu  Bronchitis  Malaria  Childhood illnesses  Tonsillitis  Appendicitis  Ear aches  Most headaches  Some infectious diseases, etc. 3.2 Defining Chronic Illness Chronic diseases are those that occur across the whole spectrum of illnesses, mental health problems and injuries. Chronic diseases tend to be complex conditions in how they are caused, are often long-lasting and persistent in their effects and can produce a range of complications. Chronic conditions are those which are long-term (lasting more than 6 months) and can have a significant effect on a person‘s life. Management to reduce the severity of both the symptoms and the impact is possible in many conditions. Management includes medication and/or lifestyle changes such as diet and exercise, and stress management. At the same time, it should be noted that chronic diseases may get worse, lead to death, be cured, remain dormant or require continual monitoring. 3.2.1 Types of Chronic Illness The following are various types of chronic illness  Epilepsy – Neurological Disease The condition arises when there is a brief interruption in the normal electrical function of the brain. Epileptic attacks can vary between 33 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS momentary withdrawal without loss of consciousness (petit mal) and muscular spasms and convulsions (grand mal) (Wikipedia – The free Encyclopedia, 2007)  Heart Disease This is an umbrella term for a number of different diseases which affect the heart. The most common heart diseases are: Coronary Heart Disease: a disease of the heart itself caused by the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium. Ischaemic Heart Disease: another disease of the heart itself, characterized by reduced blood supply to the organ. Cardiovascular Disease: a sub-umbrella term for a number of diseases that affect the heart itself and/or the blood vessel system, especially the veins and arteries leading to and from the heart. Research on disease dimorphism suggests that women who suffer with cardiovascular disease usually suffer from forms that affect the blood vessels while men usually suffer from forms that affect the heart muscle itself. Known or associated causes of cardiovascular disease include diabetes mellitus, hypertension, hyperhomocysteinemia and hypercholesterolemia. Cor pulmonale: a failure of the right side of the heart. Hereditary Heart Disease: heart disease caused by unavoidable genetic factors since birth. Hypertensive Heart Disease: heart disease caused by high blood pressure, especially localized high blood pressure. Inflammatory Heart Disease: heart disease that involves inflammation of the heart muscle and/or the tissue surrounding it. Valvular Heart Disease: heart disease that affects the valves of the heart. (Retrieved from "http://en.wikipedia.org/wiki/Heart_disease")  Asthma – Respiratory Disease Asthma is characterized by attacks of breathlessness, coughing and wheezing. Attacks vary in severity and duration. Attacks can be triggered by a variety of factors: exposure to allergens, dust, humidity and infection, emotional factors etc. 34 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS  Mental Illness A mental illness as defined in psychiatry and other mental health professions is abnormal mental condition or disorder expressing symptoms that cause significant distress and/or dysfunction. This can involve cognitive, emotional, behavioural and interpersonal impairments. Similar but sometimes alternative concepts include: mental disorder, psychological or psychiatric disorder or syndrome, emotional problems, emotional or psychosocial disability. The term insanity, sometimes used colloquially as a synonym for expressing symptoms of a mental health condition or irrationality, is used technically as a legal term. Specific disorders often described as mental illnesses include clinical depression, generalized anxiety disorder, bipolar disorder, and schizophrenia. Diagnosis is performed by a mental health professional. Mental health conditions have been linked to both biological (e.g. genetics, neurochemistry, brain structure), disease (viruses, bacteria, toxins), drugs (both illegal and over-the-counter medication) and psychosocial (e.g. cognitive biases, emotional problems, trauma, socioeconomic disadvantage) causes. Different schools of thought offer different explanations, although current research employing the term 'mental illness' would most probably originate in a biopsychiatry point of view (Wikipedia – The free Encyclopedia, 2007).  Diabetes – Metabolic Disease Diabetes is one of the leading causes of death in Africa and the world, and contributes to significant illness disability, and poor quality of life. It shares several of the risk factors with cardiovascular disease and is itself a risk factor. There is a marked difference in the age profile of people with different types of diabetes. There are two types: - Type 1: Insulin-dependent diabetes – IDD (common among children); - Type 2: Non-insulin-dependent diabetes – NID (adults over 40). Type 1 diabetes is the most common form among children and young adults. In these children, the pancreas does not produce sufficient insulin. Type 2 diabetes is predominant among middle- aged and elderly due to its rapid increase in prevalence after age 45. Here, blood sugar is increased and sugar in the urine is increased also (Wikipedia – The free Encyclopedia, 2007). 35 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS  Cancer Cancer develops when cells in a part of the body begin to grow out of control. Although there are many kinds of cancer, they all start because of out-of-control growth of abnormal cells. Normal body cells grow, divide, and die in an orderly fashion. During the early years of a person's life, normal cells divide more rapidly until the person becomes an adult. After that, cells in most parts of the body divide only to replace worn-out or dying cells and to repair injuries. Because cancer cells continue to grow and divide, they are different from normal cells. Instead of dying, they outlive normal cells and continue to form new abnormal cells. Cancer usually forms as tumour. Some cancers, like leukemia, do not form tumours, instead, these cancer cells involve the blood and blood- forming organs and circulate through other tissues where they grow. Often, cancer cells travel to other parts of the body where they begin to grow and replace normal tissue. This process is called metastasis. Regardless of where a cancer may spread, however, it is always named for the place it began. For instance, breast cancer that spreads to the liver is still called breast cancer, not liver cancer. Not all tumours are cancerous. Benign (noncancerous) tumours do not spread (metastasize) to other parts of the body and, with very rare exceptions, are not life threatening. Different types of cancer can behave very differently. For example, lung cancer and breast cancer are very different diseases. They grow at different rates and respond to different treatments. That is why people with cancer need treatment that is aimed at their particular kind of cancer. The overall incidence for cancer is lowest in late childhood. In adult life it increases with age. Death rates from cancer increase with age, from age 15. The older population makes up a higher proportion of those dying from cancer, and this proportion is increasing (wikipedia – The free Encyclopedia, 2007).  HIV/AIDS HIV/AIDS was to enter the world‘s consciousness and become part of the vocabulary of the human soul as a result of the dawning awareness of the advent of the strange new disease first reported in California in 1981. With time, the HIV/AIDS pandemic is unfolding and revealing its secrets. (Pratt, 2003). AIDS is therefore a new disease and its full name is Acquired Immune Deficiency Syndrome. As the name implies, it is a disease caused by a deficiency in the body‘s immune system. It is a syndrome because there is a range of different symptoms which are 36 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS always found in each case. It is acquired because HIV/AIDS is an infectious disease caused by a virus which spread from person to person through a variety of routes. This makes it different from immune deficiency from other causes such as treatment with anti-cancer drugs or immune system suppressing drugs given to persons receiving transplant operations. (Hubley, 1995). Thus, with Africa, inclusive Nigeria, bearing about 70%, of HIV infections, there is no gainsaying that the epidemic is one of the new factors responsible for the continued underdevelopment of the continent (Human Development Report, Nigeria, 2004). SELF ASSESSMENT EXERCISE i. Define acute and chronic illness ii. Identify the various types of acute and chronic illnesses Answer to Exercise  Acute illness is, by definition, a self-limiting disease which is mostly characterized by the symptoms having a rapid onset. These symptoms are fairly intense and resolve in short period of time as either cure or death in the patient. Chronic conditions are those which are long-term (lasting more than 6 months) and can have a significant effect on a person‘s life.  Types of acute illness are flu, malaria, ear aches, tonsillitis, etc.  Types of chronic illness are diabetes, mental illness, HIV/AIDS, heart diseases cancer, etc. 3.3 Distinction between Acute and Chronic Illness We have looked at various definitions of acute and chronic illness as well as some various types obtainable, now let us look at the basic distinctions between them.  Acute diseases have a limited duration, while chronic diseases can remain in the individual for decades.  Suffice to note that these diseases do not necessarily result in the death of the individual and they may not die directly from the symptoms of this disease. However, the chronic nature of the escalating symptomatology associated with chronic diseases, brings about great hardship to the individual in one way or another and severely undermines the quality of life through a continuum of ongoing fixed symptoms as well as the addition of ancillary sufferings. All this eventually leads to a terminal situation due to a weakening of the vital force. 37 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS  A person with chronic illness is more likely to depend longer on healthcare services than those suffering from acute illness. He or she is more likely to be dependent more on family and friends for normal everyday activities, than those with acute symptoms.  Psychological, social and family stress could be more visible in the case of chronic illness than acute illness. For example, a HIV positive individual grapples daily with the depression, fear, anger, stigma and discrimination associated with the disease and may feel traumatized by such medical state.  Chronic diseases bring about gradual deterioration of the mental, physical and emotional spheres of a person, while this may not be so for acute disease. Thus, the deterioration observed for acute disease is most times sudden and reduces when the person gets medical attention. For example, a person suffering from terminal cancer, long before it has been diagnosed, may show mental and emotional symptoms years before the overt symptoms manifest. Some people may suggest that this person used to be friendly and out going until a particular tragedy occurred some years earlier. The patient may also complain how their mental clarity used to be clearer before the said event. The patient will be able to relate their loss of mental clarity by stating that they now have a horrible memory for peoples‘ names, or that now, unlike before, they can‘t remember anything and always have to make lists of everything. However, this almost imperceptible decline is recognized by the vital force‘s attempt to call for help, by producing symptoms. It is the accurate reporting and faithful recording of these injured cries that allow the healer to clearly prescribe a therapeutic protocol for the alleviation of the suffering. 3.4 Chronic Illness and Hospitalization When individuals have a chronic disease, whether from birth or contracted in later life, they are likely to engage with the health system to a greater extent than anyone else. This may begin with visits to a general practitioner, followed by diagnostic tests, pharmaceutical prescriptions, consultations with specialists, visits to hospitals and possibly surgery. This may also take place in the context of a reduced earning capacity. Put differently, people with chronic diseases require maximum health services and they are least able to afford them. Those within the 60+ population with a sustained chronic disease are likely to have been on welfare benefits, if there is any, before the usual retirement age of 60 to 65 years. People with chronic disease may have also continued to work, though this may have been part time or casually. 38 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS An important aspect of living with a chronic disease is that as people become older they may develop other illnesses. Co-morbidities have a number of impacts; these people have even more expenses, they suffer the effects of polypharmacy, and suffer increased effects of the illnesses. 4.0 CONCLUSION Advances in research and the delivery of health care have reduced mortality from disease and extended life expectancy in developed countries. We are living longer, but are we necessarily living better? Those who would have died from their condition may now survive but there is the emotional cost of long-term treatment and medical surveillance to consider (for example, the patient who has had a liver transplant must then continue immuno suppression treatment). Such patients must cope with a chronic condition and yet the emotional dimensions of these conditions are frequently overlooked when medical care is considered. 5.0 SUMMARY In this unit, we have briefly defined acute and chronic illnesses. We also enumerated the various types of acute and chronic illnesses. This unit also provided a detailed distinction between acute and chronic illness and also went further to look at chronic illness and hospitalization. Let us now answer the questions stated below. 6.0 TUTOR MARKED ASSIGNMENT 1. Distinguish between acute and chronic illness 2. Identify the influence of chronic illness on hospitalization 7.0 REFERENCES/FURTHER READINGS Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall Human Development Report, Nigeria, (2004). HIV and AIDS: A challenge to sustainable development. UNDP Hubley, A. (1995). The AIDS Handbook: A guide to the understanding of AIDS and HIV. Second Edition, Oxford: Macmillan Education Ltd. Pratt, R. J. (2003). HIV and AIDS: A foundation for nursing and healthcare practice. Fifth Edition. London: Book Power. 39 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw Hill. Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and Illness, (5th edition). Safari book online. Retrieved from http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th March 2007. Wikipedia – The free Encyclopedia. ‗Heart Diseases‘ Retrieved from "http://en.wikipedia.org/wiki/Heart_disease") Site visited on 4th April 2007 Wikipedia – The free Encyclopedia. ‗Mental Illness‘ Site last modified 03:41,4 April 2007. Site visited on 4th April 2007. 40 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS UNIT 3 CULTURE AND SOCIO-DEMOGRAPHIC DETERMINANTS OF HEALTH AND ILLNESS CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Cultural factors of Health and Illness 3.2 Social and Demographic factors of Health and Illness 3.2.1 Age, Health and Illness 3.2.2 Gender, Health and Illness 3.2.3 Marital status, Health and Illness 3.2.4 Living Condition, Health and Illness 3.2.5 Socioeconomic status, Health and Illness 4.0 Conclusion 5.0 Summary 6.0 Tutor Marked Assignment 7.0 References/Further Readings 1.0 INTRODUCTION We have looked at several conceptions of illness, disease and health, illness and the mind-body relationship. We also looked at certain dichotomies of illness, such as acute versus chronic illnesses. We presented other contributory factors that accounted for changing patterns of illness. This unit therefore hopes to further identify contributory variables of illness and health. Specifically, this unit looks at cultural, social, demographic and situational perspectives of illness and health. Thus, illness does not occur in isolation, it is such contributory variables that predict various human behaviours in illness and health. 2.0 OBJECTIVES At the end of this unit, you should be able to:  Illustrate cultural factors influencing health and illness behaviour  Identify the socio-demographic factors of health and illness behaviour 3.0 MAIN CONTENT 41 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.1 Cultural Factors of Health and Illness Understanding the nature of health and illness and how people engage in several health behaviour, in a bid to keep healthy or respond to physical distress when ill, as the case may be, requires a consideration of the cultural context in which health and illness behaviours takes place. Although, the biological processes involved in disease are the same across cultural boundaries, but how people understand, experience and respond to illness is often radically different. Anthropological studies of different illness and health seeking behaviours across culture have shown that health and illness conceptions do not occur in isolation, but are part of the larger cultural belief system. Western technological societies tend to think of illness in terms of germs or specific dysfunctions within the body, while others may have a mystical interpretation to it. In Fabrega (1974) study of illness belief and medical care among the Spanish speaking people, the author described two contrasting approaches to illness. Indians of Mayan descent, regard illness as either a sign of sin or an indication that one‘s enemies have plotted with devils and witches to cause harm. A return to health requires that the sick person and his family make certain social, moral and religious reparations. Individuals of direct Spanish descent, however, have different and more individualistic views of illness. They regard the occurrence as evidence that the person‘s strength has been overcome and depleted. For these individuals, illness can be caused by biological, social and psychological factors, with the principal causes found in the person‘s emotions and social relationships. Thus, a return to health means a return of a person‘s strength, positive emotions and good social relationships. These beliefs, in turn, reflect the more differentiated world view that conceives of the individual as a separate person but with strong ties to the social group. Even within Western technological society, cultural groups differ in their responses to illness. For example, Zola (1964), found a classical difference between Irish American and Italian American. Whereas, patients of Irish descendants tended to describe a relatively small number of localized symptoms and downplay the pain, patients of Italian descent reported more symptoms relating to more areas of the body and were vocal about the pain. Also, in a comparison of reaction to pain among the Jewish, Italians, Iris and Americans, Zborowski (1952) observed that Italian and Jewish patients tended to be emotional about the pain, often exaggerating their illness experience. Irish tended to deny the pain while the Americans tended to be more stoical and ―objective‖ about their discomfort. The 42 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS writer observed that, even though the Jews and Italians tended to be more expressive about their illness experience, they apparently did so for different reasons. He noted that Italians were primarily concerned with pain sensation and were satisfied simply to find relief. Jews, however, were more concerned with the meaning of the pain and with potential consequences. In these studies therefore, the different responses to discomfort reflect overall cultural differences between groups and they also provide basic orientations and categories for interpreting somatic experiences. SELF ASSESSMENT EXERCISE How are illness and health perceived in your culture? Answer to Exercise Providing answer to this exercise will be highly subjective. Please, find time to attempt this exercise and also discuss with your friends or course mates. I am sure this experience will be a very insightful and interesting one. Ok! Can we move on? Next are the socio-demographic factors of health and illness. 3.2 Social and Demographic Factors of Health and Illness Although culture provides basic orientations to interpreting health and illness experiences, the experience of such, however, is further shaped by various demographic factors. Such factors therefore include: age, gender, marital status, living arrangement and socioeconomic status. 3.2.1 Age, Health and Illness Observations indicate that childhood and youthfulness signifies good health and vigour while illness and thus, decline in health increases as one gets older. Thus, older people are likely to report more activity restriction, physician visit and health complications due to chronic diseases and frail immune systems than the younger ones. Younger people are also more likely to engage in risky health behaviours like unprotected sexual habits, drug abuse or even engage in dangerous physical activities than the older ones because of the assumption that they are younger and full of energy. They are also more likely to be careless with illness experience and might interpret symptoms differently than the older ones. Whereas the older people might view symptom experience seriously and work towards getting well, the younger ones are likely to ignore those symptoms until its late to get medical attention. 43 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.2.2 Gender, Health and Illness Studies have shown that women report more illnesses than do men. Also, because of their physical make-up and experiences like child birth and motherhood, women are more likely to engage in health seeking behaviour than men. Although there are some questions as to whether women actually experience more symptoms, one study has found evidence that women have more ―diffuse‖ view of illness, often reporting symptoms that ―radiate‖ throughout the body. In addition, men often appear unaware of serious health problems when reporting symptoms to a doctor (Verbrugge, 1980). It is also known that breast cancer is more common in women than men and only men have prostrate cancer. 3.2.3 Marital Status, Health and Illness Marital status also seems to have significant effect on illness behaviour. Studies have shown that compared with those who are married, unmarried individuals are likely to report more symptoms and think themselves to be in poorer health than the married ones. This may be due to the poor feeding habit and other associated health risks likely to be observed among the unmarried individuals. For the unmarried females, boredom and an urge for a husband may predispose them to stress, depression and poor immunity to diseases. Also, child bearing and motherhood may predispose the married ladies to several forms of health complications, stress and loss of energy may sometimes arise when they had to combine motherhood with a formal job. Thus, they are more likely to engage in health seeking behaviours in a bid to function adequately in the home. Likewise, married men are more likely to engage less in risky health and physical behaviours than the unmarried one, especially when there are children involved. 3.2.4 Living Conditions, Health and Illness Overall, individuals living with one to three others may report fewest symptoms than those living with four or more others. Also, those living in a crowded and poorly ventilated environment are more vulnerable to diseases than those living in neat and spacious environment. Overall, poor living condition predisposes one to frequent hospital visits and self medications. 44 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS 3.2.5 Socioeconomic Status, Health and Illness Social class or socioeconomic status plays an important role in health and illness behaviour. A poor person is more like to have less purchasing power, poor feeding habit, and poor health service, live in poor and indecent environment and die younger due to complications of diseases. In their comparison between the white and blue collar jobs, Rosenblatt and Suchman (1964) observed that the blue-collar workers are less informed about health and illness, more skeptical about medical care, more dependent when ill than their white-collar counterparts. 4.0 CONCLUSION We have seen that the cultural and socio-demographic factors of illness experience are indeed part of the very many facets of health and illness. Observations indicate that though biological processes involved in illnesses are globally similar, but the perceptions, experiences and responses to illness are often radically dissimilar. Culture described as the way people live, plays a huge role in the understanding and studying of illness behaviour. Also, the influence of certain socio-demographic factors of illness experience cannot be over-emphasized. We have seen that age, gender, marital status, living conditions and socio-economic status exert significant influence on health and illness behaviour. 5.0 SUMMARY I hope you enjoyed your studies. In this unit, we looked at the roles of culture as well as socio-demographic variables on health and illness experience. Now let us tackle the question stated below. 6.0 TUTOR MARKED ASSIGNMENT Identify and discuss the Socio-demographic factors of Health and Illness behaviour 7.0 REFERENCES/FURTHER READINGS Bishop, G. D. (1994). Health Psychology: Integrating mind and body. Boston: Allyn and Bacon. Cockerham, W. C. (2003). Medical Sociology. (9th edition). NY: Prentice Hall Fabrega, H. (1974). Disease and social behaviour: An interdisciplinary perspective. Cambridge, MA: MIT Press. 45 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS Rosenblatt, D. and Suchman, E. A. (1964). Blue-collar attitudes and information about health and illness. In A. B. Shostak and W. Gomberg (Eds.), Studies of American worker. Englewood Cliff, NJ: Prentice Hall. Taylor, S. E. (2006). Health Psychology (6th edition). Los Angeles: McGraw Hill. Verbrugge, L. M. (1980). Sex differences in complaints and diagnosis. Journal of Behavioural Medicine, 3, 327-355. Weiss, L. G. and Lonnquist, L. E. (2005). The Sociology of Health, Healing and Illness, (5th edition). Safari book online. Retrieved from http//www.safari.com/0131928406/ch07iev1sec3. Site visited on 17th March 2007. Zborowski, M. (1952). Cultural components in responses to pain. Journal of Social Issues, 8, 16-30. Zola, I. K. (1964). Illness behaviour of the working class: Implications and recommendations. In. S. Shostak and W. Gomgerg (Eds.), Blue-collar world: Study of American worker. Englewood Cliffs, NJ: Prentice Hall. 46 NSC 301 HUMAN BEHHAVIOUR IN HEALTH AND ILLNESS MODULE 3 CONCEPTUALIZING HEALTH BEHAVIOUR Unit 1 What is Health Behaviour? Unit 2 Changing Patterns of Health and Illness Unit 3 Theoretical Approaches to Health and Illness Behaviour UNIT 1 WHAT IS HEALTH BEHAVIOUR CONTENTS 1.0 Introduction 2.0 Objectives 3.0 Main Content 3.1 Defining Health Behaviour 3.2 Health Promotion: An Overview 3.3 Dimensions of Health Behaviour 3.4 What are Health Habits 3.5 Complexities of Health Behaviour 4.0 Conclusion 5.0 Summary 6.0 Tutor Marked Assignme