Pain and Disability Clinical, Behavioral, and Public Policy Perspectives (1987) / Chapter Skim
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8. Illness Behavior and the Experience of Pain
8. Illness Behavior and the Experience of Pain
Pages 146-164
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From page 146... ...
ILLNESS BEHAVIOR: AN INTEGRATING CONCEPT Much research and clinical experience with pain have demonstrated that there is no clear relation between the amount of tissue damage and the degree of discomfort or functional disability reported by the 146
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From page 147... ...
The concept of illness behavior provides a useful way of understanding and describing the many psychosocial influences that affect how people monitor their bodies, define and interpret their symptoms, come to view themselves as sick and disabled, take remedial action, and use lay and professional sources of help (Mechanic, 19781. The concept draws on psychological theories of perception, cognition, and meaning attribution and on theories of social relationships.
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From page 148... ...
THE PROCESS OF ILLNESS BEHAVIOR Although illness behavior is best conceptualized as a process, it is important to note that it usually does not proceed in a straight path from one well-defined stage to another. Rather, there are likely to be bidirectional interactions between four elements—symptom perception, symptom interpretation, symptom expression, and coping behaviors.
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From page 149... ...
One of the most powerful influences on the way in which symptoms are perceived and the amount of attention paid to them is the meaning attributed to those symptoms. Meaning Attribution Meaning attribution about the cause and likely outcome of symptoms is influenced by a host of psychosocial and cultural factors as well as by a person's prior experience with illness.
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. The meaning attributed to pain influences whether or not suffering occurs.
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19821. The interpretation of symptoms and the meaning assigned to them may have a profound influence on coping responses.
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The absence of a diagnosable disease does not mean the absence of abnormalities, disturbances, or alterations in bodily functions. Thus, severe illness, illness behavior, and
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The holistic health care movement emphasizes mind-body unity and positive health enhancement (Inglis and West, 1983) and integrates traditional practices of Eastern mysticism into medical programs for pain and stress relief (Benson, 19751.
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THE INFLUENCE OF PERSONALITY, FAMILIAL, AND SOCIOCULTURAL FACTORS ON ILLNESS BEHAVIOR All aspects of illness behavior can be influenced in important ways by an individual's personality, by his or her family, and by the broader soc~ocultural environment in which he or she lives. Personality and Illness Behavior Personality, chronic pain, and illness behavior interact in complex ways that are not fully understood.
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From page 155... ...
Moreover, as is true of other illness behaviors, people learn to somatize in ways that are understood by others and sanctioned as appropriate. Somatization, like language, is a learned form of expression modeled for us by parents, friends and the media.
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Interaction between these social conditions and the physical and mental state of a particular person provides the basis for symptom amplification and the possibility of a resulting disability. Furthermore, as discussed elsewhere in this report, health professionals and the disability system may unintentionally contribute to somatization (and other illness behaviors)
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. Part of chiT6ren's socialization includes learning about appropriate illness behavior.
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For some families, attending to the illness of one of its members may be the only way the family can continue to function (Minuchin, 1974~. As discussed previously, somatization is a particular form of illness behavior that is likely to be reinforced in some families, especially those in which the recognition and open expression of feelings is discouraged and in which tensions among family members can only be expressed indirectly through somatic complaints.
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From page 159... ...
Those unfamiliar with Italian culture can confuse the cultural mode of expression (the affect associated with the report of symptoms) with the severity of the symptoms being reported, and especially careful clinical assessment is essential.
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Understanding that these and other characteristics can influence the perception of symptoms, the meaning attributed to them, and how they are expressed and coped with sensitizes health care professionals and disability examiners to potential sources of variation. It can lead to better history taking and communication about illness and treatment, but it does not provide a formula for how to interpret and treat patients' complaints or illness behaviors (see Chapter 101.
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Carron, H., DeGood, D., and Tait, R A comparison of low back pain patients in the United States and New Zealand: psychosocial and economic factors affecting severity of disability.
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Transcultural Psychiatry Research Review 21(3)
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The concept of illness behavior. Journal of Chronic Diseases 15:189-194, 1962.
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From page 164... ...
International Journal of Family Therapy 7:223-234, 1985. Violon, A
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