Changes In The Concept Of The Individual And The Location Of Risks To Health

From her review of contemporary psychological literature, Ogden (1995) argues that, in the twentieth century, there have been fundamental shifts in our view of the individual and his or her relationship to the environment.

In the 1960s, there was a move away from the notion that individuals were passive, without agency, their behaviours being a response to external circumstances, towards a view of the individual as an interactive being. The revised model proposed that individuals processed and appraised information from the external world and that their behaviours were then shaped by the interactions between them and their environment. Thus, the nexus of "illness risk" moved, from being identified with factors that were outside the individual (biomedical models), to being the product of interpersonal interactions with external factors (the biopsychosocial model).

In the last decades of the twentieth century, there was a further shift to the view of the individual as being "intra-active". The intra-active individual is still conceptualised as an interactive being, but is also viewed as having a sense of authorship over actions, thoughts and emotional experiences, as having volition and control over behaviours, and as being the architect of intentions and plans (see also Harter, 1999).

Changing views about individual identity are reflected in contemporary cultural views about the nexus of health risks. Ogden writes that, following the paradigm shifts discussed above, current models emphasise that health risks and health-related behaviours are inherent within the individual, who has personal control and responsibility over his or her own (healthy or unhealthy) lifestyle. If this model were applied to a person with BD, it would suggest that individuals have the ability to control their own behaviour and to manage and master health treatments. In this context, risks to health are viewed as a breakdown in self-control and self-efficacy. Ogden terms this the creation of the "risky self", which is implicit in both the concept of the "expert patient" (Donaldson, 2001) and the definition of "recovery", which are discussed in the next sections.

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