Components of the illness representation

Illness beliefs cannot be assumed solely on the basis of the illness from which a person is suffering, or from his or her social context. (7) Individuals may hold unpredictable beliefs—that an illness is inherited from a family member, or that it is a punishment for a misdemeanour, or that it may be curable by adopting an unusual diet. For some, the representation of illness overlaps with the representation of self, so that they see themselves as living their illness rather than suffering from it.(8)

The characteristics of a particular disease are not the only component of the illness which may make it threatening. Illness occurs in a social and interpersonal context, and while the responses of other people may be helpful, they may in some cases contribute to the demands of the situation. For example, a partner may withdraw or become depressed, or family members may become intrusive or overcontrolling. Being ill confers a special status, the so-called sick role, but it is a status acquired at a cost in the loss of independence and certain rights.

Resources for responding to illness (the secondary appraisal)

The focus of secondary appraisal is twofold: the person's personal resources, and the resources external to them, mainly in the immediate social network.

Personal resources may be defined in a number of ways, for example cognitive attributes, personal characteristics, or personality traits.

The other resource for the individual is social support. There are many approaches to understanding support, but a useful one (9) is to regard it as having four components:

1. emotional support, conveying a sense of being cared about or loved;

2. esteem support, conveying a sense of being valued or respected;

3. instrumental support, conveying practical help;

4. informational support, conveying knowledge relevant to tackling the problem. The role of the family

The family's reaction to illness has an important impact on the type of support available. If they are rejecting, intolerant of dependence, or unsympathetic to the needs of the patient—for example, to change their diet, or stop smoking, or take more (or less) exercise—then they may offer too little support. On the other hand, they may be overprotective, refusing to allow the patient a reasonable degree of autonomy and discouraging active coping. Sometimes, members of a family will hold different views about the nature of an illness, leading to conflict which is not always revealed to doctors. More often, they share views. If such views are inaccurate (so-called family myths) and yet strongly held, then they can be a powerful barrier to the patient accepting medical advice. It is a common observation that patients with chronic illness who are depressed often have a carer who is depressed, and this tendency to share (often dysfunctional) beliefs and coping styles is one reason for that.

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