Life events and illness

For clarity, the right-hand side of Fig 1 is given in a very compressed form, but in practice it is likely to need dividing into several components. The possibility of discovering relationships in time between life events and the onset of symptoms or interference with activities, particularly if repeated, should always be kept in mind, since this may be relevant to management plans and the assessment of prognosis. The best guide to this will be a lifechart. The opinions of patients and families about the causes of illness must be listened to with respect, while bearing in mind that the attribution of illness to the effects of unpleasant experiences is a more or less universal human assumption that often has no logical justification. Clinicians have to arrive at their own conclusions about such relationships by means of experience, common sense, and some acquaintance with research findings. Researchers seeking robust evidence on this topic are faced with a very difficult task, since the assessment of vulnerability to life events is a surprisingly complicated and controversial issue. The leading method in this field is the Life Events and Difficulties Schedule developed by Brown and Harris; a bulky training manual has to be mastered during a special course, and this then serves as a guide to an interview which may last for several hours. The length and detail of these procedures illustrate well the technical and conceptual problems that have to be faced. (323

and 34)

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