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PubMed2000

A center-based approach to a transplant employment program.

The return to work after transplantation has been actively discussed in the transplant community for years. However, despite the desire for transplant practitioners to have recipients return to being healthy, contributing members of society as well as return to work, practitioners often passively support the sick role. We discovered that patients who are returning to work after transplantation may have been out of the work force for several years, and require assistance that we as healthcare providers were unable or untrained to provide. An employment specialist was added to the transplant staff and became a vital part of our attempts to create a proactive employment atmosphere and enhance our patients' quality of life. Adding an advocate for employment in our center has also facilitated the shift in our thinking and approach to care from the sick role to one of rehabilitation and from reactive to proactive. This change in attitude has assisted in empowering our recipients to feel as if they can truly resume a normal life.

Adult↗
PubMed1976

Social theory and medicine.

Three sociolgists-Talcott Parson, Eliot Freidson, and Mechanic-have explained medical phneomena within a broader theoretical framework. Although all three have made significant contributions, their conclusions remain incomplete on the theoretical level and seldom have been helpful for workers concerned with ongoing problems of health care. Our purpose here is to summarize some of the strengths and weakness of each theoretical position. Parsons has elucidated the sick role as a deviant role in society, the function of physicians as agents of social control, and the normative patterns governing the doctor-patient relationship. The principal problems in Parsons' analysis center on an uncritical acceptance of physicians' social control functions, his inattention tot the ways in which physicians' behavior may inhibit change in society, and overoptimism about the medical profession's ability to regulate itself and to prevent the exploitation of patients. Viewing medical phenomena within a broader theory of the professions in general, Freidson has formulated w wide ranging critique of the medical profession and professional dominance. On the other hand, Freidson's work neglects the full political implications of bringing professional autonomy under control. Mechanic's coceptual approach emphasizes the social psychologic factors, rather than the institutional conditions, which are involved in the genesis of illness behavior. Mechanic also overlooks the ways in which illness behavior, by permitting a controllable from of deviance, fosters institutional stability. In conclusion, we present a breif overview of a theoretical framework whose general orientation is that of Marixian analysis. Several themes recur in this framework: illness as a source of exploitation, the sick role as a conservative mechanism fostering social stability, stratification in medicine, and the imperialsm of large medical institutions and health-related industries.

Clinical Competence↗
PubMed2002

Psychosocial factors in chronic disability.

If adopted without adequate cause, the lifestyle of an invalid is a grave misfortune for the patient and for its reflection on current social attitudes that foster such states. Psychological illnesses are frequently invoked and are often a genuine source of suffering and disability. However, patients who may be rewarded by large financial settlements in courts, may also on occasion exaggerate their claims. Modern society has established systems of support, and rulings in court proceedings that conduce to illness behaviour. To some extent the portentous diagnostic labels given to these patients fosters rather than alleviates illness. It is probable that biological factors deriving from the primary event initiate the process. In medical terms, the symptoms and disabilities are often discrepant with the initial illness or injury. The patients' behaviour arises out of a desire to attain the sick role for secondary gain. If society eliminated the stigma of psychological illness, and opposed exaggeration and simulation of illness, then such chronic disability with 'retreat into illness' might disappear. Sometimes an assumed illness becomes an adopted way of life. The unfortunate patients may come to believe they are ill; symptoms then persist after settlement. It is wrong to blame everything on society and to deny the free choice of the individual. Nevertheless, the pressures of society can be difficult to withstand for those not gifted with resilience. We should also recognise and try to eliminate the contribution made by doctors and health workers who mistakenly aid and abet a 'culture' that promotes this state of chronic disability. If adopted without adequate cause, the lifestyle of an invalid is a grave misfortune for the patient and for its reflection on current social attitudes that foster such states. Psychological illnesses are frequently invoked and are often a genuine source of suffering and disability. However, patients who may be rewarded by large financial settlements in courts, may also on occasion exaggerate their claims. Modern society has established systems of support, and rulings in court proceedings that conduce to illness behaviour. To some extent the portentous diagnostic labels given to these patients fosters rather than alleviates illness. It is probable that biological factors deriving from the primary event initiate the process. In medical terms, the symptoms and disabilities are often discrepant with the initial illness or injury. The patients' behaviour arises out of a desire to attain the sick role for secondary gain. If society eliminated the stigma of psychological illness, and opposed exaggeration and simulation of illness, then such chronic disability with 'retreat into illness' might disappear. Sometimes an assumed illness becomes an adopted way of life. The unfortunate patients may come to believe they are ill; symptoms then persist after settlement. It is wrong to blame everything on society and to deny the free choice of the individual. Nevertheless, the pressures of society can be difficult to withstand for those not gifted with resilience. We should also recognise and try to eliminate the contribution made by doctors and health workers who mistakenly aid and abet a 'culture' that promotes this state of chronic disability

Chronic Disease↗
PubMed1997

Brodifacoum rodenticide ingestion in a patient with shigellosis.

Factitious disorders are characterized by the intentional feigning or induction of signs and/or symptoms in order to assume the sick role. The spectrum of diseases and symptoms simulated is extensive. Although some patients may seek only the gratifications of the sick role, typically patients seek health care for their afflictions. We report the case of a woman with a history of numerous unexplainable illnesses and laboratory findings who had shigellosis. On routine evaluation, a severe prothrombin coagulopathy was discovered and later determined to be caused by brodifacoum, a "superwarfarin" drug found in potent rodenticides. The patient was successfully treated with daily vitamin K. She continued to deny intentional or accidental ingestion but did consent to psychiatric treatment.

4-Hydroxycoumarins↗
PubMed2001

Radionuclide lung imaging in respiratory decompression sickness: potential role in the diagnosis and evaluation of hyperbaric therapy.

Of the more than 3.5 million trained divers in the United States, many will experience various illnesses specific to divers. Most of these illnesses are related to the changes in absolute pressure that divers experience while diving. During and after ascent, a diver is at risk for decompression sickness and pulmonary barotrauma. A very rare casualty is pulmonary decompression sickness from immersion. This is a literature review and case report of a young woman with acute respiratory decompression sickness who had defects on perfusion lung imaging after a diving accident and after hyperbaric oxygen therapy. However, the perfusion defects reverted to normal in less than 24 hours. Possible explanations for the changes in the appearances of the scans are offered and discussed. This case report shows the potential utility of lung scanning in the diagnostic examination of these patients and the evaluation of the adequacy of treatment with hyperbaric oxygen therapy. A greater use of ventilation-perfusion lung scans in the treatment of such patients may establish its role more definitely.

Adult↗
PubMed1980

Non-medical treatments and their outcomes.

This article focuses on outcomes of Spiritualist treatments based upon a series of follow-up studies of patients who came to a Spiritualist temple situated in a rural region of Mexico. Categories of temple patients and conditions under which they resort to alternate therapeutic regimes are also examined. Follow-ups reveal that Spiritualist healers fail more than they succeed to treating their patients. The data suggest that therapeutic benefits from Spiritualist healing tend to occur in four types of disorders--simple diarrheas, simple gynecological disorders, somatized syndromes and minor psychiatric disorders. The findings suggest that successful treatment outcomes are effected not only by concrete manipulation of physiological symptoms but by symbolic manipulation as well. That is, for a therapeutic regime to do its job it must confront cultural imperatives and employ cultural symbols relevant to the removal of the sick role. An unexpected finding of the study reveals that, in the Mexican case, the cultural imperatives relate to cleaning and purification, mediated by tactile communication, which serve symbolically to terminate the sick role.

Adult↗
PubMedDate not supplied

Exploring help-seeking for ADHD symptoms: a mixed-methods approach.

OBJECTIVE: Gender and race differences in treatment rates for attention-deficit/hyperactivity disorder (ADHD) are well documented but poorly understood. Using a mixed-methods approach, this study examines parental help-seeking steps for elementary school students at high risk for ADHD. METHODS: Parents of 259 students (male/female, African American/Caucasian) identified as being at high risk for ADHD completed diagnostic interviews and provided detailed accounts of help-seeking activities since they first became concerned about their child. Help-seeking steps (n=1,590) were analyzed using two methods: inductive analysis based on grounded theory, and deductive quantitative analysis of coded data derived from application of the network-episode model, merged subsequently with demographic and other characteristics. RESULTS: The inductive analysis revealed unique parental perceptions of their children's sick role and of the agents of identification and intervention for each of the four groups. Deductive analysis showed significant variations by race and gender in consultation experiences, in the person or entity being consulted and in the transactions occurring in the consultation, and in illness careers. CONCLUSION: ADHD symptoms are interpreted as having different implications for the sick role and the intervention, dependent on a child's gender and race. Educational interventions need to address cultural stereotypes contributing to inequitable access to treatment.

Attention Deficit Disorder with Hyperactivity↗
PubMed2001

A center-based approach to a transplant employment program.

The return to work after transplantation has been actively discussed in the transplant community for years. However, despite the desire for transplant practitioners to have recipients return to being healthy, contributing members of society as well as return to work, practitioners often passively support the sick role. We discovered that patients who are returning to work after transplantation may have been out of the work force for several years, and require assistance that we as health care providers were unable or untrained to provide. An employment specialist was added to the transplant staff and became a vital part of our attempts to create a proactive employment atmosphere and enhance our patients' quality of life. Adding an advocate for employment in our center has also facilitated the shift in our thinking and approach to care from the sick role to one of rehabilitation and from reactive to proactive. This change in attitude has assisted in empowering our recipients to feel as if they can truly resume a normal life.

Adult↗
PubMed1999

Headaches and face pains as a manifestation of Munchausen syndrome.

Virtually every psychological or physical symptom may be feigned in order to assume a sick role; the term Munchausen syndrome is applied when the physical features are predominant. Complaints of headache as a manifestation of this condition are rare. We report such a case and review the literature of similar cases. A 34-year-old man consulted several headache specialists in different cities. Many different diagnoses were made, consistent with the various histories the patient related. It seems most unlikely that any one individual could experience 14 distinct headache disorders. Dozens of medications were prescribed, and a dozen or more were taken by the patient daily. People with Munchausen syndrome consciously feign physical symptoms and signs because of the apparently senseless need to assume a sick role. This condition is distinguished from malingering in which the symptoms are consciously feigned for personal gain and from somatoform disorder in which development of symptoms for psychological purposes is unconscious. Primary headache disorders, once thought to have a psychological basis, are now recognized as biological disorders. Though psychogenic mechanisms have been largely discredited, rarely, as illustrated by the present case, psychological mechanisms are predominant.

Adult↗
PubMed1995

The role of sickness funds in secondary and tertiary prevention.

Present Swiss federal legislation on health insurance provides only a very limited basis for an active engagement of sickness funds in prevention. Nevertheless, sickness funds have offered supplementary insurance coverage benefits for primary and secondary prevention. With the revision of the health insurance act the engagement of sickness funds in prevention is bound to change. With health promotion, medical prevention and rehabilitation all three levels of prevention will be considered in the revised act. In the context of the ongoing political discussion on cost containment in health care and on health insurance premium increase, an active engagement in prevention will be of high interest for sickness funds. Sickness funds have been active in patient education for many years at the institutional level. New fields of activity can be the promotion and probably also the installation of programs in patient education, ambulatory rehabilitation, and followup activities for individual patients and target populations.

Health Promotion↗
PubMed1997

Intracerebral administration of Mycoplasma fermentans produces sickness behavior: role of prostaglandins.

Mycoplasmas are small microorganisms, which cause various diseases in animals and in humans, activate the immune system, and induce the release of various cytokines. Some of the effects of mycoplasmas are mediated by the CNS. Moreover, Mycoplasma fermentans (MF) has recently been found in the brain, as well as other tissues of some AIDS patients, who usually display severe neurobehavioral disturbances. The present study was designed to examine the behavioral effects of central administration of MF, and the role of prostaglandins in mediating these effects. In one set of experiments, rats were injected intracerebroventricularly (i.c.v.) with either saline or a dose of MF (5.1-36 microg per rat), and several behavioral parameters were measured. In addition, body temperature and locomotor activity were continuously monitored by a biotelemetric system. MF induced a significant elevation in body temperature and suppression of motor activity levels. MF also significantly reduced the time spent in social exploration, decreased locomotor and exploratory activity in the open field test, suppressed the consumption of food and saccharine solution, and reduced body weight. In a second set of experiments, i.c.v. administration of MF (7.2 microg) was found to produce a significant increase in the production of prostaglandin E2 (PGE2) in hypothalamic, hippocampal, and cortical tissues. This effect was blocked by indomethacin, a prostaglandin synthesis inhibitor. Indomethacin also attenuated the effects of MF on body temperature, motor activity and body weight, suggesting the involvement of prostaglandins in mediating some of the effects of MF. Together, these findings suggest that the presence of MF in the brain may be responsible for some of the neurobehavioral abnormalities in HIV-infected patients.

Animals↗
PubMed1997

Does unhappiness make you sick? The role of affect and neuroticism in the experience of common physical symptoms.

The relative strength of both affective state and the personality trait neuroticism in predicting common physical symptoms was tested. The authors used an event-sampling design to overcome methodological limitations of past research in the area. Contrary to much previous research, neuroticism was found to be unrelated to reports of physical symptoms, although it was found to be related to unpleasant affective state. Unpleasant affect bore a strong concurrent relation to the frequency of reported symptoms. Temporal relations between experiences of unpleasant affect and subsequent symptoms were found for some individuals, but wide individual variability was seen in both the strength and direction of this linkage. The findings suggest that when individuals are asked to report their subjective experiences of physical illness without the necessity to retrospect over significant periods of time, unpleasant affective state is more strongly related to experiences of symptoms than is the trait neuroticism.

Adaptation, Psychological↗
PubMed1998

The patient's role in rheumatology care.

This article reviews narrative and empiric studies in rheumatology and related literature to explicate the patient's role in rheumatology care. In contrast to early conceptualizations, such as Parsons' sick role that emphasized compliance, current literature describes chronic disease patients as active participants in their care, rather than passive recipients of care. Active patients roles include participant in shared decision making, self-manager, and help and information seeker. All of these roles are colored by the individual's need to preserve a personally defined acceptable lifestyle. Suggestions for strategies that physicians and health professionals can use to engage and support these essential patient roles are also reviewed.

Decision Making↗
PubMed1984

Gender differences in mental and physical illness: the effects of fixed roles and nurturant roles.

A decade ago it was widely assumed that there were no gender differences in mental illness/mental health and that any evidence that suggested that women experienced more psychological distress than men was due to women being more willing to admit to psychological distress, being more willing to seek treatment and/or sex bias on the part of clinicians. Furthermore, although it was widely recognized that on most indicators of physical illness women appeared to have higher rates of morbidity, it was generally assumed that the apparent higher rates of women did not reflect real differences in morbidity, but gender differences in illness behavior. A survey of the recent literature, however, shows that there is now a general consensus among social scientists that women experience more psychological distress than men and that this is largely due to aspects of their societal roles. Furthermore, in the last few years the cumulative evidence indicates that women do in fact have higher rates of morbidity than men and that this probably is also largely a consequence of their social roles. The present paper focuses on two aspects of the roles typically occupied by men and women, namely that the roles of men tended to be more structured or 'fixed' than the roles of women, while women are more likely to occupy nurturant roles than men. It is argued that highly structured or 'fixed' roles tend to be causally related to good mental health and low rates of morbidity. In contrast nurturant roles tend to impose a strain and to impair one's ability to effectively adopt a sick role and as a consequence nurturant roles are linked to poor mental health and the higher rates of morbidity. In short, it is suggested that the fixed role-hypothesis and the nurturant role hypothesis complement each other and together partially explain the higher rates of physical illness and psychological distress among women.

Disease↗
PubMed2005

Depression and the perpetuation of an incapacitated identity as an inhibitor of return to work.

The aim of the current study was to conduct a qualitative investigation of attitudes to work among people diagnosed with clinical depression. It was of particular interest to understand the role played by illness in attitudes to recovery. The economic and social burden of adult depression on society is becoming increasingly apparent. It has been argued that recovery from mental illness of this kind is most appropriately understood in 'functional terms' (i.e. 'getting on with life beyond illness'). One important goal in this process is return to work. Accordingly, in-depth semi-structured interviews were conducted with 19 people formally diagnosed with clinical depression. These interviews were the analyzed using Interpretative Phenomenological Analysis: a method of investigation and analysis concerned with making sense of participant experiences and accounts of their ill-health. This process identified three master themes, only one of which is the focus of this paper. This theme pertains to the unwitting role that can be played by the health care system in reinforcing the 'sick role' and in so doing providing a continued justification for an 'off-work' identity. Consequently, this study provides an unusually penetrating insight into the way depression can, through institutional practices, become inextricably part of someone's identity, with important implications for functional recovery.

Depression↗
PubMed1981

Non-medical treatments and their outcomes. Part two: Focus on adherents of spiritualism.

This article is the second of a two-part discussion of non-medical treatment outcomes based upon follow-ups of patients at a Spiritualist temple situated in a rural region of Mexico. The first part of the analysis focussed on two of three categories of patients seeking treatment there (i.e., habitual temple users and first comers). Unlike these two categories of patients who are not believers in spiritualism, the present concern is with the category of patients (i.e., regulars) who identify Spiritualism as their religion and believe in Spiritualist ideology. These patients require separate consideration because, unlike the others, they are exposed to several Spiritualist therapeutic modalities which influence treatment outcomes. Follow-ups of these patients reveal the dialectical relationship and the gradual nature of the healing process. Spiritualist treatment outcomes are assessed by an interplay of physiological, psychological, sociological, and cultural paradigms. The hypothesis is advanced that while Spiritualist healers frequently fail to eliminate patients' subjectively perceived symptoms, the therapies to which these patients are subject alter cognition by facilitating pain tolerance and promote response to cultural symbols employed by temple healers. Examination of treatment outcomes of these patients also calls attention to syndromes which fail to respond to Spiritualist therapy including psychotic episodes. A brief comparison is made between Spiritualist treatment outcome and psychotherapy which leads to the conclusion that Spiritualists succeed no less than the latter in eliminating the sick role, restoring the individual's capacities, and eliminating the feeling of "being sick."

Adult↗
PubMed1986

Role ambiguity in general practice: the care of patients dying at home.

Semi-structured interviews were given to 22 GPs to investigate their perceptions and strategies when dealing with dying patients. There seemed no clear division in practice between policies of telling and not telling patients about their illness. Most patients find out eventually, but GPs differ in the extent to which they aim for open discussions of the matter. Over half perceived care of the dying as a demanding but satisfying fulfillment of their professional skills, but nearly a quarter found it difficult and with few compensating rewards. We conclude that while there is a well established ideal type corresponding to the curative role, there is another which is still in the process of development. This type generates a role for doctors which parallels the patient's dying role, as distinct from the sick role.

Attitude of Health Personnel↗