Perception of Cause and Behavior towards an Illness - Essay Example

Introduction Physical symptoms often are ambiguous and open for ive interpretation. Given the quantity of information that is available toindividuals at any given time, it is functional for the organism to organize and reduce the incoming data. Cognitively structuring, synthesizing, and organizing the incoming information achieve this. Cognitive psychology has introduced several theoretical constructs in this context, namely schemata, cognitive sets, prototypes, expectancies, and scripts. Studies on the structure of illness schemata consistently found five dimensions according to which symptom and illness experiences are organized (Lau and Hartman 1983): Illness schemata include information about the identity or label of the disease, its consequences (i.e., the symptoms), its causes, its duration, appropriate treatments, and expectations about its cures. Cognitive structures such as illness schemata helps to organize information from internal sensations (symptoms) and disease-related information gathered from the external environment. Howard Leventhal and his colleagues (Leventhal et al. 1984) have proposed the most relevant model of symptom perception within the tradition of information processing. Their Common Sense Models of Illness approach is rooted in cognitive psychology and builds on the work on cognitive schemata and prototypes. In specific, Leventhal et al. propose that individuals tend to construct their own individual representation of symptoms or illness and that this idiosyncratic representation will, in turn, influence their behavior (e.g., help-seeking, adherence and compliance). In specific, they proposed that illness representations (or schemata) are a function of an individual's semantic knowledge about symptoms and disease and specific contextual factors such as the nature of somatic changes and the situations in which these occur. This semantic knowledge accumulates across the life span and is acquired through the media, through personal experience, and from family and friends who have had experience with the disease. Therefore, the perception of cause can have an effect on the behavior towards an illness, because the cognitive dissemination leads to the semantic knowledge of the disease. Understanding how a person views a disease can impact behavior towards the illness. People's common sense models of illness strongly influence which symptoms a person will search for and will ultimately perceive. Work by Meyer and his colleagues (Meyer et al. 1985) on hypertension illustrates this point. Hypertension disease holds one or a combination of disease models about high blood pressure. As Meyer and his colleagues demonstrated, some patients hold the belief that hypertension is a disease of the heart, others believe that it is an arterial disorder and a third group might associate hypertension with emotional upset. Importantly, the kind of belief patients' hold affects the way they monitor their body: Symptoms that are consistent with their specific illness belief are more likely to get noticed. The relationship between a person's cognitive knowledge of the cause is therefore directly related towards the symptoms and evaluation of 'cures' for the illness. This research study will incorporate that foundation of illness cause perception by quantitatively examining the differences between illness cause perception amongst participants. In addition to general concepts of illness, people also hold organized conceptions-termed disease prototypes-for particular diseases (Bishop 1991; Bishop and Converse 1986). Prototypes of specific diseases help people organize and evaluate information about bodily sensations that might otherwise not be interpretable. Thus, a person who holds the belief that he or she is vulnerable to heart disease is more likely to interpret chest pain in accord to his or her prototype of heart disease than a person who does not hold this belief (Bishop and Converse 1986). This latter person might instead regard the chest pain as signaling a gall bladder problem. Altogether, organized representations of illness-related knowledge and experiences strongly determine symptom awareness and interpretation, and the expectation individuals generate respecting their consequences and causes. This has important implications for health behavior as the kind of beliefs patients hold about symptoms and disease may lead them to alter or fail to adhere to their treatment regimens. Purpose of the Study There is a correlation between perception of cause and behavior towards an illness. The purpose of the study is to examine this relationship, based on theoretical evidence described above. The approach of this research design is varied from other research in that the scenarios where given with or without the illness label, why is the label so important and will it make any difference to the attribution of cause. This, unlike previous research, allows an interpretation that is not biased by stating the illness. Comparatively, this defines attribution beyond a specific illness such as hypertension noted in the previous research. The aim of this research is to investigate why different individuals judge the same illness as being attributable to either a physical or psychological cause. Specifically, is there a relationship between the individuals' locus of control and the judgement they make of the causal attribute of another persons illness, as according to Weinman, Wright and Johnston (1995) control beliefs are based on causal attributions. The illnesses to be used to determine if there is such a relationship are the Functional Somatic Syndromes of Chronic Fatigue Syndrome (CFS), Late Whiplash (LW) and Gulf War Syndrome (GWS). These syndromes have been selected as there is incomplete knowledge regarding the etiologic roles of biological, psychological and sociocultural factors within the syndromes themselves (Barsky & Borus, 1999), the symptoms are also medically unexplained (Wessely, Nimnuan, Sharpe, 1999). Chronic Fatigue Syndrome Chronic fatigue syndrome is a variant illness entity that is made up of a mysterious combination of parts, which defy not only a clear description, but also more exacting calculations as to how the complex illness is created. A review of the breadth of the medical and clinical literature over the past decade alone reveals a staggering quest for explanation Jason et al 1999; Jason et al 2000. Komaroff 2000). Currently the two major medical explanations of the aetiology of Chronic Fatigue Syndrome are pathologies of the central nervous system and immune system dysregulation (McCully et al 1996; Komaroff 2000), others suggest that CFS results from somatization of psychological symptoms (Lipowski 1988; Wessely et al 1998), with three psychiatric models of the causes - the depression model, the somatization model and the stress model (Farrar et al 1995). Research suggests The shift towards favour of psychiatric models for Chronic Fatigue Syndrome is an indication that biomedicine has lost confidence in finding a purely biological agent of disease causation for Chronic Fatigue Syndrome. Ware (1992) argues that the configuration of symptoms of CFS has been constructed and reconstructed into new forms, identified and then discussed at length in new terms in popular and professional discourse over time. Sociologists of health and illness and sociology of the body (Shilling 1993;Turner 1996) go a step further and argue in essence that the medical and lay experts have become embattled for control of the definitions, practices and meanings associated with medicine. Therefore, Chronic Fatigue Syndrome was chosen as an illness variable for the hypothesis because of the recognized 'possible' causes as biological and psychological. Late Whiplash Syndrome Whiplash injuries occur in more than 1 million people in the United States every year. A small minority complains of symptoms that persist for years, often with no clear demonstrable cause. Most modern work recognises that the late whiplash syndrome is not the result of a chronic injury, and current opinion implicates a biological and psychosocial model. Scholars have explored that chronic whiplash and minor head-injury litigants produced more invalid signs than severely injured persons on measures of simulated memory and motor deficits irrespective of definitional stringency (Greiffenstein and Baker 2006). These findings support Miller and Cartlidge's (1972) observations that embellishment rises as injury severity decreases, thus validating the psychological component of Late Whiplash Syndrome (Greiffenstein and Baker 2006). However, no systematic analysis of post-traumatic pain development covering several weeks has yet been performed in whiplash patients, and the dynamics of pressure pain due to whiplash injury can be quantified by means of PC-interactive pressure algesimetry, exemplifying the biological cause of chronic whiplash pain (Nebel et al 2005). Other researchers examined that Late Whiplash Syndrome can not be supported by physical and biological evidence and that chronic symptoms were not usually caused by the car accident, but rather the socio-psychological schema of the injury (Schrader et al 1996). Therefore, because there are multi-variant causes of Late Whiplash Syndrome, the chronic illness was also chosen as a variable in this research study. Gulf War Syndrome Gulf War Syndrome is a medical condition of uncertain origin that has affected many veterans of the 1991 Persian Gulf War. Fatigue, headaches, dizziness, nausea, rashes, joint pain and respiratory problems characterize it. Since the end of the 1991 Gulf War about 20,000 United States veterans and similar proportions of troops from other allied contingents have been affected by a variety of symptoms which have collectively become known as 'Gulf War Syndrome'. Similar symptoms have been reported in Iraqi civilians including children. Despite extensive investigations no agreement has been reached on whether there is an underlying cause or causes (Emmerova and Jirava 2004). Some scholars examine the causes of exposure to the following somatic causes have been suggested as possible explanations for these symptoms: (persistent) infection, abnormal immune response, administration of multiple vaccinations within a short period of time, use of malaria chemoprophylaxis, neurological abnormalities, exposure to toxicological substances and environmental factors. (Soetekouw et al 2000). Others describe the psychological causes as exposure to traumatic events during the war, suggesting reactions occurred with a frequency were seen most in individuals exposed to a greater number, and to more severe types, of traumatic events (Kingham, Nicolaou and Southwick 1998). The exposure factor has a common bond of being active military during the Gulf War. Symptoms and causes seem to vary between biological exposure and psychological stress, prompting this chronic illness as being one of contest within the medical field. Significance of the Study The research centers on addressing cause of an illness. The cause of an illness is important because, as noted in previous, causation affects behavior. Weiner (1998) notes that illnesses diagnosed to be attributing to physical cases involves a condition with onset beyond the person's control; therefore, evoking compassion and concern for the afflicted. On the other hand, psychological disorders tend to be viewed as controllable and reversible. The condition does not bring out compassion - and may even elicit anger or indifference to the patient. With this, illness explanations must consider the patient's concerns, particularly the implication of a diagnostic label. Kirmayer, et al (2004) insist that despite inherent limitations to medical explanations, clinicians and patients are anticipating that every troubling symptom will be have adequate explanations and corresponding treatments. Successful clinical interventions that prove to be effective in eliminating symptoms will no longer need clear explanations, and may be considered relatively unimportant. However, in cases of failed treatments and persisting symptoms, the role of explanations may offer a significant amount of reassurance and explanation. This mechanism will also assist in the coping and resilience of the patient, therefore making the patient able to do a more realistic and achievable plan on the state of health in the future. The assumption of illness in a person usually leads to self-scrutiny, prompting confirmatory searches that lead into the interpretations of ambiguous sensations previously ignored as a possibility of disease (Barsky and Kleinman, 1983). This process confirms the self-validating / self-perpetuating cycle of symptom magnification and disease opinion. The various assumptions in previous research lend towards the confusion of meta-information. Specifically, there is a lot of research that contradicts or correlates with other research, as noted in the above paragraphs. Therefore, this research is justified by the ambiguity of previous research. However, it is important to note that conflicting information does not mean that previous research in this area is invalid, but it does mean that the concept of illness perception and symptoms has not been explored to the fullest extent. Ranjith & Mohan (2006) explicates that the increasing migration and globalization, illness presentations are no longer confined to the boundaries of geography as well as overarching models integrating known biological and psychological factors and sociocultural factors. The role of culture in shaping illness behavior, lending itself to use in clinical settings. Helping to explain certain unique illness attributions and help-seeking patterns. A theoretical model proposed by Mumford (1989) provides an explanation how the concept of culture does its role in shaping the progression or evolution of somatic symptoms. The model explained the three levels wherein culture may be responsible for the formation of the somatic symptoms: a) Symptom expression from language and idiom used; b) Health and disease concepts that are known to cause influence symptom interpretations and; c) A culturally sanctioned illness behavior which has been considered important in symptom presentation. In the same line, Potts and Bass (1995) indicate that locating symptom origins in psychological processes within the patient tends to credit responsibility, including moral blame that patients may understandably resist. Kleinman & Becker (1998) also stated that many systems of medicine consider sociosomatic theories recognizing origins of somatic distress may lie within the social context. Therefore, the significance of this study extends beyond the understanding of causation and perception, but will develop evidence towards the behaviors that people perceive as causing illness. The cultural perception of the language used in the methodology-stressed, injured, overworked, whiplash---will lead towards supporting evidence that perception is not wholly based on the cause and effect factors of an illness, but the cultural and cognitive perceptions of that illness. Health Locus of Control (HLOC) The Health Locus of Control is used in this research as a dependant variable. The assumption is made that HLOC will have an impact on the attribution of cause. The Health Locus of Control (HLOC) examines an individual's personal attribution of health. Those with internal LOC believe that illness is under their personal control while individuals with external LOC feel that the environment dominates their health. The Multidimensional Health Locus of Control Scale (MHLC) a study examined the connection between high school students' LOC and their grade-point averages, extracurricular activity membership, amount of studying time, alcohol use, seatbelt use and tobacco use (Harvey & Thomas, 2004). The theory of LOC was derived from Rotter's Social Learning Theory of 1954 (Rotter, 1982). Rotter published his Locus of Control Scale to measure generalized perceptions of individuals toward internal or external LOC. Researchers first detected the use of LOC in the medical community in observations of recently diagnosed diabetics and medical professionals (Kaplan, Maides, Wallston & Wallston, 1976). The medical staffers were attempting to get the patients and their families to develop an internal LOC that would better the chances of controlling their illness and improve overall quality of life (Kaplan, Maides, Wallston & Wallston, 1976). Multidimensional HLOC: Wallston et al (1978) is: Internality: the extent to which LoC for health is internal (e.g. "If I become sick, I have the power to make myself well again"); Chance: the belief that chance or external factors are affecting the outcome of health problems (e.g. "Often I feel sick no matter what I do"); Powerful Others: the belief in the control of powerful others over our health (e.g. "Following doctor's orders is the best way for me to stay healthy"). Locus of Control (LOC) also refers to personal belief that the events, such as illness, are either a result of personal control and effort, or outside forces such as fate and luck. Perception of positive and negative events as being consequences of one's own actions and thereby under one's own personal control is known as internal LOC. In contrast, external LOC refers to the perception of positive or negative events being unrelated to one's own behavior and thereby beyond personal control. (Locus of Control and Cardiovascular Health, 2004). A Multidimensional Health Locus of Control Scale (MHLC) was developed in 1976 (Wallston, Wallston, & DeVellis, 1978). Mackey (2002) noted a great deal of research linked internal LOC to positive health beliefs and behaviors. According to the author, individuals with an internal LOC were more likely to seek health-related knowledge, successfully stop smoking, maintain better weight control, adhere to physician's prescriptions, use birth control effectively, seek preventative vaccines, use a seatbelt regularly, and practice proper dental hygiene. MacArthur and MacArthur (1999) added that a sense of control such as that experienced by internals led to improved emotional and mental health, reduced risk of heart disease, better self-rated health status, and lower morbidity. Therefore, it can be assumed that if: perception of cause effects behavior towards an illness, and HLOC affects the patient's overall ability to control and react to an illness, behavior and reaction towards an illness is directed by HLOC and attribution. Both concepts are then important to developing a holistic view of patient perceptions that leads to understanding behavior towards illness and cures. Hypothesis People, as noted above, have different perceptions of illness causation depending on their cognitive and cultural perception of that illness. The hypothesis seeks to answer two questions: (1) Does attribution of cause of the chronic illness depend on the acute illness context and label (2) Does attribution of cause depend on health locus of control The hypothesis will be examined using the following variables: Independent variables: the 6 different scenarios used being the 3 different illness context presented either with or without a label. 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