Health Beliefs and Living With Chronic Diseases

Copyright © 2015. Sage Publications Pvt. Ltd. All rights reserved.
May not be reproduced in any form without permission from the publisher, except fair uses permitted
2
Health Beliefs and Living with
Chronic Diseases
T raditional health-care systems in any culture are mostly based on

certain shared beliefs about the world, self and human existence,
both in the physical and metaphysical sense. Cultural beliefs provide
the necessary framework to define health, to understand the causes of
an illness and to decide about the course of treatment. Health beliefs in
this sense are part of a broader cultural belief system, which affect the
health behaviour of people within a community. Every culture has its
characteristic ways of defining health and illness, and recommending
the modes of treatment. For example, health beliefs prevalent in the West
are based on the assumption of bio-organic causation of diseases, and con-
sequently treatment regimen heavily relies on modern medicines. On the
other hand, in many traditional societies of Asia, belief in supernatural
causation structures health-related beliefs, choice of treatment alterna-
tives and expectations from health professionals. Thus, in the case of an
illness, whereas in the western societies medical hospitals and doctors
under U.S. or applicable copyright law.
are visited, in all Asian countries traditional healers are often frequented
to deal with physical, mental, interpersonal and existential problems.
Cultural beliefs influence the whole gamut of health-related behav-
iour. However, this chapter is primarily confined to discussing how these
beliefs help people in appraisal and social construction of their illness
experience. These cultural beliefs may not play a predominant role in
cases of acute and life-threatening diseases where the immediate concern
is to save a life, as in the case of heart attack. However, in the case of a
EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 7/24/2017 2:51 PM via UNIVERSIDAD DEL
ROSARIO
AN: 953682 ; Dalal, Ajit K..; Health Beliefs and Coping with Chronic Diseases
Account: s4300083
26 Health Beliefs and Coping with Chronic Diseases
Copyright © 2015. Sage Publications Pvt. Ltd. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted
long-term disease or disability the concern shifts to bringing changes in

one’s life to adjust to the demands of the new situation. Family, friends
and social network play an important role in shaping a patient’s per-
ception of the disease and its implication for his or her life. Most of
the patients gradually reconcile to the fact that the chronic disease has
become a part of their existence and that cannot be wished away. What a
patient believes is more important in such cases where a major responsi-
bility of treatment and care rests on the patient, and how much they will
recover depends on their own efforts.
With the increase in life expectancy in recent times, the prevalence
of chronic diseases is also on the increase. Of the 36 million global
deaths in 2008, 29 million deaths occurred due to non-communicable
diseases, which is roughly 63% of the total number of deaths that year.
The four main causes of deaths due to chronic diseases are cardiovascu-
lar diseases, cancers, diabetes and chronic lung diseases. The burden of
these diseases is rising disproportionately among lower income coun-
tries and populations. In 2008, nearly 80% of all non-communicable
disease occurred in low- and middle-income countries with about 29%
of deaths occurring before the age of 60 years (WHO, 2010). Presently,
about 70% of the world population above 55 years of age suffers from
one or the other chronic diseases and this number is rapidly increasing
over the years.
Defining Chronic Disease
Which diseases should be considered as chronic conditions? By defi-

nition, chronic diseases are long-lasting diseases, often lasting for the
lifetime. The symptoms may not be present all the time, but the pros-
pects of recurrence of the symptoms means that recovery prospects are

limited. Second, for such diseases the therapeutic intervention is limited
to symptomatic treatment, not complete cure of the disease. Three,
because of the long-drawn nature of the disease, people are required
to integrate it in their lives. These diseases become part of their exist-
ence. The meaning these diseases acquires in one’s life largely depend on
age, nature of occupations, achievements and responsibilities, and social
support one has. Four, in case of chronic diseases there is a good deal
of uncertainty about the future course of the disease, its debilitating
ROSARIO
Account: s4300083
Health Beliefs and Living with Chronic Diseases 27
conditions, and associated physical and psychological complications.

The afflicted person is required to comprehend the significance of the
chronic diseases in terms of the nature of adjustments that are to be
made to live with a disease in the world of healthy. Five, the person
suffering from a chronic condition is required to take up major respon-
sibility of managing his/her own disease. The afflicted person is required
to identify the symptoms, monitor progress of the disease and control
its debilitating side effects. It becomes the responsibility of the people
suffering and their families to manage medical, occupational, social and
psychological after-effects and to restore one’s sense of self-worth and
meaning in life. They are not only required to live with the illness but
also have to continue participating in every-day life; not as a patient but
as a social-being.
Very often in the literature a distinction is made between chronic
disease and chronic illness. Kleinman (1978) refers to disease as related
to the physical aspect, its physical symptoms, organic malfunctioning,
as something going wrong with the person’s body. An illness, on the
contrary, means a subjective representation of the disease, a psychologi-
cal experience of being sick. Cassell (1991) also makes a similar kind of
distinction between chronic disease and chronic illness. Chronic disease
is referred as some disturbance in the structure and functioning of any
part, organ or system of the body. While disease is confined to the body,
illness was referred to as a disorder in the person’s extended system,
including family and even community.
Opting in favour of simplification, in this chapter the terms chronic
disease and chronic illness are used interchangeably. In the whole discus-
sion, disease or illness is viewed from the patients’ point of view. This
fact is also acknowledged that a person suffering from a chronic disease
cannot be always called a patient, as in the case of bronchitis. People
suffering from chronic disease become patient only when their chronic
disease becomes acute. It may be noted that a person suffering from a

chronic disease may be acutely ill, even in the absence of physical symp-
toms, as in the case of heart disease. It may be due to the cumulative
effect of strain and the anxiety of putting up with a long-term disease.
The term patient is thus used here in a very broad sense.
The question of interest here is ‘What do people go through while
facing a disease of a chronic nature?’ The kind of psychological responses
people make and the stages they go through depend on many factors.
One is the nature of the disease itself. The onset of a disease could be
ROSARIO
Account: s4300083
sudden, as in the case of heart attack, or gradual, in which case the

patients get sufficient time to deal with the disease. The disease could
be life threatening, as cancer, or may go through an acute-chronic cycle,
as in asthma. It could be a physically disabling disease, requiring a lot
of changes in one’s life routine, like arthritis, or demanding more atten-
tion and self-care, like diabetes. Some diseases take a heavy toll of one’s
financial, social and psychological resources, some others are minor nui-
sances for the person. Again the severity of the disease, their social back-
ground, support system and individual dispositions play a crucial role in
determining the stages the patients go through in coping with a chronic
disease. Most patients eventually recover and both psychologically and
physically reach a state of reasonable psychological adjustment, but for
about 25% to 30% of patients, the adjustment phase is prolonged and
sometimes unsuccessful.
In a large number of cases, when the initial reaction to the diagnosis
of chronic disease is that of shock and disbelief, people actively seek dis-
confirming evidences. People take time to reconcile with the idea that
they are suffering from a disease with which they have to live for a long
time, maybe for the rest of their lives. They oscillate between hope and
despair, and go through extreme mood swings. At a later stage, when
a realization dawns that they have to live with the disease, acceptance
of the chronic disease comes gradually. People seek more information
about the disease and its remedial and palliative aspects. They may like
to comprehend its possible implications on their lives. There are active
explorations about their own role in containing or preventing the after-
effects and integrating the disease within their own lives. People in their
endeavour to live with the disease go through the cycles of improve-
ment, remission, relapse and renewed efforts.
Patients with chronic conditions often have to adjust their aspirations,
lifestyle and employment. Chronic condition makes them dependent
on others socially, economically and even for daily living. They grieve
the loss of their healthy state, feel distressed and develop psychiatric dis-
orders, most commonly depression or anxieties. A prospective study of
general medical admissions found that 13% of men and 17% of women
had an affective disorder (Guthrie, 1996). He further observed that the
proportion of patients with conditions such as diabetes or rheumatoid
arthritis who have an affective disorder is between 20% and 25%. It can
be difficult to diagnose depression in the chronically ill. Physical symp-
toms such as disturbed sleep, impaired appetite and lack of energy may
ROSARIO
Account: s4300083
already exist as a result of their chronic condition. Often, treatment for

such a medical condition (for example, the use of steroids) may affect
the patient’s mood, as may the disease process itself. The functional lim-
itations imposed by the disease may result in ‘understandable’ distress,
and some clinicians find it difficult to conceptualize such distress as
a depressive disorder (Powell, 1997). The onset of mental health con-
dition may exacerbate physical symptoms, complicating psychological
recovery of people with chronic diseases.
How do people live with chronic diseases is one of the most fascinat-
ing and challenging areas of research in psychology. The research in this
area has been growing in recent years, though there is still little consist-
ency in the findings that have emerged. There are many reasons for this
lack of consistency in the research findings. First, a bulk of research is
from the medical perspective, where the emphasis is on the disease, not
on the person. The effort is to understand the nature of the disease, to
arrive at an accurate diagnosis, and to plan out the treatment procedure.
Patients’ own perspective and their own perception and feelings are not
much investigated. Second, patients’ own role in managing the disease
is still the least explored. Like the attending doctor, the patient is also
actively involved in understanding the disease and trying out various
remedial measures. Patients’ own beliefs about the illness play an impor-
tant role in this venture. It is suggested in many studies that patients’ own
beliefs about their health and treatment regulate their health behaviour
to greater extent than the doctors’ beliefs or objective medical data. How-
ever, there are not many longitudinal studies examining these aspects.
Third, the role of cultural factors is relatively ignored in psychological
researches in this area. Though there is substantial anthropological and
sociological work to highlight cultural differences in health practices and
treatment modalities, psychologists have yet to provide an understanding
of how these cultural beliefs gets translated into concrete actions. Psycho-
logical researches may fall into some pattern if cultural beliefs and their
psychological imports are more systematically investigated.
To put it briefly, research focusing on health beliefs should be built
on shared understanding about the human nature (Dalal, 2011). First,
people are generally actively involved in understanding the meaning
of their illness. This understanding is essential to appropriately react
to the health crisis. Second, people differ widely in the way they sub-
jectively construct the experience of even very similar illnesses. Their
beliefs about the illness and life in general provide the basic inputs for
ROSARIO
Account: s4300083
these subjective constructions. Third, these subjective constructions of

the illness in terms of their meaning, causes and control influence their
recovery (or adjustment) significantly, at times more significantly than
the nature of the disease. Fourth, people are motivated to make efforts to
recover from the crisis situation. In fact, it is assumed that the efforts to
recover begin with the onset of the chronic disease itself. Fifth, people are
not only motivated but also possess a self-curing mechanism. In the crisis
situation, this mechanism gets activated and people in few instances need
institutional support to deal with the psychological crisis. People not
only recover or successfully adjust but also learn to be more resource-
ful in facing a similar crisis in future. Sixth, people can be helped and
trained to cope with the adversities by bringing appropriate changes in
their own beliefs and attitudes.
Plurality of the Health-care Systems
One important factor that makes it imperative to study the health

beliefs of the patients is the multiple modalities of treatments existing
in all traditional societies of Asia. Each system has its own assumptions
about health, its causes and the curative mode. Decision about the treat-
ment modality greatly depends on the kind of beliefs the patients and
their social support network have about the illness.
Working primarily in the Asian region, Kleinman (1978) classified
health-care systems in traditional societies in three main sectors. These
are the popular sector, the folk sector and the professional sector. Each
sector has its own mode of interpreting and treating an illness, and
defining the role of the healer and the patients.
The popular sector: This is the most informal, non-professional mode

of health care. This kind of therapeutic advice is provided without any
payment to social network, religious institutions and self-help groups.
The treatment is generally provided at home where family provides the
basic health care. It is estimated that about 70% to 90% of health care
takes place within this sector. The health practices in this sector are pri-
marily guided by the communities’ own beliefs about healthy way to
drink, eat, sleep, work, etc. and practices, such as home-made remedies,
proper diet and care to maintain good health.
ROSARIO
Account: s4300083
The folk sector: Trained informally, or through apprenticeship, some people

in society specialize in healing people suffering from different ailments,
both physical and mental. There are diverse types of folk healers—from
purely shamans and spiritual healers to technical experts like herbalists,
bone-setters and midwives. These folk healers belong to the same com-
munity, share the basic cultural values and world views, including beliefs
about the causes, significance and treatment of ill health. Most of these
systems have divinity as basic to their practice and often the practition-
ers are presumed to possess some divine powers. These folk healers are
mostly holistic in their approach and involve the family, other com-
munity members and supernatural entities in the treatment procedure.
The professional sector: In the original sense this refers to modern western
medicine. These include the medical personnel formally trained and
legally permitted to deal with patients. This category also includes the
paramedical staff. However, as Kleinman noted, in some traditional
medical systems such as Ayurveda, Unani, homeopathy, acupuncture
practitioners are trained in the professional schools. These medical
systems also come in this category. It can be mentioned here that in
most of the Asian and African countries western medicine is accessible
to only a small section of the society and people still subscribe to these
traditional systems. In India, for example, western medical care is avail-
able to less than 8% of the population.
It is not that people always stick to only one sector of treatment. On
the contrary, people alternate or try more than one mode of treatment
at the same time. People who suffer a disease often resort to different
modes of treatment, within or across all three sectors, as they may really
not know what will really work in their case. However, in recent years
with wider reach of medical facilities more people are seeking medical
care, but in the process they are also experiencing the limitations of drug
and surgical therapies.
Meaning of Health Belief
Clearly patients’ response to chronic conditions will depend on their

lager belief system within which they understand various life events.
Such beliefs are the basis of our thoughts and understanding of the
ROSARIO
Account: s4300083
world we live in. They provide the basis for decision and actions we take
in everyday life. These beliefs we acquire in social interactional process
and are sustained because of their functional value. These beliefs cannot
be viewed in isolation but they serve as integrated and cohesive constitu-
ents of a larger belief system pertaining to all domains of life. Cultural
and social milieu creates the context for formation, change and main-
tenance of these beliefs, and also for interpreting the experiential world
we live in. Indigenous health beliefs, in this sense, need to be examined
as part of the belief system of a society.
Beliefs can be understood as shared and assumed truths within a
cultural set-up. Beliefs are thus taken as propositions that are consid-
ered to be correct and the basis of social interaction. Beliefs are part
of our understanding of the world we live in, the people we are, and
explanations of happenings. We imbibe many beliefs in the course of
growing up in a family and culture. They are part of our conscious-
ness, guiding our thoughts and actions. Beliefs here do not refer to sub-
conscious thoughts, or a mental activity occurring below the threshold
of consciousness. When a person owns a belief, he or she consciously
accepts its meaning and implication. The degree of valence with which
one owns a belief can vary from mild acceptance to confident certainty.
Beliefs require conscious acceptance. Furthermore, beliefs may vary in
terms of their complexity, centrality and flexibility, as they implicate
everyday life of the people.
Taken from this perspective, beliefs lie in the grey area between
assumption and knowledge (Walker, 2006). At one extreme they can be
termed as dogmas or delusions; in milder form they are termed as faith,
convictions, superstitions and misconceptions. Belief and faith overlaps,
both accept the phenomenon a priori. However, the rational presump-
tion that often lies behind belief is wholly lacking in faith. One cannot
argue with a faith; it simply is. We try to anchor our beliefs in some
kind of proof. It may be anchored in some authority, logic or personal

observation. It could be mediated through some chain of information,
the source of which one can rely on. Religion is one of the most potent
sources of beliefs, as is science.
Health beliefs of Indian people are in many ways distinct from the
health beliefs of people in western societies. Singh (2011) has exam-
ined many such cultural beliefs of the Indian heart patients. Many of
these illness beliefs are product of age-old customs, traditions, rituals,
mythologies and spiritual texts. These beliefs have evolved over a long
ROSARIO
Account: s4300083
history. Some characteristic features of these beliefs can be identified

(Dalal, 2011). One, these health beliefs seldom stand independent of
the other indigenous beliefs. They are intricately weaved into the other
community beliefs. From the ontological standpoint, health is integral
to the very fact of living. Health from the Indian perspective is thus seen
as part of the general well-being of the individual. It is contended that
individual well-being is also contingent on happiness and well-being
of others, including well-being of other living beings. Two, traditional
health beliefs are part of the sacred. Faith, fear and reverence are the
hallmarks of indigenous health beliefs. They are part of the beliefs peo-
ple have about life and death. Gods, spirits and ancestors are taken as
important agencies—causing health crises, as well as triggering recovery
process. Three, Indian health beliefs have positive connotation; they are
characterized by hope and positivism. This positivism is evident in the
way people construe the meaning of their health and well-being and
deal with illness incidences. Belief in the theory of karma, for example,
seems to facilitate acceptance of tragic life events and help in retaining
hopes. Four, people go to the same healer for their health problems,
as well as for other wide-ranging problems they face in personal life,
including those of business loss or marital discord. People do not make
a clear distinction between physical, social and moral problems.
Functional Nature of Health Beliefs
Beliefs influence human health implicitly and explicitly in various ways.

The human mind converts beliefs and expectations into biochemical
realities. The mechanisms that link beliefs to the bodily processes are
still not very clear. Most of the evidences are anecdotal suggesting that
these works, but no direct linkages have yet been established. Perhaps
the most compelling evidence is provided by the placebo studies. It
is observed in a large number of studies that anticipation of physical
effects as outcomes of medication placebos bring about actual physical
changes. In a study, Fielding et al. (1983) reported that patients were
expected to experience hair loss from chemotherapy, but 30% patients
who were on placebo instead of chemotherapy suffered hair loss, which
was to the same extent as the chemotherapy group. As argued by Radley
(1994) where doctors and patients subscribe to the same beliefs strongly
ROSARIO
Account: s4300083
and where there is greater faith in doctors, placebos will have more ther-
apeutic powers.
Expectations work varied ways. One related phenomenon ‘anniver-
sary effect’ signifies that people are more likely to die around important
dates in their lives. Phillips et al. (1992) surveyed the records of over
2 million people. It revealed that women are more likely to die within
a week after their birthdays; men peak just before their birthday. The
interpretation was that women are more likely to believe that birthdays
are occasions to celebrate and meet friends and relatives; whereas for
men it is a time to take stock of their accomplishments, which they
often dread.
Lazarus (1993, 2000) has talked about ‘healthy illusions’—the beliefs
that make life liveable. Such beliefs (like, I am a good person) are essen-
tial to lead a healthy life. Such self-serving illusions include illusion of
well-being, illusion of personal control, unrealistic optimism, etc. Such
illusions have positivity bias and are associated with subjective well-
being. Taylor and Brown (1994) have discussed some of the important
functions that healthy illusions serve for people. First, they provide
explanations as to why do people fall sick. It is important to have an
explanation, no matter how aversive it is to make life events predictable.
It helps people in having mental preparations to face the hard truth.
Second, beliefs about the causes of illness help people in deciding about
the kind of treatment to be sought. People postpone decisions regarding
the alternative medicine to be sought till they are sure about the causal-
ity. Third, beliefs play an important role in building hopes and expecta-
tions, which trigger the healing mechanism of the body. People who
expect to die on the operation table often fail the surgery. Beliefs help
people in reintegrating within the culture they come from. Cultural
beliefs help find meaning in their suffering. Dalal (2011) has discussed
cultural beliefs about self and health in India, which have such positivity
bias and thus implicates recovery from chronic diseases.
Indian Perspective on Disease and Suffering
Suffering is believed to be a universal characteristic of the human condi-

tion though its causality is understood in different ways in different cul-
tures. In Hindu and Buddhist traditions, it is viewed as a mental state, a
ROSARIO
Account: s4300083
personal experience (Miri, 1976). The personal experience of falling ill

is subsumed within the holistic conception of well-being and suffering.
Conversely, as the sage Vedavyasa says in his commentary on Patanjali’s
Yoga Sutra (2.15), suffering is like a disease and yoga is like the medicine
for its removal (as quoted by Paranjpe, 1984). Thus, though traditional
medicine and healing systems pay attention to physical pain, they often
lay their emphasis on removal of suffering in its holistic sense.
The distinctiveness of the Indian approach lies in trying to eliminate
the root causes of the problem, and thereby focusing on the sufferer
rather than on the suffering. In the Samkhya, as well as in many other
classical philosophical systems of India, the thrust of inquiry is more
on finding out who is it that experiences pleasure and pain, than on
what is being experienced (Paranjpe, 1998). The Ayurvedic theory of
medicine is consistent with this viewpoint and insists that medicine
should target the person rather than the disease. The person in whole-
ness is called the ‘asylum’ of disease and constitutes the main subject
of medicine (Kakar, 1982). The Ayurvedic science thus focuses on the
knowledge of the patient’s present mental state and his more endur-
ing personality traits, which should be supplemented with gaining a
thorough familiarity with his familial, social, geographical and cultural
contexts. It takes into consideration different levels of human existence:
physical, mental, social and metaphysical and a harmony among these
different levels of existence.
The main treatise of the Sankhya system, Sankhya Karika has pro-
vided the most exhaustive understanding of the causes of suffering and
disease. The three different sets of factors are presumed to cause suffering.
These are material factors (adhibhautika), sorcery (adhidaivika) and self
(adhyatmika). Self refers to both bodily and mental causes. The physical
causes include bodily conditions as well as social and environmental fac-
tors, which adversely affect health conditions. Sorcery refers to spirits,
demons and deities that can be taken care of by offering prayers, chant-
ing mantras, wearing amulets and visiting spiritual healers. The bodily
conditions of disease were caused by imbalances of the body. The bodily
conditions of disease are supposed to be caused by imbalance of three
life energies (tridoshas) and could be alleviated by taking medicine and
regulating diet. From the Sankhya viewpoint, mental suffering consists
of affective reactions like greed, envy, lust, etc. The complete annihila-
tion of suffering is thus possible when all the causes of suffering are
removed (Paranjpe, 1998, 2006). In this endeavour not only physicians,
ROSARIO
Account: s4300083
but family, friends, society and traditional healers also are presumed to
play an important role. The vast variety of healing systems practiced in
India work on these basic premises.
Coping with Chronic Diseases
In the light of the above discussion, it should now be possible for us to

explore more systematically how people react and put up with a disease
at its different stages? How health beliefs get translated into relevant
health behaviour? In the following presentation, these questions will be
dealt with in greater detail.
Onset of an Illness
When do people realize that they are chronically sick? In some instances
like coronary heart disease, the impinging reality leaves no scope for
thinking otherwise. However, in most of the other instances it takes
quite long for patients to reconcile with the fact that they are chroni-
cally sick. People tend to believe, even in the face of hard evidences to
the contrary, that they will be fully cured. When the disease is diagnosed
as chronic, there is a tendency to explore the possibility of an error in
the diagnosis. People are very susceptible at this stage to suggestions that
the disease is curable. Even patients at the advanced stage of cancer are
found to be hopeful of complete cure (Kubler-Ross, 1975).
In the Indian setting, it is generally not during the routine check-up that
the disease is detected. When people observe some unusual symptoms or
bodily changes, they confide it to their close relatives and friend, who help
in interpreting the symptoms to arrive at a naïve diagnosis (Singh, 1987).
These are the people in close social network who provide initial interpreta-
tions about the possible implications of the symptoms. Those who appraise
the illness as still at the initial stage may try domestic remedies. In quite a
number of cases, formal medical check-up does not take place to arrive at
a diagnosis. There is a greater degree of reliance on the diagnosis made by
elders, priests and paramedical personnel (Banerjee, 1986).
Once a diagnosis of the chronic disease dawns upon the patient, the
immediate crisis reaction may be that of fear and anxiety. The patient is
ROSARIO
Account: s4300083
uncertain as to how to handle the anxiety. An easy way out is to refuse

to accept the diagnosis or to delink symptoms from the illness, and thus
unconsciously blocks any cognizance of the illness. This state, however,
cannot last long, as the increasing evidence and everyday inconven-
ience usually makes it difficult for the patient to sweep the hard reali-
ties of their health under the rug. The other option for the patients is
to accept the diagnosis but resort to other ego-defence mechanisms
such as rationalization, compartmentalization, isolation, displacement,
projection and the like. These patients belittle the significance of the
symptoms, delay seeking medical care, or fail to comply with the treat-
ment regimen and the rehabilitation programme. One such example
is of heart patients who oftentimes procrastinate in seeking diagnosis,
and thereby jeopardize their chances of survival.
At some stage when the patients come to terms with realities a new
phase of crisis begins. The acceptance of a diagnosis of chronic disease
triggers several major worries. One needs to ascertain as to how much
functioning will be impaired by the illness? How can it be integrated with
their lives in the long-term perspective? What kind of adjustments they
would be required to make in their occupational and social life? Generally,
patients get enough time to ponder over the illness and its consequences,
test their naïve theories of illness and recovery, and form some stable opin-
ion about the causes of the illness and about appropriate coping strategies.
These inquisitive exercises, which Lazarus (1981) has called secondary
appraisal, are essential to clear some of the mist shrouding the illness.
Subjective Meaning of an Illness
People assign meaning to their illness in many different ways. As pointed

out by a medical sociologist (Parson, 1972), the sick role is necessarily

socially deviant and society will permit it only after the doctor legiti-
mizes the patient’s need, both to regress and accept the sick condition.
Psychologists, however, take a different viewpoint. Herzlich’s (1973)
empirical study focused on social psychological meaning and implica-
tions of health and illness as stages of being. The respondents regarded
illness as an intrusion, an external imposition, which renders a person
passive and powerless. Herzlich observed that when people face an
illness, particularly a long-term one, their self-perceptions are blurred.
To regain some sense of self-sensibility, they need to make sense out of
ROSARIO
Account: s4300083
their illness. Sometimes the need to understand the illness is so compel-

ling that it actually overshadows the desire to be cured.
Such understanding of the meaning of illness includes beliefs about
the symptoms, causes, consequences, cures and duration of illness are
thought to be derived from personal experiences with illness, support
group, health professional and social networks. Two important aspects
of illness perceptions are that patients’ beliefs about their condition
are often at variance from those who are treating them, and secondly,
patients’ perceptions vary widely, even in patients with the same medical
condition (Petrie et al., 2007). Many studies have investigated the rela-
tionships between illness perceptions and outcomes in different patient
populations. A meta-analysis of 45 empirical studies among patients
with various medical conditions, demonstrated that perceptions that the
illness was curable/controllable were significantly and positively related
to the adaptive outcomes of psychological well-being, social function-
ing and vitality, and negatively related to psychological distress and dis-
ease state. Conversely, perceptions of illness consequences, timeline and
identity exhibited significant, negative relationships with psychological
well-being, role, and social functioning and vitality (Hagger and Orbell,
2003; Leventhal and Benyamini, 1997). In 1986, Turk et al. developed
a 45-item Implicit Models of Illness Questionnaire (IMIQ), which
includes questions assessing the components of illness representations.
They identified a four-factor structure using this scale: seriousness, per-
sonal responsibility, controllability and changeability.
Clearly, the meaningful understanding that a sick person seeks is not
limited to the medical explanations of one’s sickness. Patients extend
their formulations to embrace the social, psychological implications for
themselves and their family. This view is contrary to the view held by
psychoanalysts who regard illness as ‘motivated’ (Lipowski, 1983). The
cognitive view advocated here considers it unlikely that many people
actively seek illness. It is possible that some patients may impart neu-
rotic meaning to it, for example, they may view illness as a punishment
or as an escape from the rigor of life.
Lipowski (1978) also examined in greater detail the different mean-
ings, which people assign to their illness. These are illness as a challenge
(insightful acceptance), illness as an enemy, illness as punishment, ill-
ness as weakness, illness as relief, illness as a strategy (as a means), illness
as an irreparable loss and damage, and illness as value. The meaning
that a person assigns to his or her illness is predominantly conscious,
ROSARIO
Account: s4300083
but at time may be unconscious, influencing one’s emotional and moti-

vational response to the disease. Lipowski further suggested the different
emotional reactions and coping strategies associated with these mean-
ings. Schussler (1992) studying patients with chronic problems found
overall support for the illness concepts of Lipowski. For example, it was
found that patients who viewed their disease as a challenge showed no
anxiety and depression and were emotionally stable, whereas those who
viewed their disease as an enemy or as a punishment were on the other
end of the same continuum. It is, however, an open question as to how
those who view their illness as a punishment from God will emotionally
react to their illness.
Beliefs about Personal Control
Belief in personal control is defined by most of the theorists as a belief

that one has at one’s disposal, a response that can influence the aversive-
ness of an event. It is argued that the belief in personal control is integral
to self-concept and self-esteem, constituting a fundamental psychologi-
cal state. Fighting a chronic disease and long-term hospitalization quite
often undermines one’s sense of personal control and a sense of help-
lessness pervades. To have an effective coping, it is essential that people
regain some amount of control. Most of the theories of personal control
predict that feeling of control reduces the experience of stress; it helps
people cope with unavoidable, unpleasant events and enable them to
live a better life. Moreover, these theories recognize that control does not
need to be exercised for it to be effective and it does not even need to be
real for it to have desired effects.
Building on the typologies suggested by Averill (1973) and Miller
and Norman (1979), Thompson (1981) developed a four-fold typol-

ogy of perceived controllability: behavioural, cognitive, information
and retrospective. People can control the course of their illness in many
ways. Thompson (1981) identified five types of control beliefs, which
patients can exercise in a crisis situation. One is behavioural control,
which is the belief in one’s ability to take some steps to reduce the inten-
sity of the illness, can reduce its frequency, or can alter its timing and
duration. Patients believe that by taking appropriate actions, negative
consequences of the prolonged sickness can be averted. To be effective,
ROSARIO
Account: s4300083
behavioural control need not be real, the belief that one can take steps
to control one’s illness is sufficient to reduce distress. Second is cogni-
tive control, which is the availability of some cognitive skills to think
differently about the illness. For example, a hospitalized patient about
to undergo a painful diagnostic medical procedure may be instructed
to focus on the benefits of the procedure rather than on the current
discomfort. Decision control is the belief in the ability to make decisions
about the future course of action. The patients who believed that they
have options to choose from are capable of making their own decisions.
The fourth is information control, which is a sense of control achieved
when one acquires sufficient information about the obnoxious event
itself. A patient awaiting surgery, for example, may have all post-operative
side effects carefully explained, so that when they occur, it will not be
distressing. The fifth is retrospective control, a term coined by Thompson,
to refer to the belief that the event that just occurred was controllable,
thereby implying that its reoccurrence can be controlled in future. He
stated that the kind of control exercised would depend on the appraisal
of the potentially stressful event by the individual.
Another important theory was proposed by Rothbaum et al.
(1982). Their two-process model of perceived control claimed that
people attempt to gain control not only by bringing the environment
into line with their wishes (primary control) but also by bringing
themselves into line with environmental forces (secondary control).
According to Rothbaum et al., four manifestations of secondary con-
trol (changing oneself ) are (i) predictive control by attributing the
event to severely limited ability, thus guarding oneself against future
disappointment; (ii) attribution to luck, which can lead to illusory
control; this occurs when luck is construed as a personal characteristic;
(iii) vicarious control, when the individual identifies him or herself
with the powerful others (God or a leader); (iv) interpretive con-
trol, in which the individual seeks to understand and derive meaning

from the otherwise uncontrollable events in order to accept them.
About 27 years later, Rothbaum et al. (2009) tested and validated
their model for its contemporary relevance taking patients suffering
from depression.
Since personal control is believed to be effective in dealing with eve-
ryday events as well as health-related events, people under some circum-
stances exaggerate the degree of control they have, in situations that are
ROSARIO
Account: s4300083
chance happenings, thus developing what Langer (1975) called an ‘illu-

sion of control’. This illusion of control is very frequently manifested
in choosing auspicious occasions such as ‘lucky’ numbers in buying a
lottery ticket, playing cricket with a lucky bat, etc. In many instances,
this illusion of control is healthy in the sense that people strive hard to
prevent an undesirable outcome. But it may greatly aggravate the stress
if a tragic event shatters this illusion. Beliefs of more personal control,
less impact of the illness and its treatment, and less concern were the
most important contributors to perceived autonomy and self-esteem in
case of chronic kidney patients (Jansen et al., 2010).
In recent years, the basic assumptions of theories of perceived con-
trollability that people seek control and that the control is desirable are
questioned. Carver et al. (2000) argued that perceived control is sali-
ent to the extent it enhances the expectation of recovery. Conducting
a study on cancer patients, they showed that expectation of remain-
ing cancer-free was a good predictor of distress, but perceived control
over the disease was not. As pointed out by Taylor (1984), ‘control is
a double-edged sword’, it is beneficial in some circumstances and not
under others; it is beneficial for some people and not for others; it may
work in one cultural set-up and fail in the other.
It is now argued that people are often willing to give up control
depending on their understanding of the tragic circumstances, rather
than seeking more personal control. Misra (1994) argued that the theory
of personal control needs to be viewed from a larger cross-cultural per-
spective. According to Misra, the idea of control in the Indian scripture
is seen in the framework of consciousness, harmony and interrelated-
ness, not from the individual perspective. Personal control is considered
to be an illusion in an interconnected world and the human suffering is
needed to be seen from a larger cosmic perspective. In fact, sense of per-
sonal (ego) control is viewed as a major causative factor in precipitating
pain and suffering. Studies have revealed the chaos and mental health
problem which this cultural ideal of sense of personal control has caused
in the West (Schwartz, 2000). Giving up the sense of personal control
and accepting the destiny is many times prescribed as the remedy for
alleviation of the suffering one is going through. The message of the
Gita that one has control over the efforts one can make, not on the out-
come can help in alleviating pain and suffering (Bhawuk, 2012). One
has to learn what one can control and what one cannot. Surrender and
ROSARIO
Account: s4300083
‘letting go’ are the other concepts, which need to be critically examined
for their role in dealing with health- and illness-related issues.
Health Beliefs and Affective Reactions
A wide variety of reactions are observed when people are told about the
diagnosis of a chronic illness. Quite often, the initial reaction is that of
denial or disbelief, which averts the onset of any emotional crisis. Denial
also gives some time to adjust to the impinging reality. Other typical reac-
tions are of high anxiety and emotional disturbance, clouding clear think-
ing. On the other hand, there are people who accept the diagnosis rather
stoically. Chronic illness is something people have to live with, and they
have to make long-term alterations in their lifestyle. There could be wide
fluctuations in the mood of patients with changes in their physical con-
ditions and nature of disability. Pain and discomfort are other factors
influencing the affective state. Many of these affective reactions may be
transitory or of diffused kind, whereas other reactions are specific to the
appraisal of the symptoms. Broadly speaking, affective reactions could
be of two types—a general response to the situation like fear, sadness,
unpleasantness, anxiety, etc., and those which are belief dependent. The
belief-related affects are often very specific reactions, based on causal
beliefs and control the appraisal of the situation. Such affective reactions
are those of anger, depression, disappointment, pity, etc.
Studies have been done to establish linkages between affective reac-
tions to an undesirable life condition, and causal and control-related
beliefs. Causal appraisal gives rise to a qualitative distinction among the
feelings. Weiner (1985) found that in the case of giving help, lack of
effort on the part of the help seeker aroused anger, whereas physical
disability led to aroused feeling of pity. Dalal and Tripathi (1987) in

a study of help-seeking behaviour found the linkages between control
beliefs (situation controllable or uncontrollable) and affective reactions
stable and reversible. Some attribution–affect linkages found in their
two experimental studies were uncontrollable sympathy, controllable
anger and dislike.
The onset of a chronic illness and subsequent hospitalization result in
more frequent feelings of anxiety, depression, suppressed anger and help-
lessness (Westbrook and Viney, 1982). In an Indian study by Agrawal
ROSARIO
Account: s4300083
and Dalal (1993), the dominant affective reactions found in hospital-

ized patients were helplessness, depression and metaphysical ration-
alization. There were some gender differences: female patients showed
greater anger and anxiety, whereas male patients more often engaged in
disengagement and rationalization. It was also noted that anger was the
least frequent reaction. In a study by Kohli (1992) on cancer patients,
evidence of anger response was very low. There is a greater degree of
acceptance and rationalization in terms of the theory of Karma, where
people look for justification in their own wrongdoing in their previ-
ous births. Higher attribution to metaphysical factors probably explains
why Indian patients are low on anger reaction.
It seems that the feeling more often expressed in response to loss of
control is that of helplessness. People show acute helplessness when they
feel a loss of control in a tragic situation. When all previously acquired
behaviour skills fail to yield any desirable results and the patients start
doubting their own ability to exercise any control, then the feeling of
helplessness overtakes.
The feeling reported most frequently in the cases of chronic illnesses
is that of depression. Depression is characterized by a dejected mood,
loss of desire to do things, general tiredness and inability to concentrate.
A depressed person may think that nothing can be done to change the
undesirable life conditions. Like anger and helplessness, the feeling of
depression sets in at a later stage of the chronic illness. During the initial
phase of the illness, the patients may be too pre-occupied with diagnos-
tic hospital procedure to feel depressed. The feeling surfaces at a later
stage when the patient has tried many treatments unsuccessfully and
now has to cope with a host of new problems, related to adjustment
in his day-to-day living. Many researchers suggest that the emotional
reaction of depression is beneficial in a sense that it is preparatory to
the later adjustments that must be made as a consequence of the illness.
However, acute or prolonged depression is pathological.
Compliance with Treatment Regimen
In a chronic illness the treatment is long-drawn, sometimes lifelong,

and its discontinuation at any stage may be hazardous. Second, in a
chronic illness the onus of adhering to the treatment largely depends on
ROSARIO
Account: s4300083
the patient himself or herself, once he or she is out of the critical phase.
In diabetes and arthritis, for example, patients are expected to monitor
their physical condition, follow the treatment regimen and take neces-
sary precautions. Same is the case with heart patients, where any neglect
may be fatal at times. Patients’ role in following the treatment regimen
thus seems crucial in chronic illness.
Notwithstanding, universally, lack of compliance seems more a rule
than exception. WHO (2003) inferred that more than 50% of the patients
do not take prescribed medication in accordance with the instructions.
Thus even in situations where proper medical care is available, compli-
ance is still a problem. The social characteristics of the patients such as
age, gender and education were found to be poor predictors of compli-
ance, though a high correlation was found between characteristics of the
treatment regimen and nature of patient doctor relationship.
Rosenstock’s (1966, 1974) health belief model originally developed
to predict preventive health behaviour, was later extended to account for
compliance to the treatment regimen. In this health belief model, the
perception of threat to health is the most crucial factor. The perceived
threat of the disease is determined by two considerations: perceived
threat of the disease one is suffering from, or could suffer from, and per-
ceived vulnerability to the illness and its consequences. For example,
a diabetic would first assess his condition as severe or mild and would
think about its possible consequences for his life adjustments, before he
perceives diabetes as a threat.
However, this perception of threat is not sufficient to engage in
health-care behaviour. One important factor is the belief that a par-
ticular health-related activity will protect oneself from the threat. The
second factor in the model, which will determine health behaviour, is
the perceived cost and benefit of compliance. In order to comply, the
patient must believe that the recommended regimen will be effective and
the accrued benefits will offset the cost, such as discomfort, side effects
and other negative aspects. According to the health belief model, to ini-
tiate or sustain any treatment regimen, the patient waits for some cues
so as to make him/her aware of the potential consequences. Internal
cues are very important in this context.
The health belief model is tested taking various chronic illnesses, and
is found useful in predicting compliance. Where an illness is diagnosed
and a course of treatment recommended, the patients’ perception of the
ROSARIO
Account: s4300083
threat in terms of symptoms and future consequences becomes crucial.

It is in relation to this threat that possible actions and their costs can be
evaluated. Becker and Maiman (1975) and Kirscht (1983) reviewed the
literature on patient compliance from the point of view of the health
belief model. The model has been applied in the studies of compliance
to hypertensive regimen (Becker et al., 1977) and cardiac care of rural
population (Leight, 2003). There are now a number of studies that do
not support the health belief model particularly when unhealthy behav-
iour is strongly habitual, like cigarette smoking or deeply rooted in the
local culture, or where chronic disease is already set in (Rawlett, 2011;
Tanner-Smith, 2010).
Attempts have been made in the past to enhance compliance
through systematic changes in health attitudes and beliefs. Tagliacozzo
and others (1984) examined the role of information in compliance
behaviour. To the experimental group, a special nurse gave detailed
instructions about various aspects of the disease, whereas the control
group received regular medical care. There was no effect of instructions.
However, the factors found in that study having the significant impact
were duration of illness, multiple illnesses, high anxiety, favourable
attitude towards the clinic and the doctor, and perceived severity of
illness. It appears that any information, which is general and abstract
does not result in compliance.
It was observed in many studies that those patients who show
helplessness and depression also show poor compliance. Some
interventions using attributional concepts have tried to inculcate a
sense of self-efficacy and self-control. One such study was conducted
by Chambliss and Murray (1979). In their study, the subjects who were
inclined to give up smoking were given a placebo capsule to complement
their efforts at self-control. The placebo was described as increasing,
decreasing or having no effect on the symptoms of withdrawal. In
the second phase of the study, half of the subjects were told that the
drug was inactive and that they had reduced their smoking through
their own efforts, while the rest of the subjects were not debriefed at
all. The debriefed group, and in particular those with an internal locus
of control, went on to reduce their smoking by a significantly greater
amount than the others. Colletti and Kopel (1979) also reported that
the more the subjects attributed their improvement to their own efforts,
the less they were smoking one year later. Sonney and Janoff (1982) gave
ROSARIO
Account: s4300083
their obese patients a choice between two weight loss programmes, one
emphasizing self-control and another external control by the therapist.
Both programmes were equally effective during the treatment period,
but the self-control group maintained better progress, as found in the
follow-up interview.
Living with Chronic Illness
Learning to live with any long-term adversity is always problematic.

How people will cope with their chronic condition will depend on the
nature of illness, its severity and socio-psychological resources, which
people have to deal with. The most difficult initial problem is to accept
the fact that one has to live with the chronic disease they are suffering
from. In spite of medical confirmation, people find it hard to accept it
as a reality of their life. As discussed earlier, many people continue in
the denial mode, keep seeking one or the other course of treatment and
repeated failures make them feel worse. The more time they take to rec-
oncile with the reality, the more complicated the process of readjusting
in life becomes.
Once the diagnosis of chronic illness is accepted and patients have
reconciled to the fact that they have to live with it, the spotlight shifts
on efforts to integrate the illness in the patients’ lives. The concern is
how to go about that and how soon can patients be brought back to
their usual life routine. In a large number of cases, a major readjustment
is required. The self-management of chronic illness is characterized by
taking responsibilities regarding medication use and lifestyle changes,
and taking steps to prevent long-term complications.
Much would depend on the extent of physical impairment due to
the illness. Physical problems engendered by the illness range widely.

Breathlessness associated with asthma, metabolic changes in diabetic
patients, motor coordination problems in spinal cord injury cases, and
impaired body limb movement associated with arthritis are a few exam-
ples of the physical problems. There may be psychological problems,
such as loss of memory in epilepsy, for example, with which patients are
required to put up with.
In many chronic illnesses, such as arthritis, pain is the most disturb-
ing consequence. Sometimes treatment of the disease produces chronic
ROSARIO
Account: s4300083
pain and discomfort, which by itself poses a management problem.

The chronic pain in many instances has greater debilitating effects than
the illness itself. Even though it may have a physiological basis, pain is
basically a psychological experience. For example, pain can be minimal
when attention is distracted but when attention is focused on the pain,
the pain experience is heightened. Sternbach (1978) had reported that
pain tends to increase as the anxiety level of the person increases. There
is considerable research evidence showing that the degree of pain and
level of distress that people experience largely depends on the labels and
cognitions that are applied to the physical state. Persistent, unrelent-
ing pain and stress often leads to uncertainty and anxiety, which many
patients and their families find hard to cope with. People have to fre-
quently resort to taking painkillers, which has its own implications.
Chronic disease affects not only the patients, their families too have
to go through major changes in their life conditions. They are needed
to mobilize their financial, social and community resources to deal
with impending crises. If the person is earning member of the family
then chronic condition results in financial crisis as well. It is thus not
uncommon for patients and family members to have prolonged periods
of worries about the effect the illness on their lives. On the part of the
patient worries include physical symptoms, such as difficulty breathing,
headache, lack of mobility and body pain. Psychological symptoms of
anxiety, such as fear of what will happen, include worrying about who
will care for them, and how the illness will progress. What one feels and
deals with accompanying emotions can affect one’s ability to cope with
a long-term chronic condition.
Most of the chronic illness episodes are managed within family set-up.
Barring the acute phase of the chronic illness when the patient may need
hospitalization, it is the extended and close family, which takes care of
the health regimen of the suffering member. Family support is crucial
for medical and psychosocial recovery of the person. Though as many

studies show, Indian families are overindulging and overprotective, their
support is considered crucial to bring the person back to normal routine
(Chadda and Deb, 2013).
In chronic illnesses, physical rehabilitation is integral to the treat-
ment procedure itself. According to Taylor (2006), physical rehabilita-
tion of chronically ill patients typically involves several goals: to help
them use their body as much as possible, to sensitize patients about the
physical changes and reality, and to develop new management skills.
ROSARIO
Account: s4300083
Quite often patients are required to read bodily signals about the onset
of the crisis, take precautionary measures, administer medicine, etc. Any
comprehensive physical rehabilitation programme must pertain to all or
most of these goals. The task is certainly challenging.
In the long term, an even more challenging task is that of psycho-
social rehabilitation. Social support and patients’ own internal resources
are crucial factors in successful long-term coping with the chronic
disease. The psychosocial rehabilitation of the patient does not fol-
low a predetermined course; rather there are many ups and downs and
uncertainties, which keep cropping up from time to time. Much of the
successful rehabilitation depends on patients’ positive interaction with
people in their socio-cultural milieu. Fortunately, most of the patients
show an impressive ability to cope with adverse life conditions. Many
of the survival strivings are built-in in the human nature, which are
activated whenever survival is endangered. Thus, very few patients need
professional help to get rehabilitated (Taylor, 1983).
The phenomenon that facilitates the task of rehabilitation is,
what Rosenbaum (1983) termed ‘learned resourcefulness’. Learned
resourcefulness refers to an acquired repertoire of self-regulated inter-
nal responses, such as emotions, pain and cognitions (Rosenbaum,
1983; Rosenbaum and Ben-Ari, 1987). The conditions that activate the
self-regulatory process are similar to those that are recognized as stress
conditions. In the condition of prolonged stress due to chronic illness,
people gradually acquire a large response repertoire to cope successfully.
In many instances, it is observed that psychological adjustment or exist-
ence is even better than the one prior to the illness.
Against this background, the emphasis of any rehabilitation pro-
gramme should be to provide an opportunity wherein a patient can
learn to be resourceful, that is, acquire self-regulatory skills to live with
the illness. Perhaps the important question is how can one learn to be
resourceful? Meichenbaum (1977, 1975) developed a stress inoculation

programme for this purpose. The major components of the stress inoc-
ulation programme are (1) self-monitoring of maladaptive thoughts,
images, feelings and behaviours; (2) training in cognitive and behav-
ioural skills, which enable them to cope effectively with stress, and
(3) emotion regulation. Meichenbaum argues that those who have
acquired these skills develop a sense of learned resourcefulness. It is
assumed that without any formal training these behaviours are acquired
in different degrees by most of the patients. These behavioural and
ROSARIO
Account: s4300083
cognitive skills facilitate the process of rehabilitation. Furthermore, it

is suggested here that those who are able to help themselves (highly
resourceful persons) will be most helped by others. Those who are
unable to help themselves are likely to deplete their social resources by
their highly socially dependent behaviour (Monroe and Steiner, 1986;
Wortman and Lehman, 1985).
Consistent with this ideology, many self-help programmes are evolved
in recent years. The basic philosophy behind self-help is that people
who are suffering from similar illnesses can provide mutual support,
understanding and information for successful adjustment. It is gener-
ally observed that patients tend to bring needed changes in their health
habits through sharing experiences with others in the same plight. In a
typical self-help programme, people with common illnesses are brought
together and often with the help of a counsellor, they attempt to solve
their problems collectively. A self-help group emphasizes face-to-face
social interaction and assumes personal responsibility on the part of
the members. These people come together for mutual assistance in sat-
isfying a common need, that is, overcoming a common handicap or
life-disrupting problem, and bringing about desired social and personal
changes (Katz and Bender, 1976). In these self-help groups, the patients
not only learn the skills to help themselves but also help those who face
similar crisis. Borne et al. (1986) reviewed a large number of studies to
examine the efficacy of self-help groups of cancer patients. They found
positive results in almost all the studies reviewed, that is, improvement
in terms of general health perception and reduction in negative feelings.
The mutual support among fellow patients is a widely observed phe-
nomenon. These patients come in contact with each other when they
are in-patient in the same hospital ward or visiting the same doctor.
Kakar (2003) has described many social and religious institutions in
India, which are a common meeting ground for patients and their rela-
tives. Though their functioning is loosely structured and quite informal,

they do serve the purpose. At the other extremity, as in the West, contact
among fellow patients may be part of a highly structured intervention
programme, which is initiated in the hospital. There seems to be enough
scope to develop various self-help types of interventions to alleviate the
suffering of chronic patients and to accelerate their rehabilitation.
ROSARIO
Account: s4300083

Health Beliefs and Living With Chronic Diseases

Uploaded by

Copyright:

Available Formats

Health Beliefs and Living With Chronic Diseases

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Health Beliefs and Living With Chronic Diseases

Uploaded by

Copyright:

Available Formats

Copyright © 2015. Sage Publications Pvt. Ltd. All rights reserved.

T raditional health-care systems in any culture are mostly based on

long-term disease or disability the concern shifts to bringing changes in

Defining Chronic Disease

Which diseases should be considered as chronic conditions? By defi-

pects of recurrence of the symptoms means that recovery prospects are

conditions, and associated physical and psychological complications.

disease becomes acute. It may be noted that a person suffering from a

sudden, as in the case of heart attack, or gradual, in which case the

already exist as a result of their chronic condition. Often, treatment for

these subjective constructions. Third, these subjective constructions of

Plurality of the Health-care Systems

One important factor that makes it imperative to study the health

The popular sector: This is the most informal, non-professional mode

The folk sector: Trained informally, or through apprenticeship, some people

and surgical therapies.

Meaning of Health Belief

Clearly patients’ response to chronic conditions will depend on their

kind of proof. It may be anchored in some authority, logic or personal

history. Some characteristic features of these beliefs can be identified

Functional Nature of Health Beliefs

Beliefs influence human health implicitly and explicitly in various ways.

bias and thus implicates recovery from chronic diseases.

Indian Perspective on Disease and Suffering

Suffering is believed to be a universal characteristic of the human condi-

personal experience (Miri, 1976). The personal experience of falling ill

Coping with Chronic Diseases

In the light of the above discussion, it should now be possible for us to

uncertain as to how to handle the anxiety. An easy way out is to refuse

Subjective Meaning of an Illness

People assign meaning to their illness in many different ways. As pointed

out by a medical sociologist (Parson, 1972), the sick role is necessarily

their illness. Sometimes the need to understand the illness is so compel-

but at time may be unconscious, influencing one’s emotional and moti-

Beliefs about Personal Control

Belief in personal control is defined by most of the theorists as a belief

and Norman (1979), Thompson (1981) developed a four-fold typol-

trol, in which the individual seeks to understand and derive meaning

chance happenings, thus developing what Langer (1975) called an ‘illu-

Health Beliefs and Affective Reactions

disability led to aroused feeling of pity. Dalal and Tripathi (1987) in

and Dalal (1993), the dominant affective reactions found in hospital-

However, acute or prolonged depression is pathological.

Compliance with Treatment Regimen

In a chronic illness the treatment is long-drawn, sometimes lifelong,

threat in terms of symptoms and future consequences becomes crucial.

Living with Chronic Illness

Learning to live with any long-term adversity is always problematic.

the illness. Physical problems engendered by the illness range widely.

pain and discomfort, which by itself poses a management problem.

for medical and psychosocial recovery of the person. Though as many

resourceful? Meichenbaum (1977, 1975) developed a stress inoculation

cognitive skills facilitate the process of rehabilitation. Furthermore, it

tives. Though their functioning is loosely structured and quite informal,

You might also like