Illness behavior and the sick role in chronic disease. The case of multiple sclerosis.
Illness behavior and the sick role in chronic disease. The case of multiple sclerosis.
复制标题
疾病行为和疾病在慢性病中的作用。
DOI：
10.1016/0277-9536(82)90134-4
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发表时间：
1982
影响因子：
5.4
通讯作者：
T. J. Sullivan
中科院分区：
文献类型：
--
作者：
David Stewart;T. J. Sullivan
本文描述了60例多发性硬化症患者诊断前疾病行为的研究结果。本研究的结果扩展了以下领域先前研究的结果：（1）多发性硬化症初始症状的外行和专业定义存在更多多样性和冲突;（2）医患关系的特征是更大的定义和角色分歧;（3）多发性硬化症患者在治疗过程中发挥更积极的作用。根据这些发现，先前的研究结果和概念的适用性与慢性疾病，如多发性硬化症的个人的经验提出了质疑。此外，有人建议，结构功能的方法，假定疾病的经验是由明确的规范性期望已经取得了突出的地位，因为疾病行为的研究和理论化的重点一直在急性条件和疾病行为过程的有限阶段（寻求专业帮助前或诊断后的时期）的模型似乎适合的描述。也就是说，由于医生可以很容易地诊断和治疗大多数急性疾病，整个疾病行为过程的特点似乎是定义和角色清晰，共识和和谐。相反，当医生难以诊断和治疗疾病时，如多发性硬化症和许多其他慢性疾病，整个过程就更成问题。这种情况缺乏规范控制，因此，社会纠纷和不和谐很可能发生。有人认为，病态的角色行为和治疗的遭遇涉及到一个过程，结构功能理论家忽视：角色协商。病人和医生的行为既受规范性期望的影响，也受情景谈判过程的影响。
This paper describes the findings of a study of the pre-diagnosis illness behavior of 60 individuals with multiple sclerosis. The findings of this study expand on those of prior research in the following areas: (1) more diversity and conflict occurs in lay and professional definitions of the initial symptoms of multiple sclerosis; (2) the doctor-patient relationship is characterized by greater definitional and role dissensus; and (3) multiple sclerosis patients take a more active role in the therapeutic encounter. On the basis of these findings, the applicability of prior research findings and concepts to the experiences of individuals with chronic illnesses such as multiple sclerosis are questioned. In addition, it is suggested that the structural-functional approach which postulates that the illness experience is governed by explicit normative expectations has achieved prominence because the focus of illness behavior research and theorizing has been on acute conditions and on limited stages of illness behavior process (before seeking professional help or the post-diagnosis period) where the model appears to fit the description. That is, since physicians can readily diagnose and treat most acute illnesses, the entire illness behavior process appears to be characterized by definitional and role clarity, consensus and harmony. It is proposed that, in contrast, when physicians have difficulties diagnosing and treating an illness, as is the case in multiple sclerosis and many other chronic illnesses, the entire process is more problematic. The situation is less normatively controlled and as a result, social dissensus and disharmony are likely to occur. It is argued that sick role behavior and the therapeutic encounter involve a process ignored by structural-functional theorists: role negotiation. The behavior of patients and physicians is shaped as much by a situational bargaining process as by normative expectations.