There is a large range of health and illness and there is an overlap. A person suffering from depression may be physically very healthy but they are psychologically ill with depression. Medical sociologist Aaron Antonovsky (1979, 1987) suggested we consider health and illness as ends of a continuum (E.Sarafino 2008).
By looking at health on a continuum it takes into account all aspects of the person and gives a more overall picture of their state of health.
There are many aspects affecting health and how a person experiences health or illness. The Biopsychosocial modal of health care as developed by Engel (J.Ogden, 2012) takes into account the connections between the Biological, Psychological and Social factors. These factors all have an effect on each other, to demonstrate the interactions between the biological, psychological and social aspects an example will be used. The example case is a 42year old female that was diagnosed with Fibromyalgia 10 years ago, hereafter referred to as Miss W. The condition has affected more than just her physical state, it has completely changed her lifestyle. Her daily activities are now very different and it has had an effect on her personality. Due to the physical problems she could not maintain her job or social activities. The decline in social interactions and her financial situation has affected her psychological state which has intern exacerbated her physical symptoms. It has become a vicious cycle resulting in a drastic decline in her biological and psychological health.
Miss W had a physical job working with animals and spent her leisure time training/competing with her dogs at dog agility. She had a strong social network and usually had a happy and cheerful disposition. She did not have much of a surplus income but managed her money well and was not in debt and enjoyed a full and engaging life. Miss W began to experience widespread pain, she felt fatigued even after sleep, and she had trouble concentrating and started to experience symptoms of Irritable bowel syndrome. I order function enough to go to work she reduced her leisure activities to an almost nonexistent level and after a short time could not manage to work and was given medical severance. It took nearly 2 years for fibromyalgia to be diagnosed. By the time of diagnoses Miss W had reduced her activities to a short dog walk each day and her only social interactions were with friends that came to visit. She struggled to get going in the mornings due to pain and stiffness, she was constantly tired and experienced regular headaches. She had begun to experience depression and was struggling to pay the household bills.
The biological effects of the fibromyalgia are the pain, stiffness, fatigue, sleep disturbances and irritable bowel syndrome. Physically her health has declined but the significant effects of the condition are on Miss W’s psychological and social health.
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Depression is associated with fibromyalgia but this may be due to the chronic pain. It has been found that 40 -50 % of chronic pain patients suffer from depression (Romano and Turner, 1985 as cited in chronic physical disorders 2002). Miss W was used to having an active life so it would be reasonable to expect her feel a loss and grieve for her previous lifestyle. The impact of her diminished interactions means that her social support network has dwindled to only a couple of friends that still make the effort to visit her. It has been found that an absence of social support seems to be associated with the onset of depression (Paykel E.S. 1994). The effect of the depression is that Miss W now no longer takes good care of herself. She has put on a considerable amount of weight and is now classed as morbidly obese. The weight increase is partially down to the decline in physical activity, but also due to the poor eating habits she has developed. She now comfort eats and eats out of boredom, she rarely eats a proper meal and the food she eats is of poor nutritional content and generally high fat and/or high in sugar. Dietary components are suggested to influence depression (Rogers 2001), so her nutritional intake alone could exacerbate her problems. She is now unhappy with her appearance due to the weight increase and the lack of mental stimulation has resulted in low self esteem. Her once happy and cheerful disposition has gone and she now has a very negative and angry attitude.
The change in Miss W’s psychological health and the fact she now leads what could be considered an unhealthy lifestyle exacerbates her symptoms. Healthy lifestyles have been associated with feeling more awake and energetic (Resnick et al, 2006). The excess weight puts more of a strain on her body and her now sedentary lifestyle means her muscles are now weak. This means that when she does try to be active, along with the muscle soreness associated with the fibromyalgia, she experiences rapid fatigue due to her poor physical fitness level. Her now negative and angry attitude prevents her from making new friends and has resulted in the loss of some of her existing friendships.
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Miss W’s poor diet also exacerbates her symptoms as poor nutrition is known to have a negative effect on energy levels. She will even admit that when she eats better she feels better. The depression leaves her feeling unmotivated to make the effort to look after herself better and make the changes that could decrease her symptoms and improve her quality of life. Of the few friends she has only one has any understanding of the situation and has been unable to persuade Miss W that making some small changes would improve her quality of life. Sarifino (2008) stated that social factors, personality and emotional state can affect health related behaviours. Miss W is now resigned to this being her life from now on and does not believe it can change.
How it could be different
Informational support has been associated with positive morale (schaefer, 1981), therefore the lack of informational support in Miss W’s case is likely to have contributed to her negative attitude and lack of motivation. Her doctor does not look beyond the symptoms and treats her only with anti depressants and pain medication. If the doctor followed a biopsychosocial modal of care her treatment would likely have been different. By helping Miss W to gain a more positive outlook and helping her to increase her support network she may gain the motivation to help herself. There are support groups for many conditions, including fibromyalgia, and by talking to other people with the condition Miss W would see others making changes and improving their quality of life. She would also be likely to gain comfort in making friends with other people that understand her struggles. Kunda (1990) proposed that motivation may affect reasoning and that people are more likely to arrive at the conclusions they want to.
There are many non-pharmacological treatments considered useful with Fibromyalgia. These include cognitive behavioural therapy (CBT) (Mease, 2005) which is used to help learn pacing and pain management techniques. CBT can also be effective in reducing the sleep problems associated with fibromyalgia. With access to CBT and other non pharmacological treatments Miss W would be likely to have a more positive outlook. With a more positive attitude Miss W is more likely to look after herself better. Simply by having a healthy diet she would increase her quality of life significantly. Her body would have the nutrients it needs to function better and she would lose weight. By losing weight some of the strain would be taken off her body and she would feel better about herself. By feeling better about herself she is more likely to stick to an exercise plan and improve her overall fitness level giving her more stamina. Self-efficacy is key to making self management more effective (Lorig et al, 2003). She would still have bad days but with some coaching in how to pace herself she would have a vastly improved activity level. By regaining some control of her life and increasing her activity levels it is likely she would either reduce her level of depression or no longer suffer depression. She would have more social interactions and gain more friends, increasing her support network.
A person’s Biological, psychological and social state all contribute to where they would be on the health continuum. Each aspect affects the other, as seen in the example case a decline in one aspect can cause a decline in another aspect. A vicious cycle can begin, plunging their overall health into decline. It does work in both directions, by improving one state the other states can be improved and overall health can be increased. If only the biological aspect is looked at a person may not reach their maximum potential level of wellness. Miss W has a limited understanding of her condition and therefore has a much more negative outlook than she may if she fully understood. By understanding the links between biological, psychological and social factors the person gains an element of control. The person’s biological health, psychological health and social interactions all create the overall picture of their health. By understanding these relationships and looking at the person as a whole their experience of health and illness can be very different to if only their biology is taken into account.
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