Psychosocial Aspects of Health and Disease

PSYCHOSOCIAL ASPECTS
O F H E A LT H & D I S E A S E
P R O F. D R . F A Z A I L A S A B I H
D E PA R T M E N T O F B E H AV I O U R A L S C I E N C E S
MOHI-UD-DIN ISLAMIC MEDICAL COLLEGE
(MIMC)
HEALTH AND NORMALITY
• Parameters that describe a state of psychosocial health
and normality include:
• Dynamism
• Optimization
• Personal contentment
• Social responsibility
• Occupational efficacy
• Economic emancipation
• Relief from pain and discomfort
• Homeostasis
DYNAMISM
• Various roles and functions a person has in life and their changing
and evolving nature.
• These roles contribute to individual’s growth, that of the society
and the world at large.
• Roles of family member, student, teacher, friend, breadwinner etc.
• More roles – more dynamic s/he is.
• Illness and disability limit the dynamism of a human being.
OPTIMIZATION
• When a person performs most of his/her roles in an
optimum state, s/he is considered psychosocially healthy.
• Viewing him/herself as being in state of productivity.

PERSONAL CONTENTMENT
• Despite failures and difficulties and inability to be the world’s

best scientist or best parent, a person accepts him/herself as
‘good enough’.
• Focus on positive aspects and achievements in one’s life

SOCIAL RESPONSIBILITY
• A healthy person takes responsibility of the roles and duties
assigned by the society.
• From immediate family to the neighborhood, town, and

country, to the world at large.
• Works towards making this world a better place for their

own self and subsequent generations.
OCCUPATIONAL EFFICACY
• In order for an individual to be normal and healthy they must
be well-versed in the knowledge, skills and attitudes
required for their occupation, i.e. they must perform effectively.
• Pass their skill, knowledge, and wisdom to others.

ECONOMIC STABILITY
• A core component of health and normality is economic stability.
• This means that whatever a person’s means of earning may be s/he

is the free of the pressure to acquire the basic necessities of life.
• This allows an individual to pursue their goals of self-

actualization.
RELIEF FROM PAIN AND DISCOMFORT
• In order for an individual to be healthy, s/he must be devoid of
distress, discomfort and pain at the physical as well as at a
psychological level.
• S/he must also be able to form and sustain relationships

that are free of mistrust, deceit, jealousy, prejudice, and
ignorance.
HOMEOSTASIS
• When a person respects the rights of others in their
interactions with other human beings and gives due
importance to the laws of nature in his/her interactions with the
environment they are said to maintain homeostasis with the world
around them.
• Neither threaten the environment nor feel threatened by it.
• Able to be in harmony with their internal and external

environment.
DEFENSE MECHANISMS
✓Defense mechanism are unconscious strategies that people
use to protect themselves from anxious thoughts or feelings.
✓Defense mechanisms are rooted in Freud’s theory of personality.
• According to Freud:
“Defense mechanism are tactics developed by
ego to protect against anxiety”.

DEFENSE MECHANISMS
• Defense mechanisms can be, both beneficial and maladaptive.
• They emerge in a developmental sequence from less mature to more mature.
• Contribute towards formation of personality traits.
• Can be brought under conscious control to ward off anxiety.
• Maintain a sense of wellbeing and safety.
• May be episodic or become more habitual and pervasive.
TYPES OF DEFENSE MECHANISMS
• SUBLIMATION • DISPLACEMENT
• RATIONALIZATION • PROJECTION
• ANTICIPATION • REGRESSION
• HUMOR • FANTACY
• REACTION FORMATION
• DENIAL
DEFENSE MECHANISMS
• Rationalization:
Defensive mechanism in which an individual justifies his failures and
socially unacceptable feelings and behavior by making excuse or formulate
logical reason
• Repression:
Consciously blocking (suppressing painful memories thoughts) of
unpleasant emotion impulses memories and thoughts from your conscious
mind.
• Sublimation :
Displacement of emotion in constructive manner.
CONT…
• Denial:
Refusing to recognize or acknowledge real facts or experience
that lead to anxiety.
• Humor:
Use of comedy to deal with unpleasant situations.
• Fantasy:
Sort of imagination which can provide an escape from frustration
by giving us imaginary satisfaction.
CONT..
• Anticipation:
Preparing in advance for an unpleasant situation.
• Regression:
Temporary reversion of the ego to an earlier stage of
development rather than handling unacceptable impulses in a more
adult way, for example, using whining as a method of communicating
despite already having acquired the ability to speak with an appropriate
level of maturity.
• Reaction formation:
In this mechanism the unacceptable real feelings are repressed and
acceptable opposite feelings are expressed.
CNTD…
• Displacement:
An unconsciously emotional feeling is transferred to
person or object who are less dangerous than those who initially
aroused emotion.
• Projection:
Placing blame for own weaknesses/difficulties upon other.
PSYCHOSOCIAL ASSESSMENT IN
H E A LT H C A R E
PSYCHOSOCIAL ASSESSMENT
• Psychosocial assessment involves psychological, social, familial,
and cultural aspects that can influence health.
• These factors affect the
• Etiology
• Presentation
• Diagnosis
• Intervention
• Prognosis of illness
• Management of illness
• Clinical Situations Demanding a Comprehensive Psychosocial
Assessment:
• Patients affected by natural and human-made disasters and
catastrophes
• History of Psychological trauma
• Cancer patients
• Psychiatric patients
• Sexually transmitted diseases like AIDS and infectious diseases
• Lifestyle disorders such diabetes mellitus, hypertension, coronary
artery disease, depression
• Dementias
• Intractable diseases such as spinal injuries, paraplegias
HOW TO UNDERTAKE PSYCHOSOCIAL
ASSESSMENT
• Identification of stresses in a patient’s life
• Emotional and psychological reactions to these stresses
• Symptoms
• Challenges to health
• Mental state examination
• Assessment for risk of deliberate self-harm or suicide
• Risk of violence or harm to others
PSYCHOLOGICAL REACTIONS TO ILLNESS AND
HOSPITALIZATION
• The severity of stress and individual’s response to it plays
a major role in the suffering the patient experience and
prognosis of illness.
• Major concerns include:
– Nature of disease
– The possibility of passing it to the next generation through
inheritance
– How long the treatment will last
– Whether there are consequent/residual disabilities
1. STRESS DUE TO ILLNESS
• Change of role
• Financial loss
• Stigmatization
• Loss of self esteem
• Fear of becoming handicapped
• Uncertain prognosis
• Intervention
2. STRESS OF HOSPITALIZATION
• Loss of privacy
• Loss of autonomy
• Separation
• Need of doctors approval
• Handing over personal matters
• Threat to social or financial circumstances
• Unsatisfactory information
3. REACTION OF THE PATIENT TO ILLNESS AND
HOSPITALIZATION
• Patient who are at a higher risk of reacting to the stress of

illness & hospitalization include those suffering from psychiatric
illness
• Denial
• Anger
• Depression
• Dependence
FAMILIES REACTIONS TO PATIENT
HOSPITALIZATION
• Whether planned or unplanned hospitalization
increase the family stress & anxiety level. Parents &
siblings have their own reactions to this experience.
▪ Reactions of parents
▪ Reactions of siblings
▪ Factors influencing family reactions
STIGMA
➢ Stigma is a broad term which is used to describe the
negative & stereotypical thoughts, attitudes, & feelings about
people on the basis of traits of a person,
➢ Can include gender, skin color, sexual orientation, religion &
mental illness.
➢ It has been used to label certain groups of people as less
worthy of respect.
➢ Erving Goffman defined stigma as the process by which the
reactions of others spoils normal identity
ROLE OF PSYCHOLOGICAL PRINCIPLES AND
FACTORS IN THE MAINTENANCE OF HEALTH &
ILLNESS
• Role of Psychological Factors in the Etiology of Health Problems
– Dysfunctional lifestyles
– Risk-taking behavior
– Misuse and abuse of drugs
• Role of Psychological Factors in the Precipitation (Triggering) of Illness
– Traumatic life events
– Adverse childhood experiences (ACE)
– Persistent high stress situations
CONT….
• Role of Psychological Factors in the Management of Illness
– Positive behavioral change/lifestyle chnges
– Social support
• Role of Psychological and Social Factors in the Diseases causing
Disability, Handicap and Stigma
– Mental illness
– HIV/AIDS
• Role of Psychological Factors in Patients’ Reactions to Illness
– Compliance
– Treatment adherence
• Medically Unexplained Physical Symptoms
TREATMENT ADHERENCE
➢ The extent to which patient behavior coincide with medical advice.
➢ Medical adherence is following the treatment plan your health care
provider prescribed.
➢ Example : taking your medication correctly and following prescribed
activities including reducing stress, eating better and sleeping more etc.
❖Affect quality, length of life, healthcare cost health outcomes.
❖ If you don’t adhere then:
❑Disruption to the medication cause your disease to progress.
❑Your symptoms to get worse.
Medically Unexplained Physical Symptoms

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PSYCHOSOCIAL ASPECTS

• Viewing him/herself as being in state of productivity.

• Despite failures and difficulties and inability to be the world’s

• Focus on positive aspects and achievements in one’s life

• From immediate family to the neighborhood, town, and

• Works towards making this world a better place for their

• Pass their skill, knowledge, and wisdom to others.

• This means that whatever a person’s means of earning may be s/he

• This allows an individual to pursue their goals of self-

• S/he must also be able to form and sustain relationships

• Neither threaten the environment nor feel threatened by it.

• Able to be in harmony with their internal and external

✓Defense mechanisms are rooted in Freud’s theory of personality.

“Defense mechanism are tactics developed by

ego to protect against anxiety”.

• Patient who are at a higher risk of reacting to the stress of

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