1. PSYCHOSOCIAL FACTORS AFFECTING PHYSICAL ILLNESS Dr Tabassum Alvi Assistant Professor Psychiatry/Behavioural Sciences Majmaah University

2. OUTLINE Objectives Brain storming Acceptance of illness-stages Non-acceptance Defense mechanism Factors in acceptance of illness influence of culture on disease and treatment Q & A Conclude

3. OBJECTIVES At the end of session the student should be able to: Explain the concept of “acceptance of illnesses” Explain the “non acceptance of illness” and defense mechanisms. Identify Psychological factors affecting the acceptance of mode of treatment Discuss the influence of other members of the society on disease Discuss the influence of culture on disease and treatment

4. BRAINSTORMING

5. ACCEPTANCE OF ILLNESSES DenialAngerFearGriefAcceptance

6. NON-ACCEPTANCE OF ILLNESS Not uncommon phenomenon Delays help seeking May worsen outcome Increases risk of Depression Indicates hopelessness May need more education/awareness Challenge for health provider

7. DEFENSE MECHANISM “ Manners in which we behave or think in certain ways to better protect or “defend” ourselves. Defense mechanisms are one way of looking at how people distance themselves from a full awareness of unpleasant thoughts, feelings and behaviors” Its and unconscious phenomenon!

8. DEFENSE MECHANISMS DENIAL: Refusal to accept reality. Example? ACTING OUT: extreme behavior in order to express thoughts or feelings the person feels incapable of otherwise expressing. Example? DISSOCIATION: Disconnect from the real world Example?

9. Contd… INTELLECTUALIZATION: using knowledge and jargons to think/show otherwise. Separating an emotion from an idea or thought because the emotional reaction is too painful to be acknowledged. Example? RATIONALIZATION: offering a different explanation for one’s perceptions Example? COMPENSATION: counterbalancing perceived weakness with strength in other areas. Example?

10. Displacement Discharging pent-up feelings on people less dangerous than those who initially aroused the emotion. Example ? Identification Unconscious assumption of similarity between oneself and another. Example ? Projection Unacceptable feelings disguised by repression of the real feeling and by reinforcement of the opposite feeling. Example?

11. FACTORS IN ACCEPTANCE OF ILLNESSES Universal phenomenon Individualized responses Nature of illness Stigma related to illness Past personal experience Family history Coping skills Comorbid psychiatric problem

12. INFLUENCE OF CULTURE ON DISEASE AND TREATMENT “Culture is a pattern of ideas, customs and behaviors shared by a particular people or society”

13. Contd…. Evil spirit VS Germ theory Depression VS Crazy/Mad Strong VS obese Epilepsy/Jadoo Expressing pain means “you are weak” Doctor VS Alternative care providers Doctor: Helper or a Master Antibiotics are “heavy” or acidic in nature Treatment means ‘injection’ and drips

14. Contd…. Please do not tell my mother she may not tolerate this news. Family VS patient OR both Vaccine conspiracy theory: Polio is for infertility! Having TB is shameful HIV means this person was involved in inappropriate activities. “Gas syndrome” British Pakistani women Cold and hot concept of food

15. Q & A

16. CONCLUDE Students to summarize!