Capita selecta summary
Chapter 1: How to notice when someone is ill?
There are two types of symptoms: physical and subjective. Whereas an illness is more subjective and
the sensation of being is sick, a disease is something the doctor diagnoses you with and is more of
organic nature and therefor more objective.
The stages of noticing illness:
1. Perceiving symptoms
There are several models of symptom perception:
- The attentional model of Pennebaker (1982) describes how competition for attention
between multiple internal or external cues or stimuli leads to the same physical sign or
physiological change going unnoticed in some contexts but not in others.
- The cognitive–perceptual model of Cioffi (1991) focuses more on the processes of
interpretation of physical signs and influences upon their attribution as symptoms while also
acknowledging the role of selective attention (Cioffi 1991).
> Overall, research has highlighted an array of biological, psychological and contextual influences
upon symptom perception with bottom–up influences upon perception arising from the physical
properties of a bodily sensation, and top–down influences being seen in the influence of attentional
processes or mood
Stimuli that will be interpreted as symptom usually poses these remarks:
- Painful and disrupt focus/attention
- Novel/unusual (novel symptoms lead to seeking medical attention. People don’t seek
attention when the sensation is familiar)
- Persistent
- Pre-existing IF they are familiar, they will less likely be somatised
Individual differences exist in the amount of attention people give to their symptoms. Increasing
attention makes people more aware of new bodily sensations. In combination with anxiety, this can
lead to stress and overthinking about tiny things. Distinguished between two attentional systems
which are proposed to influence how symptom information is processed. Furthermore, previous
experience with an illness can increase a person’s attentional bias. Attentional process might play a
role in perceived placebo-effects. The anxiety and attention give rise to non-existing perception of
symptoms.
The first, the primary attentional system (PAS), is proposed to operate below the level of
consciousness and acts on stored representations, such as illness schema which it
automatically selects from when a person for whatever reasons, over-attends to somatic
(bodily) experiences. This can thus lead a symptom to be wrongly matched to a pre-existing
schema, such as might happen in cases of ‘mass psychogenic illness’ or ‘medical student’s
disease’.
The secondary attentional system (SAS) on the other hand is considered more amenable to
executive control, i.e. attention here can be manipulated by conscious thoughts and cognitive
processes, such as rational weighing up of likelihood
, However, this process is hampered if the PAS has already dictated where the person’s
attention is focused on, and, if a ‘label’ has already been assigned to the symptoms, it can
be difficult to shift.
Attention Generally refers to the selection of some stimuli over others for internal
processing
Whether people notice their symptoms also depends on context. People tend to stereotype people
who experience certain symptoms, so if they do not meet the stereotyped conditions, they consider
themselves less likely to experience the symptoms, lessening attention. Context also plays a role in
willingness to express symptoms with peers.
The individual differences in symptoms perception:
Gender Females perceiving symptoms easier than men is not true. It’s actually the result
of socialization. Men are thought to be tough and not express their pain.
Socialization The process by which a person learns – from family, teachers, peers –
the rules, norms and moral codes of behavior expected of them.
Life stage Older age is associated to more self-reported symptoms.
Emotions People that are positive tend to see themselves as more healthy and people who
are more negative, will usually consider themselves less healthy. Negative people tend to notice
symptoms more because of anxiety. The upside of this anxiety is that they will seek help when
needed. People who score high on neuroticism tend to more likely to perceive symptoms.
Neuroticism (N) Described as a trait-like tendency to experience negative
emotional states and is related to the broader construct ‘negative affectivity’ (NA). NA can
manifest itself either as a state (situation-specific) or a trait (generalized)
Cognition Coping style. People who are type A personalities or use repression as a coping
style are less likely to experience symptoms due to optimism. These two have also been related to
poor physical health.
Type A behavior (TAB) A constellation of characteristics, mannerisms and behavior
including competitiveness, time urgency, impatience, easily aroused hostility, rapid and
vigorous speech patterns and expressive behavior. Extensively studied in relation to the
aetiology of coronary heart disease, where hostility seems central.
Repression A defensive coping style that serves to protect the person from
negative memories or anxiety-producing thoughts by preventing their gaining access to
consciousness.
Comparative optimism Initially termed ‘unrealistic optimism’, this term describes
an individual’s estimate of their risk of experiencing a negative event compared with
similar others (weinstein and Klein 1996).
A distinct has been made between these coping styles:
Monitors This generalized coping style involves attending to the source of stress or
threat and trying to deal with it directly, e.g. through information-gathering/ attending to
threat-relevant information (as opposed to blunters).
