Sociological dimensions of illness behavior

The almost exclusive dependence on the diagnostic disease model limits addressing the burden of illness and disability typically seen in primary medical care. With aging of populations and increasing prevalence of chronic disease and disability and behavioral disorders, new approaches to patient assessment and intervention are needed to extend traditional models. Using illness behavior as a point of departure, I examine the disability process and the types of considerations relevant to promoting function and maintianing patients' quality of life. At the individual level, alternatives include modifying impairments, increasing patient motivation and encouraging helpful attitudes, teaching coping strategies, identifying helpful assistive devices, educating family members and employers and providing support. A broader view also makes clear that varying aspects of the disability process are appropriate issues for social policy and environmental remediation. In examining various examples of the disability process, the paper focusses on self-appraisal and illness behavior and the way social movements help to define and redefine conceptions of illness and disability. Recognizing that the kinds of changes discussed will not come easily, the paper concludes with a discussion of trends encouraging broader practice orientations and the types of interventions that can be helpful in encouraging and reinforcing such developments.