When an individual is faced with a health or capacity challenge through an illness, ageing or disability, the experience for that person is individual and should be respected.
What individuals may be experiencing on the outside may be different to their internalised world, and may include interwoven aspects of sensory, emotional, cognitive and behavioural elements.
Lumby (1994) believes that experience is knowing about the world and the individual’s relationship with the world, rather than an emotive concept.
The theories supporting this include Piaget’s schemas, Kelly’s personal construct theory and Vygotsky’s social constructivism theory, which similarly represent an individual‘s perceptions of an experience that are formed and resurface at later stages in life.
Additionally, Freud’s instinct and drives theory and Rossouw’s neuropsychotherapy theory depict experience from increasing pleasure and avoiding pain, however individuals with health challenges are experiencing a conflict with these theories. Moreover, the complex interaction of an individual’s experience of health or capacity challenge can be represented through the biopsychosocial-spiritual model of illness.
How internal experiences of illnesses, disability or ageing may be constructed can be explained by many psychological theories. Each theory suggests that an individual takes the input from the health challenge and internalizes it to become the unique experience of each individual.
Possible Psychological Theories
Possible theories that explain the process of the individual include developmental schemas, personal construct theory, neurobiology, drives and instincts from a Freudian perspective and social constructivism.
Piaget explains his theory on developmental schemas as ideas about the world that are formed from a young age and used to understand and to respond to situations (Piaget, 1954). A health challenge that is experienced at an early age can create a schema through internalising the experience, which is stored so if future health challenges arise, these schemas are re-experienced.
To a young person, a health challenge may look completely different to the same experience at an older age. This may create reactions in the older adult whereby the reaction does not appear to be congruent with the experience.
Likewise, George Kelly’s personal construct theory depicts that individuals form constructs about the how the world works from their experiences (Kelly, 2003). These constructs are then used to predict and anticipate future experiences, which in turn determine an individual’s behaviours, feelings and thoughts. Furthermore, Vygotsky’s social constructivism theory shows that individuals learn in response to interactions with their social environment (Vygotsky, 1978). This suggests that individuals experiencing a health capacity issue may learn about how they relate to world through the experience of illness.
Freud’s theory on instinct and drives depicts that individuals strive for maximising gratification and minimising guilt and punishment (Freud, 1959). He believes life is in conflict between instincts and drives, which makes an individual move toward earlier states of development.
Similarly, Rossouw’s (2014) model of the base elements of the theory of neuropsychotherapy suggest a basic need, after safety is established, of pain avoidance and pleasure. With these two theories in mind, an individual’s experiences with a health capacity may generally be psychically painful, therefore that individual may experience more pain than pleasure, and more guilt and punishment than gratification.
The Biopsychosocial-Spiritual Model
The biopsychosocial-spiritual model of care suggests that an individual’s experience in care is a complex interrelationship between biological, psychological, social and spiritual components and may influence the experience of illness.
Sulmasy (2002) suggests the model is based on the individual’s disruption of homeostasis through changes to interpersonal and extrapersonal relationships. The individual’s relationship with their physical body and its processes, and their relationship between their emotions and physical body, are defined as interpersonal relationships; while extrapersonal relationships include the effects of the environment on the individual (Sulmasy, 2002). Furthermore, each aspect of the model can interact and work together in a way to alter the experience of illness.
The biopsychosocial-spiritual model can explain various factors that may influence the experience of illness. This perspective includes viewing individuals from a holistic stance whereby the biological, psychological, social and spiritual aspects are investigated to gauge the experience of the individual’s perspective of the illness.
Internal factors specific to the individual may include birth order, attachment patterns, limbic system, anxiety, and being in tune with sensory experiences. For example, from a biological perspective, studies show that later birth order results in a more severe form of schizophrenia (Gaughran, Blizard, Mohan, Zammit & Owen, 2007). Similarly, groups of children with chronic conditions like cystic fibrosis and congenital heart disease were less often secure as infants than a control group, and showed more disorganised attachments than their peers (Goldberg, Gotowiec & Simmons, 1995).
From a psychological perspective, the limbic system in the brain in closely linked with the socio-emotional processing and self-regulation. The default brain is the limbic system, which behaves irrationally as it loses the prefrontal cortex, reduces blood flow in the limbic system. Attitude toward illness is one pathway whereby subjective disease severity impacts psychological functioning in adolescents and young adults with allergies (Molson, Suorsa, Hullman, Ryan & Mullins, 2011).
Additionally, internal sensory processes have shown to be related to how individuals experience and interact with the environment. Sensitive responses to environmental stimuli might result in behaviours that decrease social experience, quality of life and recovery. For example, Pfeiffer, Brusilovskiy, Bauer and Salzer (2014) found adults who self reported as having low levels of sensory sensitivity, reported lower social activity levels and slower recovery from serious mental illnesses.
Author: Cassandra Gist, BPsych (Hons), MPsych, MAPS.
Brisbane Psychologist Cassandra Gist has a Masters in Health Psychology, and is able to treat clients aged from two years old right through to adulthood. She is experienced in working with Aboriginal and Torres Strait Islander communities, and children and families affected by Autism Spectrum Disorder.
To make an appointment with Brisbane Psychologist Cassandra Gist, try Online Booking – Loganholme or Online Booking – Mt Gravatt. Alternatively, you can call M1 Psychology (Loganholme) on (07) 3067 9129, or Vision Psychology (Mt Gravatt) on (07) 3088 5422.
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