Responding to Initial Symptoms

Becoming a chronically ill or disabled person begins with recognizing that some- thing about the body is troubling. This recognition can be slow to arrive. Health problems (such as stiffening joints caused by arthritis or gradual vision loss caused by cataracts) often build gradually, allowing individuals almost unconsciously to minimize and adapt to these symptoms. In addition, the signs of illness and disability often don’t differ greatly from normal bodily variations. A child who doesn’t walk by 12 months of age might have a disability or might simply be a slow devel- oper. Similarly, children with epilepsy, for example, can for many years experience “headaches,” “spaciness,” and “dizzy spells” before they or their parents recognize these experiences as signs of epilepsy.

Social scientists refer to this process of defining, interpreting, and otherwise responding to symptoms as illness behavior. A review article by anthropologists Vuckovic and Nichter summarizing 20 years of research studies concluded that U.S. residents treat between 70% and 95% of all illness episodes without a doctor’s assistance; it is likely that this percentage has grown considerably now that many people turn to the Internet for health advice before seeking medical care. Individuals typically begin by med- icating themselves or those under their care with nonprescription medications recommended by friends, families, store clerks, or pharmacists or, more rarely, with prescription medicines left over from previous illnesses.

When and whether individuals seek formal medical diagnoses for acute or chronic medical problems depends on a variety of factors. According to the illness behavior model, individuals are most likely to seek medical care if (1) their symptoms are frequent, persistent, visible, and severe enough to interfere with daily activities; (2) they lack alternative explanations for their symptoms; (3) their families and friends generally trust doctors and support seeking medical care for health problems; and (4) no psychological, economic, or practical barriers keep them from accessing health care. “Key Concepts: Predicting Illness Behavior,” summarizes this model.