BEHAVIORAL SCIENCES - Universitatea de Medicină şi Farmacie
BEHAVIORAL SCIENCES - Universitatea de Medicină şi Farmacie
BEHAVIORAL SCIENCES - Universitatea de Medicină şi Farmacie
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STATE UNIVERSITY OF MEDICINE AND PHARMACY<br />
NICOLAE TESTEMITANU OF THE REPUBLIC OF MOLDOVA<br />
Rodica GRAMMA, Adriana PALADI<br />
<strong>BEHAVIORAL</strong> <strong>SCIENCES</strong><br />
Didactic material for medical stu<strong>de</strong>nts<br />
COMPENDIUM<br />
Chisinau, 2011<br />
0
STATE UNIVERSITY OF MEDICINE AND PHARMACY<br />
NICOLAE TESTEMITANU OF THE REPUBLIC OF MOLDOVA<br />
Chair of Philosophy and Bioethics<br />
Rodica GRAMMA, Adriana PALADI<br />
<strong>BEHAVIORAL</strong> <strong>SCIENCES</strong><br />
Didactic material for medical stu<strong>de</strong>nts<br />
COMPENDIUM<br />
Chisinau<br />
Centrul Editorial-Poligrafic Medicina<br />
2011<br />
1
CZU 316.62+ 316.77 (075.8)<br />
G 76<br />
Aprobat <strong>de</strong> Consiliul Metodic Central al USMF Nicolae Testemiţanu,<br />
proces verbal nr. 2 din 18.03. 2010<br />
Recenzenţi: Angela Spinei - doctor în filosofie, conferenţiar universitar (USM)<br />
Tudor Grejdianu – dr. hab. în medicină, profesor universitar (USMF)<br />
Redactor ştiinţific: Teodor N. Ţîr<strong>de</strong>a – dr. hab. în filosofie, profesor universitar<br />
Coordonator: Vitalie Ojovanu, doctor în filosofie, conferenţiar universitar<br />
În elaborare se realizează o incursiune în cele mai importante teme ale<br />
ştiinţelor comportamentale, <strong>de</strong>finindu-se concepte <strong>de</strong> bază, relatându-se variate<br />
abordări, realizări <strong>şi</strong> probleme ale domeniului. Noţiunile cheie ale lucrării sunt:<br />
comportament, comunicare, personalitate, sănătate, eficienţă etc. Compendiumul<br />
este adresat stu<strong>de</strong>nţilor, cadrelor didactice <strong>şi</strong> tuturor celor interesaţi <strong>de</strong><br />
problematica domeniului.<br />
The work inclu<strong>de</strong>s the introduction into the most important themes of<br />
behavioral sciences, via <strong>de</strong>finition of the basic concepts, via exposure of different<br />
approaches, achievements and problems of domain. The key words of the work<br />
are: behavior, communication, personality, health, efficiency etc. The work is<br />
<strong>de</strong>signed for the stu<strong>de</strong>nts, professors and all interested in the subjects of matter.<br />
DESCRIEREA CIP A CAMEREI NAŢIONALE A CĂRŢII<br />
Gramma, Rodica; Paladi, Adriana<br />
Behavioral sciences: Compendium. Didactic material for medical stu<strong>de</strong>nts /<br />
Rodica Gramma, Adriana Paladi; red. Şt.: Teodor N.Ţîr<strong>de</strong>a; State Univ. Medicine and<br />
Pharmacy „Nicolae Testemiţanu” of Rep. of Moldova, Chair of Philosophy and Bioethics.<br />
– Ch.: CEP „Medicina”. 2011 – 158 p.<br />
50 ex.<br />
ISBN 978-9975-913-82-9<br />
[316.62 +316.77]:61(075.8)<br />
G76<br />
ISBN 978-9975-913-82-9 © Catedra Filosofie <strong>şi</strong> Bioetică,<br />
© CEP Medicina<br />
2
Table of content<br />
Preface………………………………………………………………<br />
1. Introduction in Behavioral Sciences<br />
1.1.Behavior as a Concept ……………………………………..<br />
1.2.Factors Influencing Human Behavior ……………………...<br />
1.3. Abnormal Behavior ………………………………………..<br />
2. Behavior and Personality<br />
2.1. Human Personality…………………………………………<br />
2.2. Behavior and Temperament. Temperament Typology…….<br />
2.3. Behavior and Human Somatic …………………………….<br />
2.4. Jung's Theory of Psychological Types …………………….<br />
3. Behavior and Society<br />
3.1 The Society and its Structure ………………………………<br />
3.2. The Concepts of Social Status and Role …………………...<br />
3.3. Health Care as a Social System ……………………………<br />
3.4. The Social Role of Doctors and Patients …………………..<br />
3.5. Deviations from the Role Obligations in the Doctor-Patient<br />
Relationship ……………………………………………….<br />
4. Communication. Definitions and Functions<br />
4.1. What is Communication? ………………………………….<br />
4.2. Communication Process..…………………………………..<br />
4.3. Communication Functions ………… ……………………..<br />
4.4. Communication and Health………………………………...<br />
5. Metacommunication and Cultural Differences<br />
5.1. Metacommunication as Interpretation ……………………..<br />
5.2. Verbal Communication ……………………………………<br />
5.3. Paraverbal Communication ………………………………..<br />
5.4. Body Language …………………………………………….<br />
5.5. Extraverbal Communication ………………………………<br />
5.6. Interaction of Verbal and Nonverbal Communication …….<br />
5.7. Appearance of Medical Stu<strong>de</strong>nts and Doctors. The Dress<br />
Co<strong>de</strong>……………………………………………………………..<br />
6. Barriers and Cleavages in Communication<br />
6.1. Communication Distorting Factors ….…………………….<br />
6.2. Stereotypes, Stigma and Discrimination …………………..<br />
6.3 Active Listening……………………………………………<br />
3<br />
5<br />
6<br />
9<br />
18<br />
27<br />
29<br />
31<br />
38<br />
45<br />
47<br />
50<br />
58<br />
67<br />
73<br />
75<br />
79<br />
81<br />
88<br />
89<br />
93<br />
94<br />
101<br />
105<br />
106<br />
111<br />
117<br />
125
6.4 Barriers and Solutions for an Effective Medical<br />
Communication ...........................................................................<br />
7. Behavior and Cultural Contexts<br />
7.1. The Concept of Culture ……………………………………<br />
7.2. Etiquette and Cultural Differences ………………………...<br />
7.3. Conflict - Definition and Resolution ………………………<br />
7.4. Intercultural Communication……………………………….<br />
8. Health Risk Behaviors and Communication in Risk Conditions.<br />
8.1. Dangerous Factors Determining Appearance of Illness …...<br />
8.2. Risky Health Lifestyles ………………………….………...<br />
8.3. Behavior Change Communication …………………………<br />
4<br />
129<br />
134<br />
135<br />
137<br />
142<br />
146<br />
147<br />
155
Preface<br />
What and how man is there are questions the humanity is interested in<br />
for the ages but only in the mo<strong>de</strong>rn times the more or less rigorous answers<br />
are acquired. The mo<strong>de</strong>rn sciences, shifting the accents and priorities in<br />
studying humans and moving in <strong>de</strong>ep, enrich our knowledge, enabling us for a<br />
better un<strong>de</strong>rstanding of human nature. What is really significant in this context<br />
is that the mo<strong>de</strong>rn argued approach to man, as to the bio-psycho-social<br />
integrity, changes the dominant in present therapeutic attitu<strong>de</strong>s towards person<br />
as to the exclusively biologic entity. The hallmark for replacement of<br />
biological therapeutic paradigm with that psychosomatic one is the inclusion<br />
in medical schools’ curriculum the matter called Behavioral Sciences.<br />
What are Behavioral sciences? It is a very complex domain; it is<br />
actually a generic title of a cluster of discipline such as medical sociology,<br />
medical psychology, communication sciences etc.<br />
The textbook contains essential general issues in Behavioral sciences<br />
and is <strong>de</strong>signed to make an introduction in this field. Being conceived to cover<br />
the most general and important subjects of the domain, it consists of eight<br />
themes the content of which reveal the significance of such topics as: Normal<br />
and Abnormal Behavior, Health risks behavior, Social roles of doctors and<br />
patients, Physician – patient relationship, Human psychological types,<br />
Communication and its significance in therapeutic context etc. At the end of<br />
every theme the final questions and tasks are proposed so that to facilitate the<br />
learning and at the same time to impulse for a critical thought. References to<br />
the theme give the opportunity to study <strong>de</strong>eply the subject of interest.<br />
The book is inten<strong>de</strong>d to familiarize the stu<strong>de</strong>nts with basic<br />
achievements of behavioral sciences and to make them able to apply acquired<br />
knowledge in their medical activity as well as in their daily life. At the end of<br />
studying stu<strong>de</strong>nts are expected to know the human psychological types and<br />
human behavior types, to un<strong>de</strong>rstand their professional role (as doctors) as<br />
well as the social role of their patients, to have the competences in constricting<br />
an a<strong>de</strong>quate communication and relationship in therapeutic context etc.<br />
Knowledge acquainted with as a result of this textbook’s reading will aid the<br />
stu<strong>de</strong>nts to be more self-confi<strong>de</strong>nt and accordingly more efficient in their<br />
future professional activity.<br />
5
1.1. Behavior as a Concept<br />
Introduction in Behavioral Sciences<br />
6<br />
Chapter 1<br />
Human behavior flows from three main sources:<br />
<strong>de</strong>sire, emotion, and knowledge<br />
Plato<br />
The concept of behavior became an important construct in early<br />
20th century psychology. It was consi<strong>de</strong>red to be the phenomenon<br />
passable for scientific analyses, and consequently the phenomenon<br />
studying of which can lead us to the better un<strong>de</strong>rstanding of human and<br />
<strong>de</strong>velopment. How can be <strong>de</strong>fined this concept?<br />
Behavior or behaviour is term refers to the actions of a system or<br />
organism, usually in relation to its environment, which inclu<strong>de</strong>s the other<br />
systems or organisms around as well as the physical environment. It is the<br />
response of the system or organism to various stimuli or inputs, whether<br />
internal or external, conscious or subconscious, overt or covert, and<br />
voluntary or involuntary. More generally, behavior can be regar<strong>de</strong>d as any<br />
action of an organism that changes its relationship to its environment.<br />
Behavior provi<strong>de</strong>s outputs from the organism to the environment. It is<br />
most commonly believed that complexity in the behavior of an organism is<br />
correlated to the complexity of its nervous system. Generally, organisms<br />
with more complex nervous systems have a greater capacity to learn new<br />
responses and thus adjust their behavior. In the light of this supposition<br />
human behavior is the most evolved or complex type. In Science and<br />
Human behavior B.F. Skinner mentioned that human behavior is a<br />
difficult subject matter, not because it is inaccessible, but because it is<br />
extremely complex. Since it is a process, rather than a thing, it cannot<br />
easily be held still for observation. It is changing, fluid, and evanescent,<br />
and for this reason it makes great technical <strong>de</strong>mands upon the ingenuity<br />
and energy of the scientist. But there is nothing essentially insoluble about<br />
the problems which arise from this fact. Nowadays behavior and
especially that human is studied by the many aca<strong>de</strong>mic disciplines,<br />
conventionally inclu<strong>de</strong>d in the domain called – domain of behavioral<br />
sciences<br />
Thus the term behavioral sciences (or behavioral sciences)<br />
encompass all the disciplines that explore the activities of and interactions<br />
among organisms in the natural world. It involves the systematic analysis<br />
and investigation of human behavior through controlled and naturalistic<br />
experimental observations and rigorous formulations. Behavioral sciences<br />
inclu<strong>de</strong> two broad categories: neural - <strong>de</strong>cision sciences - and social -<br />
communication sciences.<br />
Decision sciences involves those disciplines primarily <strong>de</strong>aling<br />
with the <strong>de</strong>cision processes and individual functioning used in the survival<br />
of organism in a social environment. These inclu<strong>de</strong> anthropology,<br />
psychology, cognitive science, organization theory, psychobiology, and<br />
social neuroscience.<br />
On the other hand, communication sciences inclu<strong>de</strong> those fields<br />
which study the communication strategies used by organisms and its<br />
dynamics between organisms in an environment. These inclu<strong>de</strong> fields like<br />
anthropology, organizational behavior, organization studies, sociology and<br />
social networks.<br />
The material to be analyzed in a science of behavior comes from<br />
two basic sources: observation and experiment. Observation is an act of<br />
recognizing and noting a fact or occurrence often involving measurement<br />
with instruments. Experiment can be <strong>de</strong>fine as an act or operation for the<br />
purpose of discovering something unknown or of testing a principle,<br />
supposition, etc. It is a test, trial, or tentative procedure etc. Therea many<br />
kinds of observation and experiment. B.F. Skinner classified and <strong>de</strong>scribed<br />
them in this way:<br />
(1) Casual observations. They are especially important in the early<br />
stages of investigation. Generalizations based upon them, even without<br />
explicit analysis, supply useful hunches for further study.<br />
(2) In controlled field observation, the data are sampled more<br />
carefully and conclusions stated more explicitly than in casual observation.<br />
Standard instruments and practices increase the accuracy and uniformity of<br />
field observation.<br />
(3) Clinical observation has supplied extensive material. Standard<br />
practices in interviewing and testing bring out behavior which may be<br />
easily measured, summarized, and compared with the behavior of others.<br />
7
Although it usually emphasizes the disor<strong>de</strong>rs which bring people to<br />
clinics, the clinical sample is often unusually interesting and of special<br />
value when the exceptional condition points up an important feature of<br />
behavior.<br />
(4) Extensive observations of behavior have been ma<strong>de</strong> un<strong>de</strong>r<br />
more rigidly controlled conditions in industrial,military, and other<br />
institutional research. This work often differs from field or clinical<br />
observation in its greater use of the experimental method.<br />
(5) Laboratory studies of human behavior provi<strong>de</strong> especially<br />
useful material. The experimental method inclu<strong>de</strong>s the use of instruments<br />
which improve our contact with behavior and with the variables of which<br />
it is a function. Recording <strong>de</strong>vices enable us to observe behavior over long<br />
periods of time, and accurate recording and measurement make effective<br />
quantitative analysis possible. The most important feature of the laboratory<br />
method is the <strong>de</strong>liberate manipulation of variables: the importance of a<br />
given condition is <strong>de</strong>termined by changing it in a controlled fashion and<br />
observing the result.<br />
Current experimental research on human behavior is sometimes<br />
not so comprehensive as one might wish. Not all behavioral processes are<br />
easy to set up in the laboratory, and precision of measurement is<br />
sometimes obtained only at the price of unreality in conditions. Those who<br />
are primarily concerned with the everyday life of the individual are often<br />
impatient with these artificialities, but insofar as relevant relationships can<br />
be brought un<strong>de</strong>r experimental control, the laboratory offers the best<br />
chance of obtaining the quantitative results nee<strong>de</strong>d in a scientific analysis.<br />
(6) The extensive results of laboratory studies of the behavior of<br />
animals below the human level are also available. The use of this material<br />
often meets with the objection that there is an essential gap between man<br />
and the other animals, and that the results of one cannot be extrapolated to<br />
the other. To insist upon this discontinuity at the beginning of a scientific<br />
investigation is to beg the question. Human behavior is distinguished by its<br />
complexity, its variety, and its greater accomplishments, but the basic<br />
processes are not therefore necessarily different. Science advances from<br />
the simple to the complex; it is constantly concerned with whether the<br />
processes and laws discovered at one stage are a<strong>de</strong>quate for the next. It<br />
would be rash to assert at this point that there is no essential difference<br />
between human behavior and the behavior of lower species; but until an<br />
8
attempt has been ma<strong>de</strong> to <strong>de</strong>al with both in the same terms, it would be<br />
equally rash to assert that there is.<br />
A discussion of human embryology makes consi<strong>de</strong>rable use of<br />
research on the embryos of chicks, pigs, and other animals. Treatises on<br />
digestion, respiration, circulation, endocrine secretion, and other<br />
physiological processes <strong>de</strong>al with rats, hamsters, rabbits, and so on, even<br />
though the interest is primarily in human beings. The study of behavior<br />
has much to gain from the same practice.<br />
1.2. Factors Influencing Human Behavior<br />
Human behavior as the population of behaviors exhibited by<br />
humans is <strong>de</strong>termined by many factors. It is influenced by biology,<br />
through genes, neurotransmitters and other biological mechanisms; by<br />
environment, through social factors; and psychology, through the structure<br />
of the human brain and its many, varied functions. No one mentioned area<br />
can entirely <strong>de</strong>termine human behavior. It is influenced through all of<br />
them. That mean it is influenced through the interaction of biological,<br />
sociological and psychological factors. In what is follow we will focus on<br />
these three factors and on the way these work together.<br />
Biological basis of behavior<br />
The nervous system<br />
Behavior, which can vary from driving a car to making a difficult<br />
mathematical exercise, <strong>de</strong>pends on various processes in the human body.<br />
The relation between these processes is regulated by the nervous system.<br />
Here is an example of what your body has to do in or<strong>de</strong>r to make you stop<br />
for a red traffic light. First you have to perceive the light, which means<br />
that the light has to be caught by the eye. The eye sends signals to the<br />
brain. The brain compares the signals with those received from the other<br />
eye and stores the signals temporarily in your memory. (You know you<br />
have to stop for the red light.) After that you have to push the brake pedal.<br />
To make this happen, your brains have to send a signal to the leg muscles<br />
to push the feet on the brake pedal. All these signals from and to your<br />
brains are transported through nerve cells.<br />
The nervous system is the most complex system of the human<br />
body. The human brain itself consists of at least 10 billion neurons. Every<br />
moment of the day your nervous system is active. It exchanges millions of<br />
signals corresponding with feeling, thoughts and actions. A simple<br />
9
example of how important the nervous system is in your behavior is<br />
meeting a friend.<br />
First, the visual information of your eyes is sent to your brain by<br />
nervous cells. There the information is interpreted and translated into a<br />
signal to take action. Finally the brain sends a command to your voice or<br />
to another action system like muscles or glands. For example, you may<br />
start walking towards him. Your nervous system enables this rapid<br />
recognition and action.<br />
There are three general functions of the nervous system in man<br />
and animals:<br />
1. Sensing specific information about external and internal<br />
conditions (in the example above, this is seeing your friend).<br />
2. Integrating that information (this is the un<strong>de</strong>rstanding of the<br />
information coming from the eyes).<br />
3. Issuing commands for a response from the muscles or glands<br />
(this is the reaction of walking towards him).<br />
The nervous system provi<strong>de</strong>s us the ability to perceive, un<strong>de</strong>rstand<br />
and react to environmental events. That is why the nervous system is so<br />
extremely important for human behavior.<br />
Genetic influences, the role of genes on behavior<br />
How much of the behavior is accounted for by genetic factors or<br />
heritability? This question is adresed by behavioral genetics - a field of<br />
research in psychology which began in England with Sir Francis Galton<br />
and his study of the inheritance of genius in families. He discovered that<br />
genius 'runs in families' and conclu<strong>de</strong>d that it is to a significant <strong>de</strong>gree a<br />
heritable behavioral trait. Since Galton a lot of people tried to prove that<br />
genetics play an important role in many aspects of behavior. Those people<br />
proved that complex behaviors related to personality, psychopathology and<br />
cognition are all influenced to some <strong>de</strong>gree by genetics. They have also<br />
found that genetics alone is never enough to explain behavior, because<br />
behavior is also influenced by the enviroment.<br />
Today, most psychologists believe that behavior reflects both<br />
genetic and environmental aspects. They try to explain variability in a trait<br />
like intelligence or height or musicality in terms of the genetic and<br />
enviromental differences among people within that population.<br />
Effect of the production of hormones on behavior<br />
The word hormone is <strong>de</strong>rived from the Greek word hormao and<br />
means to excite or stir into action. Hormones are chemicals secreted into<br />
10
the bloodstream by specialized organs and carried to other parts of the<br />
body to perform their task. Organs that secrete and manufacture hormones<br />
are known as endocrine glands. Exocrine glands such as tear glands<br />
secrete their products outsi<strong>de</strong> the body. Whereas exocrine glands are also<br />
called ductal glands, endocrine glands are ductless. Endocrine glands come<br />
in a variety of sizes and are located through the whole body.<br />
Hormones are found throughout the animal kingdom and even in<br />
plants, but only the vertebrates have specialized organs to produce and to<br />
store hormones. In many cases the structure of a hormone is the same over<br />
a wi<strong>de</strong> variety of animals, although its function can be different.<br />
Some human hormones are not secreted by endocrine glands but come<br />
from sources as neurons in the hypothalamus, or cells in the digestive<br />
tract. Recently the heart has been found to produce a hormone that helps<br />
regulate the blood pressure.<br />
Until the beginning of the 20th century the communication within<br />
the body was exclusively attributed to the nervous system. However,<br />
investigators discovered that the endocrine system is also important for<br />
this function. Yet, the role of endocrine glands was anticipated in several<br />
ancient civilizations in which they were eaten to modify health or<br />
behavior. In the fourth century B.C. Aristotle <strong>de</strong>scribed the effects of<br />
behavior in birds when removing the testes (castration). Although he did<br />
not what mechanism was involved, it was clear to him that the testes were<br />
important for the male characteristics. Nowadays we know that the testes<br />
produce a certain hormone (testosterone) that causes a lower voice and<br />
stronger muscles in male human beings.<br />
Psychological factors<br />
There are three psychological basic sub-systems which act on<br />
human behavior: motivation, cognition and emotion.<br />
Motivation<br />
Motivation is the driving force of human behavior. It is a force by<br />
which humans achieve their goals. One of the most wi<strong>de</strong>ly discussed<br />
theories of motivation is Abraham Maslow's theory. Accordingly to him<br />
driving forces for human action are human heeds, structured by him<br />
hierarchically from basic to most complexes as follows: Physiology<br />
(hunger, thirst, sleep, etc.), Safety / Security / Shelter / Health,<br />
Belongingness / Love/ Friendship, Self-esteem / Recognition /<br />
Achievement, Self-actualization. Having a need (<strong>de</strong>sire) human start to act<br />
11
in or<strong>de</strong>r to satisfy it. The further the progress up the hierarchy, the more<br />
individuality, humanness and psychological health a person will show.<br />
Generally speaking motivation is classified in two types: intrinsic<br />
or extrinsic. Intrinsic motivation is called also internal. They say that the<br />
person is intrinsically motivated if his action (behavior) is driven by an<br />
interest or enjoyment in the task itself, rather than relying on any external<br />
pressure. For instance stu<strong>de</strong>nts are likely to be intrinsically motivated if<br />
they attribute their educational results to internal factors that they can<br />
control (e.g. the amount of effort they put in); believe they can be effective<br />
agents in reaching <strong>de</strong>sired goals (i.e. the results are not <strong>de</strong>termined by<br />
luck).Extrinsic motivation is called also external. It comes from outsi<strong>de</strong> of<br />
the individual. Common extrinsic motivations are rewards like money and<br />
gra<strong>de</strong>s, coercion and threat of punishment. Competition is in general<br />
extrinsic because it encourages the performer to win and beat others, not to<br />
enjoy the intrinsic rewards of the activity.<br />
Motivation is many times associated with volition. Nevertheless<br />
there is difference among them. Motivation usually is seen as a process<br />
that leads to the forming of behavioral intentions. Volition is seen as a<br />
process that leads from intention to actual behavior. In other words,<br />
motivation and volition refer to goal setting and goal pursuit, respectively.<br />
Both processes require self-regulatory efforts.<br />
Cognition<br />
Cognition is a complex mental phenomenon that refers to<br />
knowledge, to the way people acquired and use their knowledge.<br />
Cognition inclu<strong>de</strong>s processes like perception, attention, remembering,<br />
producing and un<strong>de</strong>rstanding language, solving problems, and making<br />
<strong>de</strong>cisions.<br />
Perception<br />
Perception is the process of attaining un<strong>de</strong>rstanding of the<br />
environment by organizing and interpreting information got from the<br />
traditionally recognized five senses of sight (ophthalmoception), hearing<br />
(audioception), taste (gustaoception), smell (olfacoception or<br />
olfacception), and touch (tactioception), and other nontraditional senses<br />
like temperature (thermoception), kinesthetic sense (proprioception), pain<br />
(nociception), balance (equilibrioception) and acceleration<br />
(kinesthesioception). Perception <strong>de</strong>pends on complex functions of the<br />
nervous system, but subjectively seems mostly effortless because this<br />
processing happens outsi<strong>de</strong> conscious awareness.<br />
12
Memory and attention<br />
Memory is an organism's ability to store, retain, and recall<br />
information and experiences. The environment stimulates one or more<br />
sensory systems. This environmental information then passes three levels<br />
of memory called sensory memory, short-term memory and long-term<br />
memory. At each level, cognitive processes operate on the information,<br />
giving it meaning, refreshing it and integrating it. In the sensory memory,<br />
the information is enco<strong>de</strong>d to go to the short term memory. There the<br />
information is enco<strong>de</strong>d to go to the long term memory. The ability to look<br />
at an item, and remember what it looked like with just a second of<br />
observation, or memorization, is an example of sensory memory. Shortterm<br />
memory allows recall for a period of several seconds to a minute<br />
without rehearsal. Long-term memory can store much larger quantities of<br />
information for potentially unlimited duration (sometimes a whole life<br />
span). For example, given a random seven-digit number we may<br />
remember it for only a few seconds before forgetting, suggesting it was<br />
stored in our short-term memory. On the other hand, we can remember<br />
telephone numbers for many years through repetition; this information is<br />
said to be stored in long-term memory. While short-term memory enco<strong>de</strong>s<br />
information acoustically, long-term memory enco<strong>de</strong>s it semantically.<br />
The amount of information that can be processed is limited. The<br />
main bottle-neck is attention. If you are distracted by a TV program, while<br />
you are trying to study, your attention will be divi<strong>de</strong>d over both the book<br />
and the TV. When you would study without having the TV on, you would<br />
have more attention to 'spend' on your study. Cognitive processes<br />
<strong>de</strong>termine which of the available information will be used and which will<br />
be ignored.<br />
Imagination and thought<br />
Imagination is the ability of forming mental images, sensations<br />
and concepts, in a moment when they are not perceived through sight,<br />
hearing or other senses. Imagination is a fundamental facility through<br />
which people make sense of the world, create the meanings. Make the<br />
distinction between two forms of imagination: "reproductive» or<br />
"constructive" imagination. Imagination can be confused with the process<br />
of thinking, but this are two different processes, even thou inter<strong>de</strong>pen<strong>de</strong>nt.<br />
"Thought" generally refers to any mental or intellectual activity which<br />
relates with processing of information, with the producing and<br />
13
arrangements of i<strong>de</strong>as accordingly with one’s needs, attachments,<br />
objectives, plans, commitments, ends and <strong>de</strong>sires.<br />
Using language<br />
Human language can be <strong>de</strong>fined in various ways. One <strong>de</strong>finition<br />
sees language primarily as the mental faculty that allows humans to<br />
un<strong>de</strong>rtake linguistic behaviour: to learn languages and produce and<br />
un<strong>de</strong>rstand utterances. Another <strong>de</strong>finition sees language as a formal<br />
system of signs governed by grammatical rules of combination to<br />
communicate meaning. This <strong>de</strong>finition stresses the fact that human<br />
languages can be <strong>de</strong>scribed as closed structural systems consisting of rules<br />
that relate particular signs to particular meanings. Yet another <strong>de</strong>finition<br />
sees language as a system of communication that enables humans to<br />
cooperate. This <strong>de</strong>finition stresses the social functions of language and the<br />
fact that humans use it to express themselves and to manipulate objects in<br />
their environment. The different <strong>de</strong>finitions stress different aspects of<br />
lanquage, simultaniously showing the great significans of language for<br />
thinking, learning and social existance of humans. By the mean of<br />
leanguage we produse and expres our i<strong>de</strong>as, we learn from the experience<br />
of others, we comunicate with others for the better social existnce.<br />
Intelligence<br />
David Wechsler <strong>de</strong>fines intelligence as “the aggregate or global<br />
capacity of the individual to act purposefully, to think rationally, and to<br />
<strong>de</strong>al effectively with his environment”. Howard Gardner say that a human<br />
intellectual competence must entail a set of skills of problem solving —<br />
enabling the individual to resolve genuine problems or difficulties that he<br />
or she encounters and, when appropriate, to create an effective product —<br />
and must also entail the potential for finding or creating problems — and<br />
thereby laying the groundwork for the acquisition of new knowledge.<br />
Sternberg & Salter consi<strong>de</strong>r intelligence as a goal-directed adaptive<br />
behavior. Thus, numerous <strong>de</strong>finitions of intelligence have been proposed<br />
till now, but many of them contain such term as “ability of problem<br />
solving”.<br />
To indicate the intelligence of humans several tests have been<br />
<strong>de</strong>veloped. We will explain some of them. The first intelligence test was<br />
<strong>de</strong>veloped by Sir Francis Galton, a cousin of the famous Charles Darwin.<br />
Galton was interested in the differences in intelligence between human<br />
beings, and he believed that certain families were more intelligent than<br />
14
others. Galton administered a battery of tests measuring qualities such as<br />
reaction time, breathing capacity and head size.<br />
The intelligence test as we know it was formulated by the French<br />
psychologist Binet. He assumed that intelligence should be measured by<br />
tasks requiring reasoning and problem solving abilities. Binet thought that<br />
a slow learning child was like a normal child but retar<strong>de</strong>d in metal growth.<br />
So he conclu<strong>de</strong>d that a slow learning child would perform the same as a<br />
younger child in intelligence tests. He <strong>de</strong>vised a scale of mental age.<br />
Average mental age (MA) scores correspond to chronological mental age<br />
(CA). A bright child's MA is above his CA, and a slow learning child's<br />
MA is below his CA. An advantage of the mental aged scale is that it can<br />
easily be interpreted.<br />
The American psychologist Lewis Terman used Binet's method to<br />
<strong>de</strong>velop a scale for intelligence. This in<strong>de</strong>x is called Intelligence Quotient<br />
(IQ), and this scale expresses intelligence as a ratio of mental age (MA) to<br />
chronological age (CA):<br />
IQ = MA/CA × 100<br />
The 100 is used to make the result better to compare. Numbers like<br />
101, 125 and 89 are easier to handle than 1.01, 1.25 and .89. It is easy to<br />
conclu<strong>de</strong> that when a child is smarter than the average (his MA is higher<br />
than his CA), his IQ will be above 100, and otherwise.<br />
Failure on one kind of item is scored the same way as a failure on another<br />
item. So this test does not show any particular strengths or weaknesses.<br />
To distinguish between various aspects of intelligence, the<br />
Wechsler Intelligence scale is <strong>de</strong>veloped. This test is almost i<strong>de</strong>ntical to<br />
Binet's test, but it is divi<strong>de</strong>d in two parts, a verbal scale and a performance<br />
scale. Another failure of the tests is that performance increases with<br />
practice. There are books containing intelligence tests, and when you<br />
practice them a couple of time, you know how to handle every problem so<br />
you will score pretty high on an IQ-test.<br />
Emotions<br />
The word emotion inclu<strong>de</strong>s a wi<strong>de</strong> range of observable behaviors,<br />
expressed feelings, and changes in the body state. This diversity in<br />
inten<strong>de</strong>d meanings of the word emotion makes it hard to study. For many<br />
of us emotions are very personal states, difficult to <strong>de</strong>fine or to i<strong>de</strong>ntify<br />
except in the most obvious instances. Moreover, many aspects of emotion<br />
seem unconscious to us. Even simple emotional states appear to be much<br />
more complicated than states as hunger and thirst.<br />
15
To clarify the concept of emotions, three <strong>de</strong>finitions of various<br />
aspects of emotions can be distinguished:<br />
1. Emotion is a feeling that is private and subjective. Humans can<br />
report an extraordinary range of states, which they can feel or experience.<br />
Some reports are accompanied by obvious signs of enjoyment or distress,<br />
but often these reports have no overt indicators. In many cases, the<br />
emotions we note in ourselves seem to be blends of different states.<br />
2. Emotion is a state of psychological arousal an expression or<br />
display of distinctive somatic and autonomic responses. This emphasis<br />
suggests that emotional states can be <strong>de</strong>fined by particular constellations<br />
of bodily responses. Specifically, these responses involve autonomously<br />
innervated visceral organs, like the heart or stomach.<br />
3. Emotions are actions commonly "<strong>de</strong>emed", such as <strong>de</strong>fending<br />
or attacking in response to a threat. This aspect of emotion is especially<br />
relevant to Darwin's point of view of the functional roles of emotion. He<br />
said that emotions had an important survival role because they generated<br />
actions to dangerous situations.<br />
Some psychologists have tried to subdivi<strong>de</strong> emotions in categories.<br />
For example Wilhelm Wundt, the great nineteenth century psychologist,<br />
offered the view that emotions consist of three basic dimensions, each one<br />
of a pair of opposite states: pleasantness/unpleasantness, tension/release<br />
and excitement/relaxation. However, this list has become more complex<br />
over time. Plutchik suggests that there are eight basic emotions grouped in<br />
four pairs of opposites:<br />
1. joy/sadness<br />
2. acceptance/disgust<br />
3. anger/fear<br />
4. surprise/anticipation<br />
In Plutchik's view, all emotions are a combination of these basic<br />
emotions, primary emotions could blend to form the full spectrum of<br />
human emotional experience.<br />
Emotions differ not only accordingly to criteria of primary/secondary.<br />
They can be distinguished after their occurrence in time. Some emotions occur<br />
over a period of seconds (for example, surprise), whereas others can last years<br />
(for example, love). The latter could be regar<strong>de</strong>d also as a long term ten<strong>de</strong>ncy<br />
not as a proper emotion. A distinction is then ma<strong>de</strong> between emotion episo<strong>de</strong>s<br />
and emotional dispositions. Dispositions are also comparable to character<br />
traits, where someone may be said to be generally disposed to experience<br />
16
certain emotions, though about different objects. For example an irritable<br />
person is generally disposed to feel irritation more easily or quickly than<br />
others do.<br />
Social influences<br />
Humans are social creatures. There is a fundamental human need<br />
to belong to social groups, because survival and prosperity is more likely if<br />
we live and work together. However, to live together, we need to agree on<br />
common beliefs, values, attitu<strong>de</strong>s and behaviors that reduce in-group<br />
threats act for the common good. These biliefs, valuies and principles are<br />
expresed in social tradition, laws, ethical co<strong>de</strong>s and <strong>de</strong>livered among<br />
humans by the mean of diferent social sistem: educational system, juridical<br />
sistem, massmedia system etc. Society influence the behavior of its<br />
members in many ways. It pass laws through its governmental institutions,<br />
creating severe punishments for particular antisocial behaviors. It <strong>de</strong>velop<br />
a strong <strong>de</strong>sire for ethics and morals, through its religious institutions as<br />
well as secular education (begining with it elimentary or family level end<br />
ending with highest institutional level ) and tradition (seen as an ansambe<br />
of rituals that pressure people to behave in a predictable fashion and that<br />
why seen as source of social stability).<br />
As we grow and <strong>de</strong>velop in society, we internalize the values of<br />
the society around us by making these our own. The process through<br />
which society influences individuals to internalize values (attitu<strong>de</strong>s and<br />
expectations) is called socialization. Individuals do not automatically<br />
absorb, but gradually accept cultural attitu<strong>de</strong>s and roles. The individual is<br />
often unaware of his acceptance of these socially <strong>de</strong>rived roles, roles are<br />
often accepted unconsciously. This is usually accomplished through the<br />
imitation of role mo<strong>de</strong>ls. We learn to conform to rules of other people.<br />
And the more we see others behaving in a certain way or making particular<br />
<strong>de</strong>cisions, the more we feel obliged to follow suit.<br />
When a person in a society or group does not conform to the rules<br />
of society or group, then they may be consi<strong>de</strong>red a <strong>de</strong>viant and both<br />
private and public advice may be given to them on how to fit in. If they<br />
still do not obey norms, they will be marginalized (punished) by society or<br />
will be ejected and membership of the group revoked.<br />
A form of <strong>de</strong>viant behavior is criminal behavior. Generally social<br />
influence is <strong>de</strong>fined as change in an individual’s thoughts, feelings,<br />
attitu<strong>de</strong>s, or behaviors that results from interaction with another individual<br />
or a group. Particularly when we discuss about concrete type of behavior<br />
17
we have to mention the concert factor which <strong>de</strong>termined it. Thus when in<br />
concern is criminal behavior for instance in children and young people<br />
same risk factors are to be mentioned:<br />
Family<br />
• Poor parental supervision and discipline;<br />
• Family conflict;<br />
• Family history of problem behaviour;<br />
• Parental involvement / attitu<strong>de</strong>s condoning problem behaviour;<br />
• Low income and poor housing.<br />
School<br />
• Low achievement, beginning at primary school;<br />
• Aggressive behaviour, including bullying;<br />
• Lack of commitment, including truancy;<br />
• School disorganisation.<br />
Community<br />
• Community disorganisation and neglect;<br />
• Availability of drugs;<br />
• Disadvantaged neighbourhood;<br />
• High turnover and lack of neighbourhood attachment.<br />
Individuals, friends and peers<br />
• Alienation and lack of social commitment;<br />
• Attitu<strong>de</strong>s that condone problem behaviour;<br />
• Early involvement in problem behaviour;<br />
• Friends involved in problem behaviour.<br />
Protective factors are linked to positive outcomes even when<br />
children are growing up in adverse circumstances and heavily exposed to<br />
risk. These are:<br />
• Strong bonds with family, friends and teachers;<br />
• Healthy standards set by parents, teachers and community lea<strong>de</strong>rs;<br />
• Opportunities for involvement in families, schools and the<br />
community;<br />
• Social and learning skills to enable participation;<br />
• Recognition and praise for positive behaviour.<br />
1.3. Abnormal Behavior<br />
The behavior of people (and other organisms or even mechanisms)<br />
falls within a range with some behavior being common, some unusual,<br />
18
some acceptable, and some outsi<strong>de</strong> acceptable limits. Even there is a large<br />
diversity of human behavior people tend to divi<strong>de</strong> it in two broad<br />
categories: normal and abnormal one. When starting a discussion of<br />
abnormal behavior, people sometimes ask, "How can anybody tell what is<br />
abnormal, anyway?" The <strong>de</strong>finition of the word abnormal is simple<br />
enough: <strong>de</strong>viating from the norm. However, applying this to psychology<br />
poses a complex problem: What is normal? Whose norm? For what age?<br />
For what culture? Some would simply classify what is "good" as normal<br />
and what is "bad" as abnormal, but this is a vague and narrow <strong>de</strong>finition<br />
and brings up many of the same questions for the <strong>de</strong>finition of "good" as<br />
does the <strong>de</strong>finition for "normal". There are many more ways of<br />
<strong>de</strong>termining a more objective reference point. The following criteria are<br />
used to <strong>de</strong>termine whether a person behavior is abnormal or not:<br />
1. Statistical abnormality (<strong>de</strong>viation from statistical norms). A<br />
behavior may be judged abnormal if it is statistically unusual in a<br />
particular population. The word abnormal means 'away from the norm'.<br />
Many population facts are measured such as height, weight and<br />
intelligence. Most of the people fall within the middle range of<br />
intelligence, but a few are abnormally stupid. But according to this<br />
<strong>de</strong>finition, a person who is extremely intelligent would be classified as<br />
abnormal too.<br />
2. Violation of socially-accepted standards (<strong>de</strong>viation from social<br />
norms). An abnormal behavior might be <strong>de</strong>fined as one that goes against<br />
common or majority or presumed standards of behavior. By this <strong>de</strong>finition,<br />
a person is abnormal if violating the expectations and values of a<br />
community. For example, one might be judged abnormal in one's failure to<br />
behave as recommen<strong>de</strong>d by one's family, church, employer, community,<br />
culture, or subculture. The main problem with the "violation of standards"<br />
<strong>de</strong>finition of abnormality is that it is based upon cultural standards that<br />
change from place to place and time to time. What is abnormal in one<br />
culture may be regar<strong>de</strong>d as acceptable in a different culture. What is<br />
regar<strong>de</strong>d as abnormal at one time may be regar<strong>de</strong>d as normal several<br />
<strong>de</strong>ca<strong>de</strong>s later. For example, watching TV may be consi<strong>de</strong>red abnormal in<br />
the Amish culture, where mo<strong>de</strong>rn conveniences are avoi<strong>de</strong>d. Violation of<br />
standards does not necessarily correlate with statistical rarity. Physical<br />
abuse of a spouse is consi<strong>de</strong>red abnormal in the United States, although it<br />
occurs in up to a fifth of marriages.<br />
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3. Maladaptiveness of behavior. This criteria approach<br />
abnormality by starting with a theory of personality <strong>de</strong>velopment. If<br />
normal <strong>de</strong>velopment can be <strong>de</strong>fined, then abnormality is <strong>de</strong>fined by the<br />
failure to <strong>de</strong>velop in this way. For example, if adults normally arrive at a<br />
moral stage that prohibits killing other people, and someone does not<br />
arrive at this stage, that person might be called abnormal. This third<br />
criterium is how the behavior affects the well-being of the individual<br />
and/or social group.<br />
4. Subjective abnormality. The fourth criterium consi<strong>de</strong>rs<br />
abnormality in terms of the individual's subjective feelings, personal<br />
distress, rather than his behavior. Judging abnormality by subjective<br />
discomfort raises a different set of problems. In the type of abnormality<br />
called neurosis, personal distress may be the only symptom, because the<br />
individual's behavior seems normal. Psychotic people, the most seriously<br />
disor<strong>de</strong>red of all mental patients, often feel perfectly normal and suffer<br />
little distress, <strong>de</strong>spite having markedly "crazy" and unrealistic thought<br />
processes that could lead to behavior harmful to themselves or others.<br />
5. Legal approuch. The legal <strong>de</strong>finition of abnormality <strong>de</strong>clares a<br />
person insane when he is not able to judge between right and wrong.<br />
6. Biological injury. Abnormal behavior can be <strong>de</strong>fined or<br />
equated with abnormal biological processes such as disease or injury.<br />
Examples of such abnormalities are brain tumors, strokes, heart disease,<br />
diabetes, epilepsy, and genetic disor<strong>de</strong>rs.<br />
Many of the classic psychiatric syndromes we will discuss in this<br />
chapter are now recognized as brain diseases involving abnormal levels of<br />
neurotransmitters, the chemicals that neurons use to communicate. On the<br />
other hand, people tend to refer to any behavior they do not like as a<br />
disease or a disor<strong>de</strong>r. The i<strong>de</strong>a that alcoholism is a disease, for example, is<br />
quite controversial, although it is a wi<strong>de</strong>ly accepted i<strong>de</strong>a.<br />
Biological approaches to <strong>de</strong>fining abnormal behavior of many<br />
types seem to be gaining ground, because there are so many advancing<br />
technologies for <strong>de</strong>fining biological problems. Brain scans, analysis of<br />
neurotransmitters, and genetic analysis all provi<strong>de</strong> objective ways of<br />
i<strong>de</strong>ntifying biological disturbances. The vast majority of abnormal<br />
behaviors discussed in this chapter (with a few exceptions such as the<br />
personality, somatoform, and factitious disor<strong>de</strong>rs) are now thought to have<br />
a biological basis. Many respond to medication, used alone or with<br />
psychotherapy.<br />
20
Even when there are biological factors that contribute to a<br />
problem, the environment usually plays a role as well. Biological<br />
approaches to <strong>de</strong>fining abnormality may encourage people to overlook<br />
environmental factors that are easier to change than genetics or brain<br />
disor<strong>de</strong>rs. A study of adopted children showed that two distinct risk factors<br />
encouraged alcoholism: (1) familial alcoholism (one or both genetic<br />
parents were alcoholic) and (2) drinking in the family environment (the<br />
adoptive parents had drinking problems). Either heredity or environment<br />
could increase risk of alcoholism, and obviously only the environment can<br />
be manipulated or changed after a person is born, if one wants to prevent<br />
alcoholism from <strong>de</strong>veloping.<br />
Specific behavioral disor<strong>de</strong>rs<br />
1. Divi<strong>de</strong>d Brain<br />
This disease is also called split-brain, and the problem the patient<br />
has is that the both brain parts cannot communicate with each other.<br />
The brain has two hemispheres, the right and the left hemisphere.<br />
Those two hemispheres do look like mirror images of each other, but a<br />
closer examination reveals certain asymmetries. When the two<br />
hemispheres are measured during an autopsy, the left one is almost always<br />
larger than the right one. This anatomical difference are related to<br />
differences in functions between the two hemispheres: the left hemisphere<br />
is specialized for the use of language, while the right one is specialized for<br />
mental imagery and the un<strong>de</strong>rstanding of spatial relationships.<br />
Speech and the production of sounds are usually located in the left<br />
hemisphere. But some left-han<strong>de</strong>d people have speech centers located in<br />
the right hemisphere or divi<strong>de</strong>d between the two. Seeing is also<br />
complicated, the two eyes of you give their information to the opposite<br />
hemisphere; your right eye gives his information to the left hemisphere,<br />
and your left eye to the right hemisphere. The brain transforms this<br />
information so we see 'normal'. As a result of this the left hemisphere sees<br />
the right hand in the right visual field, this is correct because your right<br />
hemisphere controls you left body-half and otherwise. When someone is<br />
suffering a split-brain his both hemispheres cannot communicate. In a test,<br />
a person with a split brain is seated in front of a screen. Because of his<br />
split brain he cannot use his right hand to take something he sees with his<br />
left eye. When a word appears on the left si<strong>de</strong> of the screen, the eye passes<br />
21
the information through to the right hemisphere so he won't un<strong>de</strong>rstand the<br />
word because language <strong>de</strong>pends on the left hemisphere.<br />
Because people with split brain can not combine the information<br />
of both hemispheres, their behavior is pretty strange. Because he is not<br />
aware of everything that happens he can look stupid and his behavior can<br />
be illogical and vague.<br />
2. Schizophrenia<br />
Schizophrenia is the label given to a group of psychotic disor<strong>de</strong>rs<br />
characterized by distortion of reality, withdrawal from social interaction<br />
and disorganization of thought. The word schizophrenia is <strong>de</strong>rived from<br />
the Greek words for to split (schidzein) and mind (phren). This splitting is<br />
related to fragmenting of the thought processes.<br />
Schizophrenia occurs in all cultures, also those that are remote<br />
from western civilization and its stress. Because the disor<strong>de</strong>r often<br />
reoccurs and because the patient's suffer long from it, half of all<br />
psychiatric hospital beds are occupied by patients suffering schizophrenia.<br />
Schizophrenia usually appears in young adulthood. Sometimes the<br />
disor<strong>de</strong>r <strong>de</strong>velops slowly, but sometimes it has a sud<strong>de</strong>n onset. These are<br />
often a result of stress with people living an isolated life. Whether the<br />
disor<strong>de</strong>r <strong>de</strong>velops slowly or sud<strong>de</strong>nly, the signs are many and varied. The<br />
primary characteristics can be summarized as the following, although not<br />
every schizophrenic person will show all of them:<br />
1. Disturbance of thought and attention; people suffering<br />
schizophrenia often cannot think logically and as the result of this they<br />
cannot write a story, because every word they write down might make<br />
sense, but are meaningless in relation to each other, and they cannot keep<br />
their attention to the writing.<br />
2. Disturbances of perception; during acute schizophrenic<br />
episo<strong>de</strong>s, people say that the world appears different to them, their bodies<br />
appear longer, colors seem more intense and they cannot recognize<br />
themselves in a mirror.<br />
3. Disturbances of affect; schizophrenic persons fail to show<br />
'normal' emotions. For example, a patient may smile while talking over<br />
tragic events<br />
4. Withdrawal from reality; during schizophrenic episo<strong>de</strong>s, the<br />
individual becomes absorbed in his inner thoughts and fantasies. The self-<br />
22
absorption may be so intense that the individual may not know the month<br />
or day or the place where he is staying.<br />
5. Delusions and hallucinations; in most cases the former<br />
characteristics are accompanied by <strong>de</strong>lusions. The most common are<br />
beliefs that other persons are trying to control his thoughts, he may<br />
become suspicious of friends (paranoid), this is the reason why Robert<br />
Kennedy was assassinated.<br />
The results of schizophrenia are many and varied, but these are the<br />
main characteristics. Not everybody has the same opinion about the causes<br />
of schizophrenia, but some factors have certainly influence on<br />
schizophrenics. Disturbed home life and early trauma are frequently found<br />
in the background of schizophrenics. The early <strong>de</strong>ath of one or more<br />
parents, emotionally disturbed parents and strife between parents are found<br />
with greater frequency in the background of schizophrenics.<br />
3. Alzheimer's Disease<br />
Alzheimer's Disease is a progressive <strong>de</strong>generative disease of the<br />
brain now consi<strong>de</strong>red a leading cause of <strong>de</strong>mentia. Alzheimer's disease<br />
was first <strong>de</strong>scribed by the German neuropathologist Alois Alzheimer in<br />
1906, it affects an estimated 2.5 to 3 million people in the United States. In<br />
the United Kingdom, the number of individuals with this condition is<br />
estimated to rise to over 1 million by the year 2010. Percentage rates<br />
(cases per 100 individuals of 65 years and over) worldwi<strong>de</strong> vary<br />
consi<strong>de</strong>rably between 0.6 in China to 10.3 in Massachusetts, United States.<br />
The inci<strong>de</strong>nce of the disease increases with advancing age, but there is no<br />
evi<strong>de</strong>nce that it is caused by the aging process.<br />
The average life expectancy of people with the disease is between<br />
five and ten years, although many patients now survive 15 years or more<br />
due to improvements in care and medical treatment. The cause of this<br />
disease has not been discovered, although palliative therapy is available.<br />
The ability of doctors to diagnose Alzheimer's disease has improved in<br />
recent years, but this remains a process of elimination and final diagnosis<br />
can be confirmed only by post-mortem. Alzheimer's patients show nerve<br />
cell loss in the parts of the brain associated with cognitive functioning. The<br />
hallmark lesions of Alzheimer's disease inclu<strong>de</strong> the formation of abnormal<br />
proteins. Alzheimer's disease is also characterized by profound <strong>de</strong>ficits in<br />
the brain's neurotransmitters which has been linked with memory function.<br />
23
4. Autism<br />
Autism (from the Greek word autos, which means self) is a severe<br />
infant disor<strong>de</strong>r of behavior that <strong>de</strong>velops before the age of three. The term<br />
is used to <strong>de</strong>scribe many types of mental disor<strong>de</strong>rs, but, as originally<br />
named in 1943 by the American child psychologist Leo Kanner, early<br />
infantile autism <strong>de</strong>scribes a rare cluster of symptoms. Its inci<strong>de</strong>nce is<br />
approximately 1 in 2,500. An autistic child is unable to use language<br />
meaningfully or to process information from the environment. About half<br />
of all autistic children are mute, and those who speak often only repeat<br />
what they have heard. The term autism refers to their vacant, withdrawn<br />
appearance, but its connotation of voluntary <strong>de</strong>tachment is inappropriate.<br />
Other characteristics of autism inclu<strong>de</strong> an uneven pattern of <strong>de</strong>velopment,<br />
a fascination with mechanical objects, a ritualistic response to<br />
environmental stimuli, and a resistance to any change in the environment.<br />
Some autistic children have precocious ability, such as mathematical<br />
skills. The cause, prognosis, and treatment of autism are still un<strong>de</strong>r study.<br />
Research suggests a genetic <strong>de</strong>fect as the cause of the disor<strong>de</strong>r, which may<br />
be some form of autoimmune disease or <strong>de</strong>generative disease of nerve<br />
cells in the brain. The best treatment is special education, stressing<br />
learning in small groups, and strict behavioral control of the child.<br />
Treatment with drugs such as fenfluramine and haloperidol is also being<br />
tested. In general, prognosis is poor for those autistic children who remain<br />
mute past the age of five. Children who speak fare better, and some of<br />
them recover.<br />
5. Phobias<br />
Phobias are excessive fears in specific situations when there is no<br />
real danger or fears that are totally out of proportions. Most of the time the<br />
person with a phobia realizes that his fear is irrational and illogical but he<br />
still feels anxiety. Avoiding the feared situation can only relieve this<br />
anxiety. Most of us are afraid for something; snakes, heights, doctors,<br />
injury or <strong>de</strong>ath are the most reported fears. But a fear is different from a<br />
phobia. A fear is usually not diagnosed as a phobia unless it causes big<br />
problems in the person's daily life. An example of this is a person with a<br />
phobia for enclosed places, he/she will notice his/her phobia when he/she<br />
want to use elevators.<br />
There are a number of explanations about how phobias <strong>de</strong>velop.<br />
Some phobias may result from frightening experiences. For example, you<br />
24
might <strong>de</strong>velop fear for flying after experiencing a near air disaster. Once<br />
such a phobia <strong>de</strong>velops, the individual may go to great lengths to avoid the<br />
feared situation, and so eliminating a possible fear. Other phobias may be<br />
learned through observation. fearful parents tend to produce children who<br />
share their fears. This phobia might be inherited, but it is more likely that<br />
parents provi<strong>de</strong> a mo<strong>de</strong>l and that the children imitate that mo<strong>de</strong>l. Other<br />
phobias might <strong>de</strong>velop because they are rewar<strong>de</strong>d. When a child is afraid<br />
of going to school because he will be separated from his parents for a<br />
while, he will say he has a stomachache or something like that. Then his<br />
parents reward him with the comfort of staying home with his parents.<br />
Behavioral techniques have proved successful in treating phobias,<br />
especially simple and social phobias. One technique, systematic<br />
<strong>de</strong>sensitization, involves confronting the phobic person with situations or<br />
objects that are feared. Exposure therapy, another behavioral method, has<br />
recently been shown to be more effective. In this technique, phobias are<br />
repeatedly exposed to the feared situation or object so that they can see<br />
that no harm befalls them; the fear gradually fa<strong>de</strong>s. Antianxiety drugs have<br />
also been used as palliatives. Drugs to treat <strong>de</strong>pression have also proved<br />
successful in treating some phobias.<br />
► Exercises and Discussions:<br />
1. What is the subject-matter of behavioral sciences?<br />
2. What are the methods (sources) of knowledge in behavioral<br />
sciences?<br />
3. Describe the factors that influence human behavior (biological,<br />
psychological and social).<br />
4. What is abnormal behavior? Abnormal behavior types.<br />
5. Construct your own <strong>de</strong>finition of term “behaviors” in the light of<br />
acquired knowledge.<br />
► Recommen<strong>de</strong>d Essays<br />
1. The importance of behavioral science for medical activity.<br />
Psycho – somatic mo<strong>de</strong>l of treatment.<br />
2. A. Maslow’s conception of Motivation.<br />
3. Emotion as incentive of human behavior.<br />
4. Age and behavior.<br />
► Literature:<br />
1. Fa<strong>de</strong>m Barbara. Behavioral science. Lippincott Williams &<br />
Wilkins, 2008.<br />
25
2. Milliken Mary Elizabeth, Honeycutt Alyson. Un<strong>de</strong>rstanding<br />
human behavior: a gui<strong>de</strong> for health care provi<strong>de</strong>rs. Cengage Learning,<br />
2004.<br />
3. Stou<strong>de</strong>mire Alan. Human behavior: an introduction for medical<br />
stu<strong>de</strong>nts. Lippincott Williams & Wilkins, 1998.<br />
4. Skinner B. F. Science and human behavior. The B.F. Skinner<br />
Foundation, 2005.<br />
26
2.1. Human Personality<br />
Behavior and Personality<br />
27<br />
Chapter 2<br />
"Personality is the supreme realization of the innate<br />
idiosyncrasy of a living being. It is an act of courage<br />
flung in the face of life, the absolute affirmation<br />
of all that constitutes the individual, the most<br />
successful adaptation to the universal<br />
conditions of existence, coupled with the greatest<br />
possible freedom of self-<strong>de</strong>termination."<br />
C.G. Jung, 1875-1961<br />
Almost every day we <strong>de</strong>scribe and assess the personalities of the<br />
people around us. Whether we realize it or not, these daily musings on<br />
how and why people behave as they do are similar to what personality<br />
psychologists do. While our informal assessments of personality tend to<br />
focus more on individuals, personality psychologists instead use<br />
conceptions of personality that can apply to everyone. Even there is no<br />
consensus concerning the <strong>de</strong>finition of personality to un<strong>de</strong>rstand what is<br />
meant by the term personality it is the first step into the field of personality<br />
psychology.<br />
The term "personality" originates from the Latin persona, which<br />
means mask. Significantly, in the theatre of the ancient Latin-speaking<br />
world, the mask was not used as a plot <strong>de</strong>vice to disguise the i<strong>de</strong>ntity of a<br />
character, but rather was a convention employed to represent or typify that<br />
character. Now day most people, when they think of personality, are<br />
actually thinking of personality differences - types and traits and the<br />
like. Scientists <strong>de</strong>fine personality as a dynamic and organized set of<br />
characteristics possessed by a person that uniquely influences his or her<br />
cognitions, motivations, and behaviors in various situations. In other<br />
words personality is ma<strong>de</strong> up of the characteristic patterns of thoughts,<br />
feelings and behaviors that make a person unique. In addition to this,<br />
personality arises from within the individual and remains fairly consistent<br />
throughout life.
Some of the fundamental characteristics of personality inclu<strong>de</strong><br />
which can be summarized as follow:<br />
Consistency - There is generally a recognizable or<strong>de</strong>r and<br />
regularity to behaviors. Essentially, people act in the same ways or similar<br />
ways in a variety of situations.<br />
Psychological and physiological - Personality is a psychological<br />
construct, but research suggests that it is also influenced by biological<br />
processes and needs.<br />
Impact behaviors and actions - Personality does not just<br />
influence how we move and respond in our environment; it also causes us<br />
to act in certain ways.<br />
Multiple expressions - Personality is displayed in more than just<br />
behavior. It can also be seen in out thoughts, feelings, close relationships<br />
and other social interactions.<br />
The study of personality has a broad and varied history in<br />
psychology. Personality research has led to the <strong>de</strong>velopment of a number<br />
of theories that help explain how and why certain personality <strong>de</strong>velops.<br />
We have dozens and dozens of theories, each emphasizing different<br />
aspects of personhood, using different methods, sometimes agreeing with<br />
other theories, sometimes disagreeing.<br />
Some of major theoretical perspectives on personality inclu<strong>de</strong>:<br />
Type theories are the early perspectives on personality. These<br />
theories suggested that there are a limited number of "personality types"<br />
which are related to biological influences. Type theories inclu<strong>de</strong><br />
temperamental conception of Galen and constitutional conception of<br />
William Sheldon<br />
Trait theories viewed personality as the result of internal<br />
characteristics that are genetically based. Gordon Allport was an early<br />
pioneer in the study of traits, which he sometimes referred to as<br />
dispositions. Significant contribution to this approach Hans Eysenck had.<br />
Psychodynamic theories of personality are heavily influenced<br />
by the work of Sigmund Freud, and emphasize the influence of the<br />
unconscious on personality. Psychodynamic theories inclu<strong>de</strong> Sigmund<br />
Freud’s psychosexual stage theory and Erik Erikson’s stages of<br />
psychosocial <strong>de</strong>velopment.<br />
Behavioral theories suggest that personality is a result of<br />
interaction between the individual and the environment. Behavioral<br />
theorists study observable and measurable behaviors, rejecting theories<br />
28
that take internal thoughts and feelings into account. Behavioral theorists<br />
inclu<strong>de</strong> B. F. Skinner and John B. Watson.<br />
Humanist theories emphasize the importance of free will and<br />
individual experience in the <strong>de</strong>velopment of personality. Humanist<br />
theorists inclu<strong>de</strong> Carl Rogers and Abraham Maslow.<br />
In following paragraphs we will unfold the main features of some<br />
significant type personality theories.<br />
2.2. Behavior and temperament. Temperament typology<br />
The concept of personality type refers to the psychological<br />
classification of different types of individuals. An early form of<br />
personality type theory was the Four Temperaments system. What is<br />
temperament? From at least classical times, temperament has referred to<br />
an individual's stable pattern of behaviour or reaction, one that persists<br />
across time, activity, and space.<br />
Temperament theory has its roots in the ancient four humors<br />
theory <strong>de</strong>veloped by the Greek physician Hippocrates (460-370 BC). He<br />
believed certain human moods, emotions and behaviors were caused by<br />
body fluids (called "humors"): blood, yellow bile, black bile, and phlegm.<br />
Next, Galen (AD 131-200) <strong>de</strong>veloped the first typology of temperament in<br />
his dissertation De temperamentis. He mapped them to a matrix of<br />
hot/cold and dry/wet taken from the Four Elements (fire, air, earth, water).<br />
The word "temperament" itself comes from Latin "temperare", "to mix". In<br />
the i<strong>de</strong>al personality, the complementary characteristics or warm-cool and<br />
dry-moist were exquisitely balanced. In four less i<strong>de</strong>al types, one of the<br />
four qualities was dominant over all the others. In the remaining four<br />
types, one pair of qualities dominated the complimentary pair; for<br />
example; warm and moist dominated cool and dry. These latter four were<br />
the temperamental categories Galen named "sanguine", "melancholic",<br />
"choleric" and "phlegmatic" after the bodily humors. Each was the result<br />
of an excess of one of the humors that produced, in turn, the imbalance in<br />
paired qualities. Thus sanguine suppose the excess of blood and<br />
dominance of hot/wet qualities, choleric – yellow bile - hot/dry ,<br />
melancholic – black bile - cold/dry and phlegmatic – phlegm - cold/wet.<br />
Although each person was <strong>de</strong>emed to have his or her own individual<br />
temperament, they were generally <strong>de</strong>scribed as variations on four basic<br />
types: choleric, melancholic, sanguine, and phlegmatic. What are the basic<br />
features of each type of temperaments?<br />
29
Sanguine<br />
The Sanguine temperament personality is fairly extroverted.<br />
People of a sanguine temperament tend to enjoy social gatherings and<br />
making new friends. They tend to be creative and often day dream.<br />
However, some alone time is crucial for those of this temperament.<br />
Sanguine can also mean very sensitive, compassionate and thoughtful.<br />
Sanguine personalities generally struggle with following tasks all the way<br />
through, are chronically late, and tend to be forgetful and sometimes a<br />
little sarcastic. Often, when pursuing a new hobby, interest is lost quickly-when<br />
it ceases to be engaging or fun.<br />
Choleric<br />
A person who is choleric is a doer. They have a lot of ambition,<br />
energy, and passion, and try to instill it in others. They can dominate<br />
people of other temperaments, especially phlegmatic types. Many great<br />
charismatic military and political figures were cholerics.<br />
Melancholic<br />
A person who is a thoughtful pon<strong>de</strong>red has a melancholic<br />
disposition. Often very kind and consi<strong>de</strong>rate, melancholic can be highly<br />
creative – as in poetry and art - and can become occupied with the tragedy<br />
and cruelty in the world. A melancholic is also often a perfectionist. They<br />
are often self-reliant and in<strong>de</strong>pen<strong>de</strong>nt.<br />
Phlegmatic<br />
Phlegmatic tend to be self-content and kind. They can be very<br />
accepting and affectionate. They may be very receptive and shy and often<br />
prefer stability to uncertainty and change. They are very consistent,<br />
relaxed, rational, curious, and observant, making them good administrators<br />
and diplomats. Unlike the Sanguine personality, they may be more<br />
<strong>de</strong>pendable.<br />
Common traits of temperaments<br />
From the beginning, with Galen's ancient temperaments, it was<br />
observed that pairs of temperaments shared certain traits in common,<br />
related especially to the rapidity of the responses to the stimulus and to the<br />
sustainability of the responses.<br />
Sanguine - quick, impulsive, and relatively short-lived reactions.<br />
(hot/wet)<br />
Phlegmatic - a longer response-<strong>de</strong>lay, but short-lived response.<br />
(cold/wet)<br />
30
Choleric - short response time-<strong>de</strong>lay, but response sustained for a<br />
relatively long time. (hot/dry)<br />
Melancholic - long response time-<strong>de</strong>lay, response sustained at<br />
length, if not, seemingly, permanently. (cold/dry)<br />
From this schema it is evi<strong>de</strong>nt that the sanguine and choleric<br />
shared a common trait: quickness of response, while the melancholy and<br />
phlegmatic shared the opposite, a longer response. The melancholy and<br />
choleric, however, shared a sustained response, and the sanguine and<br />
phlegmatic shared a short-lived response. That meant, that the Choleric<br />
and melancholy both would tend to hang on to emotions like anger, and<br />
thus appear more serious and critical than the fun-loving sanguine, and the<br />
peaceful phlegmatic. However, the choleric would be characterized by<br />
quick expressions of anger, while the melancholy would build up anger<br />
slowly, silently, before exploding.<br />
The medical theory of temperament began to lose favor in the<br />
early mo<strong>de</strong>rn period. As a characterization of a person's psychological<br />
state, however, temperament continued to be employed by both<br />
psychologists and the lay public well into the twentieth century. The<br />
temperamental theories as well as tests were <strong>de</strong>veloped in contemporary<br />
periods by David Keirsey, Myers-Briggs, Ernst Kretschmer etc.<br />
2.3. Behavior and Human Somatic<br />
One very famous though discussable personality type conception<br />
belong to William Sheldon (1898-1977). He was an American<br />
psychologist who <strong>de</strong>voted his life to observing the variety of human<br />
bodies and temperaments. He taught and did research at a number of U.S.<br />
universities and is best known for his series of books on the human<br />
constitution. For his study of the human physique, Dr. Sheldon started<br />
with 4,000 photographs of college-age men, which showed front, back and<br />
si<strong>de</strong> views. By carefully examining these photos he discovered that there<br />
were three fundamental elements which, when combined together, ma<strong>de</strong><br />
up all these physiques or somatotypes. With great effort and ingenuity he<br />
worked out ways to measure these three components and to express them<br />
numerically so that every human body could be <strong>de</strong>scribed in terms of three<br />
numbers, and that two in<strong>de</strong>pen<strong>de</strong>nt observers could arrive at very similar<br />
results in <strong>de</strong>termining a person's body type.<br />
31
These basic elements he named endomorphy, mesomorphy and<br />
ectomorphy, for they seemed to <strong>de</strong>rive from the three layers of the human<br />
embryo, the endo<strong>de</strong>rm, the meso<strong>de</strong>rm and the ecto<strong>de</strong>rm. So:<br />
Endomorph is centered on the abdomen, and the whole digestive<br />
system.<br />
Mesomorph is focused on the muscles and the circulatory system.<br />
Ectomorph is related to the brain and the nervous system.<br />
We have all three elements in our bodily makeup, just as we all<br />
have digestive, circulatory and nervous systems. No one is simply an<br />
endomorph without having at the same time some mesomorph and<br />
ectomorph, but we have these components in varying <strong>de</strong>grees. Sheldon<br />
evaluated the <strong>de</strong>gree a component was present on a scale ranging from one<br />
to seven, with one as the minimum and seven as the maximum.<br />
The Extreme Endomorph - Roundness<br />
In this physique the body is round and soft, as if all the mass had<br />
been concentrated in the abdominal area. The arms and legs of the extreme<br />
endomorph are short and tapering, and the hands and feet comparatively<br />
small, with the upper arms and thighs being hammed and more <strong>de</strong>veloped<br />
than the lower arms and legs. The body has smooth contours without<br />
projecting bones, and a high waist. There is some <strong>de</strong>velopment of the<br />
breast in the male and a fullness of the buttocks. The skin is soft and<br />
smooth like that of an apple, and there is a ten<strong>de</strong>ncy towards premature<br />
baldness beginning at the top of the head and spreading in a polished<br />
circle. The hair is fine and the whole head is spherical. The head is large<br />
and the face broad and relaxed with the features blending into an over-all<br />
impression of roundness. Santa Claus is our society's image of the extreme<br />
endomorph.<br />
The Extreme Mesomorph – Muscles<br />
The chest area, which Sheldon likened to an engine room,<br />
dominates over the abdominal area and tapers to a relatively narrow, low<br />
waist. The bones and muscles of the head are prominent as well, with<br />
clearly <strong>de</strong>fined cheek bones and a square, heavy jaw. The face is long and<br />
broad and the head tends towards a cubical shape. The muscles on either<br />
si<strong>de</strong> of the neck create a pyramid-like effect. Both the lower and upper<br />
arms and legs are well-<strong>de</strong>veloped and the wrists and fingers are heavy and<br />
massive. The skin is thick and tends towards coarseness. It takes and holds<br />
a tan well and can <strong>de</strong>velop a leathery appearance with heavy wrinkles.<br />
32
Sheldon compared it to the skin of an orange. The hair is basically heavytextured,<br />
and baldness, usually starts at the front of the head. The extreme<br />
mesomorph is Mr. Universe or Tarzan.<br />
Women on the whole tend to have less mesomorph than men and<br />
more endomorph. Women who are primarily mesomorphs rarely show the<br />
same <strong>de</strong>gree of sharp angularity, prominent bone structure and highly<br />
relieved muscles found in their male counterparts. Their contours are<br />
smoother, yet the chest area clearly dominates over the abdominal area and<br />
both upper and lower arms and legs are well-muscled. The skin tends to be<br />
finer than in the male mesomorph, but shows some of the same<br />
characteristics in terms of tanning and wrinkling.<br />
The Extreme Ectomorph – Linear<br />
The highly ectomorph physique is fragile and <strong>de</strong>licate with light<br />
bones and slight muscles. The limbs are relatively long and the shoul<strong>de</strong>rs<br />
droop. In contrast to the compactness of the endomorph and mesomorph,<br />
the ectomorph is exten<strong>de</strong>d in space and linear. The ribs are visible and<br />
<strong>de</strong>licate and the thighs and upper arms weak. The fingers, toes and neck<br />
are long. The features of the face are sharp and fragile, and the shape of<br />
the face as a whole is triangular with the point of the triangle at the chin.<br />
The teeth are often crow<strong>de</strong>d in the lower jaw which is somewhat receding.<br />
The skin is dry and is like the outer skin of an onion. It tends to burn and<br />
peel easily and not retain a tan. The relatively great bodily area in relation<br />
to mass makes the ectomorph suffer from extreme heat or cold. The hair is<br />
fine and fast-growing and sometimes difficult to keep in place. Baldness is<br />
rare. The extreme ectomorph in our society is the absent-min<strong>de</strong>d<br />
professor.<br />
Once we had grasped these three basic elements we tried to<br />
recognize them in ourselves and our friends. We, in<strong>de</strong>ed, found some<br />
people who were extreme endomorphs, or mesomorphs or ectomorphs,<br />
with little of the other components, but there were not many of them. Most<br />
of the people we knew were a bewil<strong>de</strong>ring variety of combinations, and we<br />
practiced mentally weighing how much of each component they had.<br />
Sheldon liked to draw a body type diagram on which he plotted the<br />
different body types. Here's where he placed the extreme endomorph,<br />
mesomorph and ectomorph:<br />
33
Other people were strong in two elements, and had less of the third. They fell<br />
in between the poles of Sheldon's diagram. Four of these combinations<br />
captured our attention. There was the hefty muscular person, the muscular thin<br />
person, and close to him, the thinner yet still muscular person, and between the<br />
ectomorph and the endomorph the person who was spread out and round<br />
without really being muscular.<br />
In the middle are mid-range physiques well endowed with all the basic<br />
elements. And somewhere in this panoramic rainbow of physiques is you. Can<br />
you find yourself?<br />
The classification of body types was not Sheldon's ultimate goal.<br />
He wanted to help resolve the age-old question: Whether our body type<br />
was connected with the way we acted (eat and sleep, laugh and snore,<br />
speak and walk)? In short, he wanted to explore the link between body and<br />
temperament, un<strong>de</strong>rstood as body type in action. Sheldon's procedure in<br />
looking for the basic components of temperament was much like the one<br />
he used in discovering the body type components. He interviewed in <strong>de</strong>pth<br />
several hundred people and tried to find traits which would <strong>de</strong>scribe the<br />
basic elements of their behavior. He found there were three basic<br />
components which he called viscerotonia, somatotonia and cerebrotonia,<br />
and named endotonia, mesotonia and ectotonia.<br />
Endotonia is seen in the love of relaxation, comfort, food and people.<br />
Mesotonia is centered on assertiveness and a love of action.<br />
Ectotonia focuses on privacy, restraint and a highly <strong>de</strong>veloped<br />
self-awareness.<br />
Sheldon <strong>de</strong>vised a way of numerically rating the strength of each<br />
area based on a check-list of 60 characteristics (see the end of this chapter<br />
34
for a simplfied version) that <strong>de</strong>scribe the basic components. The 7-1-1 was<br />
the extreme endotonic, the 1-7-1 the extreme mesotonic and the 1-1-7 the<br />
extreme ectotonic. He found a strong correspon<strong>de</strong>nce between the<br />
endomorphic body type and the endotonic temperament, the mesomorphic<br />
body type and the mesotonic temperament, and the ectomorphic body type<br />
and the ectotonic temperament. Just as in our body type we have all three<br />
elements, so, too, with our temperament.<br />
A look at the three extremes in temperament will give us some<br />
i<strong>de</strong>a of what these components are like.<br />
The Extreme Endotonic - Friendliness<br />
The endotonic shows a splendid ability to eat, digest and socialize.<br />
A good <strong>de</strong>al of his energy is oriented around food, and he enjoys sitting<br />
around after a good meal and letting the digestive process proceed without<br />
disturbance. They fall readily to sleep and their sleep is <strong>de</strong>ep and easy;<br />
they lie limp and sprawled out and frequently snore.<br />
Endotonic are relaxed and slow-moving. Their breathing comes<br />
from the abdomen and is <strong>de</strong>ep and regular. Their speech is unhurried and<br />
their limbs often limp. They like sitting in a well-upholstered chair and<br />
relaxing. All their reactions are slow, and this is a reflection on a<br />
temperament level of a basal metabolism, pulse, breathing rate and<br />
temperature which are all often slower and lower than average. The<br />
circulation in their hands and feet tends to be poor.<br />
The endotonic love to socialize their eating, and the sharing of<br />
meals becomes an event of the highest importance. They treat guests well.<br />
They love company and feel more complete with other people around.<br />
They like people simply because they are people. They have a strong<br />
<strong>de</strong>sire to be liked and approved of, and this often leads them to be very<br />
conventional in their choices in or<strong>de</strong>r not to run the risk of social<br />
disapproval. The endotonic are open and even with their emotions which<br />
seem to flow out of them without any inhibitions. Whether they are happy<br />
or sad, they want the people around them to know about it, and if others<br />
express emotion they react directly and convincingly in sympathy. When<br />
an endotonic has been drinking he becomes even more jovial and radiates<br />
an expansive love of people. Endotonic are family-oriented and love<br />
babies and young children and have highly <strong>de</strong>veloped maternal instincts.<br />
They express affection and approval readily and need both back in kind.<br />
35
The Extreme Mesotonic - Action<br />
They are always ready for action, and good posture is natural to<br />
them. They get up with plenty of energy and seem tireless. They can work<br />
for long periods of time and both need and like to exercise. If they are<br />
forced into inactivity they become restless and <strong>de</strong>jected.<br />
The mesotonic tends to eat his food rapidly and somewhat<br />
randomly, often neglecting set meal times. He sleeps the least of the three<br />
types and sometimes contents himself with six hours. He is an active<br />
sleeper who thrashes about. He shows insensitivity to pain and a ten<strong>de</strong>ncy<br />
to high blood pressure and large blood vessels.<br />
The mesotonic has no hesitation in approaching people and<br />
making known his wants and <strong>de</strong>sires. The ten<strong>de</strong>ncy to think with his<br />
muscles and find exhilaration in their use leads him to enjoy taking<br />
chances and risks, even when the actual gain is well-known to be minimal.<br />
They can become fond of gambling and fast driving and are generally<br />
physically fearless. They can be either difficult and argumentative, or slow<br />
to anger, but always with the capacity to act out physically and usually<br />
with some sort of history of having done so on special occasions.<br />
This physical drive manifests itself on the psychological level in a<br />
sense of competition. The mesotonic wants to win and pushes himself<br />
forward. He tends to walk roughshod over the obstacles in his path and the<br />
people who stand in the way of his achieving what he wants. On the<br />
positive si<strong>de</strong> this is called being practical and free from sentimentality, but<br />
on the negative si<strong>de</strong> it is called ruthlessness or obnoxious aggressiveness.<br />
This outward energetic flow makes mesotonic generally noisy.<br />
Their voices carry and sometimes boom out as if speech were another<br />
form of exercise. When alcohol reduces their inhibitions, they become<br />
more assertive and aggressive. They look ol<strong>de</strong>r than their chronological<br />
age. The extraversion of action that is so strong here goes together with a<br />
lack of awareness of what is happening on the subjective level. He likes<br />
wi<strong>de</strong>-open spaces and freedom.<br />
The female mesotonic shows the same extraversion of action, but<br />
how this action expresses itself has a different quality. There is not the<br />
same overt physical combativeness and competitive aggressiveness. The<br />
action is more muted and flows in more socially acceptable channels. The<br />
mesotonic woman should be compared not with men but with other<br />
women, and it is in relation to other women that she shows the distinctive<br />
mesotonic traits in a feminine way.<br />
36
The Extreme Ectotonic - Reflection<br />
The outstanding characteristic of the ectotonic is his finely-tuned<br />
receptive system. His spread-out body acts like a giant antenna picking up<br />
all sorts of inputs. He is like a sonar operator who must constantly be wary<br />
of a sud<strong>de</strong>n loud noise breaking in on the <strong>de</strong>licate sounds he is trying to<br />
trace. He likes to cross his legs and curl up as if he is trying to minimize<br />
his exposure to the exterior world. He tries to avoid making noise and<br />
being subjected to it. He shrinks from crowds and large groups of people<br />
and likes small, protected places.<br />
The ectotonic suffers from a quick onset of hunger and a quick<br />
satiation of it. He is drawn to a high protein, high calorie diet, with<br />
frequent snacking to match his small digestive system. He has a nervous<br />
stomach and bowels. He is a quiet sleeper, but a light one, and he is often<br />
plagued by insomnia. He tends to sleep on one si<strong>de</strong> with his legs drawn up,<br />
and his sleep, though slow in coming, can be hard to shake off. His energy<br />
level is low, while his reactions are fast he suffers from a quasi-chronic<br />
fatigue and must protect himself from the temptation to exercise heavily.<br />
His blood pressure is usually low and his respiration shallow and rapid<br />
with a fast and weak pulse. His temperature is elevated slightly above<br />
normal and it rises rapidly at the onset of illness. The ectotonic is resistant<br />
to many major diseases, but suffers excessively from insect bites and skin<br />
rashes. His hypersensitivity leads not only to quick physical reactions but<br />
to excessively fast social reactions as well. It is difficult for this type to<br />
keep pace with slow-moving social chit-chat. He races ahead and trips<br />
over his own social feet.<br />
Self-awareness is a principle trait of ectotonia. The feelings of the<br />
ectotonic are not on display, even though they can be very strong, and so<br />
he is sometimes accused of not having any. When they are in a situation of<br />
<strong>de</strong>aling with someone who has authority over them or with someone of the<br />
opposite sex whom they are interested in, they often make a poor first<br />
impression. They are uncomfortable in coping with social situations where<br />
overt expressions of sympathy are called for or where general idle<br />
conversation is the norm, for example in parties and dinners where they<br />
have no intimate acquaintances.<br />
The ectotonics are hypersensitive to pain because they anticipate it<br />
and have a lower pain threshold as well. They do not project their voices<br />
like the mesotonics, but focus it to reach only the person they are<br />
addressing. They appear younger than their age and often wear an alert,<br />
37
intent expression. They have a late adolescence, consi<strong>de</strong>r the latter part of<br />
life the best, and are future-oriented. The more extreme ectotonics have a<br />
distaste for alcohol and their accentuated consciousness fights alcohol,<br />
drugs, anesthesia and is resistant to hypnosis. When they become troubled<br />
they seek privacy and solitu<strong>de</strong> in or<strong>de</strong>r to try to work out the difficulty.<br />
2.4. Jung's Theory of Psychological Types<br />
While typologies of all sorts have existed throughout time the<br />
most influential i<strong>de</strong>a of psychological types originated in the theoretical<br />
work of Carl Jung, published as Psychological Types in 1921. According<br />
to Jung, the conscious psyche is an apparatus for adaptation and<br />
orientation, and consists of a number of different psychic functions.<br />
Among these he distinguishes four basic functions:<br />
• sensing - perception by means of the sense organs;<br />
• intuition - perceiving in unconscious way or perception of<br />
unconscious contents.<br />
• thinking - function of intellectual cognition; the forming of logical<br />
conclusions;<br />
• feeling - function of subjective estimation;<br />
These functions are putted by author in pair accordingly to the<br />
criteria of rationality. Thus, thinking and feeling functions are rational,<br />
while sensing and intuition are nonrational.<br />
Rationality consists of figurative thoughts, feelings or actions<br />
with reason — a point of view based on objective value, which is set by<br />
practical experience.<br />
Non-rationality is not based in reason. Jung notes that elementary<br />
facts are also nonrational, not because they are illogical but because, as<br />
thoughts, they are not judgments.<br />
In a person one function of pair is dominant while other is<br />
auxiliary.<br />
Thinking and feeling<br />
Women use feeling more than thinking, and men use thinking<br />
more than feeling.<br />
This seems to be a general rule, though each of us has both<br />
functions and what function we use most has nothing to do with the<br />
question of intelligence.<br />
38
Suppose a couple wants to buy a house. The husband may think of<br />
the house in terms of its price, closeness to work, maintenance and so<br />
forth, while his wife might consi<strong>de</strong>r the purchase in terms of how she<br />
might feel when friends and relatives come over and how the house will<br />
look during next year's Thanksgiving dinner.<br />
Sensation and Intuition<br />
Just as there are two equally valid ways to arrive at a judgment,<br />
Jung saw that there were two ways of perception: sensation and intuition.<br />
Sensation is easy to grasp. It means perception by means of our<br />
various senses. It means contact with people and things by way of sight,<br />
hearing, touch, taste and smell. Sensation is in touch with the here and<br />
now in all its rich <strong>de</strong>tail.<br />
Intuition means the perception of possibilities. If sensation is<br />
oriented to the present, intuition revels in the future.<br />
When sensation is in a room, it glories in all the sha<strong>de</strong>s of color,<br />
and the styles of <strong>de</strong>coration it finds there, while intuition immediately<br />
looks for the nearest window in or<strong>de</strong>r to float out of it and search out<br />
hid<strong>de</strong>n possibilities in the future.<br />
According to the direction of psychic energy Carl Jung elaborate<br />
other typology. He divi<strong>de</strong>s human personality in introvert and extrovert. If<br />
a person’s energy usually flows outwards, he or she is an extravert, while<br />
if this energy normally flows inwards, this person is an introvert.<br />
Extraverts feel an increase of perceived energy when interacting with a<br />
large group of people, but a <strong>de</strong>crease of energy when left alone.<br />
Conversely, introverts feel an increase of energy when alone, but a<br />
<strong>de</strong>crease of energy when surroun<strong>de</strong>d by a large group of people.In more<br />
<strong>de</strong>tails Extraversion is "the act, state, or habit of being predominantly<br />
concerned with and obtaining gratification from what is outsi<strong>de</strong> the self".<br />
Extraverts tend to enjoy human interactions and to be enthusiastic,<br />
talkative, assertive, and gregarious. They take pleasure in activities that<br />
involve large social gatherings, such as parties, community activities,<br />
public <strong>de</strong>monstrations, and business or political groups. Acting, teaching,<br />
directing, managing, brokering are fields that favor extraversion. An<br />
extraverted person is likely to enjoy time spent with people and find less<br />
reward in time spent alone. They enjoy risk-taking and often show<br />
lea<strong>de</strong>rship abilities.<br />
39
An extravert is energized when around other people. Extraverts<br />
tend to "fa<strong>de</strong>" when alone and can easily become bored without other<br />
people around. Extraverts tend to think as they speak. When given the<br />
chance, an extravert will talk with someone else rather than sit alone and<br />
think.<br />
Introversion is "the state of or ten<strong>de</strong>ncy toward being wholly or<br />
predominantly concerned with and interested in one's own mental life".<br />
Introverts tend to be low-key, <strong>de</strong>liberate, and relatively less engaged in<br />
social situations. They often take pleasure in solitary activities such as<br />
reading, writing, drawing, watching movies, and using computers. The<br />
archetypal artist, writer, sculptor, composer and inventor are all highly<br />
introverted. An introverted person is likely to enjoy time spent alone and<br />
find less reward in time spent with large groups of people (although they<br />
tend to enjoy interactions with close friends). They prefer to concentrate<br />
on a single activity at a time and like to observe situations before they<br />
participate. Introversion is not the same as shyness. Introverts choose<br />
solitary over social activities by preference, whereas shy people avoid<br />
social encounters out of fear. An introvert is energized when alone.<br />
Introverts tend to "fa<strong>de</strong>" when with people and can easily become<br />
overstimulated with too many others around. Introverts tend to think<br />
before speaking.<br />
To give a complete <strong>de</strong>scription of a person's psychological type,<br />
Jung refers to both the function and attitu<strong>de</strong> type. As a result we have<br />
eight personality types:<br />
The Extraverted Sensation Type is a realist who seeks to<br />
experience as many concrete sensations as possible - preferably, but not<br />
necessarily, ones that are pleasurable. These experiences are seen as ends<br />
in themselves and are rarely utilized for any other purpose.<br />
Such persons are sensualists or aesthetes who are attracted by the<br />
physical characteristics of objects and people. They dress, eat and entertain<br />
well, and can be very good company.<br />
Not at all reflective nor introspective, they have no i<strong>de</strong>als except<br />
sensory enjoyment. They generally mistrust inner psychological processes<br />
and prefer to account for such things in terms of external events (e.g., they<br />
may blame their moods on the weather).<br />
If extreme, they are often cru<strong>de</strong>ly sensual and may exploit<br />
situations or others in or<strong>de</strong>r to increase their own personal pleasure. When<br />
40
neurotic, repressed intuition may be projected onto other people, so that<br />
they may become irrationally suspicious<br />
The Introverted Sensation Type is subjectively filtered. Perception<br />
is not based directly on the object, but is merely suggested by it.<br />
Perception <strong>de</strong>pends crucially upon internal psychological<br />
processes that will differ from one person to the next. At its most positive,<br />
introverted sensation is found in the creative artist. At its most extreme, it<br />
produces psychotic hallucinations and a total alienation from reality.<br />
The introverted sensation type reacts subjectively to events in a<br />
way that is unrelated to objective criteria. Often this is seen as an<br />
inappropriate and uncalled-for overreaction.<br />
The person may perceive the world as illusory or amusing. In<br />
extreme (psychotic) cases, this may result in an inability to distinguish<br />
illusion from reality. The subjective world of archaic images may then<br />
come to dominate consciousness completely, so that the person lives in a<br />
private, mythological realm of fantasy.<br />
Repressed intuition may also be expressed in vaguely imagined<br />
threats or an apprehension of sinister possibilities.<br />
The Extraverted Intuition Type - is an excellent diagnostician and<br />
exploiter of situations. Such people see exciting possibilities in every new<br />
venture and are excellent at perceiving latent abilities in other people.<br />
They get carried away with the enthusiasm of their vision and often inspire<br />
others with the courage of their conviction.<br />
As such, they do well in occupations where these qualities are at a<br />
premium - for example in initiating new projects, in business, politics or<br />
the stock market. They are, however, easily bored and stifled by<br />
unchanging conditions. As a result they often waste their life and talents<br />
jumping from one activity to another in the search for fresh possibilities,<br />
failing to stick at any one project long enough to bring it to fruition.<br />
Furthermore, in their commitment to their own vision, they often<br />
show little regard for the needs, views or convictions of others.<br />
When neurotic, repressed sensation may cause this type to become<br />
compulsively tied to people, objects or activities that stir in them primitive<br />
sensations such as pleasure, pain or fear. The consequence of this can be<br />
phobias, hypochondriacal beliefs and a range of other compulsions.<br />
41
The Introverted Intuition Type - is directed inward to the contents<br />
of the unconscious. It attempts to fathom internal events by relating them<br />
to universal psychological processes or to other archetypal images.<br />
Consequently it generally has a mythical, symbolic or prophetic quality.<br />
Such a person has a visionary i<strong>de</strong>al that reveals strange,<br />
mysterious things. These are enigmatic, 'unearthly' people who stand aloof<br />
from ordinary society. They have little interest in explaining or<br />
rationalizing their personal vision, but are content merely to proclaim it.<br />
Partly as a result of this, they are often misun<strong>de</strong>rstood. Although<br />
the vision of the artist among this type generally remains on the purely<br />
perceptual level, mystical dreamers or cranks may become caught up in<br />
theirs. The person's life then becomes symbolic, taking on the nature of a<br />
Great Work, mission or spiritual-moral quest.<br />
If neurotic, repressed sensation may express itself in primitive,<br />
instinctual ways and, like their extraverted counterparts, introverted<br />
intuitive often suffers from hypochondria and compulsions.<br />
The Extraverted Thinking Type - is driven by the objective<br />
evi<strong>de</strong>nce of the senses or by objective (collective) i<strong>de</strong>as that <strong>de</strong>rive from<br />
tradition or learning. Thinking is never carried out for its own sake, merely<br />
as some private, subjective enterprise.<br />
The extraverted thinking type bases all actions on the intellectual<br />
analysis of objective data. Such people live by a general intellectual<br />
formula or universal moral co<strong>de</strong>, foun<strong>de</strong>d upon abstract notions of truth or<br />
justice. They also expect other people to recognize and obey this formula.<br />
This type represses the feeling function (e.g., sentimental attachments,<br />
friendships, religious <strong>de</strong>votion) and may also neglect personal interests<br />
such as their own health or financial well-being.<br />
If extreme or neurotic, they may become petty, bigoted, tyrannical<br />
or hostile towards those who would threaten their formula. Alternatively,<br />
repressed ten<strong>de</strong>ncies may burst out in various kinds of personal<br />
'immorality' (e.g., self-seeking, sexual mis<strong>de</strong>meanors, fraud or <strong>de</strong>ception).<br />
The Introverted Thinking Type - is contemplative, involving an<br />
inner play of i<strong>de</strong>as. It is thinking for its own sake and is always directed<br />
inward to subjective i<strong>de</strong>as and personal convictions rather than outward to<br />
practical outcomes. The introverted thinking type tends to be impractical<br />
and indifferent to objective concerns. These persons usually avoid notice<br />
and may seem cold, arrogant and taciturn.<br />
42
Alternatively, the repressed feeling function may express itself in<br />
displays of childish naivety. Generally people of this type appear caught<br />
up in their own i<strong>de</strong>as which they aim to think through as fully and <strong>de</strong>eply<br />
as possible.<br />
If extreme or neurotic they can become rigid, withdrawn, surly or<br />
brusque. They may also confuse their subjectively apprehen<strong>de</strong>d truth with<br />
their own personality so that any criticism of their i<strong>de</strong>as is seen as a<br />
personal attack. This may lead to bitterness or to vicious counterattacks<br />
against their critics.<br />
The Extraverted Feeling Type - is based upon accepted or<br />
traditional social values and opinions. It involves a conforming, adjusting<br />
response to objective circumstances that strives for harmonious relations<br />
with the world.<br />
The extraverted feeling type follows fashion and seeks to<br />
harmonize personal feelings with general social values.<br />
Thinking is always subordinate to feeling and is ignored or<br />
repressed if intellectual conclusions fail to confirm the convictions of the<br />
heart. When this type is extreme or neurotic, feeling may become gushing<br />
or extravagant and <strong>de</strong>pen<strong>de</strong>nt upon momentary enthusiasms that may<br />
quickly turn about with changing circumstances. Such a person may<br />
therefore seem hysterical, fickle, moody or even to be suffering from<br />
multiple personality. Repressed thinking may also erupt in infantile,<br />
negative, obsessive ways. This can lead to the attribution of drea<strong>de</strong>d<br />
characteristics to the very objects or people that are most loved and valued.<br />
The Introverted Feeling Type - is unrelated to any external object.<br />
It <strong>de</strong>values objective reality and is rarely displayed openly. When it does<br />
appear on the surface, it generally seems negative or indifferent. Such a<br />
person aims to be inconspicuous, makes little attempt to impress and<br />
generally fails to respond to the feelings of others.<br />
The outer, surface appearance is often neutral, cold and<br />
dismissive. Inwardly, however, feelings are <strong>de</strong>ep, passionately intense, and<br />
may accompany secret religious or poetic ten<strong>de</strong>ncies. The effect of all this<br />
on other people can be stifling and oppressive. When extreme or neurotic,<br />
this type may become domineering and vain.<br />
Negative repressed thinking may also be projected so that these<br />
persons may imagine they can know what others are thinking. This may<br />
<strong>de</strong>velop into paranoia and into secret scheming rivalries.<br />
43
► Exercises and Discussions:<br />
a. Give a <strong>de</strong>finition of personality.<br />
b. What are the basic approaches or theories about personality?<br />
c. Describe the classical conception of temperament.<br />
d. What is somatotype and how many personality types were<br />
established by Sheldon?<br />
e. Sketch the significant moments of Jung’s conception of<br />
personality types.<br />
f. Make the comparison between conceptions analyzed in the<br />
chapter.<br />
g. Chose one of the three conceptions analyzed which is more<br />
relevant in your opinion. Justify you option.<br />
► Recommen<strong>de</strong>d Essays<br />
h. Psychodynamic conception of personality.<br />
i. Behaviorist conception of personality.<br />
j. Humanist conception of personality.<br />
k. Personality disor<strong>de</strong>rs.<br />
►Literature:<br />
1. Stou<strong>de</strong>mire Alan. Human behavior: an introduction for medical<br />
stu<strong>de</strong>nts. Lippincott Williams & Wilkins, 1998.<br />
2. Engler Barbara. Personality Theories: An Introduction. Cengage<br />
Learning, 2008.<br />
3. Lindsay J. E.,Carter Barbara. Honeyman Heath. Somatotyping<strong>de</strong>velopment<br />
and applications. Cambridge University Press, 1990.<br />
4. Sharp Daryl. Personality types: Jung's mo<strong>de</strong>l of typology. Inner<br />
City Books, 1987.<br />
44
3.1 Human Society and its Structure<br />
Behavior and Society<br />
45<br />
Chapter 3<br />
One of the greatest diseases<br />
is to be nobody to anybody.<br />
Mother Teresa<br />
The term society came from the Latin word societas, which in turn<br />
was <strong>de</strong>rived from the noun socius ("comra<strong>de</strong>, friend, ally"). Thus this term<br />
is used to <strong>de</strong>scribe an interaction among parties that are friendly. Human<br />
society is consequently a group of people related to each other through<br />
persistent relations, that must be friendly or at least civil so that to be<br />
efficient. There is a common vision among scientist that ten<strong>de</strong>ncy of<br />
humans for association (forming and living in groups) is conditioned<br />
primarily by the heed to cope. A society allows its members to realize<br />
needs or wishes they cannot fulfill alone. In this circumstance they need to<br />
work for the global success of the society as a prerequisite for achieving<br />
their own individual success. As such, society is a collaborative means to<br />
accomplish individual ends.<br />
Societies can differ from each other on the level of historical,<br />
economical or technological <strong>de</strong>velopment, on the types of government and<br />
political structure on the specific of cultural traditions, but all human<br />
societies have more or less alike structures. Formally social structure<br />
consists of individuals, groups, and other social entities, and of the<br />
networks of social ties between them. Functionally social structure<br />
consists of statuses, roles, and social institutions. Formally and<br />
functionally social structure is patterned social arrangements which form<br />
the society as a whole, and which <strong>de</strong>termine, regulate the interactions<br />
among members of the society. To un<strong>de</strong>rstand better the significance the<br />
meanings of each <strong>de</strong>fying element will be <strong>de</strong>scribe.<br />
An individual is a person or any specific object or thing in a<br />
collection. Individuality is the state or quality of being an individual; a
person separate from other persons and possessing his or her own needs,<br />
goals, and <strong>de</strong>sires.<br />
Social group is an association of two or more humans who<br />
interact with one another, share similar characteristics and collectively<br />
have a sense of unity. To have a sense of unity mean interacting with each<br />
other with respect to:<br />
1. Common motives and goals;<br />
2. An accepted division of labor, i.e. roles;<br />
3. Established status (social rank, dominance) relationships;<br />
4. Accepted norms and values with reference to matters relevant to<br />
the group;<br />
5. Development of accepted sanctions (praise and punishment) if<br />
and when norms were respected or violated.<br />
Characteristics shared by members of a group may inclu<strong>de</strong><br />
interests, values, representations, ethnic or social background, and kinship<br />
ties. Thus a true social group is a group that exhibits some <strong>de</strong>gree of social<br />
cohesion and is not a simple collection or aggregate of individuals, such as<br />
people waiting at a bus stop, or people waiting in a line. Social groups can<br />
be many types, but sociologist divi<strong>de</strong>d into two big categories: primary<br />
and secondary groups. Primary groups are small groups with intimate,<br />
kinship-based relationships: families, for example. They commonly last<br />
for many years or even generations. They are small and display face-toface<br />
interaction. Secondary groups, in contrast to primary groups, are large<br />
groups involving formal and institutional relationships. They may last for<br />
years or may disband after a short time. The formation of primary groups<br />
happens within secondary groups. Primary groups can be present in<br />
secondary settings. For example, attending a university exemplifies<br />
membership of a secondary group, while the friendships that are ma<strong>de</strong><br />
there would be consi<strong>de</strong>red a primary group that you belong to. Likewise,<br />
some businesses care <strong>de</strong>eply about the well being of one another, while<br />
some immediate families have hostile relations within it.<br />
Social status is the honor or prestige attached to one's position in<br />
society. It is the position or rank of a person or group within the society.<br />
Social role is a set of connected behaviors, rights and obligations<br />
of a person or group in a social situation or position.<br />
Social institution is any structure or mechanism of social or<strong>de</strong>r<br />
and cooperation governing the behavior of groups within a given human<br />
community. Institutions are i<strong>de</strong>ntified with a social purpose and<br />
46
permanence, transcending individual human lives and intentions, and with<br />
the making and enforcing of rules governing cooperative human behavior.<br />
3.2. The Concepts of Social Status and Role<br />
The first person who gives the <strong>de</strong>finition to the concept of status<br />
was R. Linton (1936). He <strong>de</strong>fined status simply as a position in a social<br />
system. Eventually one occupies the statuses son or daughter, playmate,<br />
pupil, husband, mother bread-winner, cricket fan, and so on, one has as<br />
many statuses as there are groups of which one is a member. For analytical<br />
purposes, statuses are divi<strong>de</strong>d into two basic types: ascribed and achieved.<br />
Ascribed statuses are those which are fixed for an individual at birth.<br />
Ascribed statuses that exist in all societies inclu<strong>de</strong> those based upon sex,<br />
age, race, ethnic group and family background. Achieved statuses are<br />
those which the individual acquires during his or her lifetime as a result of<br />
the exercise of knowledge, ability, skill and/or perseverance. In other<br />
words achieved status is when people are placed in the stratification<br />
structure based on their individual merits or achievements. This status can<br />
be achieved through education, occupation, and marital status. Their place<br />
within the stratification structure is <strong>de</strong>termined by society's bar, which<br />
often judges them on success, success being financial, aca<strong>de</strong>mic, and<br />
political and so on. America most commonly uses this form of status with<br />
jobs. The higher you are in rank the better off you are and the more control<br />
you have over your co-workers.<br />
Societies vary in both the number of statuses that are ascribed and<br />
achieved and in the rigidity with which such <strong>de</strong>finitions are held. Both<br />
ascribed and achieved statuses exist in all societies and these are directly<br />
related to the stratification of society that <strong>de</strong>scribes the way people are<br />
placed in society. It is associated with the ability of individuals to live up<br />
to some set of i<strong>de</strong>als or principles regar<strong>de</strong>d as important by the society or<br />
some social group within it. The German sociologist Max Weber<br />
<strong>de</strong>veloped a theory proposing that stratification is based on three factors<br />
that have become known as "the three p's of stratification": property (i.e.<br />
material possessions), prestige (respect) and power (i.e. ability to do what<br />
one wants, regardless of the will of others). These factors all together or<br />
one by one can show the position of a person in the society. For example, a<br />
teacher may have a high status because of the prestige of the profession<br />
while having no propriety or power.<br />
47
In relation to the stratification of society is elaborated and i<strong>de</strong>a of<br />
status groups. Status groups are communities that are based on i<strong>de</strong>as of<br />
proper lifestyles and the honor given to people by others. These groups<br />
only exist because of people's i<strong>de</strong>as of prestige or dishonor. Also, people<br />
in these communities are only supposed to associate with people of like<br />
status, and all other people are looked at as inferiors. Thus human are<br />
likely to interact with people with the same personal income, the same<br />
political views/position, the same religion, nationality, race or social class.<br />
Status can be changed through a process of social mobility,<br />
un<strong>de</strong>rstood as change of position within the stratification system. A move<br />
in status can be upward (upward mobility), or downward (downward<br />
mobility). Social mobility allows a person to move to another social status<br />
other than the one he or she was born in. Social mobility is more frequent<br />
in societies where achievement rather than ascription is the primary basis<br />
for social status.<br />
The term social role is borrowed by social scientists originally<br />
from the Greek Drama. Greek actors wore masks when they performed in<br />
their drama. This leads us directly to the <strong>de</strong>finition of the concept of social<br />
role. A social role is a set of social norms that govern a person's behavior<br />
in a group and <strong>de</strong>termine his relationships with other group members. Put<br />
somewhat differently a role is the expected pattern of behavior associated<br />
with a given social status. Status and role are reciprocal aspects of the<br />
same phenomenon. Status, or position, is the static aspect that fixes the<br />
individual's position in a group; role is the dynamic behavioral aspect that<br />
<strong>de</strong>fines how the person who occupies the status should behave in different<br />
situations. Each of the statuses involves a role, set of behavior or actionpatterns<br />
that people belonging to a given status are expected to perform.<br />
One plays as many roles as he has statuses. A given man may both<br />
concurrently and sequentially enact the roles of husband, father breadwinner,<br />
and football fan and so on.<br />
Social roles may be linked to blue-prints for behavior that are<br />
han<strong>de</strong>d to the individual, hypothetically, when he becomes a member of a<br />
group. As such these constitute the group's expectations concerning how<br />
one would behave. Thus, whereas the status of a person tells us what he is,<br />
his role will tell us what he does as a member of a status group. There are<br />
no roles without statuses and no statuses without roles. In<strong>de</strong>ed, there are<br />
some exceptions. Though all statuses imply some role or roles, it is not<br />
always possible to infer people's statuses from what they do, as for<br />
48
example, two persons, who bear the title of knighthood and thus holding<br />
same social positions, might be performing completely different roles.<br />
Also, many statuses are wholly or partly <strong>de</strong>fined with reference to roles<br />
which their occupants are expected to perform. For example policemen,<br />
poets, etc.<br />
As was said above a person can play simultaneously many roles,<br />
but in or<strong>de</strong>r to play any role, individuals must meet certain conditions, for<br />
instance biological or sociological. A boy cannot take the biological role<br />
of mother because of biological reason as well as a doctor cannot practice<br />
medicine without certificate (social reason). The role achievement and<br />
<strong>de</strong>velopment can be also influenced by a additional factors. Some of them<br />
ate as follow:<br />
Societal factor: The structure of society often forms individuals<br />
into certain roles based on the social situations they choose to experience.<br />
Parents enrolling their children in certain programs at a young age increase<br />
the chance that the child will follow that role.<br />
Genetic predisposition: People take on roles that come naturally to<br />
them. Those with athletic ability generally take on roles of athletes. Those<br />
with mental genius often take on roles <strong>de</strong>voted to education and<br />
knowledge. This does not mean that people must choose only one path,<br />
multiple roles can be taken on by each individual<br />
Cultural influence: Different cultures place different values on<br />
certain roles based on their lifestyle. For instance, soccer players are<br />
regar<strong>de</strong>d higher in European countries than in the United States, where<br />
soccer is less popular.<br />
Situational influence: Roles can be created or altered based on the<br />
situation a person is put in outsi<strong>de</strong> their own influence. For instance a<br />
person must assume the role of lea<strong>de</strong>r even such a position is improper for<br />
his personality.<br />
In many case a person performs many roles consistently, but there<br />
are situations in which it is not possible, there are situation when one is<br />
forced to take on two different and incompatible roles at the same time.<br />
This situation is called the situation of role conflict. For example, a person<br />
may find conflict between her role as a mother and her role as an<br />
employee of a company when her child's <strong>de</strong>mands for time and attention<br />
distract her from the needs of her employer.<br />
49
3.3. Health Care as a Social System<br />
As <strong>de</strong>fine above in the first paragraph an institution is a term that<br />
refers to any structure or mechanism of social or<strong>de</strong>r and cooperation<br />
governing the behavior of a set of individuals within a given human<br />
community for acquiring a purpose important to a society as a hole. The<br />
interaction of these structures and mechanisms (i.e. institutions) constitute<br />
social systems. In the light of this <strong>de</strong>finition medicine is a system or is a<br />
form of organization of activity directed towards health improvement.<br />
World Medical Organization <strong>de</strong>fines a Health System as the structured and<br />
interrelated set of all actors and institutions contributing to health<br />
improvement. "A health system consists of all organizations, people and<br />
actions whose primary intent is to promote, restore or maintain health.<br />
This inclu<strong>de</strong>s efforts to influence <strong>de</strong>terminants of health as well as more<br />
direct health-improving activities…”<br />
Medical organization<br />
Medical organization is an institution that provi<strong>de</strong>s preventive,<br />
curative, promotional or rehabilitative health care services in a systematic<br />
way to individuals, families or communities. Among medical organization<br />
can be listed: Hospital, Health care centre, Medical nursing home,<br />
Pharmacies and drug stores, Medical laboratory and research etc.<br />
A hospital is an institution for health care providing patient<br />
treatment by specialized staff and equipment, and often, but not always<br />
providing for inpatient care (is the care of patients whose condition<br />
requires admission to a hospital) or longer-term patient stays. Today,<br />
hospitals are usually fun<strong>de</strong>d by the public sector, by health organizations<br />
(for profit or nonprofit), health insurance companies or charities, including<br />
by direct charitable donations. Historically, however, hospitals were often<br />
foun<strong>de</strong>d and fun<strong>de</strong>d by religious or<strong>de</strong>rs or charitable individuals and<br />
lea<strong>de</strong>rs.<br />
Health care centers, including clinics (i.e. health care facility that<br />
is primarily <strong>de</strong>voted to the care of outpatients) and ambulatory surgery<br />
centers (i.e. health care centers where surgical procedures not requiring an<br />
overnight hospital stay are performed), serve as first point of contact with<br />
a health professional and provi<strong>de</strong> outpatient medical, nursing, <strong>de</strong>ntal and<br />
other types of care services.<br />
Medical nursing homes, including resi<strong>de</strong>ntial treatment centers<br />
(i.e. live-in health care facility providing therapy for substance abuse,<br />
50
mental illness, or other behavioral problems) and geriatric care facilities<br />
(i.e. el<strong>de</strong>r care management), are health care institutions which have<br />
accommodation facilities and which engage in providing short-term or<br />
long-term medical treatment of a general or specialized nature not<br />
performed by hospitals to inpatients with any of a wi<strong>de</strong> variety of medical<br />
conditions.<br />
Pharmacies and drug stores comprise establishments engaged in<br />
retailing prescription or nonprescription drugs and medicines, and other<br />
types of medical goods. Regulated pharmacies may be based in a hospital<br />
or clinic or they may be privately operated, and are usually staffed by<br />
pharmacists, pharmacy technicians and pharmacy ai<strong>de</strong>s.<br />
A medical laboratory or clinical laboratory is a laboratory where<br />
tests are done on biological specimens in or<strong>de</strong>r to get information about<br />
the health of a patient. Such laboratories may be divi<strong>de</strong>d into categorical<br />
<strong>de</strong>partments such as microbiology, hematology, clinical biochemistry,<br />
immunology, serology, histology, cytology, cytogenetics, or virology. In<br />
many countries, there are two main types of labs that process the majority<br />
of medical specimens. Hospital laboratories are attached to a hospital, and<br />
perform tests on these patients. Private or community laboratories receive<br />
samples from general practitioners, insurance companies, and other health<br />
clinics for analysis.<br />
Health care practitioners<br />
Health care practitioner is an individual or an institution that<br />
provi<strong>de</strong>s preventive, curative, promotional or rehabilitative health care<br />
services in a systematic way to individuals, families or communities.<br />
Health care practitioners inclu<strong>de</strong> physicians (including general<br />
practitioners and specialists), <strong>de</strong>ntists, physical therapists, audiologists,<br />
speech pathologists, physician assistants, nurses, midwives,<br />
pharmacologists/pharmacists, dietitians, therapists, psychologists,<br />
chiropractors, clinical officers, phlebotomists, occupational therapists,<br />
optometrists, emergency medical technicians, paramedics, medical<br />
laboratory technicians, medical prosthetic technicians, radiographers,<br />
social workers, and a wi<strong>de</strong> variety of other human resources trained to<br />
provi<strong>de</strong> some type of health care service. They often work in hospitals,<br />
health care centers and other service <strong>de</strong>livery points, but also in aca<strong>de</strong>mic<br />
training, research and administration. Some provi<strong>de</strong> care and treatment<br />
services for patients in private homes. Many countries have a large number<br />
51
of community health workers who work outsi<strong>de</strong> of formal health care<br />
institutions. Managers of health care services, medical records and health<br />
information technicians, and other assistive personnel and support workers<br />
are also consi<strong>de</strong>red a vital part of health care teams.<br />
In what will follow is clarified the significance of basic terms<br />
assigned to health givers.<br />
A physician also known as medical practitioner, doctor of<br />
medicine, medical doctor, or simply doctor — is a person which practices<br />
the ancient profession of medicine, which is concerned with maintaining<br />
or restoring human health through the study, diagnosis, and treatment of<br />
disease or injury. This properly requires both a <strong>de</strong>tailed knowledge of the<br />
aca<strong>de</strong>mic disciplines (such as anatomy and physiology) un<strong>de</strong>rlying<br />
diseases and their treatment — the science of medicine — and also a<br />
<strong>de</strong>cent competence in its applied practice — the art or craft of medicine.<br />
The word physician comes from the Ancient Greek word φύσις<br />
(physis) and its <strong>de</strong>rived adjective physikos, meaning "nature" and<br />
"natural". From this, amongst other <strong>de</strong>rivatives came the Vulgar Latin<br />
physicus, which meant a medical practitioner. After the Norman Conquest,<br />
the word entered Middle English, via Old French fisicien, as early as 1100.<br />
Originally, physician meant a practitioner of physic (pronounced with a<br />
hard C). This archaic noun had entered Middle English by 1300 (via Old<br />
French fisique). Physic meant the art or science of treatment with drugs or<br />
medications (as opposed to surgery), and was later used both as a verb and<br />
also to <strong>de</strong>scribe the medications themselves.<br />
In mo<strong>de</strong>rn English, the term physician is used in two main ways,<br />
with relatively broad and narrow meanings respectively. This is the result<br />
of history and is often confusing. These meanings and variations are<br />
explained below.<br />
Especially in North America, the title physician is now wi<strong>de</strong>ly<br />
used in the broad sense, and applies to any medical practitioner holding a<br />
medical <strong>de</strong>gree. In the United States and Canada, the term physician<br />
usually <strong>de</strong>scribes all those holding the <strong>de</strong>grees of Doctor of Medicine<br />
(MD) and Doctor of Osteopathic Medicine (DO). Within North America,<br />
the title physician, in this broad sense, also <strong>de</strong>scribes the hol<strong>de</strong>rs of<br />
medical <strong>de</strong>grees from other countries that are equivalent to the North<br />
American Doctor of Medicine <strong>de</strong>grees; typical examples of such <strong>de</strong>grees<br />
from Commonwealth countries are MB BS, MB BChir etc.<br />
52
Physician is still wi<strong>de</strong>ly used in its ol<strong>de</strong>r, narrower sense,<br />
especially outsi<strong>de</strong> North America. In this usage, a physician is a specialist<br />
in internal medicine or one of its many sub-specialties (especially as<br />
opposed to a specialist in surgery). This traditional meaning of physician<br />
conveys a sense of expertise in treatment by drugs or medications, rather<br />
than by the procedures of surgeons.<br />
Currently, a specialist physician in this ol<strong>de</strong>r, narrower sense<br />
would probably be <strong>de</strong>scribed in the United States as an internist. Another<br />
term, hospitalist, was introduced in 1996, to <strong>de</strong>scribe US specialists in<br />
internal medicine who work largely or exclusively in hospitals. Such<br />
'hospitalists' now make up about 19% of all US general internists, who are<br />
often called general physicians in Commonwealth countries.<br />
The ol<strong>de</strong>r, more narrow usage of physician as an internist is<br />
common in the United Kingdom and other Commonwealth countries (such<br />
as Australia, Bangla<strong>de</strong>sh, India, New Zealand, Pakistan, South Africa, Sri<br />
Lanka, Zimbabwe), as well as in places as diverse as Brazil, Hong Kong,<br />
Indonesia, Japan, Ireland, and Taiwan. In such places, the more general<br />
English terms doctor or medical practitioner are prevalent, <strong>de</strong>scribing any<br />
practitioner of medicine (whom an American would likely call a physician,<br />
in the newer, broad sense). In Commonwealth countries, specialist<br />
pediatricians and geriatricians are also <strong>de</strong>scribed as specialist physicians<br />
who have sub-specialized by age of patient rather than by organ system.<br />
Nurse practitioners (NPs) are not <strong>de</strong>scribed as physicians; the<br />
American College of Nurse Practitioners do not <strong>de</strong>scribe themselves this<br />
way. They are classified as advance practice registered nurses/clinicians,<br />
and are also known as mid-level (healthcare) practitioners in US<br />
government regulations. Nurse practitioners may perform work similar to<br />
that of physicians, especially within the realm of primary care, but use<br />
advanced nursing mo<strong>de</strong>ls instead of medical mo<strong>de</strong>ls. A nurse is a<br />
healthcare professional who, in collaboration with other members of a<br />
health care team, is responsible for: treatment, safety, and recovery of<br />
acutely or chronically ill individuals; health promotion and maintenance<br />
within families, communities and populations; and, treatment of lifethreatening<br />
emergencies in a wi<strong>de</strong> range of health care settings. Nurses<br />
perform a wi<strong>de</strong> range of clinical and non-clinical functions necessary to<br />
the <strong>de</strong>livery of health care, and may also be involved in medical and<br />
nursing research.<br />
53
The scope of practice for a Nurse Practitioner in the United States<br />
is <strong>de</strong>fined by individual state boards of registration in nursing, as opposed<br />
to state boards of registration in medicine. Physician Assistants are also<br />
classified as midlevel advance practice clinicians, have a similar scope of<br />
practice as nurse practitioners, and are regulated by state boards of<br />
registration in medicine.<br />
A paramedic is a medical professional, usually a member of the<br />
emergency medical services, who primarily provi<strong>de</strong>s pre-hospital<br />
advanced medical and trauma care. A paramedic is charged with providing<br />
emergency on-scene treatment, crisis intervention, life-saving stabilization<br />
and transport of ill or injured patients to <strong>de</strong>finitive emergency medical and<br />
surgical treatment facilities, such as hospitals and trauma centers.<br />
The use of the specific term paramedic varies by jurisdiction, and<br />
in some places is used to refer to any member of an ambulance crew. In<br />
countries such as Canada and South Africa, the term paramedic is used as<br />
the job title for all EMS personnel, who are then distinguished by the<br />
terms primary or basic (e.g. Primary Care Paramedic) intermediate, or<br />
advanced (e.g. Advanced Care Paramedic). This approach may be<br />
completely appropriate in such jurisdictions, where primary care staff<br />
receive more than double the classroom and clinical training of an EMT,<br />
and in fact more than those in some jurisdictions permitted by law to call<br />
themselves paramedics. In countries such as the United States and the<br />
United Kingdom, the use of the word paramedic is restricted by law, and<br />
the person claiming the title must have passed a specific set of<br />
examinations and clinical placements, and hold a valid registration (in the<br />
UK, with the Health Professions Council), certification, or license with a<br />
governing body. Even in countries where the law restricts the title, lay<br />
persons may incorrectly refer to all emergency medical personnel as<br />
'paramedics', even if they officially hold a different qualification, such as<br />
emergency medical technician - basic.<br />
Pharmacists are health professionals who practice the science of<br />
pharmacy. In their traditional role, pharmacists typically take a request for<br />
medicines from a prescribing health care provi<strong>de</strong>r in the form of a medical<br />
prescription, evaluate the appropriateness of the prescription, dispense the<br />
medication to the patient and counsel them on the proper use and adverse<br />
effects of that medication. In this role pharmacists act as a learned<br />
intermediary between physicians and patients and thus ensure the safe and<br />
effective use of medications. Pharmacists also participate in disease-state<br />
54
management, where they optimize and monitor drug therapy or interpret<br />
medical laboratory results – in collaboration with physicians and/or other<br />
health professionals. Advances into prescribing medication and in<br />
providing public health advices and services are occurring in Britain as<br />
well as the United States and Canada. Pharmacists have many areas of<br />
expertise and are a critical source of medical knowledge in clinics,<br />
hospitals, medical laboratory and community pharmacies throughout the<br />
world. Pharmacists also hold positions in the pharmaceutical industry as<br />
well as in pharmaceutical education and research and <strong>de</strong>velopment<br />
institutions.<br />
In much of the United Kingdom and the British Commonwealth<br />
pharmacists are customarily sometimes referred to as chemist (or<br />
dispensing chemists), a usage which can, especially without a context<br />
relating to the sale or supply of medicines, cause confusion with scientists<br />
in the field of chemistry. This term is a historical one, since some<br />
pharmacists passed an examination in Pharmaceutical Chemistry (PhC) set<br />
by the then Pharmaceutical Society of Great Britain in 1852 and these<br />
were known as "Pharmaceutical Chemists". This title is protected by the<br />
Medicines Act 1968 section 78.<br />
Notion of Patient<br />
The word patient originally meant 'one who suffers'. This English<br />
noun comes from the Latin word patiens, the present participle of the<br />
<strong>de</strong>ponent verb, patior, meaning 'I am suffering,' and akin to the Greek verb<br />
πάσχειν (= paskhein, to suffer) and its cognate noun πάθος (= pathos).<br />
A patient is any person who receives medical attention, care, or<br />
treatment. The person is most often ill or injured and in need of treatment<br />
by a physician or other health care professional, although one who is<br />
visiting a physician for a routine check-up may also be viewed as a patient.<br />
Nowadays we can mentioned several types of patients.<br />
An outpatient is a patient who is not hospitalized overnight but<br />
who visits a hospital, clinic, or associated facility for diagnosis or<br />
treatment. Treatment provi<strong>de</strong>d in this fashion is called ambulatory care.<br />
Outpatient can be met even in surgery. Outpatient surgery eliminates<br />
inpatient hospital admission, reduces the amount of medication prescribed,<br />
and uses a doctor's time more efficiently. More procedures are now being<br />
performed in a surgeon's office, termed office-based surgery, rather than in<br />
an operating room. Outpatient surgery is suited best for healthy people<br />
55
un<strong>de</strong>rgoing minor or intermediate procedures (limited urologic,<br />
ophthalmologic, or ear, nose, and throat procedures and procedures<br />
involving the extremities).<br />
An inpatient on the other hand is "admitted" to the hospital and<br />
stays overnight or for an in<strong>de</strong>terminate time, usually several days or weeks<br />
(though some cases, like coma patients, have been in hospitals for years).<br />
Due to concerns such as dignity, human rights and political<br />
correctness, the term "patient" is not always used to refer to a person<br />
receiving health care. Other terms that are sometimes used inclu<strong>de</strong> health<br />
consumer, health care consumer or client. These may be used by<br />
governmental agencies, insurance companies, patient groups, or health<br />
care facilities. Individuals who use or have used psychiatric services may<br />
alternatively refer to themselves as consumers, users, or survivors.<br />
In nursing homes and assisted living facilities, the term resi<strong>de</strong>nt is<br />
generally used in lieu of patient, but it is not uncommon for staff members<br />
at such a facility to use the term patient in reference to resi<strong>de</strong>nts. Similarly,<br />
those receiving home health care are called clients.<br />
The term 'virtual patient' is used to <strong>de</strong>scribe interactive computer<br />
simulations used in health care education. Virtual patients allow the<br />
learner to take the role of a health care professional and <strong>de</strong>velop clinical<br />
skills such as making diagnoses and therapeutic <strong>de</strong>cisions The use of<br />
virtual patient programs is increasing in healthcare education, partly in<br />
response to increasing <strong>de</strong>mands on health care professionals and education<br />
of stu<strong>de</strong>nts but also because they allow opportunity for stu<strong>de</strong>nts to practice<br />
in a safe environment. There are many different formats a virtual patient<br />
may take. However the overarching principle is that of interactivity - a<br />
virtual patient will have mechanisms for the learner to interact with the<br />
case and material or information is ma<strong>de</strong> available to the learner as they<br />
complete a range of learning activities.<br />
Medical procedures<br />
A medical procedure is a course of action inten<strong>de</strong>d to achieve a<br />
result in the care of persons with health problems. Medical procedure also<br />
is <strong>de</strong>fine as the act or conduct of diagnosis, treatment, or operation.<br />
Diagnosis (from ancient Greek διάγνωσις = discernment) is the<br />
i<strong>de</strong>ntification of the nature and cause of anything. Diagnosis is used in<br />
many different disciplines. In medicine diagnosis is establishment of the<br />
nature and cause of patient’s illness. A patient typically presents a set of<br />
56
complaints (the symptoms) to the physician, who then obtains further<br />
information about the patient's symptoms, previous state of health, living<br />
conditions, and so forth. The physician then makes a review of systems<br />
(ROS) or systems inquiry, which is a set of or<strong>de</strong>red questions about each<br />
major body system in or<strong>de</strong>r: general (such as weight loss), endocrine,<br />
cardio-respiratory, etc. Next comes the actual physical examination and<br />
often laboratory tests; the findings are recor<strong>de</strong>d, leading to a list of<br />
possible diagnoses. These will be investigated in or<strong>de</strong>r of probability.<br />
Therapy (in Greek: θεραπεία), or treatment, is the attempted<br />
remediation of a health problem, usually following a diagnosis. In the<br />
medical field, it is synonymous with the word "treatment". A supportive<br />
therapy is one that does not treat or improve the un<strong>de</strong>rlying condition, but<br />
instead increases the patient's comfort. Supportive treatment may be<br />
palliative care.<br />
A therapeutic effect is a consequence of a particular treatment<br />
which is judged to be <strong>de</strong>sirable and beneficial. This is true whether the<br />
result was expected, unexpected, or even an uninten<strong>de</strong>d consequence of<br />
the treatment. In talk therapy a therapeutic effect can be brought on by<br />
insight from the client that is caused by the clinician asking thoughtful and<br />
discerning questions regarding the past and/or present moment. Freud's<br />
main purpose in therapy was to make the unconscious conscious.<br />
A treatment treats a problem, and may lead to its cure, but<br />
treatments more often ameliorate a problem only for as long as the<br />
treatment is continued. For example, there is no cure for AIDS, but<br />
treatments are available to slow down the harm done by HIV and <strong>de</strong>lay the<br />
fatality of the disease. Treatments don't always work. For example,<br />
chemotherapy is a treatment for some types of some cancers, which may in<br />
some cases enact a cure, but not in all cases for all cancers.<br />
Cures are a subset of treatments that reverse illnesses completely<br />
or end medical problems permanently. A cure is the end of a medical<br />
condition. The term may refer specifically to a substance or procedure that<br />
ends the medical condition, such as a medication, a surgical operation, a<br />
change in lifestyle, or even a philosophical mindset that helps a person<br />
suffer. It may also refer to the state of being healed, or cured.<br />
The proportion of people with a disease that are cured by a given<br />
treatment, called the cure fraction or cure rate, is <strong>de</strong>termined by<br />
comparing disease-free survival of treated people against a matched<br />
control group that never had the disease. If everyone treated for a disease<br />
57
is cured, then they will all remain disease-free and live as long as any<br />
person that never had the disease.<br />
Inherent in the i<strong>de</strong>a of a cure is the permanent end to the specific<br />
instance of the disease. When a person has the common cold, and then<br />
recovers from it, the person is said to be cured, even though the person<br />
might someday catch another cold. Conversely, a person that has<br />
successfully managed a disease, such as diabetes mellitus, so that it<br />
produces no un<strong>de</strong>sirable symptoms for the moment, but without actually<br />
permanently ending it, is not cured.<br />
Remission is the state of absence of disease activity in patients<br />
with known chronic illness that cannot be cured. It is commonly used to<br />
refer to absence of active cancer or inflammatory bowel disease when<br />
these diseases are expected to manifest again in the future. The term can<br />
be used incorrectly with mental illness when the illness is un<strong>de</strong>r control. A<br />
partial remission may be <strong>de</strong>fined for cancer as 50% or greater reduction in<br />
the measurable parameters of tumor growth as may be found on physical<br />
examination, radiologic study, or by biomarker levels from a blood or<br />
urine test. A complete remission is <strong>de</strong>fined as complete disappearance of<br />
all such manifestations of disease. Each disease or even clinical trial can<br />
have its own <strong>de</strong>finition of a partial remission.<br />
Prevention is another important medical action it is a way to avoid<br />
an injury, sickness, or disease in the first place, and generally it will not<br />
help someone who is already ill (though there are exceptions). For<br />
instance, many babies and young children are vaccinated against polio and<br />
other infectious diseases, which prevent them from contracting polio. But<br />
the vaccination does not work on patients who already have polio. A<br />
treatment or cure is applied after a medical problem has already started.<br />
3.4. The Social Role of Doctors and Patients<br />
The doctor-patient relationship is central to the practice of<br />
healthcare and is essential for the <strong>de</strong>livery of high-quality health care in<br />
the diagnosis and treatment of disease. The quality of the patient-physician<br />
relationship is important to both parties. The better the relationship in<br />
terms of mutual respect, knowledge, trust, shared values and perspectives<br />
about disease and life, and time available, the better will be the amount<br />
and quality of information about the patient's disease transferred in both<br />
directions, enhancing accuracy of diagnosis and increasing the patient's<br />
knowledge about the disease. Where such a relationship is poor the<br />
58
physician's ability to make a full assessment is compromised and the<br />
patient is more likely to distrust the diagnosis and proposed treatment.<br />
Doctor - patient relationship can be analyzed in different manners.<br />
Sociologists conceptualized it in context of social roles. As was exposed<br />
above social role is un<strong>de</strong>rstood as the expected behaviors (including) of<br />
someone with a given position (status) in society towards others with the<br />
same or other status. Accordingly the relation between doctor and patient<br />
is an ensemble of rights and obligations of doctor towards patient as well<br />
as vice versa. The first who <strong>de</strong>fine the doctor-patient relationship in term<br />
of social role was Talcott Parsons (1951). He consi<strong>de</strong>r that the illness is a<br />
form of dysfunctional <strong>de</strong>viance that requires reintegration with the social<br />
organism. Illness, or feigned illness, exemptes people from work and other<br />
responsibilities, and thus is potentially <strong>de</strong>trimental to the social or<strong>de</strong>r if<br />
uncontrolled. Maintaining the social or<strong>de</strong>r required the <strong>de</strong>velopment of a<br />
legitimized "sick role" to control this <strong>de</strong>viance, and make illness a<br />
transitional state back to normal role performance. In Western society,<br />
there are four norms (rights and obligations) governing the functional sick<br />
role.<br />
Rights:<br />
(1) The sick person is exempt from “normal” social roles. An<br />
individual’s illness is grounds for his or her exemption from normal role<br />
performance and social responsibilities. This exemption, however, is<br />
relative to the nature and severity of the illness. The more severe the<br />
illness, the greater the exemption. Exemption requires legitimating by the<br />
physician as the authority on what constitutes sickness. Legitimating<br />
serves the social function of protecting society against malingering<br />
(attempting to remain in the sick role longer than social expectations allow<br />
– usually done to acquire secondary gains, or additional privileges<br />
affor<strong>de</strong>d to ill persons).<br />
(2) The sick person is not responsible for his or her<br />
condition. An individual’s illness is usually thought to be beyond his or<br />
her own control. A morbid condition of the body needs to be changed and<br />
some curative process apart from person will power or motivation is<br />
nee<strong>de</strong>d to get well.<br />
59
Obligations:<br />
(1) The sick person should try to get well. The first two<br />
aspects of the sick role are conditional upon the third aspect, which is<br />
recognition by the sick person that being sick is un<strong>de</strong>sirable. Exemption<br />
from normal responsibilities is temporary and conditional upon the <strong>de</strong>sire<br />
to regain normal health. Thus, the sick person has an obligation to get<br />
well.<br />
(2) The sick person should seek technically competent help<br />
and cooperate with the physician. The obligation to get well involves a<br />
further obligation on the part of the sick person to seek technically<br />
competent help, usually from a physician. The sick person is also expected<br />
to cooperate with the physician in the process of trying to get well.<br />
What are the rights and obligations of physician? The physician's<br />
role is to represent and communicate these norms to the patient to control<br />
their <strong>de</strong>viance. Physicians exemplify the shift to "affect-neutral"<br />
relationships in mo<strong>de</strong>rn society, with physician and patient being protected<br />
by emotional distance. Medical education and social role expectations<br />
impart normative socialization to physicians to act in the interests of the<br />
patient rather than their own material interests, and to be gui<strong>de</strong>d by an<br />
egalitarian universalism rather than a personalized particularism. Because<br />
physicians have mastered a body of technical knowledge, it is functional<br />
for the social or<strong>de</strong>r to allow physicians professional autonomy and<br />
authority, controlled by their socialization and role expectations.<br />
Summarizing we can say that the physician’s role inclu<strong>de</strong>s following<br />
norms:<br />
Rights or privileges:<br />
(1)access to patient’s physical and personal intimacy;<br />
(2)professional autonomy;<br />
(3)professional dominance.<br />
Obligations<br />
(1)Acting for the benefit of patient’s well-being (orientation<br />
towards collective and not personal interest);<br />
(2)Behavior according to professional rules (universality/to treat<br />
all in the same way/ vs. particularity);<br />
(3)Application to a high <strong>de</strong>gree of acquired knowledge and skills<br />
to treatment of disease;<br />
60
(4)Objectivity and emotional neutrality /do not adjudicate the<br />
patient or make them closer than it is requested by the principles of<br />
objectivity/.<br />
Parsons mention the i<strong>de</strong>a of asymmetric physician dominance in<br />
relation with sick person. The features of this dominance are following:<br />
1. Higher status and power;<br />
2. Professional prestige;<br />
3. Situational physician authority, a monopoly over what the<br />
patient wants: since <strong>de</strong>mand exceeds supply;<br />
4. Physician is advantageous because the patient has to come to<br />
him;<br />
5. Situational <strong>de</strong>pen<strong>de</strong>ncy to receive medical care, the patient has<br />
to consent to condition prescribed by physician.<br />
Thus, the role of doctor is an active but the role of patient is<br />
passive one.<br />
Talcott Parsons have a great contribution in analyses of doctorpatient<br />
relationships as a relation of roles. Firstly because creates an<br />
original conception on it and secondly because his conception stimulates<br />
other sociologists to formulate different approaches to the doctor- patient<br />
relation, essentially via criticism to this original conception. The main<br />
these approaches being exposed below.<br />
Thus, Hafferty (1988) accuses Parson of having been overly<br />
optimistic about the success of physician socialization to universalism and<br />
affective-neutrality. Physicians often react negatively to dying patients,<br />
patients they do not like, and patients they believe are complainers.<br />
Physicians also are subject to personal financial and personal interests in<br />
patient care. Kelly (1987) consi<strong>de</strong>rs that while the basic notion that norms<br />
and social roles influence illness and doctoring has remained robust, there<br />
have been numerous qualifications to the particular elements that Parsons<br />
attributed to the patient-physician role relationship. For instance,<br />
physicians and the public consi<strong>de</strong>r some illnesses in the West and in other<br />
societies to be the responsibility of the ill, such as lung cancer, AIDS and<br />
obesity, making it more difficult for them to be normatively reintegrated<br />
into society. Physicians and other provi<strong>de</strong>rs react less favorably to patients<br />
who are held responsible for their illness than to "innocent" patients.<br />
Another weakness of Parsons' <strong>de</strong>scription is that it was specific to<br />
acute illness, and did not speak to the increasingly prevalent chronic<br />
illnesses and disabilities, a sick role which is permanent and not<br />
61
transitional. Szasz and Hollen<strong>de</strong>r's (1956) work refined Parsons by<br />
elaborating different doctor-patient mo<strong>de</strong>ls arising around different types<br />
of illness:<br />
(1) Patient passivity and physician assertiveness are the most<br />
common reactions to acute illness;<br />
(2) Less acute illness is characterized by physician guidance and<br />
patient cooperation;<br />
(3) Chronic illness is characterized by physicians participating in a<br />
treatment plan where patients had the bulk of the<br />
responsibility to help themselves.<br />
Critics have also shown that there is a great <strong>de</strong>al of inter-cultural<br />
and inter-personal variation in sick roles and norms. The "American" sick<br />
role is not as useful a concept as the more specific "white, Midwestern,<br />
Scandinavian, male" sick role. There is also cross-class variation. Some of<br />
the poor adapt to their lack of access to medical care by becoming<br />
fatalistic, rejecting the necessity of medical treatment, and coming to see<br />
illness and <strong>de</strong>ath as inevitable. On the other hand, the educated classes<br />
have become more assertive in the relationship, rejecting the norm of<br />
passivity in favor of self-diagnosis or negotiated diagnosis. There is also<br />
inter-cultural variation in physician roles, and variation among physicians<br />
in the success of their role socialization. While Parsons' mo<strong>de</strong>l of doctors'<br />
affective neutrality, collective-orientation, and egalitarianism towards<br />
patients did express the professional i<strong>de</strong>al, some physicians are more<br />
affectively neutral than others. Following Parsons' lead, some sociologists<br />
began to focus on the socialization (professionalization) of physicians and<br />
the factors in medical school and resi<strong>de</strong>ncy that facilitated or discouraged<br />
optimal role socialization to doctor-patient relationships.<br />
Thus, Conrad (1989) consi<strong>de</strong>rs that the Parsons’ work generally<br />
took the division of labor in medicine for granted, and painted a more or<br />
less heroic picture of medical self-sacrifice. Beginning to focus on aspects<br />
of the physician role and medical education which themselves militated<br />
against humanistic patient care he suggested that medical schools and<br />
resi<strong>de</strong>ncies socialized physicians into "<strong>de</strong>humanization," and to place<br />
professional i<strong>de</strong>ntity and camara<strong>de</strong>rie before patient advocacy and social<br />
i<strong>de</strong>alism.<br />
James "J." Hughes consi<strong>de</strong>rs that the most important weakness of<br />
Parsons' functionalist account of the doctor-patient relationship arose from<br />
his poor un<strong>de</strong>rstanding of the ecological concepts of dysfunction and niche<br />
62
width. Social structures cannot be assumed to be functional for the social<br />
system simply because they exist, any more than an organic structure, such<br />
as an appendix, can be assumed to be functional for its organism. All that<br />
can be said about a structure, or in this case a role relationship, is that it<br />
has not yet pushed the organism outsi<strong>de</strong> its niche, causing its extinction. In<br />
other words, the study of doctor-patient relationships in one society does<br />
not indicate how many the particular structures and norms of the provi<strong>de</strong>rpatient<br />
relationship are simply the result of historical chance, rather than<br />
necessitated by the nature of illness and healing in industrial society. And<br />
second, such a study does not indicate whether the particular practices and<br />
norms are leading in a dysfunctional direction. A critical sociology of the<br />
doctor-patient relationship thus arose to challenge the internal<br />
contradictions of the Parsonsian biological metaphor: were American<br />
doctors the perfect immune system for society, or had they <strong>de</strong>veloped into<br />
a parasitic growth threatening the health of society?<br />
To the more critical 60's generation of social scientists, inspired by<br />
growing resistance to unjust claims to power, physicians' <strong>de</strong>fense of<br />
professional power and autonomy appeared to be merely self-interested<br />
authoritarianism. Physicians' battle-cry of the sacred nature of the doctorpatient<br />
relationship soun<strong>de</strong>d hollow in their struggles against universal<br />
health insurance. Physicians' high incomes and <strong>de</strong>fense of autonomy<br />
appeared to result in both bad medicine and bad health policy, and<br />
physician's unaccountable power appeared all the more nefarious because<br />
of medicine's intimate invasion of the body.<br />
In this context, Eliot Freidson's work (1961, 1970, 1975, 1986)<br />
crystallized the notion that professional power was more self-interested<br />
than "collectivity-oriented." Freidson saw the doctor-patient relationship<br />
as a bargained interface between a professional system and a lay system,<br />
each with its own interests and hence with the high potentiality of conflict.<br />
Freidson's approach to the sick role went beyond Parsons to assert that<br />
doctors create the legitimate categories of illness. Professionalization<br />
grants physicians a monopoly on the <strong>de</strong>finition of health and illness, and<br />
they use this power over diagnosis to extend their control. This control<br />
extends beyond the claim to technical proficiency in medicine, to claims of<br />
authority over the organization and financing of health care, areas which<br />
have little to do with their training.<br />
63
All these approaches mentioned above criticizing Parson’s vision,<br />
have expose the weaknesses of the relationship in concern but also suggest<br />
a historical evolution in patient and physician relation.<br />
The history of medicine has witnessed a gradual erosion of the<br />
physician's time-honored role as all-knowing healer. Whether physicians<br />
were experts in their fields, self-taught folk healers, or complete quacks,<br />
the doctor's words, for generations, were accepted as correct, complete,<br />
final, and to be obeyed. In<strong>de</strong>ed, the language of the 1847 Co<strong>de</strong> of Medical<br />
Ethics of the American Medical Association, titled "Obligations of<br />
Patients to Their Physicians", endorsed this paradigm: “The obedience of a<br />
patient to the prescriptions of his physician should be prompt and implicit.<br />
He should never permit his own cru<strong>de</strong> opinions as to their fitness, to<br />
influence his attention to them. A failure in one particular may ren<strong>de</strong>r an<br />
otherwise judicious treatment dangerous, and even fatal”.<br />
The patient was treated like a child; innocent, unschooled, and too<br />
simple to know how to take care of himself or herself. This wise fathersimple<br />
child relationship led to an inherently paternalistic mo<strong>de</strong>l of the<br />
physician-patient relationship.<br />
But while science and technology have filled medical books with<br />
more and more treatment options and diseases are better un<strong>de</strong>rstood, the<br />
instantaneous dissemination of news around the world has simultaneously<br />
ren<strong>de</strong>red the public hyper-aware of the new capabilities of medicine. As a<br />
result, patients have shifted from approaching physicians with hope and<br />
faith to approaching them with high expectations of precision, of speed, of<br />
a virtual superstore of treatment options.<br />
Patients have taken the reins of health care with both hands. They<br />
come to doctor's offices armed with reams of printouts from health Web<br />
sites. They specifically request medicines or treatments advertised in<br />
popular magazines, on television, and on the Internet. In response to this<br />
type of informed (though sometimes misinformed) patient, many<br />
physicians have come to grant a greater level of autonomy or shared<br />
<strong>de</strong>cision making to all the patients in their practices.<br />
A turning point in the shift from physician paternalism to respect<br />
for patient autonomy was the requirement for the patient's informed<br />
consent to treatment. The concept of informed consent did not exist in<br />
writings on Egyptian, Greek, or Roman medicine. In<strong>de</strong>ed, the phrase<br />
"informed consent" was not used until the 1950s. The notion of "consent<br />
to treatment" was a consequence of the Nuremberg Trials that later<br />
64
ecame enshrined in the research and treatment co<strong>de</strong>s of <strong>de</strong>mocratic<br />
nations.<br />
There have been major changes in the doctor-patient relationship<br />
over the past <strong>de</strong>ca<strong>de</strong>s; both from patients' and doctors' point of view. There<br />
is, in<strong>de</strong>ed, some evi<strong>de</strong>nce that changes in society and health care have<br />
resulted in real changes in what people expect from their doctors and in<br />
how doctors view patients. Many patients want more information than they<br />
are given. Many also say that they want to take an active part in <strong>de</strong>cisions<br />
about their treatment, in the light of its chances of success and any si<strong>de</strong><br />
effects. Concepts like 'patient empowerment', 'informed consent', 'shared<br />
<strong>de</strong>cision making' and 'consumerism' have been introduced to label this<br />
transformation of the patient role from that of passive <strong>de</strong>pen<strong>de</strong>ncy to<br />
active autonomy. According to the literature, the traditional paternalistic<br />
mo<strong>de</strong>l is no longer the only, nor the preferred doctor-patient relationship<br />
mo<strong>de</strong>l. There is a wi<strong>de</strong> consensus that a mo<strong>de</strong>l based on a more equal<br />
doctor-patient relationship is both beneficial for patients and more in<br />
keeping with current ethical views.<br />
Today, most procedures in a hospital are prece<strong>de</strong>d by explanations<br />
and discussions at the patient's bedsi<strong>de</strong> that make clear all the risks and<br />
benefits of the procedure. The consent conversation must be conducted by<br />
an MD, and the patient must be able to un<strong>de</strong>rstand what he or she is being<br />
asked to agree to.<br />
Reflecting the importance of informed consent in mo<strong>de</strong>rn health<br />
care, an opinion from the current AMA Co<strong>de</strong> of Ethics, on "Fundamental<br />
Elements of the Patient-Physician Relationship" states: "The patient has<br />
the right to make <strong>de</strong>cisions regarding the health care that is recommen<strong>de</strong>d<br />
by his or her physician. Accordingly, patients may accept or refuse any<br />
recommen<strong>de</strong>d medical treatment".<br />
As a physician, the doctor-patient relationship greatly impacts the<br />
approach to education, motivation, and negotiation of treatment plans. In<br />
literature are <strong>de</strong>scribed the following four mo<strong>de</strong>ls of the physician-patient<br />
relationship:<br />
Paternalistic - The physician is parental, recommending what<br />
he/she feels is best for the patient. The patient chooses whether or not to<br />
follow the recommendations.<br />
Informative - This is a "consumer" mo<strong>de</strong>l of care. The<br />
physician provi<strong>de</strong>s information about all available treatment choices in as<br />
65
accurate and as unbiased a manner as possible. The patient chooses from<br />
the available options.<br />
Interpretive - In this mo<strong>de</strong>l, the patient is not expected to<br />
simply choose among available options because he/she lacks medical<br />
training. Instead, the physician tries to un<strong>de</strong>rstand or interpret the patient’s<br />
general values and preferences. The physician then recommends the<br />
treatment option which is most consistent with the patient’s values.<br />
Deliberative - In this mo<strong>de</strong>l, part of the physician’s role is to<br />
promote health by influencing the patient’s health-related choices, using<br />
non-coercive approaches to motivate the patient.<br />
All these mo<strong>de</strong>l of doctor- patient interaction occur within the<br />
limits of professional sets of norms <strong>de</strong>signed to gui<strong>de</strong> the behavior in<br />
medical context. One of such a set of norm is A U.S. Patient's Bill of<br />
Rights is a statement of the rights to which patients are entitled as<br />
recipients of medical care. Typically, a statement articulates the positive<br />
rights which doctors and hospitals ought to provi<strong>de</strong> patients, thereby<br />
providing information, offering fair treatment, and granting them<br />
autonomy over medical <strong>de</strong>cisions.<br />
Shrewsbury Surgery Center PATIENT BILL OF RIGHTS<br />
1.Information Disclosure. Consumers have the right to receive<br />
accurate, easily un<strong>de</strong>rstood information and some require assistance in<br />
making informed health care <strong>de</strong>cisions about their health plans,<br />
professionals, and facilities.<br />
2.Choice of Provi<strong>de</strong>rs and Plans. Consumers have the right to a<br />
choice of health care provi<strong>de</strong>rs that is sufficient to ensure access to<br />
appropriate high-quality health care.<br />
3.Access to Emergency Services. Consumers have the right to<br />
access emergency health care services when and where the need arises.<br />
Health plans should provi<strong>de</strong> payment when a consumer presents to an<br />
emergency <strong>de</strong>partment with acute symptoms of sufficient severity -including<br />
severe pain -- such that a "pru<strong>de</strong>nt layperson" could reasonably<br />
expect the absence of medical attention to result in placing that<br />
consumer's health in serious jeopardy, serious impairment to bodily<br />
functions, or serious dysfunction of any bodily organ or part.<br />
4.Participation in Treatment Decisions. Consumers have the right<br />
and responsibility to fully participate in all <strong>de</strong>cisions related to their<br />
health care. Consumers who are unable to fully participate in treatment<br />
66
<strong>de</strong>cisions have the right to be represented by parents, guardians, family<br />
members, or other conservators.<br />
5.Respect and Nondiscrimination. Consumers have the right to<br />
consi<strong>de</strong>rate, respectful care from all members of the health care system at<br />
all times and un<strong>de</strong>r all circumstances. An environment of mutual respect is<br />
essential to maintain a quality health care system.<br />
6.Confi<strong>de</strong>ntiality of Health Information. Consumers have the<br />
right to communicate with health care provi<strong>de</strong>rs in confi<strong>de</strong>nce and to have<br />
the confi<strong>de</strong>ntiality of their individually i<strong>de</strong>ntifiable health care information<br />
protected. Consumers also have the right to review and copy their own<br />
medical records and request amendments to their records.<br />
7.Complaints and Appeals. All consumers have the right to a fair<br />
and efficient process for resolving differences with their health plans,<br />
health care provi<strong>de</strong>rs, and the institutions that serve them, including a<br />
rigorous system of internal review and an in<strong>de</strong>pen<strong>de</strong>nt system of external<br />
review.<br />
8.Consumer Responsibilities. In a health care system that protects<br />
consumers' rights, it is reasonable to expect and encourage consumers to<br />
assume reasonable responsibilities. Greater individual involvement by<br />
consumers in their care increases the likelihood of achieving the best<br />
outcomes and helps support a quality improvement, cost-conscious<br />
environment.<br />
3.5. Deviations from the Role Obligations in the Doctor-Patient<br />
Relationship<br />
As was mention above one basic obligation of physician is to<br />
behave in the best interest of patient while the last is to find the most<br />
qualitative health aid. Medical practice exposes the significant <strong>de</strong>viation<br />
from these obligations via medical malpractice and patient selfmedication.<br />
Medical malpractice is professional negligence by act or omission<br />
by a health care provi<strong>de</strong>r in which care provi<strong>de</strong>d <strong>de</strong>viates from accepted<br />
standards of practice in the medical community and causes injury to the<br />
patient. Standards and regulations for medical malpractice vary by country<br />
and jurisdiction within countries. Most medical malpractice actions are<br />
filed against doctors who have failed to use reasonable care to treat a<br />
patient. But the legal concept of medical malpractice is not limited to the<br />
conduct of medical doctors, but applies also to nurses, anesthesiologists,<br />
67
health care facilities, pharmaceutical companies, and others that provi<strong>de</strong><br />
health care services. Common types of medical malpractice, including bad<br />
diagnosis, sub-standard care, lack of "informed consent", as well as breach<br />
of doctor-patient confi<strong>de</strong>ntiality. Cases of medical malpractice usaly are<br />
brought in court.<br />
When someone consi<strong>de</strong>rs that was injured in medical care context<br />
he addresses to lawsuit, whose goal to pay him back if a doctor injures<br />
him. For a successful medical malpractice claim a plaintiff must establish<br />
the elements of the tort of negligence. These are as follow:<br />
1.A duty was owed: a legal duty exists whenever a hospital or health<br />
care provi<strong>de</strong>r un<strong>de</strong>rtakes care or treatment of a patient.<br />
2.A duty was breached: the provi<strong>de</strong>r failed to conform to the<br />
relevant standard of care. The standard of care is proved by expert<br />
testimony or by obvious errors.<br />
3.The breach caused an injury: The breach of duty was a proximate<br />
cause of the injury.<br />
4.Damages: Without damages (losses which may be pecuniary or<br />
emotional), there is no basis for a claim, regardless of whether the medical<br />
provi<strong>de</strong>r was negligent. Likewise, damages can occur without negligence,<br />
for example, when someone dies from a fatal disease.<br />
The plaintiff's damages may inclu<strong>de</strong> compensatory and punitive<br />
damages. Compensatory damages are both economic and non-economic.<br />
Economic damages inclu<strong>de</strong> financial losses such as lost wages (sometimes<br />
called lost earning capacity), medical expenses and life care expenses.<br />
These damages may be assessed for past and future losses. Non-economic<br />
damages are assessed for the injury itself: physical and psychological<br />
harm, such as loss of vision, loss of a limb or organ, the reduced<br />
enjoyment of life due to a disability or loss of a loved one, severe pain and<br />
emotional distress. Punitive damages are only awar<strong>de</strong>d in the event of<br />
wanton and reckless conduct. Malpractice lawsuits are time consuming<br />
and costly for doctors, even if the doctor is insured or wins the case. Thus,<br />
medical professionals are required to maintain professional liability<br />
insurance to offset the risk and costs of lawsuits based on medical<br />
malpractice. The fear of malpractice is meant to keep doctors from making<br />
medical mistakes and from acting carelessly. In this way, the law can<br />
control the quality of health care. Malpractice puts the responsibility on<br />
doctors to act in a way that will not result in an injury to you. If doctors are<br />
68
forced to pay for the costs of their medical mistakes, they will be more<br />
careful to make sure that mistakes do not happen in the first place.<br />
Confi<strong>de</strong>ntiality violation as a form of malpractice<br />
The ethical principle of confi<strong>de</strong>ntiality requires that information<br />
shared by the client with the therapist in the course of treatment is not<br />
shared with others. This is important for the therapeutic alliance, as it<br />
promotes an environment of trust. However, there are important<br />
exceptions to confi<strong>de</strong>ntiality, namely where it conflicts with the clinician's<br />
duty to warn or duty to protect. This inclu<strong>de</strong>s instances of suicidal or<br />
homicidal i<strong>de</strong>ation, child abuse, el<strong>de</strong>r abuse and <strong>de</strong>pen<strong>de</strong>nt adult abuse.<br />
Confi<strong>de</strong>ntiality shows a respect for an individual's autonomy and<br />
their right to control the information relating to their own health. In<br />
keeping information about the patient secret the doctor is acting<br />
beneficently. Disclosing information without the patient's consent can<br />
damage the patient. For instance if a doctor were to reveal privileged<br />
information about a celebrity patient to the newspapers then this would be<br />
the very reverse of beneficent i.e. maleficent.<br />
Drug misuse<br />
Drug misuse is a term used commonly for prescription<br />
medications with clinical efficacy but abuse potential and known adverse<br />
effects linked to improper use, such as psychiatric medications with<br />
sedative, anxiolytic, analgesic, or stimulant properties. Prescription misuse<br />
has been variably and inconsistently <strong>de</strong>fined based on drug prescription<br />
status, the uses that occur without a prescription, intentional use to achieve<br />
intoxicating effects, route of administration, co-ingestion with alcohol, and<br />
the presence or absence of abuse or <strong>de</strong>pen<strong>de</strong>nce symptoms. Tolerance<br />
relates to the pharmacological property of substances in which chronic use<br />
leads to a change in the central nervous system, meaning that more of the<br />
substance is nee<strong>de</strong>d in or<strong>de</strong>r to produce <strong>de</strong>sired effects. Stopping or<br />
reducing the use of this substance would cause withdrawal symptoms to<br />
occur.<br />
Self-medication<br />
It is a term used to <strong>de</strong>scribe the use of drugs other self-soothing<br />
forms of behavior to treat untreated and often undiagnosed distress. Every<br />
day, everywhere, consumers reach for self-care products to help them<br />
through their common health problems. They do so because it may be<br />
easier for them, it may be more cost or time efficient, they may not feel<br />
their situation merits making an appointment with a healthcare<br />
69
professional, or they may have few or no other options. Self medication<br />
can be very dangerous for the health of people, because of <strong>de</strong>laying of<br />
professional aid, addiction, adverse effects of substance consumed. In<br />
condition when there is evi<strong>de</strong>nce that consumer can and do practice selfmedication,<br />
which can be harmful, the obligation of governments is to<br />
elaborate a responsible framework for self-medication.<br />
In this circumstance The World Medical Association (WMA) has<br />
<strong>de</strong>veloped the statement to provi<strong>de</strong> guidance to physicians and their<br />
patients regarding responsible self-medication. This statement is adopted<br />
by the 53rd WMA General Assembly, Washington, DC, USA, October<br />
2002.<br />
1. Distinction between Self-Medication and Prescription<br />
Medicines<br />
a. Medicinal products can generally be divi<strong>de</strong>d into two separate<br />
categories: prescription and non-prescription medicines. This classification<br />
may differ from country to country. The national authorities must assure<br />
that medicines, categorized as non-prescription medicines, are sufficiently<br />
safe not to be harmful to health.<br />
b. Prescription medicines are those which are only available to<br />
individuals on prescription from a physician following a consultation.<br />
Prescription medicines are not safe for use except un<strong>de</strong>r the supervision of<br />
a physician because of toxicity, other potential or harmful effects (e.g.<br />
addictiveness), the method of use, or the collateral measures necessary for<br />
use.<br />
c. Responsible self-medication, as used in this document, is the<br />
use of a registered or monographed medicine legally available without a<br />
physician’s prescription, either on an individual’s own initiative or<br />
following advice of a healthcare professional. The use of prescription<br />
medicines without a prior medical prescription is not part of responsible<br />
self-medication.<br />
d. The safety, efficacy and quality of non-prescription medicines<br />
must be proved according to the same principles as prescription medicines.<br />
2. Use of Self-Medication in conjunction with Prescription<br />
Medication<br />
A course of treatment may combine self-medication and<br />
prescription medication, either concurrently or sequentially. The patient<br />
must be informed about possible interactions between prescription<br />
medicines and non-prescription medicines. For this reason the patient<br />
70
should be encouraged to inform the physician about his / her selfmedication.<br />
3. Roles & Responsibilities in Self-Medication<br />
a. In self-medication the individual bears primary responsibility<br />
for the use of self-medication products. Special caution must be exercised<br />
when vulnerable groups such as children, el<strong>de</strong>rly people or pregnant<br />
women use self-medication.<br />
b. If individuals choose to use self-medication, they should be<br />
able:<br />
i. to recognize the symptoms they are treating;<br />
ii. to <strong>de</strong>termine that their condition is suitable for self-medication;<br />
iii. to choose an appropriate self-medication product;<br />
iv. to follow the directions for use of the product as provi<strong>de</strong>d in the<br />
product labelling.<br />
c. In or<strong>de</strong>r to limit the potential risks involved in self-medication<br />
it is important that all health professionals who look after patients should<br />
provi<strong>de</strong>:<br />
i. Education regarding the non-prescription medicine and its<br />
appropriate use, and instructions to seek further advice from a physician if<br />
they are unsure. This is particularly important where self-medication is<br />
inappropriate for certain conditions the patient may suffer from;<br />
ii. Encouragement to read carefully a product’s label and leaflet (if<br />
provi<strong>de</strong>d), to seek further advice if necessary, and to recognize<br />
circumstances in which self-medication is not, or is no longer, appropriate.<br />
d. All parties involved in self-medication should be aware of the<br />
benefits and risks of any self-medication product. The benefit-risk balance<br />
should be communicated in a fair, rational manner without<br />
overemphasizing either the risks or the benefits.<br />
e. Manufacturers in particular are obliged to follow the various<br />
co<strong>de</strong>s or regulations already in place to ensure that information provi<strong>de</strong>d to<br />
consumers is appropriate in style and content. This refers in particular to<br />
the labelling, advertising and all notices concerning non-prescription<br />
medicines.<br />
f. The pharmacist has a professional responsibility to recommend,<br />
in appropriate circumstances, that medical advice be sought.<br />
4. Role of Governments in Self-Medication<br />
Governments should recognize and enforce the distinction<br />
between prescription and non-prescription medicines, and ensure that the<br />
71
users of self-medication are well informed and protected from possible<br />
harm or negative long-term effects.<br />
5. The Promotion and Marketing of Self-Medication Products<br />
a. Advertising and marketing of non-prescription medicines<br />
should be responsible, provi<strong>de</strong> clear and accurate information and exhibit a<br />
fair balance between benefit and risk information. Promotion and<br />
marketing should not encourage irresponsible self-medication, purchase of<br />
medicines that are inappropriate, or purchases of larger quantities of<br />
medicines than are necessary.<br />
b. People must be encouraged to treat medicines (prescription and<br />
non-prescription) as special products and that standard precautions should<br />
be followed in terms of safe storage and usage, in accordance with<br />
professional advice.<br />
► Exercises and Discussions:<br />
1. What is society?<br />
2. What is the structure of human society? Describe its elements.<br />
3. Define the terms social status and role. What is difference<br />
between them?<br />
4. What are Role obligations and rights of physician and patient?<br />
5. Listed the forms of role obligations’ <strong>de</strong>viation.<br />
6. Find and <strong>de</strong>scribe the case of medical malpractice.<br />
7. What is self medication? What risk it implies?<br />
► Recommen<strong>de</strong>d Essays<br />
1. Health and Social Class<br />
2. Social factors influencing human health.<br />
3. Self medication or addiction?<br />
► Literature:<br />
1. Parsons Talcott. Social System. Routledge, 1991.<br />
2. Blum R. H. The Management of the Doctor-Patient<br />
Relationship. McGraw-Hill, 1960.<br />
3. An<strong>de</strong>rson Richard E. Medical malpractice: a physician's<br />
sourcebook. Humana Press, 2005.<br />
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4.1. What is Communication?<br />
73<br />
Chapter 4<br />
Communication: Definitions and Functions<br />
Without knowing the force of words<br />
it is impossible to know men.<br />
Confucius<br />
Communication has existed since the beginning of human beings,<br />
but it was not until the 20th century that people began to study the process.<br />
When World War I en<strong>de</strong>d, the interest in studying communication<br />
intensified as communication technologies <strong>de</strong>veloped and the socialscience<br />
study was fully recognized as a legitimate discipline. During the<br />
last <strong>de</strong>ca<strong>de</strong>, the outpouring of scientific research on human communication<br />
has increased at a staggering rate. This burst of research activity is due to<br />
the ever-wi<strong>de</strong>ning usage of the term "communication" and to a <strong>de</strong>claration<br />
of vested interest in communication research by numerous scientific<br />
disciplines. One review of <strong>de</strong>velopments in the field lists more than twenty<br />
aca<strong>de</strong>mic disciplines which currently provi<strong>de</strong> content and method for<br />
research on some phase of human interaction. This increase in<br />
communication research or studies reveals that communication is central<br />
to the human experience and life. The interest of many discipline in<br />
communication studies also reveal that communication is not so univocal<br />
or obvious subject.<br />
What is communication? The word communication <strong>de</strong>rived from<br />
Latin communis – common and communication - to give and make<br />
something common. Beginning from these original meaning of Latin<br />
words different modalities of <strong>de</strong>fining or explaining communication were<br />
elaborated. Each of modality emphasizes one aspect of communication as<br />
phenomenon. Thus, communication can be <strong>de</strong>fined as speech,<br />
un<strong>de</strong>rstanding, social process, reduction of uncertainties, transmission,<br />
commonality, behavior modifying response, power etc.<br />
Communication as speech: “Communication is the verbal<br />
interchange of thought or i<strong>de</strong>a” (Hoben, 1954).
Communication as un<strong>de</strong>rstanding: “Communication is the process<br />
by which we un<strong>de</strong>rstand others and in turn en<strong>de</strong>avor to be un<strong>de</strong>rstood by<br />
them. It is dynamic, constantly changing and shifting in response to the<br />
total situation” (An<strong>de</strong>rson, 1959).<br />
Communication as social process: “Interaction, even on the<br />
biological level, is a kind of communication; otherwise common acts could<br />
not occur” (Mead, reprinted 1963).<br />
Communication as reduction of uncertainties: “Communication<br />
arises out of the need to reduce uncertainty, to act effectively, to <strong>de</strong>fend or<br />
strengthen the ego” (Barnlund, 1964).<br />
Communication as transfer, transmission: “The connecting thread<br />
appears to be the i<strong>de</strong>a of something’s being transferred from one thing, or<br />
person, to another. We use the word ‘communication’ sometimes to refer<br />
to what is so transferred, sometimes to the means, by which it is<br />
transferred, sometimes to the whole process. In many cases, what is<br />
transferred in this way continues to be shared; if I convey information to<br />
another person, it does not leave my own possession through coming into<br />
his. Accordingly, the word ‘communication’ acquires also the sense of<br />
participation. It is, in this sense, for example, that religious worshipers are<br />
said to communicate” (Ayer, 1955).<br />
Communication as commonality: “It (communication) is a process<br />
that makes common to two or several what was the monopoly of one or<br />
some” (Go<strong>de</strong>, 1959).<br />
Communication as Discriminative Response/Behavior Modifying<br />
Response: “Communication is the discriminatory response of an organism<br />
to a stimulus” (Stevens, 1950).<br />
Communication as intention: “In the main, communication has as its<br />
central interest those behavioral situations in which a source transmits a<br />
message to a receiver(s) with conscious intent to affect the latter’s<br />
behaviors” (Miller, 1966).<br />
Communication as power: “Communication is the mechanism by<br />
which power is exerted” (Schacter, 1951).<br />
Communication as a process:” Communication can be <strong>de</strong>fine as a<br />
process of conveying information from a sen<strong>de</strong>r to a receiver with the use<br />
of a medium in which the communicated information is un<strong>de</strong>rstood the<br />
same way by both sen<strong>de</strong>r and receiver” (Shannon, 1963).<br />
74
As can be seen human communication is un<strong>de</strong>rstood in various<br />
manners. This diversity is the result of communication complexity as well<br />
as its being a subject - matter of a very broad constituency of disciplines<br />
that inclu<strong>de</strong>s Rhetoric, Journalism, Sociology, Psychology, Anthropology,<br />
and Semiotics, and others. Because many fields of study <strong>de</strong>dicate a portion<br />
of attention to communication, when speaking about communication it is<br />
very important to be sure about what aspects of communication one is<br />
speaking about.<br />
Nevertheless beyond the diversity in un<strong>de</strong>rstand or <strong>de</strong>fining of<br />
communication there are some common accepted things. All of humans<br />
communicate. Communication occurs to all areas of life: home, school,<br />
community, work, and beyond. Communication inclu<strong>de</strong>s acts or interacts<br />
that confer knowledge and experiences, share emotion, give advice and<br />
commands, and ask questions. Communication requires a vast repertoire<br />
of skills in intrapersonal and interpersonal processing such as listening,<br />
observing, speaking, questioning, analyzing, and evaluating.<br />
Communication requires skills in utilization of technique of encoding and<br />
<strong>de</strong>coding, that is grammatical rules but also knowledge about culture,<br />
habits, behavioral rules etc. Communication requires physical and<br />
psychological capability to send and receive information, because the<br />
efficiency in information interchanging <strong>de</strong>pends in many respects on such<br />
factor as anxiety, fatigue, boring, annoyance, and interest. Human<br />
communication happened at many levels (i.e. verbal, nonverbal, paraverbal,<br />
extra-verbal) take many forms (i.e. intrapersonal, interpersonal,<br />
social mediated), in one of the various manners (i.e. verbal presentation,<br />
letter, through movements, sounds, reactions, physical changes, gestures,<br />
languages, breath, etc).<br />
4.2. The Communication Process<br />
In or<strong>de</strong>r to clarify what is communication and how does it occur<br />
were created a lot of theoretical mo<strong>de</strong>ls of communication. The Shannon–<br />
Weaver mo<strong>de</strong>l of communication has been called the "mother of all<br />
mo<strong>de</strong>ls”. This mo<strong>de</strong>l was wi<strong>de</strong>ly adopted into the social science fields,<br />
such as education, organizational analysis, psychology, etc.<br />
Shannon–Weaver mo<strong>de</strong>l of communication<br />
In 1949, the American engineer Shannon elaborated this mo<strong>de</strong>l<br />
with intention to explain what basically happens in communication. He<br />
75
<strong>de</strong>veloped his i<strong>de</strong>as in a 1963 book with Warren Weaver titled The<br />
Mathematical Theory of Communication.<br />
Information<br />
Source Transmiter Receiver Destination<br />
Signal Recevied<br />
Message Signal Message<br />
Noise<br />
Source<br />
Shannon's diagram of a general communication system.<br />
Here are laid out the basic elements of communication as they were<br />
<strong>de</strong>veloped by Shannon and others:<br />
1. Source, emissor, sen<strong>de</strong>r (by whom the information is conveyed?).<br />
When we speak, write, smile, and make gesture we are in the posture of<br />
sen<strong>de</strong>r. Information source produces a message or sequence of messages to be<br />
communicated to the receiving terminal.<br />
2. Message (what types of things and in what form are<br />
communicated?). Message is information which is sent from a source to a<br />
receiver. It may be any thought expressed in a language, prepared in a form<br />
suitable for transmission by any means of communication. In communication<br />
between humans, messages can be verbal or nonverbal:<br />
A verbal message is an exchange of information using words.<br />
Examples inclu<strong>de</strong> face-to-face communication, telephone calls, voicemails,<br />
etc. A nonverbal message is communicated through actions or behaviors<br />
rather than words. Examples inclu<strong>de</strong> the use of body language.<br />
3. Encoding is a process of message production. To codify means to<br />
translate our i<strong>de</strong>as, attitu<strong>de</strong>s, emotions into language. Language may be<br />
spoken and written (i.e. sounds and words). Also there are paralanguage (for<br />
instance tone of voice, quality of voice, rhythm and intonation), and body<br />
language (for instance posture and gesture).<br />
4. Transmitter operates on the message in some way to produce<br />
a signal suitable for transmission over the channel. In telephony this<br />
operation consists merely of changing sound pressure into a proportional<br />
76
electrical current. In telegraphy we have an encoding operation which<br />
produces a sequence of dots, dashes and spaces on the channel<br />
corresponding to the message.<br />
5. Decoding is the opposite process. Sen<strong>de</strong>r is in this context the<br />
enco<strong>de</strong>r, but receiver is the <strong>de</strong>co<strong>de</strong>r. A co<strong>de</strong> is a rule for converting a piece<br />
of information (for example, a letter, word or gesture) into another form or<br />
representation (one sign into another sign), not necessarily of the same<br />
type. Cod may also be <strong>de</strong>fined as a system of sign and symbols in<br />
communication.<br />
6. The channel (through which medium is communication<br />
realized?) is merely the medium used to transmit the signal from<br />
transmitter to receiver. It may be a pair of wires, a coaxial cable, a beam of<br />
light, etc. Channel, in communications, refers to the medium used to<br />
convey information from a sen<strong>de</strong>r (or transmitter) to a receiver. It may be<br />
for instance air in case of face-to-face communication, or telephone cable<br />
in case of message telephonically sent.<br />
7. Context (in what condition is communication realized?) refers<br />
to the interrelated conditions of communication. It consists of everything<br />
that is not in the message, but on which the message relies in or<strong>de</strong>r to have<br />
its inten<strong>de</strong>d meaning. Context has several dimensions:<br />
- Space (the physical place where the communication occurs).<br />
- Time (that is hour, day, season when communication occurs)<br />
- Social dimension (for example: relations between participants,<br />
their assumed role).<br />
- Psychological dimension (for instance official or nonofficial<br />
character of communication; presence or absence of hostility in<br />
communication).<br />
8. Communication noisy is <strong>de</strong>fined as all factors which impe<strong>de</strong><br />
communication. Shannon in his conception of communication argued that<br />
the input, or inten<strong>de</strong>d message, is sent by a sen<strong>de</strong>r via a channel. The<br />
message received becomes the output. Input and output may differ<br />
substantially as a channel is usually exposed to circumstances that may<br />
alter its inten<strong>de</strong>d quality of transmission. For instance, the channel of a<br />
telephone communication line is usually impaired with noise, which in<br />
turn affects the outcome, i.e. output, of the message. Reiterating in<br />
category of “noisy” as usual are inclu<strong>de</strong>d not only physical technical<br />
impediments of communication but all type of communicative barriers.<br />
These may be difficulties in intercultural communication, <strong>de</strong>fective<br />
77
perception, unclear message, social stress etc. There are many examples of<br />
noise:<br />
Environmental noise: Noise that physically disrupts<br />
communication, such as standing next to loud speakers at a party, or the<br />
noise from a construction site next to a classroom making it difficult to<br />
hear the professor.<br />
Physiological-Impairment noise: Physical maladies that prevent<br />
effective communication, such as actual <strong>de</strong>afness or blindness preventing<br />
messages from being received as they were inten<strong>de</strong>d.<br />
Semantic noise: Different interpretations of the meanings of<br />
certain words. For example, the word "weed" can be interpreted as an<br />
un<strong>de</strong>sirable plant in your yard, or as a euphemism for marijuana.<br />
Syntactical noise: Mistakes in grammar can disrupt<br />
communication, such as abrupt changes in verb tense during a sentence.<br />
Organizational noise: Poorly structured communication can<br />
prevent the receiver from accurate interpretation. For example, unclear and<br />
badly stated directions can make the receiver even more lost.<br />
Cultural noise: Stereotypical assumptions can cause<br />
misun<strong>de</strong>rstandings, such as unintentionally offending a non-Christian<br />
person by wishing them a "Merry Christmas".<br />
Psychological noise: Certain attitu<strong>de</strong>s can also make<br />
communication difficult. For instance, great anger or sadness may cause<br />
someone to lose focus on the present moment. Disor<strong>de</strong>rs such as Autism<br />
may also severely hamper effective communication.<br />
9. Destination, receiver, target (whom is message conveyed to?)<br />
person (or thing) for whom the message is inten<strong>de</strong>d. When we listen, read,<br />
look at we are in posture of receiver. Receiver may be oneself and in this<br />
case we say that occurs intrapersonal communication, may be another<br />
person and in this case we have interpersonal communication, may be a<br />
group of persons and when we can say that happens intercultural<br />
communication.<br />
10. Feedback is <strong>de</strong>fine as a mechanism, process or signal that is<br />
looped back to control a system within itself. The purpose of feedback is<br />
to alter messages so the intention of the original communicator is<br />
un<strong>de</strong>rstood by the second communicator. It inclu<strong>de</strong>s verbal (i.e.<br />
paraphrasing) and nonverbal (i.e. nodding your head to show agreement,)<br />
responses to another person's message. Carl Rogers listed five main<br />
78
categories of feedback. They are listed in the or<strong>de</strong>r in which they occur<br />
most frequently in daily conversations.<br />
o Evaluative: Making a judgment about the worth, goodness, or<br />
appropriateness of the other person's statement.<br />
o Interpretive: Paraphrasing - attempting to explain what the other<br />
person's statement means.<br />
o Supportive: Attempting to assist or bolster the other<br />
communicator.<br />
o Probing: Attempting to gain additional information, continue the<br />
discussion, or clarify a point.<br />
o Un<strong>de</strong>rstanding: Attempting to discover completely what the<br />
other communicator means by her statements.<br />
4.3. Communication Functions<br />
What we are communicating for? There are many significant and<br />
much elaborated answers to this interrogation. In what proceed will be<br />
exposed the most famous of them, that introduced by the Russian-<br />
American linguist, Roman Jakobson (1960).<br />
Jakobson distinguishes six communication functions, each<br />
associated with a dimension of the communication process: context,<br />
message, sen<strong>de</strong>r, receiver, channel, co<strong>de</strong>. Jakobson allocates a<br />
communicative function to each of the components.<br />
The referential function refers to the context. Here we have the<br />
function emphasizing that communication is always <strong>de</strong>aling with<br />
something contextual, referential (the dominant function in a message like<br />
'Water boils at 100 <strong>de</strong>grees'). The referential function of communication is<br />
illustrated via the words: this, that, those etc.<br />
The poetic function is allocated to the message and puts 'the focus<br />
on the message for its own sake'. Messages convey more than just the<br />
content. They always contain a creative 'touch' of our own. These<br />
additions have no purpose other than to make the message "nicer".<br />
Rhetorical figures, pitch or loudness are some aspects of the poetic<br />
function.<br />
The emotive function focuses on the sen<strong>de</strong>r, as in the interjections<br />
'Bah!' and 'Oh!'. The sen<strong>de</strong>r's own attitu<strong>de</strong> towards the content of the<br />
message is emphasized. Examples are emphatic speech or interjections<br />
(exclamation).<br />
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The conative function is allocated to the addressee (imperatives<br />
and apostrophes). It is directed towards the addressee. One example is the<br />
vocative or appellative, imperative, interrogation.<br />
The phatic function helps to establish contact, prolong or<br />
discontinue communication and refers to the channel of communication.<br />
Some of these utterances only serve to maintain contact between two<br />
speakers, for instance via repetition, or confirm whether the contact is still<br />
there (as in 'Hello?').<br />
The metalinguistic function <strong>de</strong>als with the co<strong>de</strong> itself; is used to<br />
establish mutual agreement on the co<strong>de</strong>. This is the function of language<br />
about language (for example, a <strong>de</strong>finition). This whole rea<strong>de</strong>r is an<br />
example of metalanguage. We use it to examine the co<strong>de</strong>. The<br />
metalinguistic function is also predominant in questions like "Sorry, what<br />
did you say?" where the co<strong>de</strong> is misun<strong>de</strong>rstood and needs correction or<br />
clarification.<br />
Naturally, several functions may be active simultaneously in<br />
utterances. To find out which function predominates requires analysis. In a<br />
proper analysis, we start by <strong>de</strong>termining whether each of the functions of<br />
language is present or absent. In theory, each factor is necessary to<br />
communication. This does not necessarily mean that each function is<br />
always present. We will assume that while one or more – or even all – of<br />
the functions of language may be absent in short units (such as an isolated<br />
sign), lengthy units can activate all of them. Where more than one function<br />
is present, we will establish either: (1) a simple hierarchy, by i<strong>de</strong>ntifying<br />
the dominant function and not ranking the other functions, or (2) a<br />
complex hierarchy, by specifying the <strong>de</strong>gree of presence of some or all of<br />
the functions.<br />
Various criteria can be used to establish the functional hierarchy.<br />
For example, Arcand and Bourbeau (1995) use an intention-based<br />
criterion: "The dominant function is the one that answers the question,<br />
'With what intention was this message transmitted?' and [...] the secondary<br />
functions are there to support it." We must distinguish the intention<br />
associated with each fragment from the overall intention, which is "a<br />
sentence or series of sentences that corresponds to an intention" (1995).<br />
Since the intention can be hid<strong>de</strong>n, the function that is dominant in terms of<br />
overt <strong>de</strong>gree of presence may not be dominant in terms of intention.<br />
Arcand and Bourbeau also distinguish between direct and indirect<br />
manifestations of intention, which correlate to the opposition between<br />
80
actual and overt functions. The appellative (conative) function is<br />
manifested directly in "Go answer the door" and indirectly in "The<br />
doorbell rang" (which is equivalent to "Go answer the door"), where the<br />
overt function is the referential (or informative) function. In addition, we<br />
need to distinguish between cause and effect functions, as well as ends and<br />
means functions (the ends being the effect that is sought). For example,<br />
when the phatic function (cause) is overactivated, it can trigger the poetic<br />
function (effect); overactivation can be used for esthetic ends, and in this<br />
case the poetic function is an end and the phatic function is a means.<br />
4.4. Communication and Health<br />
Communication is a means of survival. This statement is not just a<br />
metaphor it is a conclusion based on the empirical studies. Without any<br />
form of communication humans cannot live. Lack of communication or<br />
inefficient communication could injure seriously the quality human life<br />
and health. Public Health surveys show that:<br />
People who lack strong relationships have 2 - 3 times the risk of<br />
early <strong>de</strong>ath, regardless of whether or not they smoke or drink.<br />
Terminal cancer strikes socially isolated people more often than<br />
those who have close personal relationships.<br />
Divorced, separated, and widowed people are 5 - 10 times more<br />
likely to need hospitalization for mental problems than their married<br />
counterparts.<br />
Pregnant women un<strong>de</strong>r stress and without supportive<br />
relationships have three times more complications than pregnant women<br />
who suffer from the same amount of stress but have strong social<br />
support.<br />
Studies show that social isolation is a major risk factor<br />
contributing to coronary disease, comparable to physiological factors<br />
such a s diet, smoking, obesity an lack of physical activity socially<br />
isolated people are four times more susceptible to the common cold than<br />
those who have active social networks<br />
When the subject of communication and health is discussed of<br />
interest is not only the impact of communication as such on the individual<br />
health but rather the importance of communication to disease prevention,<br />
health promotion, health care policy, and the business of health care as<br />
well as enhancement of the quality of life and health of individuals within<br />
81
the community. Nowadays Health communication is an important aria of<br />
medical activity (theory and practice) which may be <strong>de</strong>fined as “The art<br />
and technique of informing, influencing, and motivating individual,<br />
institutional, and public audiences about important health issues. Or it can<br />
be <strong>de</strong>fine as an area of theory, research and practice related to<br />
un<strong>de</strong>rstanding and influencing the inter<strong>de</strong>pen<strong>de</strong>nce of communication<br />
(symbolic interaction in the forms of messages and meanings) and health<br />
related beliefs, behaviors and outcomes. Accordingly to this aria an<br />
efficient communication is essential to successful public health practice at<br />
every level of the ecological mo<strong>de</strong>l; intrapersonal, interpersonal, group,<br />
organizational, and societal. At each level there are a variety of<br />
communication channels which must be consi<strong>de</strong>red, from face-to-face to<br />
mass communications. The social contexts in which health communication<br />
occurs are also wi<strong>de</strong>ly varied and can inclu<strong>de</strong> (but are not limited to)<br />
homes, schools, doctor’s offices, and workplaces. Wherever, good<br />
communication is associated with positive health outcomes, whereas poor<br />
communication is associated with a number of negative outcomes. In<br />
what is follow we will focus on three levels of heath communication: 1.<br />
interpersonal medical communication emphasizing especially the<br />
importance of communication between doctor and patient; 2.<br />
Organizational level, emphasizing the importance of communication in<br />
medical team; and 3. Societal level emphasizing the importance of<br />
communication in public health.<br />
The importance of communication in physician – patient<br />
relationship<br />
Good communication skills are essential to establish good doctor patient<br />
relationship, which in turn has a positive impact on medical outcomes.<br />
Good communication engen<strong>de</strong>rs meaningful and trusting<br />
relationships between healthcare professionals and their patients. Studies<br />
suggest that physician sensitivity - specifically a doctor's interest in people<br />
- results in greater patient confi<strong>de</strong>nce and increased adherence to treatment<br />
regimens. We have much more confi<strong>de</strong>nce in our doctor if he or she can<br />
communicate with us and seems sensitive to our needs. Good<br />
communication skills are integral to medical and other healthcare practice.<br />
In <strong>de</strong>livering care, doctors encounter a diverse range of patients<br />
requiring different communication approaches - from the very young to<br />
the el<strong>de</strong>rly. Various patient subgroups may present particular difficulties in<br />
terms of communication. For example, doctors may find it more difficult<br />
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to communicate with patients with a chronic or complex disease, a<br />
terminal illness or those for whom there is no diagnosis. Un<strong>de</strong>r these<br />
circumstances more effort must be ma<strong>de</strong> to communicate with the patient<br />
sensitively. In some cases an explanation of the patient’s illness will need<br />
to be paced over several sessions in or<strong>de</strong>r to suit the patient or family’s<br />
emotional or cognitive ability to attend to, comprehend or incorporate the<br />
information. Patients themselves may have communication difficulties<br />
such as those with sensory impairments or speech problems, those with<br />
language barriers or learning difficulties, and patients from different ethnic<br />
groups. Communication with patients’ relatives is also commonly<br />
required. To provi<strong>de</strong> appropriate care, doctors must possess the<br />
appropriate skills to communicate sensitively with people, irrespective of<br />
cultural, social, religious or regional differences. In patient-doctor<br />
interaction the main responsibility for cultural sensitivity and<br />
un<strong>de</strong>rstanding rests with the doctor. It is, therefore, imperative that<br />
medical education inclu<strong>de</strong>s intercultural communication training.<br />
In all doctor-patient interactions a variety of communication skills<br />
will be required for different phases of the consultation. During the start of<br />
a consultation, doctors must establish a rapport and i<strong>de</strong>ntify the reasons for<br />
the consultation. They must go on to gather information, structure the<br />
consultation, build on the relationship and provi<strong>de</strong> appropriate<br />
information.<br />
A number of healthcare trends are increasing the need for strong<br />
communication skills in medicine. In relation to communication with<br />
patients, an increasing focus on shared <strong>de</strong>cision making and<br />
communication of risk are two of the most important factors. For example,<br />
communication skills can help healthcare staff to explain the results of<br />
epi<strong>de</strong>miological studies or clinical trials to individual patients in ways that<br />
can help patients to un<strong>de</strong>rstand risk. Doctors can do this more effectively if<br />
they <strong>de</strong>velop relationships with their patients and if they take into account<br />
knowledge and perceptions of health risks in the general public.<br />
Benefits of good communication can be i<strong>de</strong>ntified for both doctors<br />
and patients:<br />
Benefits for patients<br />
• The doctor-patient relationship is improved. The doctor is better<br />
able to seek the relevant information and recognize the problems of the<br />
patient by way of interaction and attentive listening. As a result, the<br />
patient’s problems may be i<strong>de</strong>ntified more accurately.<br />
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• Good communication helps the patient to recall information and<br />
comply with treatment instructions thereby improving patient satisfaction.<br />
• Good communication may improve patient health and outcomes.<br />
Better communication and dialogue by means of reiteration and repetition<br />
between doctor and patient has a beneficial effect in terms of promoting<br />
better emotional health, resolution of symptoms and pain control.<br />
• The overall quality of care may be improved by ensuring that<br />
patients ‘views and wishes are taken into account as a mutual process in<br />
<strong>de</strong>cision making.<br />
• Good communication is likely to reduce the inci<strong>de</strong>nce of clinical<br />
error.<br />
Benefits for doctors<br />
• Effective communication skills may relieve doctors of some of<br />
the pressures of <strong>de</strong>aling with the difficult situations encountered in this<br />
emotionally <strong>de</strong>manding profession. Problematic communication with<br />
patients is thought to contribute to emotional burn-out and low personal<br />
accomplishment in doctors as well as high psychological morbidity. Being<br />
able to communicate competently may also enhance job satisfaction.<br />
• Patients are less likely to complain if doctors communicate well.<br />
There is, therefore, a reduced likelihood of doctors being sued ( of medical<br />
malpractice).<br />
The importance of good communication in medical team<br />
Good communication within the healthcare team is essential in<br />
or<strong>de</strong>r to ensure continuity of care and effective treatment for patients.<br />
Moreover, poor communication between professional staff has been<br />
i<strong>de</strong>ntified as an un<strong>de</strong>rlying factor for failed communication with patients.<br />
For example, a patient may be given different information<br />
regarding their condition by different members of the healthcare team.<br />
In today’s health care system, <strong>de</strong>livery processes involve<br />
numerous interfaces and patient handoffs among multiple health care<br />
practitioners with varying levels of educational and occupational training.<br />
During the course of a 4-day hospital stay, a patient may interact with 50<br />
different employees, including physicians, nurses, technicians, and others.<br />
Effective clinical practice thus involves Successful Teamwork.<br />
Components of Successful Teamwork are as follow:<br />
- Non-punitive environment,<br />
- Clear direction;<br />
- Clear and known roles and tasks for team members;<br />
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- Respectful atmosphere;<br />
- Shared responsibility for team success;<br />
- Appropriate balance of member participation for the task at<br />
hand;<br />
- Acknowledgment and processing of conflict;<br />
- Clear specifications regarding authority and accountability;<br />
- Clear and known <strong>de</strong>cision-making procedures;<br />
- Regular and routine communication and information sharing;<br />
- Enabling environment, including access to nee<strong>de</strong>d resources;<br />
- Mechanism to evaluate outcomes and adjust accordingly.<br />
All these elements are <strong>de</strong>termine by an open and effective<br />
communication<br />
When health care professionals are not communicating effectively,<br />
patient safety is at risk for several reasons: lack of critical information,<br />
misinterpretation of information, unclear or<strong>de</strong>rs over the telephone, and<br />
overlooked changes in status.<br />
Lack of communication creates situations where medical errors<br />
can occur. These errors have the potential to cause severe injury or<br />
unexpected patient <strong>de</strong>ath. Medical errors, especially those caused by a<br />
failure to communicate, are a pervasive problem in today’s health care<br />
organizations.<br />
Effective communications make effective the work of teams;<br />
enhance trust, respect, and collaboration, reduce the risk of medical errors,<br />
increase the parent as well as health professionals satisfaction.<br />
The importance of communication in public health<br />
Public health is the approach to medicine that is concerned with<br />
the health of the community as a whole. Public health is community<br />
health. It has been said that: "Health care is vital to all of us some of the<br />
time, but public health is vital to all of us all of the time."<br />
The three core public health functions are:<br />
1. The assessment and monitoring of the health of communities<br />
and populations at risk to i<strong>de</strong>ntify health problems and priorities;<br />
2. The formulation of public policies <strong>de</strong>signed to solve<br />
i<strong>de</strong>ntified local and national health problems and priorities;<br />
3. To assure that all populations have access to appropriate and<br />
cost-effective care, including health promotion and disease prevention<br />
services, and evaluation of the effectiveness of that care.<br />
85
The efficiency in accomplishment of these tasks is directly related<br />
to efficient communication, but there are some public health arias where<br />
good communication is of special importance.<br />
First one is communication for health education directed to learning<br />
experiences and the voluntary actions people can take, individually or<br />
collectively, for their own health, the health of others, or the common good<br />
of the community. Health education is a systematically planned activity,<br />
and can thus be distinguished from inci<strong>de</strong>ntal learning experiences.<br />
Further, this construction of health education draws attention to voluntary<br />
behavioral actions taken by an individual, group, or community with the<br />
full un<strong>de</strong>rstanding and acceptance of the purposes of the action—either to<br />
achieve an inten<strong>de</strong>d health effect or to build capacity for health.<br />
The second aria is communication for health behavior change.<br />
Nowadays there are a lot of people that practice behavior with high health<br />
risk, like smoking, drug abuse, alcohol consuming etc. the individuals with<br />
such types of behavior will be more likely to change their health-related<br />
behavior if they recognize a health risk or condition as important, if they<br />
view themselves as susceptible to the risk or condition and if they regard<br />
the benefits of change as outweighing barriers to making change.<br />
Communication strategies play a key role in influencing these perceptions.<br />
The third aria is communication in condition of health emergency.<br />
Health emergencies inclu<strong>de</strong>:<br />
significant communicable disease outbreaks, e.g. an influenza pan<strong>de</strong>mic;<br />
chemical, biological or radiological inci<strong>de</strong>nts either criminal or acci<strong>de</strong>ntal;<br />
mass casualty inci<strong>de</strong>nts, e.g. an earthquake or transport acci<strong>de</strong>nt; any<br />
emergency where there are a significant number of people needing<br />
medical treatment which requires a coordinated national approach. In all<br />
this conditions the risk for community, damages, and panic will be low<br />
down as a result of good (well planed) communication.<br />
► Exercises and Discussions:<br />
1.What is communication?<br />
2.How is communication? Give some attributes of communication.<br />
3.What are the elements of communication as a process?<br />
4.Describe the functions of communication.<br />
5.I<strong>de</strong>ntify your own reasons for communication.<br />
6.What is health communication?<br />
7.What are the benefits of efficient communication in physician and<br />
patient, and in medical team?<br />
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► Recommen<strong>de</strong>d Essays<br />
1.Theoretical mo<strong>de</strong>ls of communication<br />
2.E. Bern and transactional analysis<br />
3.Neuro-linguistic programming<br />
4.Communication behavior in a hospital setting<br />
5.Communication in public health emergency/ its importance<br />
► Literature:<br />
1.Dance, Frank E. X., and Larson, Carl E. The Functions of Human<br />
Communication: A Theoretical Approach. New York: Holt,<br />
Rinehart and Winston, 1976.<br />
2.Berry Dianne. Health communication: theory and practice.<br />
McGraw-Hill International, 2006.<br />
3.Brian Williams. Communications. Heinemann Library, 2002.<br />
4.O’Daniel Michelle, Rosenstein Alan H. Professional<br />
Communication and Team Collaboration.<br />
http://www.ahrq.gov/qual/nurseshdbk/docs/O'DanielM_TWC.pdf<br />
5.Samuel YS Wong, Albert Lee. Communication Skills and Doctor<br />
Patient Relationship.<br />
http://www.fmshk.org/database/articles/607.pdf<br />
87
Metacommunication and Cultural Differences<br />
5.1. Metacommunication as Interpretation<br />
88<br />
Chapter 5<br />
Messages we send through our posture,<br />
gestures, facial expression,<br />
and spatial distance account for 55% of what<br />
is perceived and un<strong>de</strong>rstood by others. In fact,<br />
through our body language we are always<br />
communicating, whether we want to or not!<br />
Albert Mehrabian<br />
According to etymological meaning of word Meta-communication<br />
is "communicating about communication”. In the early 1970s, Gregory<br />
Bateson coined the term to <strong>de</strong>scribe the un<strong>de</strong>rlying messages in what we<br />
say and do. In other words meta-communication can be <strong>de</strong>fine as a<br />
process of interpretation and un<strong>de</strong>rstanding of communication and<br />
consequently as a tool for <strong>de</strong>veloping one's interpersonal relationships.<br />
People communicate all the time. It’s not possible to avoid it. We<br />
are always sending out signals that others read, interpret, and respond to<br />
while we are reading, interpreting and responding to theirs. Our<br />
communication occurs not flatly, but on different levels and via various<br />
processes. Could be mentioned conventionally even four levels on which<br />
communication take place:<br />
- Verbal level: communication by words;<br />
- Para-verbal level: loudness of speaking, manner of speaking,<br />
when keeping silent, meaning of interrupting or interfering the<br />
conversation;<br />
- Non-verbal level: body language (facial expression, eye<br />
contact, gestures), messages without words;<br />
- Extra-verbal level: time, place, context, orientation towards<br />
target groups, tactile (feeling by touching) and olfactory<br />
(smelling) aspects.
In condition of the complexity of communication as a process<br />
Meta-communication is an indispensable tool. Because people<br />
communicate on different levels, one may not be aware of all the messages<br />
he is sending. The actual content of what one says is the obvious form of<br />
communication, but there are others: the context in which one says<br />
something, the tone and volume of his voice, the look in his eyes, and<br />
other body language, to name a few. Meta-communication can help one<br />
ensure that his messages are consistent. It can also help him better<br />
un<strong>de</strong>rstand the messages sent by others.<br />
5.2. Verbal Communication<br />
Verbal communication inclu<strong>de</strong>s written and oral communication.<br />
Oral communication, is primarily referring to spoken verbal<br />
communication, which typically relies on words. Oral communication may<br />
be face-to-face discussion, interpersonal medicate communication<br />
(telephone discussion) or public presentations.<br />
Written communication involves any type of interaction that<br />
makes use of the written word. Examples of written communication<br />
avenues typically pursued inclu<strong>de</strong> electronic mail, Internet Web sites,<br />
letters, proposals, telegrams, faxes, postcards, contracts, advertisements,<br />
brochures, and news releases. Indifferently of variety verbal<br />
communication supposed the use of language.<br />
Language is a real power. Our use of language has tremendous<br />
power in the type of atmosphere that is created at the problem-solving<br />
table. Words that are critical, blaming, judgmental or accusatory tend to<br />
create a resistant and <strong>de</strong>fensive mindset that is not conducive to productive<br />
problem solving. On the other hand, we can choose words that normalize<br />
the issues and problems and reduce resistance.<br />
What is the meaning of term Language? Language may refer<br />
either to the specifically human capacity for acquiring and using complex<br />
systems of communication, or to a specific instance of such a system of<br />
complex communication. The scientific study of language in any of its<br />
senses is called linguistics.<br />
The approximately 3000–6000 languages that are spoken by<br />
humans today are the most salient examples, but natural languages can<br />
also be based on visual rather than auditive stimuli, for example in sign<br />
languages and written language. Co<strong>de</strong>s and other kinds of artificially<br />
89
constructed communication systems such as those used for computer<br />
programming can also be called languages. A language in this sense is a<br />
system of signs for encoding and <strong>de</strong>coding information. The English word<br />
<strong>de</strong>rives from Latin lingua, "language, tongue." This metaphoric relation<br />
between language and the tongue exists in many languages and testifies to<br />
the historical prominence of spoken languages. When used as a general<br />
concept, "language" refers to the cognitive faculty that enables humans to<br />
learn and use systems of complex communication.<br />
Language is thought to have originated when early hominids first<br />
started cooperating, adapting earlier systems of communication based on<br />
expressive signs to inclu<strong>de</strong> a theory of other minds and shared<br />
intentionality. This <strong>de</strong>velopment is thought to have coinci<strong>de</strong>d with an<br />
increase in brain volume. Language is processed in many different<br />
locations in the human brain, but especially in Broca’s and Wernicke’s<br />
areas. Humans acquire language through social interaction in early<br />
childhood, and children generally speak fluently when they are around<br />
three years old. The use of language has become <strong>de</strong>eply entrenched in<br />
human culture and, apart from being used to communicate and share<br />
information, it also has social and cultural uses, such as signifying group<br />
i<strong>de</strong>ntity, social stratification and for social grooming and entertainment.<br />
Many spoken languages are written. Written communication is<br />
divi<strong>de</strong>d into three revolutionary stages called Information Communication<br />
Revolutions. During the 1st stage written communication first emerged<br />
through the use of pictographs. The pictograms were ma<strong>de</strong> in stone; hence<br />
written communication was not yet mobile. During the 2nd stage writing<br />
began to appear on paper, papyrus, clay, and wax (etc). Common alphabets<br />
were introduced and allowed for the uniformity of language across large<br />
distances. A leap in technology occurred when the Gutenberg printingpress<br />
was invented in the 15th century. The 3rd stage is characterized by<br />
the transfer of information through controlled waves and electronic<br />
signals.<br />
However, even today, there are many world languages that can be<br />
spoken but have no standard written form. Such languages can be<br />
expressed in writing using the International Phonetic Alphabet. Spoken<br />
language is much richer than written language; for example, transcripts of<br />
actual speech show numerous hesitancies which are usually left out of<br />
written forms of 'speech' such as screenplays.<br />
90
Even from the point of view of syntax, spoken language usually<br />
has its own set of grammatical patterns which sometimes may be quite<br />
different from that in written language. In many languages, the written<br />
form is consi<strong>de</strong>red a different language, a situation called diglossia.<br />
Human language is unique in comparison to other forms of<br />
communication, such as those used by other animals, because it allows<br />
humans to produce an infinite set of utterances from a finite set of<br />
elements, and because the symbols and grammatical rules of any particular<br />
language are largely arbitrary, so that the system can only be acquired<br />
through social interaction. The known systems of communication used by<br />
animals, on the other hand, can only express a finite number of utterances<br />
that are mostly genetically transmitted. Human language is also unique in<br />
that its complex structure has evolved to serve a much wi<strong>de</strong>r range of<br />
functions than any other kinds of communication system.<br />
Verbal communication can be efficient, inefficient and even<br />
socially inacceptable.<br />
The form of antisocial verbal communication is verbal abuse.<br />
Verbal abuse (also called reviling or verbal attack) is a form of<br />
abusive behavior involving the use of language. It is a form of profanity<br />
that can occur with or without the use of expletives. While oral<br />
communication is its most common form, verbal abuse may be expressed<br />
in the form of written word as well.<br />
Verbal abuse is a pattern of behavior that can seriously interfere<br />
with a person's healthy emotional <strong>de</strong>velopment. A single exposure to<br />
verbal assault can be enough to significantly affect a person's self-esteem,<br />
emotional well-being, and physical state.<br />
Verbal abuse is best <strong>de</strong>scribed as an ongoing emotional<br />
environment organized by the abuser for the purposes of control. The<br />
un<strong>de</strong>rlying factor in the dynamic of verbal abuse is the abuser’s low regard<br />
for him or herself. The abuser attempts to place their victim in a position to<br />
believe similar things about him or herself, a form of warped projection.<br />
Reports of verbal and emotional abuse indicate that it frequently<br />
occurs in romantic relationships between men and women, where women<br />
are generally reported as the victims. However, verbal abuse may occur to<br />
a person of any gen<strong>de</strong>r, race, culture, size, sexual orientation, or age.<br />
Typically, verbal abuse increases in intensity over time and often<br />
escalates into physical abuse as well.<br />
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During intense verbal abuse, the victim usually suffers from low<br />
self-worth and low self-esteem. As a result, victims may fall into clinical<br />
<strong>de</strong>pression and post-traumatic stress disor<strong>de</strong>r.<br />
Verbal abuse starting from a young age contributes to inferiority<br />
complex, machismo attitu<strong>de</strong>s, and other negative behaviors that plague<br />
many people into senior age.<br />
People who feel they are being attacked by a verbal abuser on a<br />
regular basis should seek professional counsel and remove themselves<br />
from the negative environment whenever possible. Staying around verbal<br />
abusers is damaging for a person's overall well-being, and all steps to<br />
change the situation should be pursued.<br />
The way to recognize signs of verbal abuse in an unhealthy<br />
relationship is to simply know what a healthy relationship looks like.<br />
Consi<strong>de</strong>r the things people value in a healthy and strong relationship.<br />
These could be respect, acceptance, trustworthiness, and honesty with the<br />
freedom and safety to express oneself within healthy boundaries. When we<br />
think about what constitutes a healthy relationship, it becomes easier to<br />
i<strong>de</strong>ntify when we are in an unhealthy relationship.<br />
Signs of verbal abuse exhibited by the abuser are:<br />
Actions of ignoring, ridiculing, disrespecting, and criticizing<br />
others consistently.<br />
A manipulation of words.<br />
Purposeful humiliation of others.<br />
Accusing others falsely for the purpose of manipulating a person's<br />
<strong>de</strong>cision making.<br />
Manipulating people to submit to un<strong>de</strong>sirable behavior.<br />
Making others feel unwanted and unloved.<br />
Threatening to leave the family <strong>de</strong>stitute.<br />
Placing the blame and cause of the abuse onto others.<br />
Isolating a person from some type of support system, consisting of<br />
friends or family.<br />
Harassment<br />
Threatening to do any type of harm to a family member or friend<br />
Once the victim i<strong>de</strong>ntifies and recognizes the signs of verbal<br />
abuse, the victim can be more proactive in finding help. If left too long in<br />
an abusive relationship, the person will start feeling hopeless.<br />
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5.3. Para-verbal Communication<br />
Para-verbal communication is communication by the mean of<br />
nonverbal cues of the voice. Various acoustic properties of speech such as<br />
tone, pitch and accent, loudness of speaking, manner of speaking, keeping<br />
silent, meaning of interrupting or interfering the conversation collectively<br />
known as prosody, can all give off nonverbal cues.<br />
Paraverbal communication refers to how we say something, not<br />
what we say. The paraverbal message accounts for approximately 38% of<br />
what is communicated to someone. A sentence can convey entirely<br />
different meanings <strong>de</strong>pending on the emphasis on words and the tone of<br />
voice. For example, the statement, "I didn't say you were stupid" has six<br />
different meanings, <strong>de</strong>pending on which word is emphasized:<br />
Or, if you say the sentence “Cynthia likes you” with a lilting tone<br />
you are probably teasing someone. However, if you stress the word likes,<br />
“Cynthia likes you”, the message comes out, “Whatever ma<strong>de</strong> you think<br />
she didn’t?” Stress the word you this time, “Cynthia likes you" and you<br />
might be saying, “I wish she liked me”.<br />
The linguist George L. Trager <strong>de</strong>veloped a classification system<br />
which consists of the voice set, voice qualities, and vocalization<br />
The voice set is the context in which the speaker is speaking. This<br />
can inclu<strong>de</strong> the situation, gen<strong>de</strong>r, mood, age and a person's culture.<br />
The voice qualities are volume, pitch, tempo, rhythm, articulation,<br />
resonance, nasality, and accent. They give each individual a unique "voice<br />
print".<br />
Vocalization consists of three subsections: characterizers,<br />
qualifiers and segregates. Characterizers are emotions expressed while<br />
speaking, such as laughing, crying, and yawning. A voice qualifier is the<br />
93
style of <strong>de</strong>livering a message - for example, yelling "Hey stop that!", as<br />
opposed to whispering "Hey stop that". Vocal segregates such as "uh-huh"<br />
notify the speaker that the listener acceptance.<br />
There are some points to be remembered about our para-verbal<br />
communication:<br />
- When we are angry or excited, our speech tends to become<br />
more rapid and higher pitched.<br />
- When we are bored or feeling down, our speech tends to slow<br />
and take on a monotone quality.<br />
- When we are feeling <strong>de</strong>fensive, our speech is often abrupt.<br />
Vocal characterizers (laugh, cry, yell, moan, whine, belch, yawn) -<br />
send different messages in different cultures (Japan — giggling indicates<br />
embarrassment; India – belch indicates satisfaction).<br />
Vocal qualifiers (volume, pitch, rhythm, tempo, and tone) are<br />
associated with cultural distinctions. Loudness, for example, indicates:<br />
- Strength and sincerity in Arab culture;<br />
- Confi<strong>de</strong>nce and authority to the Germans;<br />
- Impoliteness to the Thais;<br />
- Loss of control to the Japanese;<br />
- Aggressiveness in North America<br />
Gen<strong>de</strong>r based as well: women tend to speak higher and more softly<br />
than men.<br />
Vocal segregates (un-huh, shh, uh, oooo, ooh, mmmh, humm, eh,<br />
mah, lah) - indicate formality, acceptance, assent, uncertainty.<br />
Vocal rate <strong>de</strong>als with the speed at which people talk, another<br />
factor that offers various interpretations.<br />
In the Americas as well as in Arabic countries the pauses between<br />
words are usually not too long, while in India and Japan pauses can give a<br />
contradictory sense to the spoken words. Enduring silence is perceived as<br />
comfortable in India and Japan, while in Europe and North America it may<br />
cause insecurity and embarrassment. Scandinavians, by the standards of<br />
other Western cultures, are more tolerant of silent breaks during<br />
conversations.<br />
5.4. Body Language<br />
Body language is a form of non-verbal communication which<br />
consist in sending and interpreting of non verbal signals almost entirely<br />
subconscious. Body language consists of body posture, gestures, facial<br />
94
expressions, eye movements etc. Humans send and interpret such signals.<br />
When a person sends a message with conflicting verbal and nonverbal<br />
information, the nonverbal information tends to be believed. Consi<strong>de</strong>r the<br />
example of someone, through a clenched jaw, hard eyes, and steely voice,<br />
telling you they're not mad. Which are you likely to believe? What you see<br />
or what you hear?<br />
Argyle (1988) conclu<strong>de</strong>d there are five primary functions of<br />
nonverbal bodily behavior in human communication:<br />
Express emotions;<br />
Express interpersonal attitu<strong>de</strong>s;<br />
To accompany speech in managing the cues of interaction<br />
between speakers and listeners;<br />
Self-presentation of one’s personality;<br />
Rituals (greetings).<br />
The Facial Expression<br />
The face is perhaps the most important conveyor of emotional<br />
information. A face can light up with enthusiasm, energy, and approval,<br />
express confusion or boredom, and scowl with displeasure. The facial<br />
expession inclu<strong>de</strong>s:<br />
a) mimics, knit brows (frawn), wrinkle up forehead, corrugate<br />
nose, clench teeth etc.<br />
b) smile, that can be recepted from <strong>de</strong>light to cinism.<br />
c) the look, it can communicate love, frendship, sadness, guilty,<br />
indiference, hate.<br />
While some say that facial expressions are i<strong>de</strong>ntical, meaning<br />
attached to them differs. Majority opinion is that these do have similar<br />
meanings world-wi<strong>de</strong> with respect to smiling, crying, or showing anger,<br />
sorrow, or disgust. However, the intensity varies from culture to culture.<br />
Note the following:<br />
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o Many Asian cultures suppress facial expression as much as<br />
possible.<br />
o Many Mediterranean (Latino / Arabic) cultures exaggerate<br />
grief or sadness while most American men hi<strong>de</strong> grief or sorrow.<br />
o Some see “animated” expressions as a sign of a lack of control.<br />
o Too much smiling is viewed in as a sign of shallowness.<br />
o Women smile more than men.<br />
Eye gaze<br />
Eye contact is an event in which two people look at each other's<br />
eyes at the same time. It is a form of nonverbal communication and is<br />
thought to have a large influence on social behavior. Frequency and<br />
interpretation of eye contact vary between cultures and species. The study<br />
of eye contact is sometimes known as oculesics. Eye contact can indicate<br />
interest, attention, and involvement. Gaze comprises the actions of looking<br />
while talking, looking while listening, amount of gaze, and frequency of<br />
glances, patterns of fixation, pupil dilation, and blink rate.<br />
Eye contact and facial expressions provi<strong>de</strong> important social and<br />
emotional information; people, perhaps without consciously doing so,<br />
probe each other's eyes and faces for positive or negative mood signs. In<br />
some contexts, the meeting of eyes arouses strong emotions. Eye contact is<br />
also an important element in flirting, where it may serve to establish and<br />
gauge the other's interest in some situations.<br />
A 1985 study published in the Journal of Experimental Child<br />
Psychology suggested that "3-month-old infants are comparatively<br />
insensitive to being the object of another's visual regard". A 1996<br />
Canadian study with 3 to 6 month old infants found that smiling in the<br />
infants <strong>de</strong>creased when adult eye contact was removed. A recent British<br />
study in the Journal of Cognitive Neuroscience found that face recognition<br />
by infants was facilitated by direct gaze. Other recent research has<br />
confirmed the belief that the direct gaze of adults influences the direct<br />
gaze of infants.<br />
A study by University of Stirling psychologists conclu<strong>de</strong>d that<br />
children who avoid eye contact while consi<strong>de</strong>ring their responses to<br />
questions had higher rates of correct answers than children who<br />
maintained eye contact. One researcher theorized that looking at human<br />
faces requires a lot of mental processing, which <strong>de</strong>tracts from the cognitive<br />
task at hand. Researchers also noted that a blank stare indicated a lack of<br />
un<strong>de</strong>rstanding.<br />
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In some parts of the world, particularly in East Asia, eye contact<br />
can provoke misun<strong>de</strong>rstandings between people of different nationalities.<br />
Keeping direct eye contact with a work supervisor or el<strong>de</strong>rly people leads<br />
them to assume you are being aggressive and ru<strong>de</strong>.<br />
In Japan, it is more common to look at the throat of the other<br />
person. In China and Indonesia, the practice is to lower the eyes because<br />
direct eye contact is consi<strong>de</strong>red bad manners, and in Hispanic culture<br />
direct eye contact is a form of challenge and disrespect. In Mediterranean<br />
society, men often look at women for long periods of time that may be<br />
interpreted as starring by women from other cultures.<br />
In some Western cultures the eye to eye contact is consi<strong>de</strong>red as<br />
positive (advise children to look a person in the eyes). But within USA,<br />
African-Americans use more eye contact when talking and less when<br />
listening with reverse true for Anglo Americans. This is a possible cause<br />
for some sense of unease between races in US. A prolonged gaze is often<br />
seen as a sign of sexual interest.<br />
In Arab culture, it is common for both speakers and listeners to<br />
look directly into each others’ eyes for long periods of time, indicating<br />
keen interest in the conversation. The prolonged eye contact shows interest<br />
and helps them un<strong>de</strong>rstand truthfulness of the other person (a person who<br />
doesn’t reciprocate is seen as untrustworthy).<br />
Movement and body position<br />
Kinesics is the study of body movements, facial expressions, and<br />
gestures. It was <strong>de</strong>veloped by anthropologist Ray L. Birdwhistell in the<br />
1950s. Kinesic behaviors inclu<strong>de</strong> mutual gaze, smiling, facial warmth or<br />
pleasantness, childlike behaviors, direct body orientation, and the like.<br />
The body movements way.<br />
lateral movements – good communicator.<br />
forward / backword movements – action man.<br />
vertical movements – man with strong persuasion power<br />
Posture can be used to <strong>de</strong>termine a participant’s <strong>de</strong>gree of<br />
attention or involvement, the difference in status between communicators,<br />
and the level of fondness a person has for the other communicator. Our<br />
body postures can create a feeling of warm openness or cold rejection.<br />
Studies investigating the impact of posture on interpersonal relationships<br />
suggest that mirror-image congruent postures, where one person’s left si<strong>de</strong><br />
is parallel to the other’s right si<strong>de</strong>, leads to favorable perception of<br />
communicators and positive speech; a person who displays a forward lean<br />
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or a <strong>de</strong>crease in a backwards lean also signify positive sentiment during<br />
communication. Posture is un<strong>de</strong>rstood through such indicators as direction<br />
of lean, body orientation, arm position, and body openness. For example,<br />
when someone faces us, sitting quietly with hands loosely fol<strong>de</strong>d in the<br />
lap, a feeling of anticipation and interest is created. A posture of arms<br />
crossed on the chest portrays a feeling of inflexibility. The action of<br />
gathering up one's materials and reaching for a purse signals a <strong>de</strong>sire to<br />
end the conversation.<br />
The position of the body gives us the information about the<br />
subject’s attitu<strong>de</strong> and emotions. The dominating person will keep the head<br />
up, but the inferior will keep the head down. The inclination of the body<br />
means the interest, anxiety.<br />
Consi<strong>de</strong>r the following actions and note cultural differences:<br />
o Bowing (not done, criticized, or affected in US; shows rank in<br />
Japan)<br />
o Slouching (ru<strong>de</strong> in most Northern European areas)<br />
o Hands in pocket (disrespectful in Turkey)<br />
o Sitting with legs crossed (offensive in Ghana, Turkey)<br />
o Showing soles of feet. (Offensive in Thailand, Saudi Arabia<br />
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Gesture is a non-vocal bodily movement inten<strong>de</strong>d to express<br />
meaning. They may be articulated with the hands, arms or body, and also<br />
inclu<strong>de</strong> movements of the head, face and eyes, such as winking, nodding,<br />
or rolling one's eyes. The boundary between language and gesture, or<br />
verbal and nonverbal communication, can be hard to i<strong>de</strong>ntify.<br />
According to Ottenheimer (2007), psychologists Paul Ekman and<br />
Wallace Friesen suggested that gestures could be categorized into five<br />
types: emblems, illustrators, affect displays, regulators, and adaptors<br />
emblems are gestures with direct verbal translations, such as a<br />
goodbye wave;<br />
illustrators are gestures that <strong>de</strong>pict what is said verbally, such as<br />
turning an imaginary steering wheel while talking about driving<br />
an affect display is a gesture that conveys emotions, like a smile;<br />
regulators are gestures that control interaction;<br />
and finally, an adaptor is a gesture that facilitates the release of<br />
bodily tension, such as quickly moving one's leg.<br />
Some emblems seem to be universal, while others are cultural,<br />
with different interpretations in various cultures, or perhaps with different<br />
uses by men and women. An example of a universal emblem is the<br />
uplifted shoul<strong>de</strong>rs and upturned hands that indicate “I don’t know”<br />
virtually everywhere in the world. An example of a culture-bound emblem<br />
is the encircled thumb and forefinger "O". "Everything ok" is shown in<br />
western European countries, especially between pilots and divers. This<br />
sign, especially when fingers are curled, means in Korea and Japan "now<br />
we may talk about money", in southern France the contrary ("nothing,<br />
without any value"). In Brazil, it is consi<strong>de</strong>red ru<strong>de</strong>, especially if<br />
performed with the three exten<strong>de</strong>d figures shown horizontally to the floor<br />
while the other two fingers form an O.<br />
Gestures can be also categorized as either speech-in<strong>de</strong>pen<strong>de</strong>nt or<br />
speech-related. Speech-in<strong>de</strong>pen<strong>de</strong>nt gestures are <strong>de</strong>pen<strong>de</strong>nt upon<br />
culturally accepted interpretation and have a direct verbal translation. A<br />
wave hello or a peace sign are examples of speech-in<strong>de</strong>pen<strong>de</strong>nt gestures.<br />
Speech related gestures are used in parallel with verbal speech; this form<br />
of nonverbal communication is used to emphasize the message that is<br />
being communicated.<br />
Speech related gestures are inten<strong>de</strong>d to provi<strong>de</strong> supplemental<br />
information to a verbal message such as pointing to an object of discussion<br />
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There are some cultural differences regarding the interpretation of<br />
a certain gesture, an acceptable in one’s own culture may be offensive in<br />
another. Amount of gesturing varies from culture to culture. Even simple<br />
things like using hands to point and count differ.<br />
For example – to point (show direction using the finger) is<br />
unpolite in Europe, offence in Thailand and usual in the US. But, pointing:<br />
in US with in<strong>de</strong>x finger; Germany with little finger; Japanese with entire<br />
hand (in fact most Asians consi<strong>de</strong>r pointing with in<strong>de</strong>x finger to be ru<strong>de</strong>).<br />
Another example is putting foot on the table in America.<br />
Dance is a form of nonverbal communication that requires the<br />
same un<strong>de</strong>rlying faculty in the brain for conceptualization, creativity and<br />
memory as does verbal language in speaking and writing. Means of selfexpression,<br />
both forms have vocabulary (steps and gestures in dance),<br />
grammar (rules for putting the vocabulary together) and meaning. Dance,<br />
however, assembles (choreographs) these elements in a manner that more<br />
often resembles poetry, with its ambiguity and multiple, symbolic and<br />
elusive meanings<br />
The tactile communication<br />
Touches can be <strong>de</strong>fined as communication inclu<strong>de</strong> handshakes,<br />
holding hands, kissing (cheek, lips, hand), back slapping, high fives, a pat<br />
on the shoul<strong>de</strong>r, hugging, taping on the shoul<strong>de</strong>r and brushing an arm.<br />
Touching of oneself during communication may inclu<strong>de</strong> licking, picking,<br />
holding, and scratching. These behaviors are referred to as "adaptor" and<br />
may send messages that reveal the intentions or feelings of a<br />
communicator. The meaning conveyed from touch is highly <strong>de</strong>pen<strong>de</strong>nt<br />
upon the context of the situation, the relationship between communicators,<br />
and the manner of touch. It <strong>de</strong>pends on age, relation and cultutre.<br />
Touch is culturally <strong>de</strong>termined. But each culture has a clear<br />
concept of what parts of the body one may not touch. Basic message of<br />
touch is to affect or control — protect, support, disapprove (i.e. hug, kiss,<br />
hit, kick).<br />
Example: An African-American male goes into a convenience<br />
store recently taken over by new Korean immigrants. He gives a $20 bill<br />
for his purchase to Mrs. Cho, who is cashier, and waits for his change.<br />
He is upset when his change is put down on the counter in front of him.<br />
What is the problem? Traditional Korean (and many other Asian<br />
countries) doesn’t touch strangers, especially between members of the<br />
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opposite sex. But the African-American sees this as another example of<br />
discrimination (not touching him because he is black).<br />
Cultures (English, German, Scandinavian, Chinese, and Japanese)<br />
with high emotional restraint concepts have little public touch; those<br />
which encourage emotion (Latino, Middle-East, Jewish) accept frequent<br />
touches. It has been noted, for example, that Mediterranean, Middle<br />
Eastern and Latin American cultures employ much social touching in<br />
conversation, including embraces and hand-holding; these are called highcontact<br />
(or high-touch) cultures. In mo<strong>de</strong>rate-touch cultures such as North<br />
America and Northern Europe, touching is used only occasionally, such as<br />
in handshakes and sporadic shoul<strong>de</strong>r touching or back slapping. In low<br />
contact cultures such as in Northern Asian cultures, meanwhile, social<br />
touching is rarely used at all. But the geography is by no means that<br />
simple. People in the Asian nation of the Philippines, for example, use a<br />
large amount of social touching in conversation and personal interaction.<br />
In USA the handshake is common (even for strangers), hugs, and<br />
kisses for those of opposite gen<strong>de</strong>r or of family (usually) on an<br />
increasingly more intimate basis. Note differences between African-<br />
Americans and Anglos in USA. Most African Americans touch on<br />
greeting but are annoyed if touched on the head (good boy, good girl<br />
overtones).<br />
In Islamic and Hindu cultures people typically don’t touch with<br />
the left hand. To do so is a social insult. Left hand is for toilet functions.<br />
Mannerly, in India to break your bread is permitted only with your right<br />
hand, sometimes is difficult for non-Indians.<br />
Islamic cultures generally don’t approve of any touching between<br />
gen<strong>de</strong>rs (even handshakes). But consi<strong>de</strong>r such touching (including hand<br />
holding, hugs) between same-sex to be appropriate.<br />
Many Asians don’t touch the head - head houses the soul and a<br />
touch puts it in jeopardy.<br />
5.5. Extraverbal Communication<br />
Extraverbal Communication is a form of communication which<br />
inclu<strong>de</strong>s receiving and sending of information by mean of time, place,<br />
context, orientation towards target groups aspects.<br />
Physical environment<br />
Environmental factors such as furniture, architectural style,<br />
interior <strong>de</strong>corating, lighting conditions, colors, temperature, noise, and<br />
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music affect the behavior of communicators during interaction.<br />
Environmental conditions can alter the choices of words or actions that<br />
communicators use to accomplish their communicative objective.<br />
The space language.<br />
Proxemics is the study of how people use and perceive the<br />
physical space around them. The space between the sen<strong>de</strong>r and the<br />
receiver of a message influences the way the message is interpreted.<br />
Proxemics was first <strong>de</strong>veloped by Edward T. Hall during the 1950s and<br />
60s. Hall's studies were inspired by earlier studies of how animals<br />
<strong>de</strong>monstrate territoriality. The term territoriality is still used in the study of<br />
proxemics to explain human behavior regarding personal space. There are<br />
i<strong>de</strong>ntified 4 such territories:<br />
1. Primary territory: this refers to an area that is associated with<br />
someone who has exclusive use of it. For example, a house that<br />
others cannot enter without the owner’s permission.<br />
2. Secondary territory: unlike the previous type, there is no “right” to<br />
occupancy, but people may still feel some <strong>de</strong>gree of ownership of a<br />
particular space. For example, someone may sit in the same seat on<br />
train every day and feel aggrieved if someone else sits there.<br />
3. Public territory: this refers to an area that is available to all, but only<br />
for a set period, such as a parking space or a seat in a library.<br />
Although people have only a limited claim over that space, they<br />
often exceed that claim. For example, it was found that people take<br />
longer to leave a parking space when someone is waiting to take that<br />
space.<br />
4. Interaction territory: this is space created by others when they are<br />
interacting. For example, when a group is talking to each other on a<br />
footpath, others will walk around the group rather than disturb it.<br />
Consequently space in nonverbal communication was <strong>de</strong>vi<strong>de</strong>d into<br />
four main categories: intimate, social, personal, and public space.<br />
Intimate space (Distance: Touching to 11/2 feet). This is the<br />
distance of lovemaking, wrestling, comforting, and protecting.<br />
Personal Distance (Distance: 11/2 feet to 4 feet). This distance is<br />
reserved for more than just a casual friend or fleeting encounter; however,<br />
it is a no-contact distance. Where people stand in relation to each other<br />
signals their relationship, or how they feel toward each other, or both. A<br />
wife can stay insi<strong>de</strong> the circle of her husband's close personal zone with<br />
impunity. For another woman to do so is an entirely different story.<br />
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Social Distance (Distance: 4 to 12 feet). Impersonal business or<br />
casual conversations can be carried on in this space. People are very much<br />
aware of the presence of one another, but they neither interfere with each<br />
other nor are they oppressively near;<br />
Public Distance (Distance: 12 to 25 feet, or farther). A person at<br />
this distance is outsi<strong>de</strong> the circle of involvement. This is the distance<br />
reserved for public speakers and/or public officials or for anyone on public<br />
occasions.<br />
Note that this distance can vary significantly. Extraverts, for<br />
example, may have smaller distances whilst introverts may prefer to keep<br />
their distance. People who live in towns and cities are used to squeezing<br />
closer to people so have smaller spaces, whilst country people stand so far<br />
apart they have to lean forwards to shake hands. Also the distance varies<br />
greatly across cultures and different settings within cultures.<br />
The distance between communicators will also <strong>de</strong>pend on sex,<br />
status, and social role.<br />
The time language<br />
Chronemics is the study of the use of time in nonverbal<br />
communication. The way we perceive time, structure our time and react to<br />
time is a powerful communication tool, and helps set the stage for<br />
communication. Time perceptions inclu<strong>de</strong> punctuality and willingness to<br />
wait, the speed of speech and how long people are willing to listen. The<br />
timing and frequency of an action as well as the tempo and rhythm of<br />
communications within an interaction contributes to the interpretation of<br />
nonverbal messages. Gudykunst & Ting-Toomey (1988) i<strong>de</strong>ntified 2<br />
dominant time patterns.<br />
Monochronic time schedule (M-time): Time is seen as being very<br />
important and it is characterized by a linear pattern where the emphasis is<br />
on the use of time schedules and appointments. Time is viewed as<br />
something that can be controlled or wasted by individuals, and people tend<br />
to do one thing at a time.<br />
Polychronic time schedule (P-time): Personal involvement is more<br />
important than schedules where the emphasis lies on personal relationships<br />
rather than keeping appointments on time.<br />
Studies show that the monochronemic conversation (talking about<br />
one thing at a time) is common in Northern Europe and North America.<br />
Meanwhile, Latin American, Asian, Middle Eastern and Mediterranean<br />
cultures are more likely to use polychronemic conversation (multiple<br />
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conversations at the same time, and frequent interruption by other speakerlisteners).<br />
The way of using the time language is correlated with:<br />
- time precision<br />
The time is something precious and personal and when somebody<br />
tries to organize out time it shows the status difference. To come in time or<br />
not to meeting shows the attitu<strong>de</strong> of the interlocutor in regards of the<br />
speaker or the subject, perception of the status and power, the respect and<br />
importance paid. The more people are ma<strong>de</strong> to wait, the more they feel<br />
humble and disrespected.<br />
In different cultures the punctuality means different times to come<br />
to a meeting or appointment. In some countries like China and Japan,<br />
punctuality is consi<strong>de</strong>red important and being late would be consi<strong>de</strong>red as<br />
an insult. However, in countries such as those of South America and the<br />
Middle East, being on time does not carry the same sense of urgency.<br />
Americans come earlier in or<strong>de</strong>r to accommodate themselves to<br />
the space and prepare for the discussion. British and Swedish come exactly<br />
in time in or<strong>de</strong>r to prove efficient time management, French come a little<br />
later in or<strong>de</strong>r to make the interlocutor a little nervous to be easier to<br />
manipulate.<br />
Thus the time language can be used consciously or not to control<br />
and subdue or to communicate respect and interest.<br />
- time lack<br />
The time is perceived as a personal scarce recourse therefore the<br />
way how the person allocates it to another person who requires a part of<br />
this recourse shows the attitu<strong>de</strong> of the subject regarding the <strong>de</strong>man<strong>de</strong>r.<br />
Miss-allocation of time for communication with a person is consi<strong>de</strong>red as<br />
miss- allocation of importance. Some sociological researches proved that a<br />
positive communication relation is built in direct proportion with the<br />
frequency.<br />
- time as symbol<br />
This aspect is related to certain usuality, like rhythm (for example<br />
we eat three times a day at a certain hour). Similarly seasons impose some<br />
certain activities and a certain life style. Holydays and rituals also are<br />
marked in time. Thus businessmen know that in the period of winter<br />
holidays people spend more money and work less.<br />
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5.6. Interaction Between Verbal and Nonverbal Communication<br />
Non-verbal communication consists of all the messages other than<br />
words that are used in communication. Humans use consciously or<br />
unconsciously nonverbal communication for many reasons:<br />
To create impressions beyond the verbal element of communication<br />
(kinesics, chronemics, vocalics, environment).<br />
To repeat and reinforce what is said verbally (occulesics, kinesics).<br />
To manage and regulate the interaction among participants in the<br />
communication exchange (kinesics, occulesics, proxemics, synchrony).<br />
To express emotion beyond the verbal element (kinesics, occulesics,<br />
haptics, vocalics, proxemics).<br />
To convey relational messages of affection, power, dominance,<br />
respect, and so on (proxemics, occulesics, haptics).<br />
To promote honest communication by <strong>de</strong>tecting <strong>de</strong>ception or<br />
conveying suspicion (kinesics, occulesics, vocalics).<br />
To provi<strong>de</strong> group or social lea<strong>de</strong>rship by sending messages of power<br />
and persuasion (kinesics, vocalics, chronemics).<br />
Nonverbal communication is a part of communication process.<br />
That mean it is in continuous interaction with verbal communication.<br />
When communicating, nonverbal messages can interact with verbal<br />
messages in six ways: repeating, conflicting, complementing, substituting,<br />
regulating and accenting/mo<strong>de</strong>rating.<br />
Repeating - consists of using gestures to strengthen a verbal<br />
message, such as pointing to the object of discussion.<br />
Conflicting - verbal and nonverbal messages within the same<br />
interaction can sometimes send opposing or conflicting messages. A<br />
person verbally expressing a statement of truth while simultaneously<br />
fidgeting or avoiding eye contact may convey a mixed message to the<br />
receiver in the interaction. Conflicting messages may occur for a variety of<br />
reasons often stemming from feelings of uncertainty, ambivalence, or<br />
frustration. When mixed messages occur, nonverbal communication<br />
becomes the primary tool people use to attain additional information to<br />
clarify the situation; great attention is placed on bodily movements and<br />
positioning when people perceive mixed messages during interactions<br />
Complementing - accurate interpretation of messages is ma<strong>de</strong><br />
easier when nonverbal and verbal communication complement each other.<br />
Nonverbal cues can be used to elaborate on verbal messages to reinforce<br />
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the information sent when trying to achieve communicative goals;<br />
messages have been shown to be remembered better when nonverbal<br />
signals affirm the verbal exchange<br />
Substituting - nonverbal behavior is sometimes used as the sole<br />
channel for communication of a message. People learn to i<strong>de</strong>ntify facial<br />
expressions, body movements, and body positioning as corresponding with<br />
specific feelings and intentions. Nonverbal signals can be used without<br />
verbal communication to convey messages; when nonverbal behavior does<br />
not effectively communicate a message, verbal methods are used to<br />
enhance un<strong>de</strong>rstanding.<br />
Regulating - nonverbal behavior also regulates our conversations.<br />
For example, touching someone's arm can signal that you want to talk next<br />
or interrupt.<br />
Accenting/Mo<strong>de</strong>rating - nonverbal signals are used to alter the<br />
interpretation of verbal messages. Touch, voice pitch, and gestures are<br />
some of the tools people use to accent or amplify the message that is sent;<br />
nonverbal behavior can also be used to mo<strong>de</strong>rate or tone down aspects of<br />
verbal messages as well. For example, a person who is verbally expressing<br />
anger may accent the verbal message by shaking a fist.<br />
5.7. Appearance of Medical Stu<strong>de</strong>nts and Doctors. The Dress Co<strong>de</strong>.<br />
Appearance refers to the communication role played by a person’s<br />
look or physical appearance. It <strong>de</strong>als with physical aspects of body shape,<br />
hair color and skin tone, as well as grooming, dress (both clothing and<br />
jewelry) and use of appearance enhancements such as body piercings,<br />
brandings and tattoos. Appearance is an important aspect of personal as<br />
well professional image. Having a professional image is important for any<br />
practice and especially for medical practice. If patients see<br />
professionalism, in addition to receiving courteous treatment and quick<br />
service, they will be impressed. Patient satisfaction with health care,<br />
compliance with medication and treatment outcome is related to the<br />
physician’s interpersonal skills including his/her sensitivity to nonverbal<br />
behavior and appearance.<br />
You may think that setting gui<strong>de</strong>lines for professional appearance<br />
is more difficult today than in years past, but women's skirt lengths and<br />
men's long hair used to challenge human resources managers. Now it's<br />
body piercing, tattoos and skimpy clothing. Whether it's the 1970s or the<br />
2010s, these issues have a common source – people <strong>de</strong>claring themselves<br />
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as individuals or maybe not knowing what's consi<strong>de</strong>red "professional."<br />
Either way, today's medical practice administrators and human resources<br />
managers must know where to draw the line so the group practice projects<br />
a competent, professional image.<br />
As stu<strong>de</strong>nts/physicians will encounter patients from diverse<br />
groups, their personal appearance becomes an important part in<br />
establishing rapport with each patient. Therefore, the therapeutic alliance<br />
must be secured before initial verbal interaction has occurred.<br />
Stu<strong>de</strong>nt/physicians should place the patient’s needs first even if this<br />
necessitates curtailing some aspects of one’s individual expression.<br />
Because of the responsibility to inspire confi<strong>de</strong>nce in our professionalism<br />
and high quality of care, physicians are expected to wear appropriate dress<br />
as <strong>de</strong>fined herein; in a manner which reflects positively on the <strong>de</strong>partment,<br />
hospital and their profession. Each stu<strong>de</strong>nt/physician is expected to reflect<br />
the organization’s high standards through professional dress, grooming,<br />
conduct, language, and <strong>de</strong>corum.<br />
Standards for dress, grooming, and personal cleanliness contribute<br />
to the morale of all staff members and affect the image of the Medicine as<br />
a Practice. During business hours, stu<strong>de</strong>nt/physicians are expected to<br />
present an appearance and dress according to the requirements of their<br />
positions. Clothing worn to work should reflect professional status,<br />
provi<strong>de</strong> for mechanical safety of stu<strong>de</strong>nt/physicians and patients, allow for<br />
full performance of all duties and provi<strong>de</strong> easy i<strong>de</strong>ntification of<br />
stu<strong>de</strong>nt/physicians.<br />
Dress co<strong>de</strong>s for a job at a hospital, medical office or any other<br />
medical institution require conservative styles. The dress co<strong>de</strong> is not<br />
simply a matter of professionalism, but also a matter of safety.<br />
Stu<strong>de</strong>nts/physicians come into contact with patients and medical<br />
equipment. They must be prepared for a number of situations, such as<br />
excessive bleeding, vomiting, chemical spills and other acci<strong>de</strong>nts.<br />
Appropriate dress for all medical personnel is as follows:<br />
Dress of medical stu<strong>de</strong>nts in routine class in the first two years could<br />
be informal.<br />
All medical stu<strong>de</strong>nts are required to wear a clean, short white coat.<br />
Hair (including facial hair) should be clean, neatly trimmed, and<br />
contained so that it does not come in contact with patients. Men’s beards<br />
are acceptable when neatly trimmed. Hair colored green, blue, pink, etc., is<br />
not acceptable<br />
107
Anything that is exaggerated or overdone, whether it is jewelry,<br />
make-up, hairstyle, perfume, or clothing, is inappropriate. A minimum of<br />
jewelry such as wedding rings or class rings are acceptable, it must be<br />
small and simple. It cannot obstruct his or her work, and should be visible<br />
on the ear only (that means no facial jewelry such as nose, eyebrow, lip,<br />
etc., piercings). Multiple rings, i.e., one on each finger, are unacceptable.<br />
Earrings, necklaces, bracelets and other piercings may impe<strong>de</strong> the<br />
employee's work or catch on a patient or equipment.<br />
Stu<strong>de</strong>nt/physicians are required to maintain a clean, odor-free<br />
personal hygiene. Strong-smelling perfume, aftershave, scented lotions,<br />
and cologne are not permitted, as some patients may be allergic.<br />
Button-down shirts should not be open below the second button<br />
(sterno-manubrial junction). Ties are required for men.<br />
Shoes should be polished, neat and clean, and always with closed<br />
toes. Do not wear sandals in patient care areas because dropped needles<br />
may pierce your feet.<br />
Stu<strong>de</strong>nt/physicians are required to maintain fingernails clean, wellmanicured,<br />
and mo<strong>de</strong>rate in length. Nail color will be in keeping with the<br />
professional image.<br />
Tattoos and other body art must be covered at all times while on<br />
duty.<br />
Clothing should fully cover the mid-back, lower-back, and<br />
stomach. Un<strong>de</strong>rgarments should not be visible. Bare legs, if applicable,<br />
must be neat and presentable.<br />
Women should wear professional blouses or sweaters. Low cut or<br />
clinging shirts, sweaters or blouses are inappropriate.<br />
Skirts should be at least three inches below the white coat and<br />
below the knee if no stockings are worn. Shorter skirts are acceptable with<br />
tights or stockings. No clam-digger or Capri pants, jeans, cargo pants or<br />
leggings without skirts. Minimize excessively bright, dark or creativelycolorful<br />
polish.<br />
Blue scrub suits are permitted in direct patient care areas and in<br />
the Operating Room<br />
In the Operating Room<br />
Women who wear scrub suits with a <strong>de</strong>ep V-neck should wear the<br />
V-neck behind so as to prevent gapping in the front.<br />
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Jewelry must come off before scrubbing. Earrings are<br />
unacceptable in the Operating Room because they may fall into the field.<br />
Short necklaces are acceptable as they are covered by O.R. gowns.<br />
Inappropriate dress for all medical personnel is as follows:<br />
Soiled, tattered, torn, frayed, or ripped clothing<br />
Shorts of any kind<br />
See-through garments, or those with plunging or revealing<br />
necklines<br />
Garments exposing midriff or un<strong>de</strong>rgarments<br />
Tube-tops, tank tops, or tight, form-fitting shirts<br />
Spaghetti straps, and low-cut or off-the-shoul<strong>de</strong>r shirts or dresses<br />
Sweatshirts<br />
Stirrups, leggings, or exercise attire<br />
Tight or transparent clothing (including tight-fitting T-shirts)<br />
Any clothing with slogans, advertising, or questionable or<br />
suggestive logos or emblems<br />
Any clothing that promotes alcohol or tobacco<br />
Belly shirts<br />
Baseball caps or hats<br />
Low-rise jeans<br />
Other<br />
Do not chew gum.<br />
No eating or drinking in front of patients or in patient care areas.<br />
Speak softly in the hospital.<br />
Never discuss one’s own or friends’ personal issues in public<br />
areas.<br />
Never discuss patient care issues in public areas, such as cafeterias<br />
and elevators.<br />
Do not criticize pedagogy, faculty, staff, others or institutions in<br />
public areas.<br />
Do not carry patient charts or X-ray fol<strong>de</strong>rs with the name<br />
exposed.<br />
Keep beepers on vibrator-silent mo<strong>de</strong> so as not to interrupt<br />
attendings and patients.<br />
► Exercises and Discussions:<br />
1. What is metacommunication?<br />
2. What are verbal communication forms and types?<br />
3. Describe the elements of paraverbal communication.<br />
109
4. Describe the elements of body language. What are your<br />
preferable gesture, body posture, face expression etc?<br />
5. What is extra verbal communication? Do you have a<br />
monochronemic or polychronemic perception of time?<br />
6. Learn the elements of professional dress co<strong>de</strong>.<br />
7. I<strong>de</strong>ntify three of the seven uses of nonverbal communication.<br />
8. Explain from personal experience an example of misun<strong>de</strong>rstood<br />
communication caused by differing interpretations of nonverbal<br />
communication techniques.<br />
► Recommen<strong>de</strong>d Essays<br />
1. The therapeutic miracle of words<br />
2. Language of colors<br />
3. Language of flowers<br />
4. Dress co<strong>de</strong> in the intercultural contexts<br />
5. How to make a good first impression?<br />
6. Smile and its significance<br />
► Literature:<br />
1. Burgoon Ju<strong>de</strong>e K., Buller David B., Woodall William Gill.<br />
Nonverbal communication: the unspoken dialogue. Harper & Row,<br />
1989.<br />
2. Esposito Anna. Fundamentals of verbal and nonverbal<br />
communication and the biometric issue. IOS Press, 2007.<br />
3. Keidar Daniela Classroom Communication. Use of Emotional<br />
Intelegence and Non-Verbal Communication in Ethics Education at<br />
Medical Schools. UNESCO Chair Office, Haifa, 2005. – 116 p.<br />
4. Krueger Juliane. GRIN Verlag, 2008.<br />
5. Kendon Adam. Gesture: visible action as utterance. Cambridge<br />
University Press, 2004.<br />
6. Wood Julia T.. Communication in Our Lives. Cengage Learning,<br />
2008.<br />
110
Barriers and Cleavages in Communication<br />
111<br />
Chapter 6<br />
A barrier to communication is something that keeps<br />
meanings from meeting. Meaning barriers exist between all<br />
people, making communication much more difficult than<br />
most people seem to realize. It is false to assume that if one<br />
can talk he can communicate. Because so much of our<br />
education misleads people into thinking that communication<br />
is easier than it is, they become discouraged and give up<br />
when they run into difficulty. Because they do not un<strong>de</strong>rstand<br />
the nature of the problem, they do not know what to do. The<br />
won<strong>de</strong>r is not that communicating is as difficult as it is, but<br />
that it occurs as much as it does."<br />
6.1 Communication Distorting Factors<br />
Reuel Howe, theologian and educator<br />
Every time people inject voluntary or involuntary barriers into<br />
their communication. These barriers can exist in any of the three<br />
components of communication (verbal, paraverbal, and nonverbal). Any<br />
one of the components of the communication mo<strong>de</strong>l (sen<strong>de</strong>r, message,<br />
receiver, context, co<strong>de</strong>, channel etc) can become a barrier to<br />
communication. For this reason, it is worthwhile to <strong>de</strong>scribe some of the<br />
common responses that will, inevitably, have a negative effect on<br />
communications. The most common of them are listed and analyzed<br />
below.<br />
a. Barrier of communication on the level of message Muddled<br />
messages<br />
Muddled messages are a barrier to communication because the<br />
sen<strong>de</strong>r leaves the receiver unclear about the intent of the sen<strong>de</strong>r. Contrast<br />
these two messages: "Please be here about 7:00 tomorrow morning."<br />
"Please be here at 7:00 tomorrow morning." The one word difference<br />
makes the first message muddled and the second message clear. Muddled<br />
messages have many causes. The sen<strong>de</strong>r may be confused in his or her<br />
thinking. The message may be little more than a vague i<strong>de</strong>a. The problem<br />
may be semantics, e.g., note this muddled newspaper ad: "Dog for sale.
Will eat anything. Especially likes children. Call 888-3599 for more<br />
information."<br />
Clarifying muddled messages is the responsibility of the sen<strong>de</strong>r.<br />
The sen<strong>de</strong>r hoping the receiver will figure out the message does little to<br />
remove this barrier to communication.<br />
Effective communication starts with a clear message. Making<br />
messages when intend an efficient communication sen<strong>de</strong>r should also take<br />
in account the receiver’s interests and abilities of <strong>de</strong>coding.<br />
Verbal Message can be a serious impediment of communication<br />
when:<br />
1. Attacking, interrogating, criticizing, blaming, and shaming:<br />
"If you were doing your job and supervising Susie in the lunch line<br />
we probably wouldn't be in this situation, would we?"<br />
"Have you followed through with the counseling we asked you to<br />
do? Have you gotten Ben to the doctor's for his medical checkup? Did you<br />
call and arrange for a Big Brother? Have you found out if you're eligible<br />
for food stamps?"<br />
"From what I can see, you don't have the training to teach a child<br />
with ADHD. Obviously if you did you would be using different strategies<br />
that wouldn't make her feel like she's a bad person."<br />
2. Moralizing, preaching, advising, and diagnosing:<br />
"You don't seem to un<strong>de</strong>rstand how important it is for your child to<br />
get this help. Don't you see that he's well on his way to becoming a<br />
sociopath?"<br />
"You obviously don't realize that if you were following the same<br />
steps we do at home you wouldn't be having this problem. You don't seem<br />
to care about whatís going on in this child's life outsi<strong>de</strong> of school."<br />
3. Or<strong>de</strong>ring, threatening, commanding, and directing:<br />
"If you don't voluntarily agree to this evaluation we can take you<br />
to due process. Go ahead and file a complaint if you want to."<br />
"I'm going to write a letter of complaint to the superinten<strong>de</strong>nt and<br />
have this in your file if you don't stop humiliating my son in front of his<br />
classmates. I know my rights."<br />
4. Shouting, name calling, refusing to speak.<br />
Some Nonverbal messages which could be Communication<br />
Barriers are:<br />
1. Flashing or rolling eyes,<br />
2. Quick or slow movements,<br />
112
3. Arms crossed, legs crossed,<br />
4. Gestures ma<strong>de</strong> with exasperation,<br />
5. Slouching, hunching over,<br />
6. Poor personal care,<br />
7. Doodling,<br />
8. Staring at people or avoiding eye contact,<br />
9. Excessive fidgeting with materials.<br />
b. Barrier of communication on the receiver’s level<br />
Listening is difficult. A typical speaker says about 125 words per<br />
minute. The typical listener can receive 400-600 words per minute. Thus,<br />
about 75 percent of listening time is free time. The free time often<br />
si<strong>de</strong>tracks the listener. Letting your attention drift away you put<br />
<strong>de</strong>liberately a barrier in commutation.<br />
Others impediments of communication related to poor listening<br />
skills are:<br />
- Automating listening.<br />
- Selective listening.<br />
Automatic listening happens when a person listening just long<br />
enough to find a word that he knows something about. Then shut off the<br />
rest of what is being said, particularly the emotional content. Then starts<br />
talking about the word he knows something about. This blocks real<br />
communications by not hearing the total content. This is the most used<br />
form of blocking true communication.<br />
Selective listening is when a person hears another but selects to<br />
not hear what is being said by choice or <strong>de</strong>sire to hear some other message.<br />
This can take several forms and result in acting out in <strong>de</strong>structive ways.<br />
An example is to become passive aggressive by pretending to hear and<br />
agree to what was said when actually your intent is to NOT act on the<br />
message, but make the other person think you will. Another form is to act<br />
on what you wanted to hear instead of what was said. Continued selective<br />
listening is one of the best ways to <strong>de</strong>stroy a relationship.<br />
c. Barriers on the channel’s level<br />
In or<strong>de</strong>r to avoid misun<strong>de</strong>rstanding, in choice of a channel, the<br />
sen<strong>de</strong>r needs to be sensitive to such things as the complexity of the<br />
message (good morning versus a construction contract); the consequences<br />
of a misun<strong>de</strong>rstanding (medication for a sick animal versus a guess about<br />
tomorrow's weather); knowledge, skills and abilities of the receiver (a new<br />
employee versus a partner in the business); and immediacy of action to be<br />
113
taken from the message (instructions for this morning's work versus a plan<br />
of work for 1994). Variation of channels helps the receiver un<strong>de</strong>rstand the<br />
nature and importance of a message.<br />
For instance an oral channel is highly appropriate for such a<br />
message as “Good morning". Writing "GOOD MORNING!" on a<br />
chalkboard in the machine shed is less effective than a warm oral greeting.<br />
On the other hand, a <strong>de</strong>tailed request to a contractor for construction of a<br />
far rowing house should be in writing, i.e., non-oral.<br />
d. Barriers on the context’s level<br />
Barriers on the context level refer to all condition in which<br />
communication occurs. These may be:<br />
Physical (for instance spatial barriers);<br />
Biological (physiological and gen<strong>de</strong>r barriers);<br />
Psychological (emotional, perceptual, cognitive barriers etc)<br />
Social.<br />
Physical barriers:<br />
Physical distractions are the physical things that get in the way of<br />
communication. Examples of such things inclu<strong>de</strong> the telephone, a pick-up<br />
truck door, a <strong>de</strong>sk, an uncomfortable meeting place, and noise.<br />
A supervisor may give instructions from the driver's seat of a pickup<br />
truck. Talking through an open window and down to an employee<br />
makes the truck door a barrier. A person sitting behind a <strong>de</strong>sk, especially if<br />
sitting in a large chair, talking across the <strong>de</strong>sk is talking from behind a<br />
physical barrier. Two people talking facing each other without a <strong>de</strong>sk or<br />
truck-door between them have a much more open and personal sense of<br />
communication. Uncomfortable meeting places may inclu<strong>de</strong> a place on the<br />
farm that is too hot or too cold. Another example is a meeting room with<br />
uncomfortable chairs that soon cause people to want to stand even if it<br />
means cutting short the discussion. Noise is a physical distraction simply<br />
because it is hard to concentrate on a conversation if hearing is difficult.<br />
Biological barriers:<br />
Gen<strong>de</strong>r barriers<br />
There are distinct differences between the speech patterns in a<br />
man and those in a woman. A woman speaks between 22,000 and 25,000<br />
words a day whereas a man speaks between 7,000 and 10,000. In<br />
childhood, girls speak earlier than boys and at the age of three, have a<br />
vocabulary twice that of boys.<br />
114
The reason for this lies in the wiring of a man's and woman's<br />
brains. When a man talks, his speech is located in the left si<strong>de</strong> of the brain<br />
but in no specific area. When a woman talks, the speech is located in both<br />
hemispheres and in two specific locations.<br />
This means that a man talks in a linear, logical and<br />
compartmentalized way, features of left-brain thinking; whereas a woman<br />
talks more freely mixing logic and emotion, features of both si<strong>de</strong>s of the brain.<br />
It also explains why women talk for much longer than men each day.<br />
Physiological barriers:<br />
They may result from individuals' personal discomfort, caused, for<br />
example, by ill health, poor eye sight or hearing difficulties.<br />
Psychological barriers:<br />
Perceptual barriers<br />
The problem with communicating with others is that we all see the<br />
world differently. If we didn't, we would have no need to communicate:<br />
something like extrasensory perception would take its place.<br />
The following anecdote is a remin<strong>de</strong>r of how our thoughts,<br />
assumptions and perceptions shape our own realities:<br />
A traveller was walking down a road when he met a man from the<br />
next town. "Excuse me," he said. "I am hoping to stay in the next town<br />
tonight. Can you tell me what the townspeople are like?"<br />
"Well," said the townsman, "how did you find the people in the last<br />
town you visited?"<br />
"Oh, they were an irascible bunch. Kept to themselves. Took me<br />
for a fool. Over-charged me for what I got. Gave me very poor service."<br />
"Well, then," said the townsman, "you'll find them pretty much the<br />
same here."<br />
Emotional barriers<br />
One of the chief barriers to open and free communications is the<br />
emotional barrier. It is comprised mainly of fear, mistrust and suspicion.<br />
The roots of our emotional mistrust of others lie in our childhood and<br />
infancy when we were taught to be careful what we said to others.<br />
"Mind your P's and Q's"; "Don't speak until you're spoken to";<br />
"Children should be seen and not heard". As a result many people hold<br />
back from communicating their thoughts and feelings to others.<br />
They feel vulnerable. While some caution may be wise in certain<br />
relationships, excessive fear of what others might think of us can stunt our<br />
115
<strong>de</strong>velopment as effective communicators and our ability to form<br />
meaningful relationships.<br />
Cognitive barriers:<br />
One of the most frequent cognitive barriers is stereotypes.<br />
Stereotyping causes us to typify a person, a group, an event or a<br />
thing on oversimplified conceptions, beliefs, or opinions. Thus, basketball<br />
players can be stereotyped as tall, green equipment as better than red<br />
equipment, football linemen as dumb, Ford as better than Chevrolet,<br />
Vikings as handsome, and people raised on dairy farms as interested in<br />
animals. Stereotyping can substitute for thinking, analysis and open<br />
min<strong>de</strong>dness to a new situation.<br />
Stereotyping is a barrier to communication when it causes people<br />
to act as if they already know the message that is coming from the sen<strong>de</strong>r<br />
or worse, as if no message is necessary because "everybody already<br />
knows." Both sen<strong>de</strong>rs and listeners should continuously look for and<br />
address thinking, conclusions and actions based on stereotypes.<br />
Social barriers<br />
When we join a group and wish to remain in it, sooner or later we<br />
need to adopt the behavior patterns of the group. These are the behaviors<br />
that the group accepts as signs of belonging.<br />
The group rewards such behavior through acts of recognition,<br />
approval and inclusion. In groups which are happy to accept you and<br />
where you are happy to conform, there is a mutuality of interest and a high<br />
level of win-win contact.<br />
Where, however, there are barriers to your membership of a group,<br />
a high level of game-playing replaces good communication.<br />
e. Barriers on the level of co<strong>de</strong><br />
When is spoken about barriers on the level of co<strong>de</strong> is meant most<br />
commonly language barriers. Language that <strong>de</strong>scribes what we want to<br />
say in our terms may present barriers to others who are not familiar with<br />
our expressions, buzz-words and jargon. When we couch our<br />
communication in such language, it is a way of excluding others.<br />
Different languages represent a national barrier which is<br />
particularly important for organizations involved in overseas business. In a<br />
global market place the greatest compliment we can pay another person is<br />
to talk in their language<br />
116
Individual linguistic ability is also important. The use of<br />
difficult or inappropriate words in communication can prevent people from<br />
un<strong>de</strong>rstanding the message.<br />
Poorly explained or misun<strong>de</strong>rstood messages can also result in<br />
confusion. We can all think of situations where we have listened to<br />
something explained which we just could not grasp.<br />
6.2. Stereotypes, Stigma and Discrimination<br />
Stereotypes<br />
The term stereotype <strong>de</strong>rives from the Greek words stereos - "firm,<br />
solid" and typos "impression" hence "solid impression". The term, in its<br />
mo<strong>de</strong>rn psychology sense, was first used by Walter Lippmann in his 1922<br />
work Public Opinion .<br />
A stereotype is a fixed, commonly held notion or image of a<br />
person or group; a generalization based on an oversimplification of some<br />
observed or imagined trait of behavior or appearance. We <strong>de</strong>velop<br />
stereotypes when we are unable or unwilling to obtain all of the<br />
information we would need to make fair judgments about people or<br />
situations. In the absence of the "total picture", stereotypes in many cases<br />
allow us to "fill in the blanks."<br />
Stereotypes can be either positive (black men are good at<br />
basketball) or negative (women are bad drivers). But most stereotypes<br />
tend to make us feel superior in some way to the person or group being<br />
stereotyped. Stereotypes ignore the uniqueness of individuals by painting<br />
all members of a group with the same brush. It is easier to create<br />
stereotypes when there is a clearly visible and consistent attribute that can<br />
easily be recognized. This is why people of color, police and women are so<br />
easily stereotyped.<br />
People from stereotyped groups can find this very disturbing as they<br />
experience an apprehension (stereotype threat) of being treated unfairly.<br />
For example, if we are walking through a park late at night and<br />
encounter three senior citizens wearing fur coats and walking with canes,<br />
we may not feel as threatened as if we were met by three high school-aged<br />
boys wearing leather jackets. Why is this so? We have ma<strong>de</strong> a<br />
generalization in each case. These generalizations have their roots in<br />
experiences we have had ourselves, read about in books and magazines,<br />
seen in movies or television, or have had related to us by friends and<br />
117
family. In many cases, these stereotypical generalizations are reasonably<br />
accurate. Yet, in virtually every case, we are resorting to prejudice by<br />
ascribing characteristics about a person based on a stereotype, without<br />
knowledge of the total facts. By stereotyping, we assume that a person or<br />
group has certain characteristics. Quite often, we have stereotypes about<br />
persons who are members of groups with which we have not had firsthand<br />
contact.<br />
A stereotype can be embed<strong>de</strong>d in single word or phrase (such as,<br />
"jock" or "nerd"), an image, or a combination of words and images. The<br />
image evoked is easily recognized and un<strong>de</strong>rstood by others who share the<br />
same views.<br />
Stereotyping can be subconscious, where it subtly biases our<br />
<strong>de</strong>cisions and actions, even in people who consciously do not want to be<br />
biased. Stereotyping often happens not so much because of aggressive or<br />
unkind thoughts. It is more often a simplification to speed conversation on<br />
what is not consi<strong>de</strong>red to be an important topic.<br />
Stereotyping can go around in circles. Men stereotype women and<br />
women stereotype men. In certain societies this is intensified as the<br />
stereotyping of women pushes them together more and they create men as<br />
more of an out-group. The same thing happens with different racial<br />
groups, such as white/black (an artificial system of opposites, which in<br />
origin seems to be more like European/non-European).<br />
Television, books, comic strips, and movies are all abundant<br />
sources of stereotyped characters. For much of its history, the movie<br />
industry portrayed African-Americans as being unintelligent, lazy, or<br />
violence-prone. As a result of viewing these stereotyped pictures of<br />
African-Americans, for example, prejudice against African-Americans has<br />
been encouraged. In the same way, physically attractive women have been<br />
and continue to be portrayed as unintelligent or unintellectual and sexually<br />
promiscuous.<br />
We change our stereotypes infrequently. Even in the face of<br />
disconfirming evi<strong>de</strong>nce, we often cling to our obviously-wrong beliefs.<br />
When we do change the stereotypes, we do so in one of three ways:<br />
Bookkeeping mo<strong>de</strong>l: As we learn new contradictory<br />
information, we incrementally adjust the stereotype to adapt to the new<br />
information. We usually need quite a lot of repeated information for each<br />
incremental change. Individual evi<strong>de</strong>nce is taken as the exception that<br />
proves the rule.<br />
118
Conversion mo<strong>de</strong>l: We throw away the old stereotype and start<br />
again. This is often used when there is significant disconfirming evi<strong>de</strong>nce.<br />
Subtyping mo<strong>de</strong>l: We create a new stereotype that is a subclassification<br />
of the existing stereotype, particularly when we can draw a<br />
boundary around the sub-class. Thus if we have a stereotype for<br />
Americans, a visit to New York may result in us having a ‘New Yorkers<br />
are different’ sub-type.<br />
Our society often innocently creates and perpetuates stereotypes,<br />
but these stereotypes often lead to unfair discrimination and persecution<br />
when the stereotype is unfavorable. When we judge people and groups<br />
based on our prejudices and stereotypes and treat them differently, we are<br />
engaging in stigmatization and discrimination.<br />
Stigmatization<br />
Stigma is a Greek word that in its origins referred to a kind of<br />
tattoo mark that was cut or burned into the skin of criminals, slaves, or<br />
traitors in or<strong>de</strong>r to visibly i<strong>de</strong>ntify them as blemished or morally polluted<br />
persons. These individuals were to be avoi<strong>de</strong>d or shunned, particularly in<br />
public places. Mo<strong>de</strong>rn American usage of the words stigma and<br />
stigmatization refers to an invisible sign of disapproval which permits<br />
"insi<strong>de</strong>rs" to draw a line around the "outsi<strong>de</strong>rs" in or<strong>de</strong>r to <strong>de</strong>marcate the<br />
limits of inclusion in any group. The <strong>de</strong>marcation permits "insi<strong>de</strong>rs to<br />
know who is "in" and who is "out" and allows the group to maintain its<br />
solidarity by <strong>de</strong>monstrating what happen to those who <strong>de</strong>viate from<br />
accepted norms of conduct. Stigmatization is an issue of disempowerment<br />
and social injustice. In this context, stigma is consi<strong>de</strong>red to be a powerful<br />
social control tool applied through the marginalization, exclusion, and<br />
exercise of power over individuals who present particular characteristics.<br />
Stigma exists when four specific components converge:<br />
1. Individuals differentiate and label human variations.<br />
2. Prevailing cultural beliefs tie those labeled to adverse<br />
attributes.<br />
3. Labeled individuals are placed in distinguished groups that<br />
serve to establish a sense of disconnection between "us" and "them".<br />
4. Labeled individuals experience "status loss and discrimination"<br />
that leads to unequal circumstances.<br />
Stigma and health<br />
Stigma is typically a social process, experienced or anticipated,<br />
characterized by exclusion, rejection, blame or <strong>de</strong>valuation that results<br />
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from experience, perception or reasonable anticipation of an adverse social<br />
judgment about a person or group. This judgment is based on an enduring<br />
feature of i<strong>de</strong>ntity conferred by a health problem or health-related<br />
condition, and the judgment is in some essential way medically<br />
unwarranted. In addition to its application to persons or a group, the<br />
discriminatory social judgment may also be applied to the disease or<br />
<strong>de</strong>signated health problem itself with repercussions in social and health<br />
policy. Many conditions and symptoms from nervous ticks and stuttering<br />
to tuberculosis and leprosy carry stigmatizing connotations. It is more<br />
expedient to focus here on several illnesses in some <strong>de</strong>tails.<br />
Patients with HIV<br />
Stereotypes about HIV that are commonplace among the general<br />
public are also evi<strong>de</strong>nt in a surprising number of clinical staff. More than<br />
25 years after its discovery, HIV still has the power to generate a broad<br />
array of stigmatizing behavior. People infected with HIV have previously<br />
labeled <strong>de</strong>aling with stigma as the most significant social and<br />
psychological challenge of the HIV experience. Sufferers' experiences<br />
were categorized by the type of stigmatizing behavior that they<br />
experienced most often in the presence of health-care personnel. These<br />
categories were: lack of eye contact; assuming physical distance; using<br />
disdainful voice tone or inflection; asking confrontational questions;<br />
showing irritation, anger, nervousness, fear or panic; taking excessive<br />
precautions; scaring, mocking, blaming or ignoring patients; providing<br />
substandard care or <strong>de</strong>nying care, and being generally abusive.<br />
Patients with mental illnesses<br />
Patients with mental illnesses are stigmatized and suffer adverse<br />
consequences such as increased social isolation, limited life chances, and<br />
<strong>de</strong>creased access to treatment. In addition to poorer social functioning as<br />
assessed by housing and employment status, those with the stigma of<br />
mental illness also encounter a significant barrier to obtaining general<br />
medical care and to recovery from mental illness. Stigma also affects<br />
family members of persons with mental illness.<br />
Obese persons<br />
Negative attitu<strong>de</strong>s toward obese persons are pervasive in<br />
contemporary society. Numerous studies have documented harmful<br />
weightbased stereotypes that overweight and obese individuals are lazy,<br />
weak-willed, unsuccessful, unintelligent, lack self-discipline, have poor<br />
willpower, and are noncompliant with weightloss treatment. These<br />
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stereotypes give way to stigma, prejudice, and discrimination against<br />
obese persons in multiple domains of living, including the workplace,<br />
health care facilities, educational institutions, the mass media, and even in<br />
close interpersonal relationships. Perhaps because weight stigma remains a<br />
socially acceptable form of bias, negative attitu<strong>de</strong>s and stereotypes toward<br />
obese persons have been frequently reported by employers, coworkers,<br />
teachers, physicians, nurses, medical stu<strong>de</strong>nts, dietitians, psychologists,<br />
peers, friends, family members,1–4 and even among children aged as<br />
young as 3 years.<br />
Discrimination<br />
Discrimination is the prejudicial treatment of an individual based<br />
solely on their membership in a certain group or category. Discrimination<br />
is the actual behavior towards members of another group. It involves<br />
excluding or restricting members of one group from opportunities that are<br />
available to other groups.<br />
There are two types of discrimination: direct discrimination and<br />
indirect discrimination.<br />
Direct discrimination is pretty straightforward in most cases. It<br />
happens when a person is <strong>de</strong>alt with unfairly on the basis of one of the<br />
grounds (compared with someone who doesn’t have that ground) and in<br />
one of the areas covered by the act.<br />
Examples:<br />
Somebody is asked at a job interview whether he/she has<br />
children. When he/she told the interviewer that has four children, she<br />
makes a remark about he/she needing a lot of time off work if they’re sick,<br />
and says he/she won’t be suitable for the position.<br />
An Aboriginal woman wanting to rent a house. When she arrives<br />
to inspect a house she is told it’s already been taken. The woman arranges<br />
for a non-Aboriginal friend to enquire about the house. She rings, is told<br />
it’s still available, looks at the house and is offered a lease. This is the<br />
third time this woman tried to rent a house through this agency. In spite of<br />
the fact she has a good tenancy record, each time she phone, she is told a<br />
house is available, and each time she meet one of the agents, she is told<br />
it’s been rented already.<br />
When a woman advises her employer that she is pregnant, she<br />
was moved to a lower-paying job out of the public view, because clients<br />
„don’t want to look at people in her condition”.<br />
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Indirect discrimination is often less obvious. Sometimes, a policy,<br />
rule or practice seems fair because it applies to everyone equally, but a<br />
closer look shows that some people are being treated unfairly. This is<br />
because some people or groups of people are unable or less able to comply<br />
with the rule or are disadvantaged because of it.<br />
Examples:<br />
An employer has a policy of not letting any staff work part-time.<br />
(People with children or family responsibilities could be disadvantaged.)<br />
A public building, while fitted with lifts, has a set of six steps at the<br />
front entrance. Entry for those needing to use the lift is through the back<br />
entrance near the industrial bins. Those using a wheelchair can’t get into<br />
the building from the front entrance.)<br />
Minimum height requirements apply for jobs in a resort, for no<br />
apparent reason. (People from an Asian background, or women, may not<br />
be able to meet the requirement.)<br />
All information about workplace health and safety in a factory, is<br />
printed in English. (Those whose first language isn’t English may be at<br />
risk.).<br />
Unlike direct discrimination, indirect discrimination is not always<br />
intentionally perpetrated.<br />
In addition, direct discrimination proceeds from an individualistic,<br />
personal complaint to the situation faced, whereas indirect discrimination<br />
is concerned with group disadvantage and group rights.<br />
Now regulations and laws are in place in most Western countries<br />
to outlaw both direct and indirect discrimination. However, cases continue<br />
to arise which prove that discrimination still occurs.<br />
Discrimination behaviors can take many forms:<br />
Racial and ethnic discrimination - differentiates between<br />
individuals on the basis of real and perceived racial differences, and has<br />
been official government policy in several countries, such as South Africa<br />
in the apartheid era, and the USA. It is direct race discrimination to treat<br />
someone less favorably than someone else would be treated in the same<br />
circumstances, because of race. Racist abuse and harassment are forms of<br />
direct discrimination. Genoci<strong>de</strong> is the last step in a continuum of actions<br />
taken by those who are prejudiced. The first step of this continuum is<br />
discrimination and treating certain groups of people differently. The<br />
second step is isolation, such as the physical segregation of minorities in<br />
ghettos or setting up separate schools. The third step is persecution,<br />
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followed by <strong>de</strong>humanization and violence. As example is the Holocaust<br />
tragedy, which was the <strong>de</strong>struction of European Jewry by the Nazis<br />
through an officially sanctioned, government-or<strong>de</strong>red, systematic plan of<br />
mass annihilation. As many as six million Jews died, almost two-thirds of<br />
the Jews of Europe.<br />
Linguistic discrimination is discrimination based on native<br />
language, usually in the language policy especially in education of a state<br />
that has one or several linguistic minorities. People are sometimes<br />
subjected to different treatment because their preferred language is<br />
associated with a particular group, class or category. Commonly, the<br />
preferred language is just another attribute of separate ethnic groups.<br />
Discrimination exists if there is prejudicial treatment against a person or a<br />
group of people who speak a particular language or dialect. Language<br />
discrimination is suggested to be labeled linguicism or logocism. Antidiscriminatory<br />
and inclusive efforts to accommodate persons who speak<br />
different languages or cannot have fluency in the country's predominant or<br />
"official" language, is bilingualism such as official documents in two<br />
languages, and multiculturalism in more than two languages.<br />
Examples:<br />
The Coptic language: At the turn of the 8th century,<br />
Caliph Abd al-Malik ibn Marwan <strong>de</strong>creed that Arabic replace Koine Greek<br />
and Coptic as the sole administrative language. Literary Coptic gradually<br />
<strong>de</strong>clined such that within a few hundred years, and suffered violent<br />
persecutions especially un<strong>de</strong>r the Mamluks, leading to its virtual extinction<br />
by the 17th century.<br />
Language policy of the British Empire in Ireland, Wales<br />
and Scotland: Cromwell's conquest, the long English colonization and<br />
Great Irish Famine ma<strong>de</strong> Irish a minority language by the end of 19th<br />
century. It had not official status until the establishment of Republic of<br />
Ireland. In Wales speaking of the Welsh language in schools was<br />
prohibited. Scottish Gaelic also had not official status until the end of 20th<br />
century. Scots was often treated as a mere dialect of English.<br />
Basque: Public usage of Basque was prohibited in Spain<br />
un<strong>de</strong>r Franco, 1939 to 1965. Galician and Catalan have similar histories.<br />
Kurdish: Kurdish remains banned in Syria. Until August<br />
2002, the Turkish government placed severe restrictions on the use of<br />
Kurdish, prohibiting the language in education and broadcast media.<br />
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Russification: Un<strong>de</strong>r the Russian Empire there were some<br />
attempts in 1899-1917 to make Russian the only official language of<br />
Finland. In the Soviet Union, following the phase of Korenizatsiya<br />
("indigenization") and before Perestroika (late 1930s to late 1980s),<br />
Russian was termed as "the language of friendship of nations", to the<br />
disadvantage of other languages of the Soviet Union.<br />
Age discrimination - is discrimination on the grounds of age; can<br />
refer to the discrimination against any age group, usually comes in one of<br />
three forms: discrimination against youth (also called adultism),<br />
discrimination against those 40 years old or ol<strong>de</strong>r, and discrimination<br />
against el<strong>de</strong>rly people.<br />
Sex, Gen<strong>de</strong>r and Gen<strong>de</strong>r I<strong>de</strong>ntity discrimination - refers to<br />
beliefs and attitu<strong>de</strong>s in relation to the gen<strong>de</strong>r of a person, such beliefs and<br />
attitu<strong>de</strong>s are of a social nature and do not, normally, carry any legal<br />
consequences.<br />
Caste discrimination - currently, there are an estimated 160<br />
million Dalits or Scheduled Castes (formerly known as "untouchables") in<br />
India. Dalit people face severe problems, such as segregation and violence<br />
against them.<br />
Religious discrimination - Religious discrimination is valuing or<br />
treating a person or group differently because of what they do or do not<br />
believe. It is discrimination to treat you unfairly compared to someone<br />
else, because of your religion or belief. This is called direct discrimination<br />
and is illegal. Examples inclu<strong>de</strong>: refusing a bank loan because the person<br />
is Jewish; refusing to allow into a restaurant because the person is Muslim<br />
; dismissing from work because the person is Rastafarian.<br />
Disability discrimination - against people with disabilities in favor<br />
of people who are not, is called ableism or disablism. Disability<br />
discrimination, which treats non-disabled individuals as the standard of<br />
‘normal living’, results in public and private places and services,<br />
education, and social work that are built to serve 'standard' people, thereby<br />
excluding those with various disabilities.<br />
Example of direct discrimination because of disability: a pub<br />
allows a family with a child who has cerebral palsy to drink in their beer<br />
gar<strong>de</strong>n but not in their family room. The family with the disabled child is<br />
not given the same choices that other families have.<br />
Example of indirect discrimination: A local authority produces an<br />
information leaflet about its services for local people. It does not produce<br />
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an easy-to-read version of the leaflet in or<strong>de</strong>r to save money. This would<br />
make it more difficult for someone with a learning disability to access the<br />
services and could amount to indirect discrimination.<br />
It is not count as a disability:<br />
Addiction to alcohol, nicotine or any other substance not<br />
prescribed by a doctor. However, damage to health caused by the addiction<br />
may be consi<strong>de</strong>red a disability.<br />
High fever.<br />
Certain personality disor<strong>de</strong>rs (for example exhibitionism,<br />
voyeurism or a ten<strong>de</strong>ncy to steal, set fires, or physically or sexually abuse<br />
other people).<br />
Tattoos and body piercing.<br />
6.3. Active Listening<br />
Effective communication is vital for people. If humans wish to<br />
construct good personal or professional relationships, to satisfy their<br />
needs, to accomplish their tasks, goals, <strong>de</strong>sire they must know how to<br />
communicate efficiently. What mean to communicate efficiently? There<br />
are many and different rules of efficient communication in different<br />
settings. But indifferently is communication occurring in personal or<br />
professional, interpersonal or collective setting it has to involve among<br />
other rules active listening in or<strong>de</strong>r to be efficient.<br />
The key to receiving messages effectively is listening. Active<br />
listening is an intent to "listen for meaning", and requires more than<br />
hearing words. It requires a <strong>de</strong>sire to un<strong>de</strong>rstand another human being,<br />
interpret, and evaluate what he or she heard; an attitu<strong>de</strong> of respect and<br />
acceptance, and a willingness to open one's mind to try and see things<br />
from another's point of view.<br />
The ability to listen actively can improve personal relationships<br />
through reducing conflicts, strengthening cooperation and fostering<br />
un<strong>de</strong>rstanding. True listening requires that we suspend judgment,<br />
evaluation, and approval in an attempt to un<strong>de</strong>rstand another frame of<br />
reference, emotions, and attitu<strong>de</strong>s. Listening to un<strong>de</strong>rstand is, in<strong>de</strong>ed, a<br />
difficult task!<br />
When interacting, people often are not listening attentively to one<br />
another. They may be distracted, thinking about other things, or thinking<br />
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about what they are going to say next (the latter case is particularly true in<br />
conflict situations or disagreements).<br />
Active listening is a structured way of listening and responding to<br />
others. It focuses attention on the speaker. Suspending one’s own frame of<br />
reference and suspending judgment are important in or<strong>de</strong>r to fully attend to<br />
the speaker.<br />
When we listen effectively we gain information that is valuable to<br />
un<strong>de</strong>rstanding the problem as the other person sees it. We gain a greater<br />
un<strong>de</strong>rstanding of the other person's perception. After all, the truth is<br />
subjective and a matter of perception. When we have a <strong>de</strong>eper<br />
un<strong>de</strong>rstanding of another's perception, whether we agree with it or not, we<br />
hold the key to un<strong>de</strong>rstanding that person's motivation, attitu<strong>de</strong>, and<br />
behavior. We have a <strong>de</strong>eper un<strong>de</strong>rstanding of the problem and the<br />
potential paths for reaching agreement.<br />
Active listening involves and an effective attending which is a<br />
careful balance of alertness and relaxation that inclu<strong>de</strong>s appropriate body<br />
movement, eye contact, and "posture of involvement". Fully attending<br />
says to the speaker, "What you are saying is very important. I am totally<br />
present and intent on un<strong>de</strong>rstanding you". We create a posture of<br />
involvement by:<br />
- Leaning gently towards the speaker;<br />
- Facing the other person squarely;<br />
- Maintaining an open posture with arms and legs uncrossed;<br />
- Maintaining an appropriate distance between us and the speaker;<br />
- Moving our bodies in response to the speaker, i.e., appropriate<br />
head nodding, facial expressions.<br />
When we pay attention to a speaker's body language we gain insight<br />
into how that person is feeling as well as the intensity of the feeling.<br />
Through careful attention to body language and paraverbal messages, we<br />
are able to <strong>de</strong>velop hunches about what the speaker (or listener) is<br />
communicating. We can then, through our reflective listening skills, check<br />
the accuracy of those hunches by expressing in our own words, our<br />
impression of what is being communicated.<br />
Providing feedback is the most important active listening skill.<br />
Ask questions. Nod in agreement. Look the person straight in the eye.<br />
Lean forward. Be an animated listener. Focus on what the other person is<br />
saying. Repeat key points. Active listening is particularly important in<br />
<strong>de</strong>aling with an angry person. Encouraging the person to speak, i.e., to<br />
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vent feelings, is essential to establishing communication with an angry<br />
person. Repeat what the person has said. Ask questions to encourage the<br />
person to say again what he or she seemed most anxious to say in the first<br />
place. An angry person will not start listening until they have "cooled"<br />
down. Telling an angry person to "cool" down often has the opposite<br />
effect. Getting angry with an angry person only assures that there are now<br />
two people not listening to what the other is saying.<br />
Reflective listening or responding is the process of restating, in<br />
our words, the feeling and/or content that is being expressed and is part of<br />
the verbal component of sending and receiving messages. By reflecting<br />
back to the speaker what we believe we un<strong>de</strong>rstand, we validate that<br />
person by giving them the experience of being heard and acknowledged.<br />
We also provi<strong>de</strong> an opportunity for the speaker to give us feedback about<br />
the accuracy of our perceptions, thereby increasing the effectiveness of our<br />
overall communication. Responses can take different forms. Some of the<br />
them are as followed.<br />
Paraphrasing<br />
This is a concise statement of the content of the speaker's message.<br />
A paraphrase should be brief, succinct, and focus on the facts or i<strong>de</strong>as of<br />
the message rather than the feeling. The paraphrase should be in the<br />
listener's own words rather than "parroting back", using the speaker's<br />
words.<br />
"You believe that Jane needs an instructional assistant because<br />
she isn't capable of working in<strong>de</strong>pen<strong>de</strong>ntly."<br />
"You would like Bob to remain in first gra<strong>de</strong> because you think the<br />
activities would be more <strong>de</strong>velopmentally appropriate."<br />
"You do not want Beth to receive special education services<br />
because you think it would be humiliating for her to leave the classroom at<br />
any time."<br />
"You want to evaluate my child because you think he may have an<br />
emotional disability."<br />
Reflecting Feeling<br />
The listener concentrates on the feeling words and asks herself,<br />
"How would I be feeling if I was having that experience?" She then<br />
restates or paraphrases the feeling of what she has heard in a manner that<br />
conveys un<strong>de</strong>rstanding.<br />
"You are very worried about the impact that an evaluation might<br />
have on Lisa's self esteem".<br />
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"You are frustrated because <strong>de</strong>aling with Ben has taken up so<br />
much of your time, you feel like you've ignored your other stu<strong>de</strong>nts."<br />
"You feel extremely angry about the lack of communication you<br />
have had in regards to Joe's failing gra<strong>de</strong>s."<br />
"You're upset because you haven't been able to get in touch with<br />
me when I'm at work."<br />
Summarizing<br />
The listener pulls together the main i<strong>de</strong>as and feelings of the<br />
speaker to show un<strong>de</strong>rstanding. This skill is used after a consi<strong>de</strong>rable<br />
amount of information sharing has gone on and shows that the listener<br />
grasps the total meaning of the message. It also helps the speaker gain an<br />
integrated picture of what she has been saying.<br />
"You're frustrated and angry that the assessment has taken so long and<br />
confused about why the referral wasn't ma<strong>de</strong> earlier since that is what you<br />
thought had happened. You are also willing to consi<strong>de</strong>r additional evaluation<br />
if you can choose the provi<strong>de</strong>r and the school district will pay for it".<br />
"You're worried that my son won't make a<strong>de</strong>quate progress in<br />
reading if he doesn't receive special services. And you feel that he needs to<br />
be getting those services in the resource room for at least 30 minutes each<br />
day because the reading groups in the classroom are bigger and wouldn't<br />
provi<strong>de</strong> the type of instruction you think he needs."<br />
Questioning<br />
The listener asks open en<strong>de</strong>d questions (questions which can't be<br />
answered with a "yes" or a "no") to get information and clarification. This<br />
helps focus the speaker on the topic, encourages the speaker to talk, and<br />
provi<strong>de</strong>s the speaker the opportunity to give feedback.<br />
"Can you tell us more about Johnny's experience when he's in the<br />
regular classroom?"<br />
"How was it for Susie when she ro<strong>de</strong> the special ed. bus for those<br />
two weeks?"<br />
"Tell us more about the afterschool tutoring sessions."<br />
"What kinds of skills do you think are important for Jim to learn in<br />
a social skills class?"<br />
"Could you explain why you think itís difficult for Ben to be on the<br />
playground for an hour?"<br />
"I'm confused - are you worried that the testing may mean time out<br />
of the classroom for Jim or is there something else?"<br />
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6.4. Barriers and Solutions for Effective Medical Communication<br />
In the first paragraph of this chapter we make the general approach<br />
to the topic of communication barriers. The barriers discussed can be met<br />
in any professional setting. And they are met in medical context also but<br />
with some peculiarities proper to medical profession.<br />
Barriers and solution for effective communication between<br />
physician and patient<br />
While the majority of doctors seek to encourage open and<br />
informative dialogue with patients, it is recognized that episo<strong>de</strong>s of poor<br />
communication occur. There are a number of barriers to communication<br />
ranging from personal traits to organizational:<br />
A lack of skill and un<strong>de</strong>rstanding of the structures of<br />
conversational interaction. For example, the importance of providing<br />
accessible information in a language that is tailored to the patient, giving<br />
structured explanations and listening to patients’ views, thereby<br />
encouraging two-way communication.<br />
Ina<strong>de</strong>quate knowledge of, or training in, other communication<br />
skills including body language and speed of speech. Problems may be<br />
caused by insufficient personal insight into communication difficulties. In<br />
some cases communication will be hampered by factors as straightforward<br />
as poorly laid out furniture.<br />
Doctors un<strong>de</strong>rvaluing the importance of communicating. For<br />
example, not appreciating the importance of keeping patients a<strong>de</strong>quately<br />
informed. In some cases this will stem from a wi<strong>de</strong>r imbalance in the<br />
relationship between doctor and patient.<br />
Negative attitu<strong>de</strong>s of doctors towards communication. For<br />
example, giving it a low priority due to a concern primarily to treat illness<br />
rather than focusing on the patient’s holistic needs such as psychological<br />
and social wellbeing. This is often an artificial distinction since health and<br />
ill health tend to be composed of physical, psychological and social<br />
components. A lack of inclination to communicate with patients can be<br />
due to lack of time, uncomfortable topics, lack of confi<strong>de</strong>nce and concerns<br />
relating to confi<strong>de</strong>ntiality lack of knowledge about the illness/condition or<br />
treatment. The last need not be a barrier to effective communication so<br />
long as doctors are honest about the limitations of their knowledge.<br />
Doctors should recognize that in many cases patients may be as<br />
knowledgeable or insightful about their own conditions as the doctor<br />
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human failings, such as tiredness and stress inconsistency in providing<br />
information language barriers.<br />
I<strong>de</strong>ntifying the specific factors inhibiting good communication<br />
should be mentioned that these are overcoming by the mean of<br />
communication skills training and reflection.<br />
Good communication skills expected of healthcare workers<br />
inclu<strong>de</strong> the ability to:<br />
o talk to patients, carers and colleagues effectively and clearly,<br />
conveying and receiving the inten<strong>de</strong>d message;<br />
o providing patients and others with a<strong>de</strong>quate information;<br />
o handling complaints appropriately;<br />
o enable patients and their carers to communicate effectively;<br />
o listen effectively especially when time is pressured;<br />
o i<strong>de</strong>ntify potential communication difficulties and work through<br />
solutions;<br />
o un<strong>de</strong>rstand the differing methods of communication used by<br />
individuals;<br />
o un<strong>de</strong>rstand that there are differences in communication signals<br />
between cultures;<br />
o cope in specific difficult circumstances;<br />
o un<strong>de</strong>rstand how to use and receive non verbal messages given by body<br />
language;<br />
o utilize spoken, written and electronic methods of communication;<br />
o know when the information received needs to be passed on to another<br />
person/professional for action;<br />
o know and interpret the information nee<strong>de</strong>d to be recor<strong>de</strong>d on patients<br />
records, writing discharge letters, copying letters to patients and<br />
gaining informed consent;<br />
o recognize the need for further <strong>de</strong>velopment to acquire specialist skills.<br />
Barriers and solution for effective communication in medical team<br />
Health professionals tend to work autonomously, even though they<br />
may speak of being part of a team. Efforts to improve health care safety<br />
and quality are often jeopardized by the communication and collaboration<br />
barriers that exist between clinical staff. Although every organization is<br />
unique, the barriers to effective communication that organizations face<br />
have some common themes. There are some common barriers to interprofessional<br />
communication and collaboration:<br />
Personal values and expectations,<br />
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Personality differences,<br />
Hierarchy ,<br />
Disruptive behavior,<br />
Culture and ethnicity,<br />
Gen<strong>de</strong>r,<br />
Historical interprofessional and intraprofessional rivalries,<br />
Differences in schedules and professional routines,<br />
Varying levels of preparation, qualifications, and status,<br />
Differences in requirements, regulations, and norms of<br />
professional education,<br />
Fears of diluted professional i<strong>de</strong>ntity,<br />
Differences in accountability, payment, and rewards,<br />
Concerns regarding clinical responsibility,<br />
Emphasis on rapid <strong>de</strong>cision making.<br />
The indicated barriers can occur within disciplines, most notably<br />
between physicians and resi<strong>de</strong>nts, surgeons and anesthesiologists, and<br />
nurses and nurse managers etc. However, most often the barriers manifest<br />
between nurses and physicians. Even though doctors and nurses interact<br />
numerous times a day, they often have different perceptions of their roles<br />
and responsibilities as to patient needs, and thus different goals for patient<br />
care. One barrier compounding this issue is that because many clinicians<br />
come from a variety of cultural backgrounds. In all interactions, cultural<br />
differences can exacerbate communication problems. For example, in<br />
some cultures, individuals refrain from being assertive or challenging<br />
opinions openly. As a result, it is very difficult for nurses from such<br />
cultures to speak up if they see something wrong. In cultures such as these,<br />
nurses may communicate their concern in very indirect ways. Culture<br />
barriers can also hin<strong>de</strong>r nonverbal communication. For example, some<br />
cultures ascribe specific meaning to eye contact, certain facial expressions,<br />
touch, tone of voice, and nods of the head.<br />
Issues around gen<strong>de</strong>r differences in communication styles, values,<br />
and expectations are common in all workplace situations. In the health<br />
care industry, where most physicians are male and most nurses are female,<br />
communication problems are further accentuated by gen<strong>de</strong>r differences.<br />
A review of the organizational communication literature shows<br />
that a common barrier to effective communication and collaboration is<br />
hierarchies. The communication failures in the medical setting arise from<br />
vertical hierarchical differences, concerns with upward influence, role<br />
131
conflict, and ambiguity and struggles with interpersonal power and<br />
conflict. Communication is likely to be distorted or withheld in situations<br />
where there are hierarchical differences between two communicators,<br />
particularly when one person is concerned about appearing incompetent,<br />
does not want to offend the other, or perceives that the other is not open to<br />
communication.<br />
In health care environments characterized by a hierarchical culture,<br />
physicians are at the top of that hierarchy. Consequently, they may feel that<br />
the environment is collaborative and that communication is open while nurses<br />
and other direct care staff perceive communication problems. Hierarchy<br />
differences can come into play and diminish the collaborative interactions<br />
necessary to ensure that the proper treatments are <strong>de</strong>livered appropriately.<br />
When hierarchy differences exist, people on the lower end of the hierarchy<br />
tend to be uncomfortable speaking up about problems or concerns.<br />
Intimidating behavior by individuals at the top of a hierarchy can hin<strong>de</strong>r<br />
communication and give the impression that the individual is unapproachable.<br />
Staff who witness poor performance in their peers may be hesitant<br />
to speak up because of fear of retaliation or the impression that speaking<br />
up will not do any good. Relationships between the individuals providing<br />
patient care can have a powerful influence on how and even if important<br />
information is communicated. Research has shown that <strong>de</strong>lays in patient<br />
care and recurring problems from unresolved disputes are often the byproduct<br />
of physician-nurse disagreement. Nurses are either reluctant or<br />
refuse to call physicians, even in the face of a <strong>de</strong>teriorating status in<br />
patient care. Reasons for this inclu<strong>de</strong> intimidation, fear of getting into a<br />
confrontational or antagonistic discussion, lack of confi<strong>de</strong>ntiality, fear of<br />
retaliation, and the fact that nothing ever seems to change. Many of these<br />
issues have to <strong>de</strong>al more with personality and communication style.<br />
The major concern about disruptive behaviors is the potential<br />
negative impact they can have on patient care. In condition of the high rate<br />
fervency of such behavior the high responsibility lay on the shoul<strong>de</strong>rs of<br />
heath managers. Lea<strong>de</strong>rs in both medicine and nursing are obliged to issue<br />
initiatives for the <strong>de</strong>velopment of a cooperative rather than a competitive<br />
agenda to benefit patient care. A powerful incentive for greater teamwork<br />
among professionals is created by directing attention to the areas where<br />
changes are likely to result in measurable improvements for the patients<br />
they serve together, rather than concentrating on what, on the surface,<br />
seem to be irreconcilable professional differences. The fact that most<br />
132
health professionals have at least one characteristic in common, a personal<br />
<strong>de</strong>sire to learn, and that they have at least one shared value, to meet the<br />
needs of their patients or clients, is a good place to start.<br />
► Exercises and Discussions:<br />
1.What are the barriers in communication?<br />
2.Give the <strong>de</strong>finition of terms “stereotype”, “stigmatization”, “and<br />
discrimination”. Describe the effects of discrimination in health care.<br />
3.What involve and active listening? Find the other rules besi<strong>de</strong>s active<br />
listening for an efficient communication.<br />
4.What are the barriers in communication between physician and<br />
patient? How can be they overcome?<br />
5.What the communication skills need physicians?<br />
6.What are the impediments of good collaboration in medical team?<br />
7.How to construct good team collaboration in medical setting?<br />
8.What communication skills need a manager in health area?<br />
► Recommen<strong>de</strong>d Essays<br />
1. Genoci<strong>de</strong>, from history to solutions<br />
2. Stigma and Discrimination in Health Care Service<br />
3. Causes and consequences of HIV patients stigmatization<br />
4. Good management of medical team<br />
► Literature:<br />
1. Aggleton Peter, Wood Kate, Malcolm Anne. HIV - Related Stigma,<br />
Discrimination and Human Rights Violations. WHO Library Cataloguingin-Publication<br />
Data. UNAIDS. Geneva, 2005.<br />
2. Burnard Ph. Effective communication skills for health professionals.<br />
Nelson Thornes, 1997.<br />
3. Hogan K, Stubbs R. Can't Get Through: 8 Barriers to Communication.<br />
Pelican Publishing, 2003.<br />
4. Macrae Neil C., Stangor Charles, Hewstone Miles. Stereotypes and<br />
stereotyping. Guilford Press, 1996.<br />
5. Fishbein Harold D. Peer prejudice and discrimination: the origins of<br />
prejudice. Routledge, 2002.<br />
6. Ray Berlin Eileen, Donohew Lewis. Communication and health:<br />
systems and applications. Routledge, 1989.<br />
7. Ray Berlin Eileen. Case studies in health communication. Routledge,<br />
1993.<br />
8. Thompson Teresa L.. Handbook of health communication. Routledge,<br />
2003.<br />
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7.1. The Concept of Culture<br />
Behavior and Cultural Contexts<br />
134<br />
Chapter 7<br />
Culture is the sum of all the forms of art, of love,<br />
and of thought, which, in the course or centuries,<br />
have enabled man to be less enslaved<br />
Andre Malraux<br />
The concept of culture has a long and complicated story.<br />
Nowadays is accounted more than one hundred meaning or <strong>de</strong>finition of it.<br />
The word culture comes from the Latin root colere (to inhabit, to cultivate,<br />
or to honor). So the firstly this concept connoted a process of cultivation or<br />
improvement, as in agriculture. Cicero, the roman ancient philosopher<br />
used an agricultural metaphor to <strong>de</strong>scribe the <strong>de</strong>velopment of a<br />
philosophical soul, which was un<strong>de</strong>rstood teleologically as the one natural<br />
highest possible i<strong>de</strong>al for human <strong>de</strong>velopment. In other words Cicero<br />
<strong>de</strong>fines culture as <strong>de</strong>velopment or improvement of the mind by education.<br />
In the nineteenth century, humanists such as English poet and essayist<br />
Matthew Arnold used the word "culture" to refer to an i<strong>de</strong>al of individual<br />
human refinement, of "the best that has been thought and said in the<br />
world." Thus culture is the quality in a person or society that arises from a<br />
concern for what is regar<strong>de</strong>d as excellent in arts, letters, manners,<br />
scholarly pursuits, etc.<br />
Sir Edward B. Tylor in 1871 gave the very cited especially by<br />
anthropologist <strong>de</strong>finition of culture. He said "culture or civilization, is that<br />
complex whole which inclu<strong>de</strong>s knowledge, belief, art, morals, law,<br />
custom, and any other capabilities and habits acquired by man as a<br />
member of society". In the 20th century "culture" emerged as the central<br />
and unifying concept of American anthropology, where it most commonly<br />
refers to the universal human capacity to classify and enco<strong>de</strong> their<br />
experiences symbolically, and communicate symbolically enco<strong>de</strong>d<br />
experiences socially. In 2002 United Nations agency UNESCO states that<br />
culture is the "set of distinctive spiritual, material, intellectual and
emotional features of society or a social group and that it encompasses, in<br />
addition to art and literature, lifestyles, ways of living together, value<br />
systems, traditions and beliefs".<br />
Analyzing the mentioned <strong>de</strong>finitions it is possible to conclu<strong>de</strong> that<br />
culture is a quality of an individual, social organization, social group (i.e.<br />
ethnic, or age group) or society as a hole to share the systems of symbols,<br />
beliefs, attitu<strong>de</strong>s, values, expectations, and norms of behavior. Culture is a<br />
quality acquired by the means of education and it is a quality which makes<br />
the difference between humans and animals, between individuals of one<br />
community, between organization, social groups and societies (of the same<br />
or different epochs).<br />
7.2. Etiquette and Cultural Differences<br />
Etiquette is French word that literally means ticket of admission.<br />
Etiquette is a co<strong>de</strong> of behavior that <strong>de</strong>lineates expectations for social<br />
behavior according to conventional norms within a society, social class, or<br />
group. Rules of etiquette encompass most aspects of social interaction in<br />
any society, though the term itself is not commonly used. A rule of<br />
etiquette may reflect an un<strong>de</strong>rlying ethical co<strong>de</strong>, or it may reflect a<br />
person's fashion or status. Rules of etiquette are usually unwritten, but<br />
aspects of etiquette have been codified from time to time.<br />
Etiquette evolves within culture. Thus etiquette is a component<br />
part of culture. It is <strong>de</strong>pen<strong>de</strong>nt on culture. What is excellent etiquette in<br />
one society may shock another. The Dutch painter Andries Both shows<br />
that the hunt for head lice (illustration, right), which had been a civilized<br />
grooming occupation in the early Middle Ages, a bonding experience that<br />
reinforced the comparative rank of two people, one groomed, one<br />
groomer, had become a peasant occupation by 1630. The painter portrays<br />
the familiar operation matter-of-factly, without the disdain this subject<br />
would have received in a nineteenth-century representation.<br />
Etiquette could vary wi<strong>de</strong>ly between different cultures and nations.<br />
In China, a person who takes the last item of food from a common plate or<br />
bowl without first offering it to others at the table may be seen as a glutton<br />
and insulting the generosity of the host. In America a guest is expected to<br />
eat all of the food given to them, as a compliment to the quality of the<br />
cooking.<br />
The term etiquette is used interchangeable with word manners<br />
which is <strong>de</strong>fine as the unenforced standards of conduct which show the<br />
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actor that you are proper, polite, and refined. They are like laws in that<br />
they codify or set a standard for human behavior, but they are unlike laws<br />
in that there is no formal system for punishing transgressions, other than<br />
social disapproval. They are a kind of norm. What is consi<strong>de</strong>red<br />
"mannerly" is highly susceptible to change with time, geographical<br />
location, social stratum, occasion, and other factors. That manners matter<br />
is evi<strong>de</strong>nced by the fact that large books have been written on the subject,<br />
advice columns frequently <strong>de</strong>al with questions of mannerly behavior, and<br />
that schools have existed for the sole purpose of teaching manners. A lady<br />
is a term frequently used for a woman who follows proper manners; the<br />
term gentleman is used as a male counterpart; though these terms are also<br />
often used for members of a particular social class.<br />
Politeness is best expressed as the practical application of good<br />
manners or etiquette. It is a culturally <strong>de</strong>fined phenomenon, and therefore<br />
what is consi<strong>de</strong>red polite in one culture can sometimes be quite ru<strong>de</strong> or<br />
simply strange in another cultural context.<br />
While the goal of politeness is to make all of the parties relaxed<br />
and comfortable with one another, these culturally <strong>de</strong>fined standards at<br />
times may be manipulated to inflict shame on a <strong>de</strong>signated party.<br />
The British social anthropologists Penelope Brown and Stephen<br />
Levinson i<strong>de</strong>ntified two kinds of politeness:<br />
Negative politeness: Making a request less infringing, such as<br />
"If you don't mind..." or "If it isn't too much trouble..."; respects a person's<br />
right to act freely. In other words, <strong>de</strong>ference. There is a greater use of<br />
indirect speech acts.<br />
Positive politeness: Seeks to establish a positive relationship<br />
between parties; respects a person's need to be liked and un<strong>de</strong>rstood.<br />
Direct speech acts, swearing and flouting maxims can be consi<strong>de</strong>red<br />
aspects of positive politeness because:<br />
o they show an awareness that the relationship is strong enough<br />
to cope with what would normally be consi<strong>de</strong>red impolite (in the popular<br />
un<strong>de</strong>rstanding of the term);<br />
o they articulate an awareness of the other person's values,<br />
which fulfills the person's <strong>de</strong>sire to be accepted.<br />
Some cultures seem to prefer one of these kinds of politeness over<br />
the other. To be polite in one culture or society mean to know and to<br />
follow the etiquette accepted in them.<br />
Examples of etiquette:<br />
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If invited to dinner, in some Asian countries it is wellmannered<br />
to leave right after the dinner: the ones who don’t leave may<br />
indicate they have not eaten enough. In the Indian sub-continent, Europe,<br />
South America, and North American countries this is consi<strong>de</strong>red ru<strong>de</strong>,<br />
indicating that the guest only wanted to eat but wouldn’t enjoy the<br />
company with the hosts.<br />
In Mediterranean European countries, Latin America, and<br />
Sub-Saharan Africa, it is normal, or at least wi<strong>de</strong>ly tolerated, to arrive half<br />
an hour late for a dinner invitation, whereas in Germany and in the United<br />
States this would be consi<strong>de</strong>red very ru<strong>de</strong>.<br />
Showing the thumb held upwards in certain parts of the world<br />
means "everything's ok", while it is un<strong>de</strong>rstood in some Islamic countries<br />
(as well as Sardinia) as a ru<strong>de</strong> sexual sign. Additionally, the thumb is held<br />
up to signify "one" in France and certain other European countries, where<br />
the in<strong>de</strong>x finger is used to signify "one" in other cultures.<br />
In Africa, Arab cultures, and certain countries in South<br />
America (not in Brazil), saying to a female friend one has not seen for a<br />
while that she has put on weight means she is physically healthier than<br />
before, whereas this would be consi<strong>de</strong>red an insult in India, Europe, North<br />
America, Australia, and Brazil.<br />
In Africa and Asian countries, avoiding eye contact or<br />
looking at the ground when talking to one's parents, an el<strong>de</strong>r, or someone<br />
of higher social status is a sign of respect. In contrast, these same actions<br />
are signals of <strong>de</strong>ception or shame (on the part of the doer) in North<br />
America and most of Europe.<br />
In African, South American and Mediterranean cultures,<br />
talking and laughing loudly in the streets and public places is wi<strong>de</strong>ly<br />
accepted, whereas in some Asian cultures it is consi<strong>de</strong>red ru<strong>de</strong> and may be<br />
seen as a mark of self-centeredness or attention-seeking.<br />
In this context is opportune to ask the question: how is possible the<br />
communication between communicators belonging to different cultures?<br />
With such an interrogation is <strong>de</strong>aling discipline called cross-cultural<br />
communication.<br />
7.3. The Conflict – Definition and Resolution<br />
In first paragraph of this chapter is said that culture as system of<br />
values, attitu<strong>de</strong>s, beliefs, expectations, norms and principles of behavior<br />
make the difference between us as humans and as representatives of<br />
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diverse communities. The differences can be source of tension and finally<br />
the source of conflict. In what will follow we will try to clarify the nature<br />
of conflict.<br />
What is a conflict? The term "conflict" has been <strong>de</strong>fined as<br />
"intense interpersonal and/or intrapersonal dissonance (tension or<br />
antagonism) between two or more parties based on incompatible goals,<br />
needs, <strong>de</strong>sires, values, beliefs, and/or attitu<strong>de</strong>s. Conflict can appear as<br />
Racial and Cross Cultural Issues - Interracial conflict, Cross-racial<br />
confrontations, Religious conflict. Nevertheless it is present in such areas<br />
as: Neighborhood – Noise, Pets, Shared common areas, Disturbances<br />
(except for domestic violence); Housing - Landlord/Tenant,<br />
Roommate/Roommate, Mobile Home Parks; Family - Parent/Teen, Youth,<br />
Peer Relations; Organization - Private Nonprofit Agencies, Community<br />
Groups, Home Owner Associations, Neighborhood Groups.<br />
The conflict response styles<br />
People may appreciate the same situation in different ways, and so<br />
respond differently to the conflict situation. According to Turner and<br />
Weed (1983), there are several response styles to conflict and classified<br />
them as follows:<br />
1. Style of addressers. Addressers are the people who are willing to<br />
take initiatives and risk to resolve conflicts by getting their opponents to<br />
agree with them on some issues. Addressers can either be first-steppers or<br />
confronters: A) First-steppers are those who believe that some trust has to<br />
be established to settle conflicts. They offer to make a gesture of affability,<br />
agreeableness or sympathy with the other person's views in exchange for a<br />
similar response. B) Confronters think that things are so bad that they<br />
have nothing to lose by a confrontation. They might be confronting<br />
because they have authority and a safe position, which reduces their<br />
vulnerability to any loss.<br />
2. Style of concealers. Concealers take no risk and so say nothing.<br />
They conceal their views and feelings. Concealers can be of three kinds: a)<br />
Feeling-swallowers swallow their feelings. They smile even if the<br />
situation is causing them pain and distress. They behave thus because they<br />
consi<strong>de</strong>r the approval of other people important and feel that it would be<br />
dangerous to affront them by revealing their true feelings. B) Subjectchangers<br />
find the real issue too difficult to handle. They change the topic<br />
by finding something on which there can be some agreement with the<br />
conflicting party. This response style usually does not solve the problem.<br />
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Instead, it can create problems for the people who use this and for the<br />
organization in which such people are working. C) Avoi<strong>de</strong>rs often go out<br />
of their way to avoid conflicts.<br />
3. Style of attackers. Attackers cannot keep their feelings to<br />
themselves. They are angry for one or another reason, even though it may<br />
not be anyone's fault. They express their feelings by attacking whatever<br />
they can even, though that may not be the cause of their distress. Attackers<br />
may be up-front or behind-the-back: a) Up-front attackers are the angry<br />
people who attack openly; they make work more pleasant for the person<br />
who is the target, since their attack usually generates sympathy, support<br />
and agreement for the target. B) Behind-the-back attackers are difficult to<br />
handle because the target person is not sure of the source of any criticism,<br />
nor even always sure that there is criticism.<br />
Types of conflict management<br />
Out of conflict styles response there are also studied the style of<br />
conflict management. Conflict management is a process in which conflict<br />
is used as a <strong>de</strong>liberate personal, social, or organizational tool. Reg Adkins<br />
consi<strong>de</strong>rs that there are at least four such styles, no one superior than other,<br />
but all <strong>de</strong>pend on the people, environment and the context: Competing;<br />
Avoiding; Harmonizing; Compromising.<br />
The avoiding style of conflict management is a nonconfrontational<br />
approach to problems. It involves passive behaviors such<br />
as withdrawing or si<strong>de</strong> stepping issues of contention in or<strong>de</strong>r to avoid<br />
issues which might be harmful to relationships involved. This approach is<br />
best used when disagreements <strong>de</strong>velop from minor unimportant issues.<br />
This is a useful technique when time is nee<strong>de</strong>d in or<strong>de</strong>r to gather additional<br />
information for informed <strong>de</strong>cision making. Unfortunately, sometimes the<br />
problems that are not quickly addressed tend to grow over time.<br />
Relationships can be damaged by unresolved issues. Overuse of this style<br />
can lead us into giving up too many of our personal goals and enable<br />
others to take advantage of us.<br />
The competing style of conflict management is an authoritarian<br />
approach to problems and involves only one si<strong>de</strong> getting their say. It is<br />
goal oriented and quick. It is most effective in conflict which involves<br />
personal differences that are unlikely to change. It is valuable as a counter<br />
measure in situations where others are likely to take advantage of those<br />
who display a non-competitive nature. It is also valuable in circumstances<br />
which require a quick <strong>de</strong>cision. Finally, one of its greatest values is in<br />
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making unpopular <strong>de</strong>cisions which need to be implemented. The down<br />
si<strong>de</strong> of the mo<strong>de</strong>l is the hostility it has a ten<strong>de</strong>ncy to breed in those on the<br />
losing si<strong>de</strong>. This is especially true when it is the only style of conflict<br />
management being utilized.<br />
The harmonizing style of conflict management puts the<br />
relationship of the interacting parties before the conflict at hand. When<br />
utilizing this technique you may find yourself giving in to the other person<br />
for the sake of the relationship. There are two situations in which this<br />
technique is particularly useful. One is when we are caught off guard by<br />
the conflict and the other party is well prepared. In these circumstances<br />
when we find ourselves situationally outmatched the technique allows us<br />
to save face and move forward. As second instance in which this technique<br />
is valuable is in the client service mo<strong>de</strong>l. It is nearly always more<br />
important to maintain a positive relationship with a client than it is to be<br />
victorious in a confrontation. This is especially true if you are goal<br />
oriented toward repeat business. On the other hand, when this technique is<br />
over used it can manifest some negative results. If you find yourself over<br />
utilizing this strategy and always putting the needs of other before your<br />
own you will find yourself with a buildup of feelings of resentment.<br />
Another negative result occurs when <strong>de</strong>aling with the unscrupulous. Those<br />
persons who perceive this technique as a weakness will always put their<br />
own interest in the self before the good of the many.<br />
Compromise is a technique often known as the "middle ground"<br />
approach. It supposes a negotiation process in which both parties give up<br />
something they want. Whatever one si<strong>de</strong> gets, the other si<strong>de</strong> loses. Neither<br />
si<strong>de</strong> gets what they want but both si<strong>de</strong>s make concessions in or<strong>de</strong>r to reach<br />
a conclusion that is equally acceptable to both. It is most useful when both<br />
parties are of equal stature and there is no simple solution. Unfortunately,<br />
no one is ever really satisfied with the results of this technique. But, at<br />
least both parties are equally dissatisfied.<br />
Ways of Conflict resolution<br />
The term "conflict resolution" refers to a range of processes<br />
aimed at alleviating or eliminating sources of conflict. Conflict resolution<br />
aims to end conflicts before they start or before they lead to verbal,<br />
physical, or legal fighting. This is different from conflict management, in<br />
which conflict is used as a <strong>de</strong>liberate personal, social, or organizational<br />
tool. Though conflict management is the more common road, it is not<br />
popular with practitioners of conflict resolution; it is better to avoid the<br />
140
conflict at the start. As pioneering self-help author Napoleon Hill said:<br />
“The most important job is that of learning how to negotiate with others<br />
without friction.”<br />
Duke Ellington had it right when he said, “A problem is a chance<br />
for you to do your best.” To <strong>de</strong>al with conflict successfully, be concerned<br />
about your own outcomes and also the outcomes for the other party.<br />
Processes of conflict resolution generally inclu<strong>de</strong> negotiation,<br />
mediation, collaborative law, and arbitration.<br />
The salient features of each type are as follows:<br />
1. In negotiation, participation is voluntary and there is no third<br />
party who facilitates the resolution process or imposes a<br />
resolution.<br />
2. In mediation, there is a third party, a mediator, who facilitates the<br />
resolution process (and may even suggest a resolution, typically<br />
known as a "mediator's proposal"), but does not impose a<br />
resolution on the parties.<br />
3. In collaborative law, each party has an attorney who facilitates<br />
the resolution process within specifically contracted terms. The<br />
parties reach agreement with support of the attorneys (who are<br />
trained in the process) and mutually-agreed experts. No one<br />
imposes a resolution on the parties.<br />
4. In arbitration, participation is typically voluntary, and there is a<br />
third party who, as a private judge, imposes a resolution.<br />
Arbitrations often occur because parties to contracts agree that any<br />
future dispute concerning the agreement will be resolved by<br />
arbitration.<br />
Beyond the peculiarities of each form of conflict resolution there<br />
are some common used strategies for conflict solving. Among success<br />
strategies for conflict resolution are following directives:<br />
Have a high concern for both your own and the other party’s<br />
outcomes, and attempt to i<strong>de</strong>ntify mutually beneficial solutions.<br />
Know and take care of yourself.<br />
o Un<strong>de</strong>rstand your perceptual filters, biases, and triggers.<br />
o Create a personally-affirming environment for yourself before<br />
addressing the conflict (sleep, eat, seek counsel, etc.).<br />
Clarify personal needs threatened by the conflict.<br />
o Know your substantive, procedural, and psychological needs.<br />
o Determine your “<strong>de</strong>sired outcomes” from a negotiated process.<br />
141
I<strong>de</strong>ntify a safe place to meet and negotiate.<br />
o Arrange an appropriate space for the discussion that is private and<br />
neutral.<br />
o Gain mutual consent to negotiate and ensure the time is<br />
convenient for all parties.<br />
o Consi<strong>de</strong>r if support people would be beneficial (for example,<br />
facilitators, mediators, advocates, etc.).<br />
o Agree to ground rules.<br />
Take a listening stance.<br />
o “Seek first to un<strong>de</strong>rstand, then to be un<strong>de</strong>rstood.”<br />
o Use active listening skills, and listen loudly.<br />
Assert your needs clearly and specifically.<br />
o Use “I-messages” as tools for clarification.<br />
o Build from what you have heard; continue to listen loudly and<br />
actively.<br />
Approach the interaction with flexibility.<br />
o I<strong>de</strong>ntify issues clearly and concisely.<br />
o Participate in generating options (brainstorming), while <strong>de</strong>ferring<br />
judgment.<br />
o Be open and don’t get distracted by “tangents” and other problem<br />
<strong>de</strong>finitions.<br />
o Clarify criteria for <strong>de</strong>cision-making.<br />
Manage impasses with calm, patience, and respectful behavior.<br />
o Clarify feelings.<br />
o Focus on un<strong>de</strong>rlying needs, interests, and concerns.<br />
o Take a structured break if nee<strong>de</strong>d.<br />
Build an agreement that works.<br />
o Review “hallmarks” of a good agreement.<br />
o Implement and evaluate—live and learn.<br />
Using these techniques can improve the outcome of a conflict<br />
resolution process for everyone concerned.<br />
7.4. Intercultural Communication<br />
We live in multicultural world, in which cultural differences could<br />
be and are the source of <strong>de</strong>ep interpersonal, institutional, group and social<br />
conflicts. The ways of conflict resolution mentioned above imply<br />
communication. How must be the communication process between<br />
cultures is a complex question address by Cross-cultural communication<br />
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(also frequently referred to as intercultural communication) - a field of<br />
study that looks at how people from differing cultural backgrounds<br />
en<strong>de</strong>avor to communication. Besi<strong>de</strong> that the significant objective of this<br />
discipline is to produce intercultural communication principles <strong>de</strong>signed<br />
to gui<strong>de</strong> the process of exchanging meaningful and unambiguous<br />
information across cultural boundaries, in a way that preserves mutual<br />
respect and minimizes antagonism.<br />
Rules of efficient Intercultural Communication<br />
1. The key to effective cross-cultural communication is knowledge.<br />
It is essential that people research the cultures and communication<br />
conventions of those whom they propose to meet. This will minimize the<br />
risk of making the elementary mistakes.<br />
2. When language skills are not high or unequal, clarifying one’s<br />
meaning in five ways will improve communication:<br />
avoid using slang and idioms, choosing words that will convey<br />
only the most specific <strong>de</strong>notative meaning;<br />
listen carefully and, if in doubt, ask for confirmation of<br />
un<strong>de</strong>rstanding (particularly important if local accents and<br />
pronunciation are a problem);<br />
recognize that accenting and intonation can cause meaning to vary<br />
significantly;<br />
respect the local communication formalities and styles, and watch<br />
for any changes in body language;<br />
Investigate their culture's perception of your culture by reading<br />
literature about your culture through their eyes before entering into<br />
communication with them. This will allow you to prepare yourself<br />
for projected views of your culture you will be bearing as a visitor<br />
in their culture.<br />
3. If it is not possible to learn the other's language, it is expedient to<br />
show some respect by learning a few words. In all important exchanges, a<br />
translator can convey the message.<br />
4. It is essential that people un<strong>de</strong>rstand the potential problems of<br />
cross-cultural communication, and makes a conscious effort to overcome<br />
these problems. It is important to assume that one’s efforts will not always<br />
be successful, and adjust one’s behavior appropriately. For example, one<br />
should always assume that there is a significant possibility that cultural<br />
differences are causing communication problems, and be willing to be<br />
patient and forgiving, rather than hostile and aggressive, if problems<br />
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<strong>de</strong>velop. One should respond slowly and carefully in cross-cultural<br />
exchanges, not jumping to the conclusion that you know what is being<br />
thought and said.<br />
5. Suggestion for heated conflicts is to stop, listen, and think, that<br />
means withdraw from the situation, step back, and reflect on what is going<br />
on before you act. Ask yourself: What could be going on here? Is it<br />
possible I misinterpreted what they said, or they misinterpreted me? Often<br />
misinterpretation is the source of the problem. Active listening can<br />
sometimes be used to check this out – by repeating what one thinks he or<br />
she heard, one can confirm that one un<strong>de</strong>rstands the communication<br />
accurately. If words are used differently between languages or cultural<br />
groups, however, even active listening can overlook misun<strong>de</strong>rstandings.<br />
6. Often intermediaries who are familiar with both cultures can be<br />
helpful in cross-cultural communication situations. They can translate both<br />
the substance and the manner of what is said.<br />
7. Do put asi<strong>de</strong> <strong>de</strong>fensiveness. When accused of not un<strong>de</strong>rstanding,<br />
admit that it’s probably true. Ask for help in un<strong>de</strong>rstanding your partner’s<br />
co<strong>de</strong>.<br />
8. Try continuously to improve your intercultural competence. That<br />
means to be intercultural sensitive (to capture and un<strong>de</strong>rstand, in<br />
interaction with people from foreign cultures, their specific concepts in<br />
perception, thinking, feeling and acting, while being free from prejudices);<br />
and to be self-confi<strong>de</strong>nt (to know what you want, your strengths and<br />
weaknesses, to be emotional stabile in or<strong>de</strong>r to express your own point of<br />
view in a transparent way with the aim to be un<strong>de</strong>rstood and respected by<br />
staying flexible where this is possible, and being clear where this is<br />
necessary).<br />
► Exercises and Discussions:<br />
1. What is culture? Give some alternative <strong>de</strong>finition to the term<br />
“culture”?<br />
2. What is the meaning of term “etiquette”? What is the relation<br />
between etiquette, politeness and culture? Give some examples<br />
cultural differences in etiquette.<br />
3. What is conflict? Describe the styles of conflict responses and<br />
types of conflict management.<br />
4. Describe the ways of conflict resolution and strategies of<br />
success conflict solving.<br />
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5. What is intercultural communication? Learn the rules of<br />
successful intercultural communication.<br />
► Recommen<strong>de</strong>d Essays<br />
1. Ethno medicine/Global health<br />
2. Health, food and culture<br />
3. Conflict in health system<br />
4. Etiquette: norms of behavior in public place, at the<br />
business lunch, in the formal meeting, a family lunch etc.<br />
► Literature:<br />
1. Bartos Otomar J., Wehr Paul Ernest. Using conflict theory.<br />
Cambridge University Press, 2002.<br />
2. Engen<strong>de</strong>r Health. (2004) Reducing Stigma and Discrimination<br />
Related to HIV and AIDS: Training for Health Care Workers,<br />
Trainer's Manual and Participant's Handbook.<br />
http://www.popline.org/docs/273667<br />
3. MacLachlan Malcolm. Culture and health: a critical perspective<br />
towards global health. John Wiley and Sons, 2006.<br />
4. Pagano Michael P., Michael Pagano. Interactive Case Studies<br />
in Health Communication. Jones & Bartlett Learning, 2010.<br />
5. Storey John. Cultural theory and popular culture: a rea<strong>de</strong>r.<br />
Pearson Education, 2006. – 657 p.<br />
6. Winkelman Michael. Culture and health: applying medical<br />
anthropology. John Wiley and Sons, 2008.<br />
145
146<br />
Chapter 8<br />
Health Risk Behaviors and Communication in Risk Conditions<br />
Every human being is the author of his<br />
own health or disease.<br />
8.1. Dangerous Factors Determining Appearance of Illness<br />
Buddha<br />
The World Health Organization (WHO) <strong>de</strong>fined health as "a state of<br />
complete physical, mental, and social well-being and not merely the<br />
absence of disease or infirmity." When these conditions of well – being are<br />
not fulfilled, then one can be consi<strong>de</strong>red to have an illness or be ill. Illness<br />
sometimes referred to as ill-health or a state of poor health. Taking in<br />
account the broad <strong>de</strong>finition of health given by WHO, it is possible to<br />
resume that human health is influenced at least by three factors: physical,<br />
mental and social. And consequently the state of poor health is <strong>de</strong>termined<br />
by the same factors.<br />
Physical factors strongly influence health status and health<br />
practices. Among them can be listed: genetic make-up, age, <strong>de</strong>velopmental<br />
level, race and sex etc. For instance the young woman who has a family<br />
history of breast cancer and diabetes is at a higher risk to <strong>de</strong>velop these<br />
conditions.<br />
Mental factor inclu<strong>de</strong> some dimensions: emotional, intellectual and<br />
spiritual. It is proved that emotion affect body function and consequently<br />
influences health. For instance long term stress affects the body systems<br />
and anxiety affects health habits; conversely, calm acceptance and<br />
relaxation can actually change body responses to illness. Or a relevant<br />
example is a stu<strong>de</strong>nt that prior to a test always has diarrhea.<br />
The intellectual dimension encompasses cognitive abilities,<br />
educational background and past experiences. These influence a client’s<br />
responses to teaching about health and reactions to health care during<br />
illness. They also play a major role in health behaviors. For instance a<br />
young person with diabetes who follows a diabetic diet but continues to<br />
drink beer and eat pizza with friends several times a week is at risk<br />
because did not realize the danger of such a behavior.
Spiritual dimension refers to spiritual and religious beliefs. These<br />
two are important components of the way the person behaves in health and<br />
illness. For instance Jehovah Witnesses’ are opposed to blood transfusions<br />
which could make a banal illness lethal one<br />
Social factors imply usually to dimensions: environmental and<br />
Socio-cultural.<br />
Housing, sanitation, climate and pollution of air, food and water are<br />
aspects of environmental dimension which have many influences on health<br />
and illness. For instance in large cities with smog are increased inci<strong>de</strong>nce<br />
of asthma and respiratory problems.<br />
Socio-cultural dimension inclu<strong>de</strong>s a person’s economic level,<br />
lifestyle, family and culture. Low-income groups are less likely to seek<br />
health care to prevent or treat illness; high-income groups are more prone<br />
to stress-related habits and illness. The family and the culture to which the<br />
person belongs <strong>de</strong>termine patterns of livings and values, about health and<br />
illness that are often unalterable. For instance the adolescent whose parents<br />
smoke and drink will see nothing wrong with smoking or drinking. Or for<br />
instance the person of Asian <strong>de</strong>scent is more likely to use herbal remedies<br />
and acupuncture to treat an illness then results of conventional medicine.<br />
8.2. Risky Health Lifestyles<br />
Lifestyle is a term to <strong>de</strong>scribe the way a person lives. It is the<br />
style of living that reflects the attitu<strong>de</strong>s and values of a person. A lifestyle<br />
is a characteristic bundle of behaviors (patterns of behavior) including<br />
social relations, consumption, entertainment, and dress. The behaviors and<br />
practices within lifestyles are a mixture of habits, conventional ways of<br />
doing things, and reasoned actions.<br />
In public health, "lifestyle" generally means a pattern of individual<br />
practices and personal behavioral choices that are related to elevated or<br />
reduced health risk. Since the mid-1970s, there has been a growing<br />
recognition of the significant contribution of personal behavior choices to<br />
health risk—in the United States thirty-eight percent of <strong>de</strong>aths in 1990<br />
were attributed to tobacco, diet and activity patterns, and alcohol. Equally<br />
important, illnesses attributable to lifestyle choices play a role in reducing<br />
health-related quality of life and in creating health disparities among<br />
different segments of the population.<br />
In what will follow are unfol<strong>de</strong>d the most heath risky lifestyle.<br />
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Smoking<br />
Smoking is a major cause of heart and blood vessel disease. The<br />
American Heart Association has named cigarette smoking as the most<br />
dangerous of the modifiable risk factors. Overall, smokers experience a<br />
70% greater <strong>de</strong>ath rate from heart and blood vessel disease than<br />
nonsmokers; and heavy smokers (two or more packs per day) have a <strong>de</strong>ath<br />
rate two to three times greater than nonsmokers. Inhaling cigarette smoke<br />
produces temporary effects on the heart and blood vessels. The nicotine in<br />
the smoke increases blood pressure, heart rate, and the amount of blood<br />
pumped by the heart and the blood flow in the vessels in the heart. Other<br />
effects inclu<strong>de</strong> narrowing of the vessels in the arms and legs. Nicotine is<br />
not the only bad element in cigarette smoke. Carbon monoxi<strong>de</strong> gets in the<br />
blood which reduces the amount of oxygen available to the heart and all<br />
other parts of the body. Cigarette smoking also causes the platelets in the<br />
blood to become sticky and cluster which can harm the heart and blood<br />
vessels. No cigarettes are consi<strong>de</strong>red safe. Many smokers who have<br />
switched to low tar and low nicotine cigarettes smoke more or inhale more<br />
<strong>de</strong>eply to make up for the <strong>de</strong>creased nicotine. By inhaling more <strong>de</strong>eply,<br />
smokers may increase their risk of disease. Regardless of how much or<br />
how long you have smoked, when you quit smoking your risk of heart and<br />
blood vessel disease gradually <strong>de</strong>creases.<br />
Finnish researchers report that men who smoke not only die<br />
younger but they have a poorer quality of life than those who never<br />
smoked. "An especially large negative effect was seen for heavy smokers<br />
[more than 20 cigarettes daily], who lost about 10 years of their life<br />
expectancy, and those who survived experienced a significant <strong>de</strong>cline in<br />
their quality of life," said lead researcher Dr. Arto Y. Strandberg, from the<br />
University of Helsinki. The report was published in the Oct. 13 issue of<br />
the Archives of Internal Medicine. For the study, Strandberg's team<br />
collected data on 1,658 men born between 1919 and 1934 and interviewed<br />
in 1974. Over 26 years of follow-up, 372 men had died. Men who had<br />
never smoked lived an average of 10 years longer than men who smoked<br />
more than 20 cigarettes a day, the researchers found. Non-smokers also<br />
scored better on quality-of-life measures, compared with smokers.<br />
"Especially significant differences were seen in physical functioning,<br />
general health, vitality and bodily pain," Strandberg said. "The impairment<br />
of the physical functioning score of smokers was equal to a 10-year age<br />
difference in the general population." Quality of life was worse even<br />
148
among men who stopped smoking. "On the individual level, the bad news<br />
is that while beneficial compared to continued smoking, cessation of<br />
smoking after midlife could not fully recover the higher risk in mortality<br />
and poorer health-related quality of life seen in smokers," Strandberg said.<br />
Alcohol consuming<br />
Each time someone has a drink, whether it is beer, wine, or liquor,<br />
he or she is consuming alcohol. Alcohol is a drug that is absorbed into the<br />
bloodstream from the stomach and small intestine. It is broken down by<br />
the liver and then eliminated from the body. There are limits to how fast<br />
the liver can break down alcohol and this process cannot be sped up. Until<br />
the liver has time to break down all of the alcohol, the alcohol continues to<br />
circulate in the bloodstream, affecting all of the body's organs, including<br />
the brain. In general, the liver can break down the equivalent of about one<br />
drink per hour and nothing can speed this up--including black coffee.<br />
As alcohol reaches the brain, the person begins to "feel" drunk. The<br />
exact nature of this feeling can vary consi<strong>de</strong>rably from individual to<br />
individual and even within the same individual from situation to situation.<br />
What is common to all individuals and all situations is that alcohol<br />
<strong>de</strong>presses the brain and slows down its ability to control the body and the<br />
mind. This is one reason why alcohol is so dangerous. Alcohol acts like a<br />
sedative and slows down muscle coordination, reflexes, movement, and<br />
speech. If an individual drinks too much alcohol, his or her breathing or<br />
heart rate can reach dangerously low levels or even stop.<br />
Drugs abuse and addiction<br />
People experiment with drugs for many different reasons. Many first<br />
try drugs out of curiosity, to have a good time, because friends are doing it,<br />
or in an effort to improve athletic performance or ease another problem,<br />
such as stress, anxiety, or <strong>de</strong>pression. Use doesn’t automatically lead to<br />
abuse (addiction), and there is no specific level at which drug use moves<br />
from casual to problematic. It varies by individual. But in many case if left<br />
unchecked, the drug is going to win, becoming a disease. Drug abuse is a<br />
disease of the brain, and the drugs change brain chemistry, which results in<br />
a change in behavior. While each drug produces different physical effects,<br />
all abused substances share one thing in common: repeated use can alter<br />
the way the brain looks and functions.<br />
1. Taking a recreational drug causes a surge in levels of dopamine<br />
in brain, which trigger feelings of pleasure. Brain remembers these<br />
feelings and wants them repeated.<br />
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2. If person becomes addicted, the substance takes on the same<br />
significance as other survival behaviors, such as eating and drinking.<br />
3. Changes in brain interfere with ability to think clearly, exercise<br />
good judgment, control behavior, and feel normal without drugs.<br />
4. Whether one is addicted to inhalants, heroin, Xanax, speed, or<br />
Vicodin, the uncontrollable craving to use grows more important than<br />
anything else, including family, friends, career, and even your own health<br />
and happiness.<br />
5. The urge to use is so strong that one mind finds many ways to<br />
<strong>de</strong>ny or rationalize the addiction. A person may drastically un<strong>de</strong>restimate<br />
the quantity of drugs taken, how much it impacts his life, and the level of<br />
control he have over his drug use.<br />
Asi<strong>de</strong> from the obvious behavioral consequences of addiction, the<br />
negative effects on a person’s health are potentially <strong>de</strong>vastating. People<br />
who use drugs experience a wi<strong>de</strong> array of physical effects other than those<br />
expected. The excitement of a cocaine effect, for instance, is followed by a<br />
"crash": a period of anxiety, fatigue, <strong>de</strong>pression, and an strong <strong>de</strong>sire to<br />
use more cocaine to alleviate the feelings of the crash.<br />
Marijuana and alcohol interfere with motor control and are factors<br />
in many automobile acci<strong>de</strong>nts. Users of marijuana and hallucinogenic<br />
drugs may experience flashbacks, unwanted recurrences of the drug's<br />
effects weeks or months after use. Abrupt abstinence from certain drugs<br />
result in withdrawal symptoms. For example, heroin withdrawal symptoms<br />
cause vomiting, muscle cramps, convulsions, and <strong>de</strong>lirium. With the<br />
continued use of a physically addictive drug, tolerance <strong>de</strong>velops; i.e.,<br />
constantly increasing amounts of the drug are nee<strong>de</strong>d to duplicate the<br />
initial effect. Sharing hypo<strong>de</strong>rmic needles used to inject some drugs<br />
dramatically increases the risk of contracting AIDS and some types of<br />
hepatitis. In addition, increased sexual activity among drug users, both in<br />
prostitution and from the disinhibiting effect of some drugs, also puts them<br />
at a higher risk of AIDS and other sexually transmitted diseases. Because<br />
the purity and dosage of illegal drugs such as heroin are uncontrolled,<br />
Drug Overdose is a constant risk. There are over 10,000 <strong>de</strong>aths directly<br />
attributable to drug use in the United States every year. Many drug users<br />
engage in criminal activity, such as burglary and prostitution, to raise the<br />
money to buy drugs, and some drugs, especially alcohol, are associated<br />
with violent behavior.<br />
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Se<strong>de</strong>ntary lifestyle<br />
A se<strong>de</strong>ntary lifestyle is a mo<strong>de</strong> of living in which a person, an adult<br />
or child, does not engage in sufficient physical activity or exercise for<br />
what is generally consi<strong>de</strong>red healthy living. The term is often used by<br />
doctors or professionals within the medical community to <strong>de</strong>scribe a<br />
lifestyle among many people in highly <strong>de</strong>veloped countries that does not<br />
afford them opportunities for physical activity. This type of living has<br />
been heavily influenced by the propagation of passive forms of<br />
entertainment such as television, vi<strong>de</strong>o games, and computer use. Along<br />
with such inactive types of entertainment, shifting of large numbers of<br />
adult workers from physical labor to office jobs has also increased the<br />
ten<strong>de</strong>ncy for many people, especially in technologically <strong>de</strong>veloped<br />
nations, toward a se<strong>de</strong>ntary lifestyle. Numerous studies conducted by<br />
doctors and researchers have indicated a variety of negative impacts on a<br />
person’s life due to living a se<strong>de</strong>ntary lifestyle. Some of the negative<br />
effects mentioned by researches are as follows:<br />
The major effect of a se<strong>de</strong>ntary lifestyle is increased weight gain<br />
and obesity. Ingesting a lot of calories and not really burning any of them,<br />
body <strong>de</strong>posit them as excess fat. Obesity is a big problem of contemporary<br />
society because it causes many difficult health problems such as heart<br />
disease, diabetes, and increased chances of certain types of cancer.<br />
Lack of physical exercise increased risk of heart diseases. Heart<br />
in or<strong>de</strong>r to keep functioning efficiently must get a proper supply of blood<br />
from the blood vessels (coronary arteries). Leading a se<strong>de</strong>ntary lifestyle<br />
can slow the blood circulation and blood vessels can get stiff and blocked.<br />
In serious cases, this can lead to arteriosclerosis and cardiac arrest.<br />
According to a study, lack of physical activity in middle age can increase<br />
risk of dying from heart disease by 52 percent in men and 28 percent in<br />
women.<br />
Se<strong>de</strong>ntary lifestyle increased risk of diabetes. According to study<br />
conducted by researchers at Duke University Medical Center, regular<br />
exercise helps in regulating the blood glucose levels. The lack of exercise<br />
results in increased blood sugar levels putting excess stress on your<br />
pancreas (which secretes the hormone Insulin), which increases chances of<br />
diabetes.<br />
Decreased activity increases the risk of <strong>de</strong>veloping certain types<br />
of cancers such as breast cancer, colon cancer, and other types of<br />
malignant tumors. According to a study carried out by the University of<br />
151
Hong Kong, physical inactivity can increase the risk of dying from cancer<br />
by 45 percent in men and 28 percent in women.<br />
Increased risk of osteoporosis: The prolonged inactivity causes<br />
your bones to lose their strength as they are no longer challenged to<br />
support your body structure, which can result in Arthritis and<br />
Osteoporosis.<br />
Se<strong>de</strong>ntary lifestyle lead to muscles tone loose: The more<br />
se<strong>de</strong>ntary lifestyle one has the lesser muscles one is likely to posses. The<br />
less muscles one possesses the lesser is one ability to carry out the day-today<br />
tasks.<br />
Sleeping difficulties: A se<strong>de</strong>ntary lifestyle doesn't put any<br />
physical pressure on the body. Thus the body doesn't feel like taking a rest<br />
often which leads to sleeping difficulties and in severe cases can also lead<br />
to insomnia.<br />
Headaches: Researchers in Norway found that that people who<br />
did not exercise were 14 percent more likely to <strong>de</strong>velop non-migraine<br />
headaches than those who did exercise.<br />
Faster aging process: Telomeres are repeat sequences of DNA<br />
that sit on the ends of chromosomes, protecting them from damage. As we<br />
get ol<strong>de</strong>r, the telomeres get shorter, and their <strong>de</strong>terioration is associated<br />
with the physical signs of middle and old age. A research study found that<br />
in inactive people the telomeres shortened more quickly than in active<br />
people. The faster is the rate of shortening, the faster is the ageing process.<br />
The faster is ageing process, the higher is the mortality rate.<br />
Unhealthy eating habits<br />
Many genetic, environmental, behavioral and cultural factors can<br />
affect a person's health. Un<strong>de</strong>rstanding family history of disease or risk<br />
factors, such as body weight and fat distribution, blood pressure and blood<br />
cholesterol, can help people make more informed <strong>de</strong>cisions about how to<br />
improve health. Making good food choices is among the most pleasurable<br />
and effective ways of improving health. People require energy and certain<br />
essential nutrients. These nutrients are essential because the body cannot<br />
make these nutrients on its own and must obtain them from food. Essential<br />
nutrients inclu<strong>de</strong> vitamins, minerals, certain amino acids and certain fatty<br />
acids. Foods also contain fiber and other components that are important for<br />
health. Each of these food components has a specific function in the body<br />
and they are all required for overall health. For example, people need<br />
calcium for strong bones, for example, but many other nutrients also take<br />
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part in building and maintaining bones. The carbohydrates, fats and<br />
proteins in food supply energy, which is measured in calories.<br />
Carbohydrates and proteins provi<strong>de</strong> 4 calories per gram. Fat contributes<br />
more than twice as much -- 9 calories per gram -- and foods that are high<br />
in fat are also high in calories.<br />
Healthy nutrition is a diet of balanced nutrients. Healthful nutrition<br />
help children grow <strong>de</strong>velop and perform well in school. A healthy diet<br />
allows adults to work productively and feel their best. Good food choices<br />
also can help to prevent chronic diseases, such as heart disease, certain<br />
cancers, diabetes, stroke and osteoporosis, which are leading causes of<br />
<strong>de</strong>ath and disability. A proper diet can also reduce major risk factors for<br />
chronic diseases, such as obesity, high blood pressure and high blood<br />
cholesterol. In opposition unhealthy nutrition can cause all mentioned<br />
above health problems. Unhealthy nutrition is not only imbalanced<br />
nutritionist diet but also unhealthy eating habits. Bad eating habits inclu<strong>de</strong>:<br />
skipping breakfast, eating before bed, excessive consuming of fast food,<br />
starvation, eating while doing something, eating too fast, lake of water.<br />
Healthy breakfast is very important because give boost of energy<br />
and help clear the fog out of brain.<br />
Eating before bed could result in bad sleep and exacerbating<br />
indigestion.<br />
Fatty snack foods like chips, pizza or cookies can lead to weight<br />
gain and dissatisfaction..<br />
Contrary to what many may think, the body’s first reaction to<br />
starvation is weight gain via the storage of fat. Well, when one doesn’t eat<br />
for long periods of time, one’s body thinks it needs to store calories as fat<br />
because it doesn’t know when the chance to eat will come again. And then,<br />
the fat remains with person.<br />
Eating while doing something lead to overeating, and<br />
subsequently, weight gain. Plus, once begin eating while doing something<br />
else, one often can’t stop it and becomes a mechanical act.<br />
Eating too quickly also encourages weight gain and indigestion as<br />
well.<br />
Water is necessary for the optimal functioning of all life forms,<br />
humans inclu<strong>de</strong>d. What’s surprising is that not drinking a<strong>de</strong>quate amounts<br />
of water throughout the day can actually slow down metabolism, making<br />
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weight gain a likely possibility, since water is necessary for all metabolic<br />
functions, including calorie burning.<br />
Concluding it is possible to say that bad food habit is a serious cause<br />
of obesity and all associated health problems.<br />
Stress<br />
Stress, as <strong>de</strong>fined by Dr. Hans Selye, is "the nonspecific response of<br />
the body to any <strong>de</strong>mand ma<strong>de</strong> upon it." More specifically, stress is <strong>de</strong>fined<br />
by perception. If a person finds a job situation, or another personality<br />
particularly stressful, the feeling often will trigger a physiological<br />
response. On the other hand, studies have shown that when a job situation<br />
or another personality stimulate feelings of challenge or a positive<br />
reaction, these same physiological reactions do not occur. Therefore, when<br />
we talk about stress in relation to disease, we are looking at the more<br />
negative stress. Physiological responses to stress inclu<strong>de</strong> an increase in<br />
heart rate, an increase in blood pressure, and an increased rate of<br />
breathing. These symptoms are caused by the release of adrenaline, which<br />
also narrows your arteries, and results in a greater workload on the heart. If<br />
you are unable to control your stress, you may be at risk for high blood<br />
pressure and possibly injury to your artery walls which sets the stage for<br />
plaque <strong>de</strong>posits. Negative stress is a risk factor for the <strong>de</strong>velopment of<br />
coronary artery disease.<br />
Stress management is a learning process. First, you need to i<strong>de</strong>ntify<br />
the particular cause of your stress. Second, you need to take steps to<br />
change those circumstances that are stressful whenever possible. Third,<br />
you need to relearn ways to cope with stress in your everyday life. The<br />
following are a few suggestions for coping with stress:<br />
- Do not waste energy being upset over little things. Remember that<br />
stress is our reaction to situations, not the situation itself. Often it helps to<br />
talk it out and get a different perspective of the situation while at the same<br />
time venting your concerns.<br />
- Escape from the stress for a period of time. Exercise, taking a walk<br />
before lunch to get rid of the morning's frustrations or taking a walk after<br />
work to help unwind, can be very helpful to reduce your stress.<br />
- Beware of the super-person urges. Set priorities, establish realistic<br />
goals and stop trying to do too much.<br />
- Take time to relax daily whether you learn relaxation techniques<br />
or just take time out for a favorite hobby.<br />
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- Take it easy with criticism or arguments. Stand your ground on<br />
what you believe is right, but make allowances for the other party. Search<br />
for the "positives" of an argument, of a critical person, as well as your own<br />
positive qualities.<br />
- Finally, if stress seems out of control, discuss it further with your<br />
doctor or health care professional. They may be able to direct you to other<br />
sources for help such as support groups or professionals trained in stress<br />
management.<br />
8.3. Behavior Change Communication<br />
Lifestyles are directly related to the health state. More over studies<br />
say that behavioral factors play a role in each of the twelve leading causes<br />
of <strong>de</strong>ath, including chronic diseases such as heart disease, cancer, and<br />
stroke. In United States and other <strong>de</strong>veloped countries the most common<br />
behavioral contributors to mortality, or <strong>de</strong>ath, in 1990 inclu<strong>de</strong>d the use of<br />
alcohol, tobacco, firearms, and motor vehicles; diet and activity patterns;<br />
sexual behavior; and illicit use of drugs. Behaviors such as these are<br />
thought to contribute to almost half of the <strong>de</strong>aths in the United States, and,<br />
according to J. McGinnis and W. Foege (1993), they were responsible for<br />
nearly 1 million <strong>de</strong>aths in the United States in the year of 1992 alone.<br />
The last two <strong>de</strong>ca<strong>de</strong>s of the twentieth century saw a rising interest in<br />
preventing disability and <strong>de</strong>ath through changes in health-related<br />
behaviors. Behavior change is not un<strong>de</strong>rstood as an even but a complex<br />
process that occurs in stages. It is not a question of someone <strong>de</strong>ciding one<br />
day to stop smoking and the next day becoming a nonsmoker for life.<br />
Likewise, most people won't be able to dramatically change their eating<br />
patterns all at once. Even where there is good initial compliance to a<br />
health-related behavior change, a relapse to previous behavior patterns is<br />
very common.<br />
Positive health-related changes come about when people learn about<br />
risks and ways of enhancing health, and when they <strong>de</strong>velop positive<br />
attitu<strong>de</strong>s, social support, self-efficacy, and behavioral skills. The main tool<br />
for acquiring this objective is communication.<br />
Communication has long been an important tool in health<br />
promotion. Although its roots date back hundreds of years (to Cotton<br />
Mather's smallpox vaccination campaign during Colonial American<br />
times), if not thousands of years (to Aristotle's theories of persuasion), the<br />
field of public health communication is very much an outgrowth of<br />
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contemporary social conditions. Demographic, social, and technological<br />
trends that <strong>de</strong>veloped over the second half of the twentieth century<br />
fostered conditions in which the value of good health information, and<br />
thus the value of effective health communication, became increasingly<br />
clear. Public health communication inclu<strong>de</strong>s a continuum of activities that<br />
span from research to interventions. Communication interventions are<br />
effectively used in or<strong>de</strong>r to change risky behavior and to improve health<br />
outcomes. For example, the National Institutes of Health of USA recently<br />
(in partnership with health professional associations, voluntary health<br />
agencies, and pharmaceutical companies) has conducted a communication<br />
campaign that has contributed to more than a 60 percent reduction in the<br />
<strong>de</strong>ath rate from stroke. Sud<strong>de</strong>n infant <strong>de</strong>ath syndrome (SIDS) campaigns<br />
conducted around the globe during the 1990s led to rapid and dramatic<br />
(50–80%) reductions in <strong>de</strong>ath rates from SIDS.<br />
More over communication for behavior change is also economically<br />
efficient. Treatment of behavior-related diseases like cancer is expensive,<br />
while the cost of behavior change interventions is low. For example each<br />
Quality Adjusted Life Year (QALY), say one England journal, gained via<br />
a brief smoking cessation intervention costs £500 compared with £30,000-<br />
£40,000 per QALY for treating patients with advanced cancer.<br />
Many distinctions can be ma<strong>de</strong> between the various types of health<br />
communication activities. The most important of them are the activities<br />
that seek to influence the actions of individuals and small groups or the<br />
actions of larger groups such as workplaces, communities, states, or<br />
nations. The objectives of communication interventions at the larger levels<br />
are focused on bringing about changes in policies. Example inclu<strong>de</strong>s<br />
improved safety a policy is the law prohibiting the driving un<strong>de</strong>r the<br />
influence of alcohol. At the individual (or small group) level there are two<br />
forms of activities. The first one is informed <strong>de</strong>cision-making<br />
interventions that seek to inform people for the purpose of enabling them<br />
to make better health <strong>de</strong>cisions. The second is persuasion-oriented<br />
interventions seek to persua<strong>de</strong> people to change their behaviors or beliefs.<br />
Situational factors <strong>de</strong>termine which of these two approaches is most<br />
appropriate.<br />
Persuasion-oriented interventions are appropriate when there is clear<br />
evi<strong>de</strong>nce that the behavior change is likely to benefit the individual, and<br />
when society is able to reach consensus about the worthiness of the<br />
behavior as a societal goal. Examples inclu<strong>de</strong> promotion of teen substance-<br />
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abuse prevention. Informed <strong>de</strong>cision-making interventions are indicated in<br />
situations when persuasion would be inappropriate, when an individual's<br />
values must be taken into consi<strong>de</strong>ration to <strong>de</strong>termine the optimal behavior<br />
(e.g., prevention of sexual assault), and when society has been unable to<br />
reach consensus about the optimal recommen<strong>de</strong>d behavior (e.g.,<br />
prevention of teen pregnancy).<br />
But indifferently of forms of communication interventions, they do<br />
share some un<strong>de</strong>rlying principles of effectiveness:<br />
The first and most important step in communication planning is to<br />
gain as much insight as possible into the target audience. This is done<br />
primarily by conducting original audience research (e.g., focus groups,<br />
surveys), assessing the results of previous communication efforts, and<br />
drawing from theories of communication and behavior change.<br />
The strategies and tactics of a communication intervention will<br />
differ <strong>de</strong>pending on the stated objective (e.g., informed <strong>de</strong>cision-making,<br />
persuasion, policy change). A clear statement of objectives focuses and<br />
enhances all other elements of the communication planning process.<br />
A critical step in communication planning is to <strong>de</strong>termine what<br />
information has the greatest value in helping to achieve the stated<br />
objective of the campaign. The i<strong>de</strong>al (albeit rare) scenario is when a single<br />
powerful i<strong>de</strong>a is sufficient to motivate and enable members of the target<br />
audience to embrace the campaign's objective.<br />
After the information with the greatest value has been i<strong>de</strong>ntified,<br />
communication planners must <strong>de</strong>termine how to convey that information<br />
simply and clearly, often, and by many trusted sources. Message repetition<br />
is an important element of program success. Audiences tend to process<br />
information incrementally over time. When the message is stated simply<br />
and clearly, when it is repeated often enough, and when it is stated by<br />
many trusted sources, audience members are more likely to learn and<br />
embrace the message.<br />
► Exercises and Discussions:<br />
1. What is health and illness?<br />
2. What are the factors which <strong>de</strong>termine appearance of illness? Share<br />
your oven experience.<br />
3. What is lifestyle? Describe the elements of unhealthy life style.<br />
4. What are the effects of alcohol consuming, of the drug abuse,<br />
smoking, se<strong>de</strong>ntary life, unhealthy nutrition? Analyze each of<br />
them.<br />
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5. Sketch a list of healthy lifestyle rules.<br />
6. How do you think what are the effects of unhealthy lifestyle on<br />
family and society?<br />
7. How can be communication used to change the health related<br />
behavior? Give exemples.<br />
► Recommen<strong>de</strong>d Essays<br />
1. Distress as a factor influencing appearance of illness.<br />
2. Environmental illnesses<br />
3. Occupation and illness.<br />
4. Grieving and <strong>de</strong>pression<br />
► Literature:<br />
1. Blaxter Mildred. Health and lifestyles. Routledge, 1990 .<br />
2. Communication for health http://www.answers.com/topic/healthpromotion<br />
3. Bury Michael. Health and illness. Polity, 2005.<br />
4. Bury Michael. Health and illness in a changing society. Routledge,<br />
1997.<br />
5. Nettleton Sarah. The sociology of health and illness. Polity, 2006.<br />
6. Kafle KK et al. Training intervention to improve the use of<br />
medicines in the communitz through school teachers and women]s<br />
groups. Pharmaceutical Horiyon of Nepal. INRUD Newa, 2001,<br />
Oct; 11 (1):5<br />
http://www.inrud.org/news_pdf/vol11no1_nopics.pdf<br />
7. Sally A. Shumaker, Ockene Judith K., Riekert Kristin A.. The<br />
handbook of health behavior change. Springer Publishing<br />
Company, 2009.<br />
8. Selection and rational use of medicine. World Health<br />
Organization, Geneva, 2006,<br />
http//www.who.int/medicines/areas/rational_use/en/in<strong>de</strong>x.html<br />
9. The Role of Education in the Rational Use of Medicine. World<br />
Health Organization, Regional Office for South-East Asia,<br />
Technical Publication Series no.45, April, 2007.<br />
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