Chronic back pain sufferers—striving for the sick role
Section snippets
IntroductionI’ve spent years trying to accept that I’m sick. But I accept it every time I get a subsidised prescription and go down and pick up my medicine. And I understand it when I go to the social security office and talk to them and they smile and they’re very friendly so then I figure that they believe me. Because who can see? You wear nice clothes and you get in and out of cars and you walk up a stairs… The thing about sickness, at least about back problems and illnesses like that, because I’m assuming that I’m not alone with this, it's a lot about being believed. I’m happy with the hospital visits. It would be nice to have a system so that those of us who are chronically ill could come once a year. Because then you’ve got a paper saying “you are sick”. It's all very well making us an information brochure, but it's as much a case of making an information brochure for the other four million people in Norway” (Informant 3, Niels, 55-year-old lorry driver).
I’ve spent years trying to accept that I’m sick. But I accept it every time I get a subsidised prescription and go down and pick up my medicine. And I understand it when I go to the social security office and talk to them and they smile and they’re very friendly so then I figure that they believe me. Because who can see? You wear nice clothes and you get in and out of cars and you walk up a stairs… The thing about sickness, at least about back problems and illnesses like that, because I’m assuming that I’m not alone with this, it's a lot about being believed. I’m happy with the hospital visits. It would be nice to have a system so that those of us who are chronically ill could come once a year. Because then you’ve got a paper saying “you are sick”. It's all very well making us an information brochure, but it's as much a case of making an information brochure for the other four million people in Norway” (Informant 3, Niels, 55-year-old lorry driver).
This study of illness experiences among Norwegian back pain sufferers shows that a common topic of concern is the degree in which ones illness is accepted among health professionals, family and friends and a fear that the reality of ones pain is being questioned. The paper discusses reasons for this fear and also discusses the use of the sick role concept in the study of chronic illness.
Discussion list data
The Norwegian Back Pain Association's website (www.ryggforeningen.no) includes a discussion list where visitors are encouraged to write about themselves, their back pain, and their experiences with treatment. Between January 1998 and January 2001 475 contributions were made to the list. Contributors ask questions and offer each other comfort, advice, and narratives about pain, diagnostic tests, treatment alternatives, welfare benefits, family life and other aspects of life with back pain. These
Findings
Most of the topics that were seen in the discussion list were repeated in the interviews. In the following, these two sources of data are therefore presented together. The source of each quote is clearly identified, however, and throughout the text individuals that have participated in the interviews are referred to as “informants” while individuals that have participated in the discussion list are referred to as “contributors”.
Delegitimation and stigma: back pain as “character blemish”
The back pain sufferers in this study describe a fear that their experience of suffering and the motives for their behaviour are being questioned. These feelings of delegitimation (Kleinman, 1992) have also been described in other studies of back pain sufferers’ experiences in Norway and elsewhere (Walker, Holloway & Sofaer, 1999; Rhodes, McPhillips-Tangum, Markham, & Klenk, 1999; Borkan, Reis, Hermoni, & Biderman, 1995; Åbyholm & Hjortdahl, 1999; Fretland & Holmen, 1990), and are closely tied
Concluding remarks
The view that chronic illness is related to a decreased dependency on the medical profession finds little support in this study. Doctors’ inability to offer chronic back pain sufferers a clear diagnosis, explanation, and/or a course of treatment or cure appears not to liberate the patient but rather prolongs his or her dependence on the doctor.
As long as the doctor serves as gatekeeper not only to health care, but also directly and indirectly to social acceptance and financial benefits, the
Acknowledgements
The author wishes to thank Simon Innvaer for his assistance in the data analysis.
This project was financed with the aid of EXTRA funds from the Norwegian Foundation for Health and Rehabilitation.
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