Week 8: Disability Paradox

How do we define pathogenesis?

The origin of the disease

• study of the origin and development of disease

How do we define salutogensis?

• looking at the factors that support health rather than factors that cause disease (pathogenesis)

• Assets approach:

  • Gratitude

  • Self-efficacy

  • Hardiness

  • Empathy

  • Humor

• What produces health

_________ and _________ factors can influence a persons health

• Personal

• Enviromental

Personal

• Persons characteristics

• Self-efficacy

Environmental

• The physical, social and attitudinal (external to the person)

• Social Support

What is the wellness-illness continuum?

• Health is a continuum

  • +H :complete health

  • - H : negative health

  • throughout your life there will be stress factors (changes in life) ) and this will impact health by creating tension in the body  

  • Salutogensis can kick in and bring them to good health  

  • Other pathology sets in and brings the person to the lower part of the continuum  

Compare Salutogenic Orientation with Pathogenic Orientation

The Sense of Coherence (SOC)

• SOC = general orientation towards the world

• WHEN A PERSON IS CONFRONTED WITH A STRESSOR, SOMEONE WITH A HIGH LEVEL OF SOC:

  • Will believe that the challenge is understandable: COMPREHENSIBILITY

  • Will believe that the necessary resources to adapt are available: MANAGEABILITY

  • Will believe that the demands and challenges are meaningful and warrant investment and commitment: MEANINGFULNESS

What have they done in terms of Salutogenesis and health promotion?

Implementing salutogensis in public health to have a better public health policy  

• Develop their personal skills  

• Reorient health services  

• Work with peoples assets  

Why do people with important disabilities report having a good or excellent quality of life when most of the external observers perceive that these people seem to live an undesirable daily existence?

• External observes have negative attitudes that are held by the public and health professionals towards people in situations of disability

• Judgement that people in these situations of disability do not have a good quality of life as those without a disability

What are the two parts of the disability paradox?

1. External Observers

2. Quality of Life

Negative Attitudes

• Sociocultural conditioning that starts at a young age (5 yrs)

• The beautiful body

• Emphasis on productivity and success

• Socio-economic factors (disability = poverty, burden on the economy)

• Attribution of “sick role”

• Disability = status degradation

What are the links between negative attitudes and health

• Perception of a negative attitude/stigma towards a person may reduce their help-seeking

• Negative attitudes towards a patient with a stroke predict shorter long-term survival

• If a person with a disability internalizes the discrimination they face, this is associated with higher levels of psychological distress and lower quality of life

• Negative thoughts can feed pessimism and increase an individual’s stress

• Social isolation has a negative effect on quality of life

Positive Attitudes/thoughts associated with health

• convenience of a wheelchair

• Family does not treat them differently

• Better life expectancy

• Less depression

• Better immune function: resistance to colds

• Better psychological and physical well-being

• Reduced number of deaths tied to cardiovascular disease

• Better adaptation in moments of stress/great challenges

What can increase Quality of Life?

• Improved quality of life of people with spinal cord injuries

• Education increases quality of life because it increases access to the job market, stable social ties and a sense of control over one’s life

• Social support helps reduce a person with a disability’s stress and creates ties to the community

What percent reported a good quality of life?

• 54.3% report a good quality of life

• Comparison: 80-85% people without disability report good quality of life

What are some factors that contribute to a good quality of life?

• Acknowledging their impairment

• Having control of their psyches and bodies

• Being able to maintain certain roles

• Having a “can do” approach to life

• Finding a life purpose, sense and harmony in life

• Spirituality

• Emotional exchange

What percent reported a passable or bad quality of life?

• 45%

Factors that contribute to a bad quality of life?

• Pain: loss of control: of body, social life, and environment

• Pain often invisible, credibility questioned

• Fatigue: loss of energy, difficulty planning a full life and maintaining roles

• No clear direction in life, no spirituality

Explain the balance PWD have for those who reported a good quality of life.

• Between body and mind: maintaining roles and functions,

• “can-do” approach: people who perform and take satisfaction from their roles are intellectually conscious of their realizations about what they can expect from their bodies’ biological functioning (p.985)

• Resilience: individual characteristic to psychologically resist life’s challenges (Balance: body and mind)

• Context: environment: Social support Quality of life

Explain the lack of balance PWD has for those who reported a bad or passable quality of life.

• Lack of balance between mind, body, spirit and the environment.

• Pain has caused deterioration of the relation between mind and body

• Incomprehensible —> depression

• Fatigue: deterioration between body and mind, body does not respond to the spirits’ wants.

• Environment: feeling detached from the outside world

Impairment does not lead directly to negative perceptions of health but _______ and ________.

Limitations and restrictions

Friedreich’s Ataxia (FA)

• degenerative neurological disease characterized by cerebellar degeneration (damage to pathways between the cerebellum and the spinal cord).

• 1-20,000 to 1-50,000

Symptoms of FA

• Lack of muscular coordination

• Lack of energy

• Communication difficulties

• Often hearing difficulties

• Difficulties with fine motor skills

How was it for John to accept his visible disability?

• there were negative attitudes

• heartbreak

• big muscular man — pitiful

• “Negative side too obvious”, burden on the family and close loved ones

• Restrictions on participation in his normal activities and employment

The real problem is “accepting our personal limits that go beyond our physical difficulties

Look the disability paradox notes