Gender, Age, Class, Ethnicity, and Illness Behavior

 Illness behavior is signifi- cantly affected by gender, ethnicity, age, and social class. As Chapter 2 describes, for a variety of biological and cultural reasons, women are more likely than men to seek medical care when they experience bodily changes that might be symp- toms of illness. Age has a more mixed effect on illness behavior. On the one hand, elderly persons experience more symptoms and more illness and so more often seek medical care. On the other hand, as the body declines, some elderly persons begin to expect a certain amount of physical discomfort, grow tired of constant visits to doctors, and so put off seeking diagnosis for new symptoms.

Similarly, working-class and poor individuals often accept physical pain as an unavoidable consequence of hard living and hard work, so they put off medical care until their symptoms interfere greatly with their daily lives. At any rate, even if they want medical care, many working-class and poor individuals can’t afford to pay for care, can’t get time off work to seek care, or lack transportation to go to a doctor or clinic. Moreover, those who can afford health care only at public clinics where long waits and rude treatment are common may put off seeking care as long as they can.

Ethnicity also affects illness behavior. Not surprisingly, members of poor eth- nic groups are less likely to seek early diagnoses for all the reasons that poor persons are less likely to do so. In addition, some ethnic groups (especially those that include many recent immigrants) may feel more comfortable seeking care from traditional healers, at least initially. Similarly, among all ethnic groups, indi- viduals are most likely to seek early diagnosis from a doctor if their friends and relatives trust doctors and encourage medical help seeking.

The Search for a Diagnosis Eventually, however, if symptoms persist—and es- pecially if they progress—individuals and their families are likely to reach a point where they can’t avoid recognizing that something is seriously wrong. As their previous interpretations of their symptoms crumble, individuals find themselves in an intolerable situation, torn by uncertainty regarding the changes in their bodies and their lives. At this point, any diagnosis can become preferable to uncertainty, so the incentive to seek diagnosis increases.

Seeking a diagnosis, however, does not necessarily mean receiving one. Al- though some problems are relatively easy to diagnose—a 45-year-old white man who complains to his doctor of pains in the left side of his chest will probably quickly find himself getting tested for a heart attack—others are far less obvious. Persons with fibromyalgia, for example, often find that doctors initially dismiss their symptoms as psychosomatic or trivial. In addition, the same symptoms may more rapidly produce a diagnosis for some than for others. For example, as previously mentioned, doctors more often dismiss women’s complaints as merely emotional problems than they do men’s complaints.

Initially, both women and men can find these alternative diagnoses comfort- ing and welcome—after all, it’s far easier to hear that you are just responding to stress than that you have multiple sclerosis. When symptoms persist, however, in- dividuals find themselves torn by ambiguity and uncertainty, experiencing anx- iety about their failing health but often receiving little sympathy or help from relatives and colleagues. As a result, most people eventually seek more accurate diagnoses, going from doctor to doctor until they find one who offers a plausible explanation for their symptoms.

When doctors cannot offer a convincing diagnosis, however, individuals may seek to diagnose themselves, a process known as self-diagnosis. The rise of the Internet and other new technologies has made self-diagnosis much easier in recent years. Individuals can now go online and research their symptoms on a wide range of websites. They can also find online support groups that provide more details on others’ experiences in obtaining diagnoses, including names of potentially helpful doctors or tests. Finally, in many cases individuals can now, on their own, pay for diagnostic tests offered direct to the public. For example, celiac disease is an autoimmune disorder that causes a wide range of gastrointestinal and other problems in affected individuals when they eat food containing gluten. Consequently, many who believe they have the disease stop eating gluten and, if they improve, feel even more confident of their self-diagnosis. Doctors, however, typically will not diagnose someone with celiac disease unless the diagnosis is confirmed by an established set of invasive and often highly un- pleasant tests (which only work if individuals keep gluten in their diet for several months). Consequently, those who believe they have celiac disease increasingly are turning to laboratories that offer apparent scientific testing for celiac disease. Although doctors do not consider these tests definitive, the test results can help individuals convince doctors of their self-diagnosis. As this suggests, in the end any diagnosis—even one that requires a lifelong, highly restrictive diet—may be easier to live with than having no explanation for one’s problems. In addition, having a diagnosis makes it more likely that others will be- lieve that one’s problems are real.