"Patients have the right to say no." Discuss this statement in relation to the adoption of the role of learned helplessness in some individuals experiencing illness.

Compliance (medicine), Learned helplessness, Chronic (medicine)

The objective of this essay is to discuss the relationship between a patient's rights to refuse certain treatments, or investigations, and how this non-compliance relates to the concept of learned helplessness in individuals, particularly in a hospital setting.

The concept of learned helplessness was first suggested by M. Seligman an animal psychologist, in 1975. During a series of experiments involving rats and dogs, he discovered that the animals which had some control over their environment (in being able to prevent a series of electric shocks) would always try to avoid the undesirable stimulus; whereas the animals which had previously had no control over their environment (and so were unable to prevent the shocks) eventually became apathetic and would not try to escape the stimulus, even if it was possible to do so.

It was found that

"Because these animals have learned that nothing they did worked, they did nothing." [Page 237] (Brannon & Feist, 1992)

The animals concerned had therefore learned to be helpless, but had also learned to apply this helplessness to other situations, where there was no perceived controllability.

The concept of learned helplessness has been criticised, however. Skevington (1995) notes three studies that criticise learned helplessness, namely Dent & Teasdale (1988), Lewinsohn et al. (1981) and Skevington (1993). Skevington (1995) states

"All three studies showed little support for the learned helplessness antecedent hypothesis that depressive attributions precede depression." [Page 147] (Skevington, 1995)

With particular regard to the duration of arthritis, Skevington (1995) maintains that learned helplessness is not a significant feature, a position she also maintains for chronic low back pain sufferers. However Skevington (1995) does accept the presence of the concept of Universal Helplessness as having a wider theoretical basis than learned helplessness.

This leads us to the concept of the locus of control,...
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