"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.

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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, as hypothesised by Rotter (1966). In this theory he stated that there are personality types who have and external locus of control, and try to hold external factors such as fate, luck, or other people as being responsible for many aspects of their lives. Those with an internal locus of control tend to believe that they have control over their own actions, and any events that happen to them during their lives, are a result of their own actions.

Whether one accepts learned helplessness or not, one of the most stressful occurrences which can occur in an individual's life is an admission to hospital due to an acute or chronic illness. It is a time when the individual's personal independence and privacy are all but destroyed, and everyday activities such as using the toilet, bathing, sleeping, eating and relaxing become part of an alien regime over which the individual has little or no control.

Some people cease their normal behaviour patterns and adopt the role of the patient, as can be seen very often in hospitals, when they immediately change into their night clothes and get into bed. Generally these patients tend to be passive, place very few demands on the ward staff, are generally co-operative with their treatment program, and seldom ask questions. The ward staff react to these "good patients" favourably, as it makes the duties of nurses and other medical staff much easier. Other patients are not as easily dealt with and may act in rebellion at their perceived loss of control.

Taylor (1979) argues that the different reactions from patients who are "good" and "bad" are a response to the depersonalisation of hospitalisation, and the perceived loss of control which accompanies it, and that the reaction is dependent on the individual differences, and past experiences of each patient. She argues that patients who are "good" are actually suffering from learned helplessness, and their passivity, while making the role of the hospital staff easier, is not...
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