Exploring Perspectives on Health and Illness

Write an essay explaining and evaluating how and to what extent a particular life course stage can add to the understandings of health and illness provided by, biology, sociology and psychology. 

This essay aims to explain the life course stage of adolescence and how it can add to the understanding of type 1 diabetes, by utilizing the lenses of sociology biology and psychology. This will be achieved by drawing on supportive evidence to support my statements. I have chosen adolescence as I find the transition from childhood to adolescence very interesting and challenging on both a personal and professional level. Being the parent of a teenager and working with them as a student nurse, I hope to gain knowledge and insight of adolescence and the challenges they face. In order to provide the best care and enable the transition to be an easier one.

Life transitions are critical times of transformation. (Bengston et al, (2005 cited by Rogers 2019) defines the life course as a sequence of age-linked transitions that are embedded in social institutions and history. The life course approach to health acknowledges key stages in people’s lives which have relevance to their health. Human development is characterized by numerous biological, psychological and sociological processes each with different aspects of importance at different stages. (The WHO, 2019) defines Adolescence as the period of transition from childhood to adulthood and one of the most rapid phases of human development in individuals between 10-19 years. Physical changes are noticed first with the onset of puberty Bailey (2006, cited by Higham, 2019a).  A surge in sexual hormones causes reproductive organs to function. Height and weight also increase which can cause issues among some teenagers.

 During this period, cognitive development also increases and the ability to reflect upon the concept of self and others. This would affect how relationships are formed and interaction between family members and peers.  According to Jean Piaget from age 11 to the end of adolescence individuals develop the ability to think abstractly and grasp the concept of probabilities Piaget (1932, cited by Bailey, 2006a). Every developing young person progresses at a personal pace and have their own personal view of the world around them. This period of transition imposes unique challenges for any young person and their families but when the young person is diagnosed with a chronic illness such as Type 1 diabetes the challenges can become a lot more difficult.

Type 1 diabetes is a chronic and potentially life-threatening condition (Higham, 2019b). Living with the condition can be viewed as a complex and profound personal experience Roper et al (2009, cited by Higham, 2019b) Type 1 diabetes occurs when the body destroys the beta cells in the pancreas that produce insulin, causing abnormalities in carbohydrate ,fat and protein metabolism (Higham, 2019c). As a result, treatment of insulin is needed to maintain blood glucose levels. Management of diabetes requires a strict monitoring regime which includes self-monitoring of glucose levels, meal planning and exercise (Higham, 2019c). This can be quite challenging as social eating events are very common among teenagers and the idea of ‘counting carbohydrates’ might be embarrassing whilst trying to fit in to a peer group. The girl in the video recalls becoming depressed as she was not allowed to eat the same things as her friends, she felt like her control started to slip because of teenage pressures (Higham, 2019d). The UK has the 5th highest population of children diagnosed with type 1 diabetes (Diabetes.co.uk, 2013) but it’s during the adolescent period where it becomes hard to manage (Higham, 2019a). A new less stringent eating regime has been developed called the DAFNE programme (Dose Adjusted for Normal Eating). It equips those with skills how to count carbohydrates within their diet. This will enable them to eat as normal as possible and adjust their dose of insulin accordingly and maintain glycaemic control  DAFNE (2010, cited in Higham, 2019e) Diabetes management needs a lot of self-discipline and is considered as being extremely demanding, but if not managed well can have long term complications in later life.

Social issues during adolescence have a major influence in the management of Type 1 diabetes and how it impacts on overall health and illness across the life course. Relationships formed with family, peers and health professionals play a key role and can either have a positive or negative affect on the young person. It can be a time of frustration for parents as some adolescent’s rebel against parental authority in search for their own identity. Coleman (2011, cited by Higham, 2019f) recognizes that the main goal for young people is to be free from parental restraint and achieve control over their own life Coleman (2011, cited by Higham, 2019f). However (Rutter et al. 1998) states that consistently authoritative parenting styles are shown to have the most beneficial effect on adolescent development since this includes warmth, structure and support for autonomy. Rutter et.al. (1998, cited by Higham, 2019a). Laura from video 12.4 finds her mums control with her diabetes causes major conflict as she would blame herself if something happened (Higham, 2019g). Conflict also happens when families are faced with stress due to environmental factors or where there is an impairment in parental capacity Bailey (2006, cited by Higham, 2019a) Adolescents tend to spend more time away from home and the social focus turns to developing relations with friends their own age. The peer group can have a major influence during adolescence which can determine how they manage their condition. There can be many young people who feel isolated from a group because of their condition which can cause loneliness and can lead to mental issues in later life.  However, some young people are afraid to disclose they have the condition and give into peer pressures and risky behaviours leading to poor glycaemic control. (Higham,2019h).

Adolescents with type 1 diabetes face a number of psychological challenges and stressors as a result of their illness. They must discover and find their own identity whilst struggling with environmental influences and try to manage a chronic illness. Today’s adolescent’s it could be argued are even more vulnerable due to the rapid changes in technology and multicultural influences in society. Young people are put under more pressure to act and look a certain way and conform to societal demands. A recent study found that 50% of type 1 diabetics were diagnosed with a mental illness most commonly depression within the 1^st year of diagnosis (Goad, 2015) Self-esteem has a powerful influence on their ability to deal with stress Bailey (2006, cited by Higham, 2019a). A young person with low self-esteem and poor motivation is at risk of poor disease management which can lead to lifelong complications. Body image causes a great deal of anxiety among adolescents with diabetes. Especially when they lose weight rapidly before diagnosis and then re-gain the weight after treatment has started (Higham, 2019a). This can cause eating disorders especially among young women. A condition called diabulimia is related to people with diabetes, who mismanage insulin in order to lose weight Philpot (2013, cited by Higham, 2019a). Over 70% of premature deaths in adults resulted from poor behaviours started in adolescence. (The WHO ,2008)

The three perspectives of biology, sociology and psychology helps are overall understanding of health and illness throughout the life course.  It offers a holistic view of the person as an individual at this specific stage of adolescence. To achieve the goal of holistic care a person-centred process is required that encapsulates the desires and goals of the individual. The healthcare professional must work in partnership with the young person and their families in order to identify, needs, fears or concerns they may have. This approach to health will help adolescents in their transition from child to adult services as this can sometimes be a traumatic event. The Department of Health (2008 cited by Higham, 2019h) recognises that a proper planned transition that puts the young person at the centre, improves health, educational and social outcomes. Saylor (2004, cited by Watson, 2019a) believes holistic health gives a more rounded view of how the ‘mind, body and spirit’ integrate. Nice guidelines recommend that young people with type 1 diabetes should be offered an ongoing integrated care package by a multidisciplinary care team in order to facilitate a smooth transition and improve long term outcomes. (Nice, 2016).

In conclusion adolescents are a complicated group who have needs different from both adults and children. The information gathered from the 3 perspectives helps us to recognise that there is more to health than just treating the illness. The overall wellbeing of the of the young person and their families must be considered. A care plan must be put in place that is tailored to the individual needs and achievable goals of the person. Adolescents must be educated in all aspects of their condition and encouraged to accept responsibility for their own level of wellbeing, and everyday choices that effect their health. We must work in partnership with members of a wider multi-disciplinary team to ensure prompt action from referrals if any issues arise.

REFERENCES

• Diabetes.co.uk. (2013) ‘Type 1 Diabetes’ [Online] Available  https://www.diabetes.co.uk/type1- diabetes.html
• (Accessed 15th Aug 2019)
• Goad K (2015) Examining the Mental Health Issues Prevalent in Adolescent Type-1 Diabetics: An Evidence-Based Review to Improve Health. Journal of Diabetes and Metabolism, vol 6 no 9 p3
• Higham, S. (2019a) ‘Psycho-social aspects (1) The developmental psychology of adolescence’, KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=4
• (Accessed 13thAug 2019)
• Higham, S. (2019b) ‘Overview’, KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=__overview
• (Accessed 15th Aug 2019)
• Higham, S. (2019c) ‘Biological processes (2) Long-term complications of type 1 diabetes’, KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=2
• (Accessed 15^th Aug 2019)
• Higham, S. (2019d) ‘Overview’, Video 12.1 Growing up with diabetes KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=__overview
• (Accessed 15th Aug 2019)
• Higham, S. (2019e) ‘Biological processes (3)  ‘Lifestyle adjustments’,  KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=3
• (Accessed 16th Aug 2019)
• Higham, S. (2019f) ‘Psycho-social aspects (2) Adolescence: sociological perspectives’, KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=5
• (Accessed 16th Aug 2019)
• Higham, S. (2019g) ‘Psycho-social aspects (2) Video 12.4 The impact of type 1 diabetes on one young persons autonomy’, KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=5
• (Accessed 16th Aug 2019)
• Higham, S. (2019h) ‘Psycho-social aspects (3) Why are peers so important to young people?’ KYN238 Unit 12 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419433&section=6
• (Accessed 16th Aug 2019)
• National Institute for Health and Care Excellence (2016) ‘Diabetes (type 1 and type 2) in children and young people: diagnosis and management’ [Online] Available  https://www.nice.org.uk/guidance/ng18
• (Accessed 17th Aug 2019
• Rogers, A. (2019) The Life course: Perspective The life course (2) KYN238 Unit 11 Life course Perspectives.  [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419429&section=2
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• Watson, N (2019a) ‘Holism’ KYN238 Unit 4 [Online] Available https://learn2.open.ac.uk/mod/oucontent/view.php?id=1419407&section=9
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• World Health Organization, Adolescent Health [online], Available
•  http://www.who.int/topics/adolescent_health/en
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