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Lecture 2


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Krista Kamstraa

WEEK 2: CHRONICITY What is a narrative? • Story’s told -- phenomenology What is narrative competence? Why use narratives? • Advantages o A short narrative example o “Having waited nine long days for the results of that evil biopsy – I mean sleeping less than four hours a night, eating virtually nothing, and jumping at the sound of anything that sounded like the telephone, I finally got the phone call. At the doctor’s office, it finally came ‘Janet, it’s cancer.’ I felt the strangest thing ever! I felt relieved that I no longer had to wait for the news and yet crushed at the sound of the ‘C’ word. Cancer had never sounded so large, so scary and so uncertain as it did for me that day. I felt like I was caving inwards. I felt small and powerless. I felt like I was finished. I thought of my children, my career, my colleagues – I thought of James – How will he and the children fair without me? I wanted to cry but was too scared to even do that. I envisioned my death.” Chronicity • What is Chronic Illness? • Some epidemiology of Chronic illness – Morbidity – Comorbidity – Multimorbidity – Mortality • Acute Illness • Disease versus Illness • Health • Risk Factors and chronic illness • Background/individual • Behavioural • Intermediate • Community level factors • Modifiable risk factors • Non-modifiable risk factors • Lifestyle and the idea of “choice” • Prevention of chronic illness – Genetics – Ageing – “Best buys” Chronic Disease Risk Factors: Chronic Disease • Disability – Medical model – Social model – Bio-psycho-social model • Word wars: A contradiction in terms Psychological Dimensions • Key Concepts – Illness behaviour • Sick role • Shared decision-making –
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