Horacio Fabrega

The biological significance of taxonomies of disease

Abstract The medical beliefs of a people have in the past been studied principally by cultural anthropologists. The focus of these studies is usually on intrasocietal dynamics and cultural relativism—a striking orientation. However, beliefs about disease are integral to the way groups have and continue to adapt, and are thus important to both social and biological scientists. In order to study the role of medical beliefs in the adaptation of the group, a comparative approach is needed. This requires viewing these beliefs more generically, comparing their symbolic properties, and analyzing how they are used in explaining and dealing with actual occurrences of disease. The concept of a taxonomy of disease is introduced, as well as the notion of different semantic regions in the taxonomy. In the attempt to clarify the biological significance of a groups taxonomy of disease, and of its mode of operation, the ideas of uncertainty and information are employed. The significance and fruitfulness of this approach is discussed.

Behavioral science and medical education: A biobehavioral perspective

Abstract A model for the teaching of behavioral science in medical schools is described. In this approach attention is concentrated on behavioral (psychological, social, cultural) factors linking the individual with physical illness and the medical care system. These factors are organized by means of an illness behavior model. The student is encouraged to view illness as a behavioral construct (i.e. as a behavioral discontinuity in the patients life) as well as a biomedical construct (i.e. as a biological disruption of functioning) and to understand the dynamic interaction between these two systems of organization. The ideal institutional setting and ideal faculty for teaching medical behavioral science are discussed.

A Behavioral Framework for the Study of Human Disease

A frame of reference for studying human disease is presented. An individuals social behavior serves as the orienting theme. Special forms of social behavior are in effect what tie an individual to his physical and social space, and alterations here can lead to disease. Causes of disease can thus be linked to behaviors of the individual. Although associated with basic changes in the psysiologies and chemistries of the individual, disease invariably comes to affect the individuals behavior and adaptation. Different ways in which such behavioral changes can be conceptualized are discussed. The individual relies on these behavioral changes as the data for evaluating his disease and deciding about medical treatment. A model of how an individual processes information about illness and makes decisions designed to alleviate his condition is presented. Finally, the rationale and value of keeping behavior and adaptation in mind when studying disease are discussed.

Further evidence on dimensionality of the index of psychophysiological stress

Cluster analysis is used to examine dimensionality if the 22-item Langner index. Intercorrelation of the 22 items reveals they do not form a cohesive set; only a few are correlated above the 0.30 level. Using this as the criterion for cluster membership, five dimensions are identified for the total sample. These results demonstrate empirically what several authors have indicated previously, namely that the symptom statements reflect a multiplicity of content. Cluster analysis by sex indicates that female and male response patterns differ both as to numbers and types of symptoms forming clusters. Females report more “psychological” symptoms, whereas males report more“physiological” symptoms. Cluster analysis by level of impairment (<4,4 + symptoms) indicates essentially no difference in cluster content—clusters for both groups contain more “physiological” than “psychological” symptoms. Examination of cluster content using the Crandell and Dohrenwend fourfold classification of the 22 items raises serious questions concerning the substantive usefulness of this a priori approach to the derivation of symptom subsets. Most clusters derived in this analysis contained items from several of the Crandell and Dohrenwend categories; several clusters contained items from all four.

The Langner items and acquiescence

Considering that the preponderance of data in the health field emanates from surveys, it is surprising that problems of response bias have not received more systematic scrutiny. In this paper, data collected in personal interviews with 652 urban blacks are used to examine acquiescence in relation to the 22-item Langner index. Acquiescence is estimated using the “distance-correlation” procedure and the 5-item Srole anomie index. The results indicate that response bias in the form of acquiescence does influence patterns of response to the 22 Langner items. Analysis of the influence of sex status and educational level reveals these factors interact with acquiescence, demonstrating that scores on the Langner index are at least partially a function of all three factors—sex, education and acquiescence. These findings, in conjunction with several previous studies, raise serious questions regarding the adequacy of the 22-item index in substantive investigations which focus on psychological impairment in community populations.