24th November 2023

Adaptations in Adult Life

Pairing

Pairing is defined as ‘a selective association that exists between two adults of the same species’. By incorporating attachment theory, we can also understand pairing (or the development of a pair bond) as including an affective component whereby there is a preference for a particular partner, a sense of loss with separation, emotional and psychological bonding and buffering of one another from life’s stressors.

Key theories

• Eshelman 1985 – Homogamous mate selection
  • Proposes that partners tend to be similar in terms of culture, socioeconomic factors and religion.
  • Upheld by Byrne et al. 1966: ‘People choose partners of similar economic status’.
• Berscheid and Walster 1974 – Equity theory
  • Proposed people tend to pair with those perceived to have ‘a similar level of physical attractiveness’ as a means by which to reduce the risk of rejection.
• Newcomb 1956 – Reinforcement theory
  • Proposes that people tend to be ‘attracted by those who reinforce the attraction with rewards’ such as pleasure, self esteem, belonging and consistency.
• Homans 1961 – Social exchange theory
  • Pairing involves a ‘consideration of cost-benefit ratio’ and relationship aims to maximise benefits and minimise costs. It will involve a comparison with other alternatives.

Illness

According to the WHO, health is defined as ‘a state of complete, physical, mental and social well being, not merely the absence of disease or infirmity’. RS Downie argues that this is ‘overambitious’, especially considering its subjective nature. However, it is a widely accepted definition of health and makes good progress towards understanding this concept.

Definitions of illness and disease have varied over time. One suggested by Professor Marshall Marinker is as follows:

‘Disease … is a pathological process, most often physical as in throat infection […]. The quality which identifies disease is some deviation from a biological norm. There is an objectivity about disease that doctors are able to see, touch, measure, and smell. Diseases are valued as the central facts in the medical view…’

‘Illness … is a feeling, an experience of unhealth which is entirely personal, interior to the person of the patient. It often accompanies disease, but it may be undeclared, as in the early stages of cancer […] or diabetes. Sometimes, illness exists where no disease can be found. Traditional medical education has made the deafening silence of illness-in-the-absence-of-disease unbearable to the clinician. The patient can offer the doctor nothing to satisfy his senses…’

‘Sickness … is the external and public mode of unhealth. Sickness is a social role, a status, a negotiated position in the world, a bargain struck between the person henceforward called ‘sick’ and a society which is prepared to recognise and sustain him. The security of this role depends on several factors, not least the possession of that much treasured gift, the disease. Sickness based on illness alone is a most uncertain status. But even the possession of disease does not guarantee equity in sickness. Those with a chronic disease are much less secure than those with an acute one; those with a psychiatric disease than those with a surgical one … . Best is an acute physical disease in a young man quickly determined by recovery or death—either will do, both are equally regarded.’

Theories relating to ‘illness’ and the ‘sick role’

In 1991, Talcott Parsons coined the term ‘sick role’, which identified 4 main expectations:

• An exemption from normal social responsibilities for those who assume the sick role.
• The individual in the sick role cannot be expected to get well by decision or will.
• The individual has to demonstrate wanting to get well.
• There is an obligation to get well, seek appropriate help and cooperate with the treatment offered.

In 1986, Mechanic described ‘illness behaviour’ as ‘how people respond to bodily indications and the conditions under which they come to view them as abnormal’ and suggested that ‘illness behaviour thus involves how individuals monitor their bodies, define and interpret their symptoms, take remedial action and utilise sources of help, as well as the more formal healthcare system’. This is a ‘dynamic process’ shaped by the individual’s personal context and can involve a variety of others, including family members and formal medical services.

Pilowsky proposed ideas about abnormal illness behaviour, which can be understood as ‘outside the range of that usually accepted in the society in which the person lives’. As such, this is highly contextual and requires observation by another for the behaviour to ‘act as a communication’ and can be used strategically.

Bereavement and stages of grief

According to dictionary.com, bereavement is defined as ‘a period of mourning or state of intense grief especially following the death of a loved one’. A person can also feel a sense of bereavement after a divorce or significant loss in their life and the resultant stress accompanying this.

According to Stroebe et al. (2018), Mourning includes ‘a range of behaviours that express to the outside world the internally experienced sorrow or sense of loss’. This process is influenced by family, cultural and religious contexts.

Grief can be understood as ‘the anguish experienced after loss’ and is generally an internal psychological experience. There is an important distinction to be made between the normal process of grief and that of clinical depression.

According to Freud (1917), mourning is a healthy and normal process which is necessary for recovery from a loss. Melancholia (which we may understand to mean depression) is an ‘abnormal pathology’.

Grief and adaptation 

John Bowlby and Colin Murray Parkes proposed a 3 stage model of grief characterised by the following:

• Shock and numbness.
• Yearning and searching.
• Despair and disorganisation.

A fourth stage was added by Parkes, which focused on ‘reorganisation and recovery’, during which the bereaved person is rebuilding their life and can have a more optimistic view of life.

In 2005, Kubler Ross suggested the following stages of grief:

• Denial.
• Anger.
• Bargaining.
• Depression.
• Acceptance.