The personal impact of multiple health problems
A family history of illness was reported by Nigel (diabetes), Anne X (heart trouble) and Lottie (epilepsy). Lottie felt that it was unfair that she had inherited high cholesterol rather than her brother, especially when she already had epilepsy. Other people did not have family histories (or were not aware of them). Another key issue seemed to be whether people had always lived with health problems or whether they appeared later in life. Gogs became ill after retirement whereas Val had health problems since childhood. They reported very different experiences. Although people live with multiple health problems at all stages of life, the numbers increase with age such that most people over 65 years old have 2 or more long-term disorders*. This was reflected in the people we interviewed, with most being older rather than younger. However, the experience can be very different. Amy was hospitalised for a serious illness in her early 20s and came out with a range of health problems. Mohammed was hospitalised following a heart attack in his 50s and found to also have diabetes. The issues of stigma and whether people looked ill or not also had an impact on how they coped with their health problems. Amy was embarrassed about using a walking stick so preferred to endure more pain instead. Farza’s tics presented problems in public. Kevin had been made fun of for having a limp and using a walking stick. On the other hand, John said that people didn’t think he was ill as there were no visible signs. Nigel said that he looked well but felt terrible. He had lived with depression for most of his adult life and was diagnosed with numerous physical conditions in his 40s.
Some conditions were seen as more stigmatising than others by the people we interviewed including; epilepsy and mental health problems. Also with epilepsy, people might look completely healthy unless having a seizure. Lottie felt that she had to justify herself all of the time for not being able to do things because of her epilepsy. Other people had problems speaking about their health problems whether or not they felt a stigma or that their conditions could not be seen by others. Pat doesn’t tell people about her diabetes unless she has to inject insulin in public. On the other hand, Anne Y had found that being open with her family and friends about her epilepsy and “joking about it” made it easier to deal with. Tammy referred to a kind of dual personality, where she would complain about her problems to family members (or health care workers) but put on a brave face for other social contacts. These issues were important as they were linked to people’s use of health services, or support groups, and whether they could get assistance from others as opposed to struggling to cope alone (see also ‘Peer support’). All the people that we interviewed were engaged with health services to different degrees, although Graham was an unusual case in that he had mostly refused medicines for his health conditions (rheumatoid arthritis and labyrinthitis – an ear problem that affects balance) preferring exercise programmes based on his own research. Such an account contrasts with that of people like Mohammed (see above) who instead saw his health problems largely as technical matters to be sorted out by trained health professionals. Pat, appeared wary of technological intervention and preferred to manage her conditions with diet or complementary therapies. However, in a sort of conversation with herself, she realised that her advancing age and the progressive nature of her diabetes meant that such technology might now be necessary. These issues are considered in more detail in other topics (see ‘Causes of health problems: certain and uncertain’, ‘Prioritising multiple health problems’ and ‘Strategies used to cope with multiple health problems’).
*Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S. and Guthrie, B., 2012. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 380(9836), pp.37-43.