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Ascribing Meanings to an Illness (I)

Often patients ascribe a meaning to their illness, and this meaning can play a significant role in their motivation and how they perceive their health.

A study by Evangelista, et al. (2001) [5] came to the following conclusions:

  • Women had more positive feelings about HF than men. Women often saw HF as a challenge to overcome, one that would make them stronger in the long run.

  • Men often saw HF as an enemy, demonstrating strong feelings of anger and resentment towards the illness

  • Ascribing positive meanings to an illness leads to higher health perceptions

Lipowski (1985) [10] describes how the meanings that patients ascribe to their illness can make the difference between an optimum recovery and psychological invalidism.

Ascribed feelings have also been shown to affect participation in treatment programs, decision making and interpretation of symptoms. [11] As worry increases, health perception and health status tend to decrease. Feelings of optimism have been related to good physical health and an increased compliance with treatments. [12]


As an example of the power of ascribing feelings to illnesses, consider the following example for breast cancer patients [13]:

  • Patients who had ascribed positive feelings to their illness developed effective coping strategies and learned more from their experiences

  • Negative feelings lead to anguish and exhaustion from using all available energy to combat the illness and deal with a constant fear of death



So why is it that women are so much more positive than men?

Women are generally older than men when they are diagnosed with heart failure. This means that they are probably retired and that the fatigue and physical limitations inherent in heart failure do not affect them to the same degree that they would affect a younger male. By this time in their lives, a woman may have already achieved many of her life goals [6]. The same example applies for older versus younger women who lead a more active lifestyle and depend on their physical functionality to perform the majority of their activities of daily living.


5. Evangelista LS, Kagawa-Singer M, Dracup K.Gender differences in health perceptions and meaning in persons living with heart failure.Heart Lung 2001;30:167 –76.

6. Stromberg A, Martensson J. Gender differences in patients with heart failure. European Journal of Cardiovascular Nursing. 2003;2:7-18.

10. Lipowski Z. Physical illness, the individual and the coping process. Psychiatry Med 1985;1:91.

11. Cohn JN, Johnson G, Ziesche S.A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure.New Engl J Med 1991;325:303 –10.

12. Garg R, Yusuf S, for the Collaborative Group on ACE Inhibitors Trials S.Overview of randomized trials of angiotensin converting enzyme inhibitors on mortality and morbidity in heart failure.JAMA 1995;273:1450 –6.

13. CONSENSUS trial study group.Effect of enalapril on mortality in severe congestive heart failure.N Engl J Med 1987;316:1429 –35.

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