Hospital Patient Behavior: Reactance, Helplessness, or Control?

Hospitals are commonly regarded as unpleasant places to be. The reason is that, as a total institution, the hospital creates a depersonalizing environment that forces the patient to relinquish control over his or her daily existence. It is suggested that patients cope with depersonalizing loss of control by assuming “good patient” behavior or “bad patient” behavior. Predictions are offered as to who will show which behavior pattern under which circumstances. However, a review of these patterns suggests that some “good patients” may actually be in a state of anxious or depressed helplessness, whereas “bad patients” are exhibiting anger and reactance against the perceived arbitrary removal of freedoms. An analysis of the behavioral, cognitive, affective and physiological correlates of these patterns, as well as the behaviors they elicit in staff, suggests that both the “good patient” and the “bad patient” sustain health risks. It is argued that a more informed and participative role for the hospital patient can eliminate or offset many of these risks and actually improve the level of physical and psychological health in the hospital setting.