The classic view

Abstract

A purely descriptive analysis of factors playing a role in patient adherence, related to the patient, her disease and the health care system, will not easily reveal the underlying psychodynamic processes that shape a patient’s adherence. To go further, various behavioral models have been proposed to put these different factors into a conceptual framework that accounts for their interactive production of adherent or nonadherent behavior : The Health Belief Model, the Theories of Reasoned Action and of Planed Behavior, the Theory of Interpersonal Behavior, the Self-Regulatory Model, the Transtheoretical Model of Change and the Reversal Theory will be briefly described in this chapter. These models demonstrate statistical correlations between mental states and certain behaviors; but, as is well known, statistical correlations do not imply causal relations. Psychological models have therefore a major limitation: They cannot explain why an individual is or is not adherent to the medical advice that she is given. At the level of the individual, specific behaviors remain wholly unexplained and mysterious. In other words, behavior averaged out over a population is no longer sufficient for our investigation; rather, I shall focus on what a given patient is actually doing and why (i.e. for what reasons) she is doing it. I seek to establish a theory, taking its roots in the philosophy of mind, that defines what is meant by the ‘reasons of care ’ and which shows how these reasons bring about caretaking—therapeutic—actions, supporting a causal relationship between Mind and Care.