How do people respond to physical symptoms, and what makes them decide whether or not to seek treatment? The methodological toolbox in psychology is large, and there are a number of potential ways to address this question. Yet the default strategy has been to rely on just one tool—the questionnaire. In this case, for example, a researcher might create a health-decision questionnaire consisting of a number of Likert-scaled items, such as "How serious do your symptoms have to be before you see a doctor?" and "When you experience symptoms, how long do you wait before you see a doctor?" An alternative approach is simply to ask people what they normally do when they experience some rather common physical symptoms.
In a recent introductory psychology class, students wrote brief essays on how they would react if they woke up sweating, feeling terrible with a 102°F fever, and having a rash on their chest. Consider the following three responses1:
Participant A: My initial impressions would be panic, going through heightened anxiety. Health is probably my highest priority here at the university, and any slight deviation from feeling decent would send off warning signals to get help ASAP. Initially, I would go to my primary source of 24/7 counseling: calling home. They wouldn't mind at all. Calling them would give me a good idea of what I might be coming
Preparation of this chapter was aided by a grant from the National Institutes of Health (MH52391) to James W. Pennebaker. I am grateful to Sherlock Campbell, Michael Eid, Samuel Gosling, James Pennebaker, Lisa Trierweiler, and an anonymous reviewer for their comments on previous drafts of this chapter.
'I thank Carla Groom and James Pennebaker for providing the essays.
down with. I have my own physician's number at hand, and if the symptoms persisted throughout the rest of the morning, I wouldn't be hesitant as to calling him.
Participant B: I would first call my mother and tell her about my situation. I would see what she would suggest, which would most likely be to go see a doctor. I would call the University Health Center and make an appointment to see a doctor that day. Because 1 am covered by my mother's health insurance, the co-pay for me visiting the doctor would be twenty dollars. If the doctor knows what is wrong with me and gives me a prescription, the twenty dollars would be well spent.
Participant C: First thing I would do is try and remember if I had ever experienced similar symptoms so I could try to figure out on my own what was wrong with me. I would then probably call my mother to see if she had any idea what could be causing my symptoms and if she thought I should see a doctor. Knowing me, I would worry myself into a panic attack if I let the symptoms persist since I do not like not knowing what is wrong with me. 1 have gotten sick so often during the past few years that I have given up on trying to just cope with any sort of illness by myself.
What is striking about these answers is that, on the surface, all three participants reacted quite similarly. They all say they would go to see a doctor on the first day. For all three participants, one of the first things they thought about was calling their family. They probably also didn't differ much in terms of how serious they considered their symptoms to be. Thus, their responses to a multiple-choice questionnaire would most likely be comparable. However, a quick read of their responses conveys impressions of psychological reactions that are quite distinct.
For example, Participant B adopted a rather cool and rational attitude, compared to Participants A and C, who reacted rather emotionally. The free responses also tell us that health is clearly an important—almost dramatic—factor in Participant As life, whereas economic considerations prevail in Participant B's thinking. Finally, there is a sense that Participant C is somewhat self-preoccupied and slightly socially isolated. It is likely that these differences—although not having an immediate impact on whether or not to see a doctor—ultimately translate into behavior relevant to the researcher's question (e.g., in terms of their expectations of the doctor or compliance with a prescribed treatment).
Of course, ad hoc impressions always run the risk of being subjective. A text analysis program such as Linguistic Inquiry and Word Count (LIWC; Pennebaker, Francis, & Booth, 2001) can paint a more objective picture. LIWC calculates the percentage of words that falls into a number of grammatical (e.g., pronouns, articles, prepositions) and psychological (e.g., words indicating emotional, cognitive, or social processes) categories. As shown in Table 11.1, LIWC analyses of the three essays generally support our intuitions: Participant C indeed used fewer emotion words than Participants A and B, and the considerably lower rate of social words and the frequent use of firstperson-singular self-references (I, me, my) support our hunch that Participant C is less socially integrated and more self-absorbed than the other two students.
The LIWC analyses, however, reveal more than meets the eye: Participant A has a tendency to use long words (a marker of cognitive complexity); Participant B uses articles at a high rate (a marker of a concrete thinking); Participant C's writings contained a large number of cognitive words (a marker of mental processing). The three also differ in other important ways, such as their orientations to time (Participant A, B, and C: future, present, and past tense, respectively). Thus, a simple word count analysis provides insights into the participants' psychological worlds that go far beyond what multiple-choice questionnaires typically capture.
Linguistic Inquiry and Word Count (LIWC) Analysis of Three Participants' Answers to the Question, "How Would You React If You Woke Up with a Series of Physical Symptoms?"
Total word count
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