Abstract
This thesis examined the relationship of behavioural self-blame and psychological adjustment to chronic illness and addressed some of the conceptual and methodological inconsistencies found in the existing literature on self-blame by studying different groups of chronically ill patients. Study One comprised a questionnaire study and was designed to mainly examine 1) differences in the levels of self-blame in three different patient groups (i.e. diabetes, heart disease and breast cancer patients), 2) the relationship between perceptions of behavioural risk factors contributing to the patients' illness and level of self-blame and 3) the relationship between self-blame, self-efficacy and psychological adjustment. Findings showed that there are significant differences in the levels of self-blame across the three groups with breast cancer patients showing the least self-blame. These differences were explained in terms of the different levels of perceived lifestyle factors contributing to the cause of illness and its subsequent management in the three groups. Also, self-blame was higher when patients were asked to consider a specific negative event relevant to their illness than when they considered their illness in general. For all three groups, self-blame was correlated to the number of behavioural risk factors patients reported as having contributed to their illness. No relationship was found between self-blame and self-efficacy or psychological adjustment. Study Two looked at the predictors of behavioural self-blame in heart disease patients by testing a theoretical model derived from evidence in the literature. The model included certain person (i.e. gender, age, characterological self-blame, and prior risk) and illness- related characteristics (i.e. type of diagnosis, time since diagnosis, perceived illness consequences, controllability of health behaviours) that had either direct paths to behavioural self-blame or indirect paths through their effect on behavioural causal attributions. The final model -showing gender and characterological self-blame as having both direct and indirect paths to self-blame, and prior risk, diagnosis and consequences as having only indirect paths- fit the data well. Also, behavioural attributions predicted improved health behaviour after the illness. No relationship between behavioural self-blame or causal attributions and psychological adjustment was found. Studies Three and Four addressed criticisms regarding the inconsistent conceptualisation and operation definitions of self-blame, which caution against unfounded generalisations such as the interchangeable use of the terms causality, responsibility and blame or the generalisation of results across different populations. This was done by 1) examining the degree to which self-blame is contingent upon the actual experience of illness, and 2) by comparing 14 negative events rated on dimensions relevant to blame and controllability. Specifically, in Study Three, non-patients were compared to patient counterparts from the previous study to look at differences in levels of self-blame for heart disease. Non-patients were found to have higher levels of self-blame than non-patients and showed no relationship between self-blame and behavioral risk suggesting a different understanding and utility of the concept. In Study Four, non-patients rated 14 negative events on the dimensions of blame, responsibility, control and avoidability. Two dimensional plots showed that while there were many similarities in the way the examined dimensions were applied to the 14 events, illnesses were represented separately from other negative events. Overall, these studies suggest a strong cognitive component in self-blaming patients as opposed to the motivational elements suggested in the literature. Possible explanations and ways to theoretically link the contradictory findings are discussed in the last chapter of the thesis and include the consideration of self-regulation processes and of changes that the self is subject to throughout the course of an illness.