This psychological concept says that your attitude determines the course of your life and health.

A famous cancer specialist I met at a conference narrated an interesting account about two of his female patients. Both of them had been diagnosed with breast cancer. One of them, let’s call her S, managed the illness by taking responsibility. She complied with the treatment, managed her diet and exercise, and regularly attended support meetings organised at the hospital. The second lady, J, spent the first month after diagnosis cursing herfate and the second doing the rounds of temples around the city. “Guess which one did better with the treatment and is symptom-free today? I really endorse that belief in oneself is more important that belief in fate.” the doctor told me.
Psychology has an interesting theory for health-related behaviour that the women in the doctor’s story were exhibiting. It is known as locus of control. Originally developed within the framework of Rotter’s social learning theory, named after American psychologist Julian Rotter, locus of control (LoC) refers to an individual’s belief that events that occur in one’s life are either a result of personal control and effort, or outside forces such as luck. The range extends from strong personal control (internal locus of control) to weak or no personal control (external locus of control).
People with an internal LoC believe that they control themselves and accept responsibility for events and their life. Conversely, people with an external LoC believe that their environment, some higher power, or other people control their decisions and their life.

LoC and health management: Health locus of control (HLoC) examines the degree to which individuals believe that their health is controlled by internal or external factors. People with an external LoC believe that their health outcomes are under the control of powerful others (ie medical professionals), or determined by fate, luck, or chance. On the other hand, people with an internal LoC believe that one’s health is the direct result of one’s own actions.
For example, obese patients who believe they can lose weight with “magic weight loss pills” are less successful at weight loss as compared to those who believe that weight management is directly related to a balanced diet coupled with regular physical activity. Likewise, smokers with a strong internal HLoC have been successfully able to quit the habit. Results from research on stopping smoking have shown that internals are far more likely than externals to be impacted by the doctor’s report regarding how smoking can affect them and are more likely to cut down on cigarettes.
A strong internal HLoC has been studied in relation to several health conditions, including diabetes, hypertension, cardiac disorders, obesity, addictions and cancer.

How to develop an Internal HLoC: Research seems to suggest that those who have a strong internal locus of control typically display certain types of behaviour that enhances their health and helps in managing disease. Here are some of the behaviours they engage in:

Do activities that will improve the situation: They comply well with medical advice, keep medical appointments and follow doctors’ instructions. Internals also work hard on lifestyle management such as diet, exercise, stress and emotional issues.

Develop their knowledge, skills and abilities: They actively look for information on their affliction, and query their doctor about areas they don’t understand.

Are inquisitive: They try to figure out causes such as history of the disease in the family, what factors in their current lifestyle set off the symptoms, and how stress and emotional factors could have contributed to it.

Look towards the future: They rarely brood over their illness, or waste time in blaming their family, genes, or their past. Instead, they look towards the future and work on their health. They also take note of information that they can use to create positive outcomes in the future. For example, obese people with strong internal LOC will keep a diary recording what they eat each day.

Set goals for themselves: Internals usually set achievable goals such as a kilo a week for losing weight, or cutting down from one cigarette pack a day to half. By working towards goals and accomplishing them, they control outcomes in their life. This builds self-confidence and ensures they stick to the plan.

They speak in the positive: Internals rarely say stuff like “I have no choice”, or “There’s nothing I can do”. They are usually upbeat: “Let’s see how we can work on my health one day at a time.”, or “Cutting out sweets is awful, but see the difference it’s making to my health.”

Your locus of control says a lot about how you view the world and your role in determining the course of your life. Research suggests that patients who initially began with high external LoC framework could change their attitudes and develop an internal LoC. And once they did that, their disease management was far more successful.

The article first appeared in Mumbai Mirror on July 21st 2018.