Featured Article
COPING WITH CHRONIC ILLNESS
Patients who struggle with enduring physical illnesses deal with a myriad of psychological issues. Some chronic illnesses are life threatening such as cancer, cardiovascular disease and AIDS; some are understood and manageable such as diabetes and hypertension; some are understood but progressively disabling such as hearing, vision loss and dementia associated with aging; and some are poorly understood and unpredictable such as arthritis, multiple sclerosis, chronic fatigue syndrome and fibromyalgia.
Continuing physical disability forces one to make changes in their basic life functions and routine. The symptoms may interfere with the ability to work, to carry out family roles, to play, and rest, all to varying degrees. Symptoms can be persistent and constant at times (which is discouraging and frightening; lessened or in remission at times (which stirs hope); unpredictably erratic at times (which is maddening and frustrating); or relentlessly progressive ( which is exhausting and overwhelming).
Chronic illnesses are a threat to:
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life and physical well being
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body integrity and comfort
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independence, privacy, autonomy, control
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self-concept, fulfillment of customary roles
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life goals, future plans
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ability to remain in familiar surroundings
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economic well-being
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Coping with chronic conditions require:
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knowing the disease
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following treatment regimes
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supplementing your life with enjoyable activities
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exercising
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modifying the environment
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reducing risk factors
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dealing with psychological issues such as beliefs, expectations, guilt, adjustment, acceptance, transitions
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Stages of adjustment to chronic illness:
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initial response - "something is wrong"
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awareness of chronicity - "something continues to be wrong"
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disorganization - "whatever is wrong is disturbing my life in significant ways"
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intensified wish for a cure - "whatever is wrong must be changed"
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acknowledgement of chronic nature - "I cannot change what is wrong"
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adaptation to illness - "how can I live with what is wrong and is changing my life?"
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People with chronic physical illnesses are an underserved population who require the services of both physicians and mental health workers sensitive to the special needs of this group. Many patients receive a wide array of services from health specialists while hospitalized but are frequently left to flounder when they return home. Psychological treatment should be integrated as part of routine disease management. It should not be left as an afterthought or a stopgap response to a crisis, offered to patients only when they break down, lose control, or make life difficult for those around them. Use of mental health providers with an interest, experience and understanding of the issues associated with coping with chronic illnesses and disabilities can assist in the adjustment not only of the patient but of their family and friends. Another source of support are the varied support groups generally made up of individuals experiencing a given condition and their family and facilitated by a health care professional.
