May 2004
Coping with the Challenges of Long-Term Illnesses
Featured Writer: Kenneth Davison, Psy.D.

Your physician gives you the bad news: "Your cancer has returned." Or a family member is in a serious car accident that left her severely injured. Perhaps a close friend tells you that their newborn son has a heart condition that will leave him permanently disabled. Your elderly mother takes a bad fall and will need extensive, ongoing care.

Chronic illness is now one of the nation's top health problems. At one time or another, you or those close to you are likely to encounter a long-term medical condition that will throw one off balance. As Irene Pollin states, "Even the most mentally healthy individuals face serious psychosocial challenges as they confront living with a lasting medical condition". How do we respond to long-term medical conditions? What will help us cope effectively? I have discovered seven components of healthy coping.

Coping effectively means coming to the realization that with a chronic illness the goal is not to cure the illness, but to adapt as well as possible to the condition. Patients, family, support systems, and even at times the medical community may deny the reality of a chronic illness. This denial can delay the patient taking the important steps of admitting and accepting the presence of limitations. People actively or passively collude to support the denial because they do not want to face the reality of the illness and what will be needed to cope effectively. When people accept the illness, the goal shifts from a cure mentality to a care mentality. Treatment focuses on helping the patient and caregivers adjust to the condition instead of remaining stuck trying to cure it.

Likewise, patients who do the best at coping effectively are usually actively involved in their own care. Positive ways to be involved include:

• searching for information through questioning service providers
• working collaboratively with their healthcare professionals
• reading and doing self-study on their particular condition
• enlisting the help of others
• attending support or informational groups
• maintaining supportive relationships with others

It is helpful to recognize that in the course of a chronic condition there will be periods of relative calm with intermittent times of crisis. Medical crises often occur at the time of diagnosis, at discharge from the hospital, or when the patient's condition rapidly deteriorates after a period of remission. Because of the intensity of these events, patients and caregivers tend to magnify their presence and their power. However, medical crises are typically temporary or at worst episodic events. Patients and caregivers can invest such significant energy in fear of a crisis that may happen that they fail to live fully in the here and now. Patients and their support systems will cope better if they can maintain a sense of equilibrium to find fulfillment in the present, coupled with flexibility to face the periodic challenges of crises as they occur.

One's outlook on the long-term illness can be a key factor with how effectively they cope. Unfortunately, some persons become negative, hating their illness. They feel hardened, angry, indifferent, and distant which results in reduced coping and possible worsening of their medical condition. Or people can become accepting of the realities of their medical condition. They feel softer, stay attuned to what is truly important, and develop deeper interpersonal connections. Stories abound where persons have faced overwhelming physical obstacles, and remark that their illness served as a source of growth. When living with a chronic illness, and particularly at times of medical crises, it is helpful to ask the question, "What can I learn from this?" Chronic illness can serve to teach valuable lessons that are often missed when feeling well.

It is important to keep in mind that there are a number of predictable issues that are faced by persons who experience chronic illness. Pollin has identified eight issues, which usually follow a similar pattern, that people with ongoing medical conditions typically face. These include:

• loss of control
• self-image
• dependency
• stigma
• abandonment
• anger
• isolation
• death

Spiritual resources can be a very helpful element in coping with chronic illness. Resources may include individual prayer, reading sacred texts, and meditative practices. A faith community can also be important. Members can provide emotional and spiritual support, and practical support such as providing meals, helping with household tasks, assisting with transportation, and allowing respite for caregivers.

Many people who experience chronic medical conditions find counseling an invaluable resource. Since it is natural for those experiencing long-term medical conditions to feel overwhelmed, confused, and unable to function well, talking to a skilled clinician can help restore well-being. Counseling for the patient or the caregivers can range from brief consultation to long-term, ongoing counseling. If you find yourself or someone you care about struggling with the medical, emotional, relational, or spiritual aspects of coping with chronic illness issues help is available.

Pollin, Irene (1995). Medical Crisis Counseling: Short-Term Therapy for Long-Term Illness. W. W. Norton & Company: New York

Featured Writer:
Kenneth Davison, Psy.D. is a Licensed Clinical Psychologist on the staff of The Counseling Center of Advocate Lutheran General Hospital. He received both his Masters and Doctorate in Clinical Psychology from the Wheaton College Graduate School and serves as Adjunct Faculty at the Wheaton College Graduate School. Dr. Davison enjoys a diverse practice and works together with clients from a holistic model that incorporates a biopsychosocial/spiritual view of wellness. Dr. Davison is comfortable addressing a wide variety of medical, emotional, relational, and spiritual concerns. He emphasizes working collaboratively with clients, their families, physicians, clergy, and others from an integrated and systemic approach. He provides brief consultation services, psychological assessment, short-term problem-focused therapy, and long-term growth oriented therapy.

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