The crisis of illness does not occur as an isolated event in the life of the person. The psychological states that occur during illness do not represent a change or difference in the person so much as temporary adaptive behaviors that maintain or promote restoring the presickness self.
The reactions to illness must be understood in terms of the person`s prior personality organization. Thus adopting the sick role and going through the phases of crisis during the stages of illness are maladaptive only when the person is not sick by commonly accepted standards.
Transition from Health to Illness, the First Stage, lasts from the time the person first considers that he might be ill until he and others around him acknowledge that the person is ill. During this period he may show signs of emotional shock if the illness is acute or severe and the disruption to normal life is considerable. Then denial is used, at least briefly, to minimize or ignore the symptoms. If denial is strong, the person has a feeling that nothing can happen to him, that he never felt better, and he may engage in more than the usual amount of activity. Denial is usually impossible to maintain for a prolonged time because of pressure from others, feelings of extreme discomfort, or manifestation of more symptoms when the person tries to maintain normal behavior.
Acceptance of Illness, the Second Stage, occurs when the person feels the reality and impact of his illness, acknowledges the illness, seeks validation from significant others, seeks help from a caretaker, and enters into the sick role with all the related behaviors previously described. During illness the petient may go through a mourning process for loss of body function or structure, even if such loss is temporary. During this time the patient has many worries-job, finances, ability of the family to manage without him or her, fidelity of the spouse, child care, and loss of status. The patient may become aggressive or haughty, displacing anger on others, even though he feels weak or inadequate. Or he may be passive in order to control his fears and anger.
The stigma, embarrassment, or shame felt because of illness begins to be worked through along with the emasculating or defeminizing effects felt as part of the illness. Feelings or rejection, of being abandoned, and self-pity gradually diminish.
Different body parts and certain body functions may have great significance to the patient. If these have been altered by illness or the treatment plan, the distortion in body image that occurs must be resolved before the patient can enter the last stage of illness, convalescence. Gradually the coping mechanisms are reorganized and perception becomes more realistic.
Convalescence, the Last Stage, is analogous to the adaptation or resolution phase of crisis. Now the patient returns to health. Or, in the case in which there is a permanent disability and no further physical improvement is possible, convalescence marks a gradual increase in satisfying experiences. The patient`s new sense of worth and reduced anxiety enable him again to utilize those abilities typical of health. This period is like moving from adolescence to adulthood. The person is reassessing the meaning of life and is becoming increasingly independent, stable, outward-looking, and involved in decision making.
There are many variations in convalescence. Physical convalescence frequently occurs before emotional convalescence or resolution of the illness. The person`s level of maturity, the kind of crisis intervention given, and the environment in which the person must function combine to determine progress. If others encourage constructive activity instead of passive, less adaptive behavior, the person can more easily resolve feelings about having been ill. Then again, health may represent more of a threat than illness due to the pressures of life. If illness justifies irresponsible behavior, provides an escape from obligations, or satisfies irresponsible behavior, provides an escape from obligations, or satisfies emotional of financial needs, then the person may actively (although perhaps unconsciously) resist convalescence.
References :
Janis, Irving, Psychological Stress. New York : John Wiley & Sons, Inc., 1958.
Norris, Catherine, “The Work of Getting Well”, American Journal of Nursing, 69: No. 10, 1969.
Murray, RB and Zentner JP., Nursing Concepts for Health Promotion, Second Edtion, Prentice-Hall, Inc, Englewood Cliffs, N.J, 1979.
