Adjustment to Chronic Illness:
Theory and Research
Annette L. Stanton
Charlotte A. Collins
Lisa A. Sworowski
University of Kansas
There are only two health outcomes that are of importance. First, there is life expectancy. Second, there is function or quality of life during the years that people are alive
—Kaplan (1990, p. 1218)
Most people confront chronic disease, if not in themselves then in those they love. Indeed, more than 50% of deaths in the United States are attributable to cardiovascular disease and malignant neoplasms alone. In addition to their interest in decreasing mortality, health psychologists are dedicated to aiding those who live with chronic disease maintain fulfilling lives. Health psychologists and others have devoted intense energy to identifying psychosocial and behavioral contributors to and consequences of chronic disease. This chapter provides an analysis of current knowledge regarding psychological adjustment to chronic conditions.
Researchers have conducted hundreds of empirical studies to enhance understanding of adaptation to chronic illness. The present literature review focused on pertinent studies of adults with cancer, cardiovascular disease, diabetes, rheumatic diseases (particularly rheumatoid arthritis), and acquired immune deficiency syndrome (AIDS), which are conditions that comprise significant causes of mortality and morbidity and have received substantial empirical attention by researchers in health psychology and related fields. The aim is not to review this voluminous literature in detail. Rather, the focus is on crosscutting issues in the conceptualization of adjustment to these conditions, as well as extant theories and empirical findings regarding determinants of adjustment to chronic illness. Further, the discussion concentrates on individual adult adjustment, and the reader is referred to relevant literatures on adjustment to chronic disease in children (e.g., Roberts, 1995), intimate partners (e.g., Revenson, 1994), and families (e.g., Kerns, 1995).
TO CHRONIC DISEASE
Sometimes when I wake up in the morning, I forget for a moment that I have cancer. Then it hits me like a ton of bricks and I think, “Will I live to see my little girl graduate from college.?” Who wouldn't have these fears?
The doctor brought the psychologist with him when I got my diagnosis. He thought I would fall apart at my third diagnosis of cancer. I figure I'll get rid of it and go on, just like I've done the last two times.
So much positive has come from my experience with cancer. But I've also never been so scared or angry or sad in my life.
I have cancer but it doesn't have me.