| The purpose of this dissertation was to explore the human experience of illness. It was grounded in a belief that illness is not just physical disease but includes the psychological experience of the sufferer as well as the broader contexts of family, culture, environment and cosmos.; It was argued that care for patients with life-changing illness should take into consideration illness meanings, and different levels in the constitution of meaning were explored. While biomedicine typically focuses on a meaning level called the disease state, most patients are left to grapple on their own with higher orders of meaning such as life context and central purpose. In the focus on cure, care is too often neglected.; This work utilized the hermeneutic method of inquiry, drawing upon patient narratives to explore the many ways that serious illness disrupts lives and to identify patterns of patient response. Four primary psychological responses to illness were discussed: regression, maintenance, transformation, and transcendence. Each of these responses may be appropriate, depending upon context and timing.; In the regression response, a patient's self is constrained and diminished by the illness and the focus is on self-preservation. In the maintenance response, in which illness is perceived as separate from the self, the patient seeks mastery over the illness. Maintaining the pre-illness self structure often involves denial and minimization of the potency and impact of the illness. It was argued that, in cases of chronic illness and disability, the maintenance response strategy may be inadequate and inappropriate. Such patients must accommodate the self to the illness, requiring major changes in self process. Depth psychology may be highly useful in supporting responses (transformation and transcendence) in which illness is integrated into self and higher orders of meaning are explored by the patient.; General systems theory was applied to critique the biomedical model and to develop a new multifactorial, process-oriented model of care. Tasks of care were identified for each of the primary illness responses, tasks aimed at helping patients cope with and make sense of their illness experience. The study maintained that illness can be a rite of passage in which one may heal, not only physically, but also heal into a new understanding, a deeper experience, a heartfelt compassion or even a transcendent vision. |
