Critical and chronic illness

By | February 28, 2017

I find that when I’m writing I often switch between the two things – critical illness and chronic illness. I have thought of them as different things, but my search into the literature is showing that the term chronic illness is the one that is more pervasive.

First I need to differentiate between illness and disease. Arthur Frank explains that “illness is the experience of living through the disease. If disease talk measures the body, illness talk tells of the fear and frustration of being inside a body that is breaking down” (1991, p. 13). This differentiation is echoed in the medical literature. A disease is something that is measured or ‘objectified’ where illness is something that is experienced. My research focuses on the illness of being a young breast cancer survivor, not the disease of breast cancer.

I have been using the different terms as meaning critical illness as one that is life threatening but not necessarily life long. Chronic illness on the other hand may not actually be acutely life threatening, but is definitely life long. Breast cancer, unfortunately, is both a critical illness (life threatening) and a chronic illness (has an effect on health for the remainder of your life).

 

In Arthur Frank’s (1991) At the will of the body: Reflections on illness, he talks about his heart attack as an illness as incident, in that it was a temporary thing in his life. It was acute, and certainly life threatening, but once it was treated it was finished. If you were to look at the model of illness provided by Jordan et al (2010), you could see the illness as incident follows the pattern that has been proposed. The illness has a beginning and end. It is that sense of end that important.

Further, when Frank is diagnosed with cancer, he enters the world of both critical and chronic illness. When looking at chronic illness, there is no sense of an end. The illness person need to come to terms with living with illness rather than through it.

This idea of a chronic illness does not fit within the conceptual model presented above. The problem I see is that the model is solution oriented. It is actually an issue with some parts of the healthcare system – it is solution oriented. There is a very that if the patient does x or the doctor does y that the health problem will be resolved. With chronic disease, the overall health problem cannot be resolved. The current acute symptom or issue might be treated, but resolution isn’t even the goal. I think of terminal cancer, where the goal is not “curative”. When they know that there is no option for a cure, then the goal changes. The purpose of healthcare becomes palliative – to reduce pain and suffering, and in some cases to extend life. Their is no resolution to the health problem, there is only mitigation of it.

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