Adult Adjustment to Chronic Illness:A Review of the Literature

The term "chronic illness" carries several meanings and inexact definitions, making the term difficult to specify and its social impact complex to ascertain. The concept of chronic illness is a relatively new phenomenon. Historically, the U.S. health care delivery system has responded organizationally to crisis demands and acute episodes of illness (Somers, 1986). Because of gains in medical knowledge, pharmacological discoveries, and technical advances made in this century, average life expectancy has risen, and people live for months or years with diseases that previously would have quickly killed them (Lapham, 1986). By 1979 chronic illness was perceived as the primary health problem in the United States. Indeed, the proportion of deaths from major chronic diseases has increased more than 250 percent since the beginning of the 20th century (U.S. Department of Health, Education and Welfare, 1979). Between 1986 and 1988 chronic conditions that resulted in the highest limitations in activities included mental retardation; malignant neoplasms of the lung, bronchus, and other respiratory sites; multiple sclerosis; blindness in both eyes; paralysis of the extremities; and cerebral palsy (U.S. Bureau of the Census, 1993). People are affected by chronic illness, either personally or through a family member, in myriad ways. It would be easy to review chronic illness using sweeping generalizations, but Lorig (1993) urged caution: "It is difficult to make generalizations about any population. There are always exceptions to the rule" (p. 14). Considering this warning, the focus of this article is on providing definitions of chronic illness and describing the current literature related to nongeriatric adults dealing with serious chronic illness. Although it acknowledges the enormous effect that chronic illness has on family members, this article focuses on adjustment issues for clients. Implications for social work practice in dealing with adult chronic illness and opportunities for further research are explored. DEFINITIONS AND INCIDENCE OF CHRONIC ILLNESS Dimond (1984) reported that one of the earliest formal definitions of chronic illness was provided by the National Commission on Chronic Illness, which was organized in 1949. The commission's definition included "all impairments or deviations from normal that have one or more of the following characteristics: are permanent; leave residual disability; are caused by nonreversible pathological alteration; require special training of the patient for rehabilitation; or may be expected to require a long period of supervision, observation or care" (p. 2). Since 1949 other definitions have been formulated around several dimensions. One dimension is time: Chronic illness is differentiated from acute illness by how long it persists. The National Center for Health Statistics considers an illness chronic if its duration exceeds three months (Lapham, 1986; Pollin, 1994). Lifestyle is another dimension often appearing in definitions. An illness that is long term or permanent and interferes with the person's ordinary physical, psychological, or social functioning may be termed chronic (Hymovich & Hagopian, 1992). Dimond (1984) spoke of chronic illness as affecting the individual's and family members' quality of life. Symptoms of chronic illness interfere with many normal activities and routines (Miller, 1983). The dimension of symptom management is another important feature in defining chronic illness: "Chronic illnesses are, by definition, not curable. Thus, no matter how vigorously we pursue diagnosis or treatment, the patient will be left with residual, usually progressive disease" (Kinzel, 1993, p. 124). Medical regimens are limited in their effectiveness; chronic illness cannot be cured by a single surgical procedure or a short course of medical therapy (Miller, 1983). Chronic illness may be many things. A chronic illness can be incapacitating or not; it may have a sudden or a gradual onset; it may be fatal, potentially life-shortening, or of no consequence to one's life span; and it may be progressive or unchanging (Pollin, 1994). …