Implications for the outcome of the coping process
Shontz developed these stages from observations of individuals in hospital and suggested
that once at the retreat stage, individuals with a diagnosis of a serious illness can
gradually deal with the reality of their diagnosis. According to Shontz, retreat is only a
temporary stage and denial of reality cannot last for ever. Therefore, the retreat stage acts
as a launch pad for a gradual reorientation towards the reality of the situation and as
reality intrudes the individual begins to face up to their illness. Therefore, this model of
coping focuses on the immediate changes following a diagnosis, suggesting that the
desired outcome of any coping process is to face up to reality and that reality orientation
is an adaptive coping mechanism.Coping with the crisis of illness
In an alternative approach to coping with illness, Moos and Schaefer (1984) have applied
‘crisis theory’ to the crisis of physical illness.What is crisis theory?
Crisis theory has been generally used to examine how people cope with major life
crises and transitions and has traditionally provided a framework for understanding
the impact of illness or injury. The theory was developed from work done on grief
and mourning and a model of developmental crises at transition points in the life cycle.
In general, crisis theory examines the impact of any form of disruption on an indi-
vidual’s established personal and social identity. It suggests that psychological systems
are driven towards maintaining homeostasis and equilibrium in the same way as
physical systems. Within this framework any crisis is self-limiting as the individual
will find a way of returning to a stable state; individuals are therefore regarded as
self-regulators.Physical illness as a crisis
Moos and Schaefer (1984) argued that physical illness can be considered a crisis as it
represents a turning point in an individual’s life. They suggest that physical illness causes
the following changes, which can be conceptualized as a crisis: Changes in identity: illness can create a shift in identity, such as from carer to patient,
or from breadwinner to person with an illness.
Changes in location: illness may result in a move to a new environment such as
becoming bedridden or hospitalized.
Changes in role: a change from independent adult to passive dependant may occur
following illness, resulting in a changed role.
Changes in social support: illness may produce isolation from friends and family
effecting changes in social support.62 HEALTH PSYCHOLOGY