sense of self-esteem. It is suggested that these processes involve developing illusions. Such
illusions are not necessarily in contradiction to reality but are positive interpretations
of this reality. For example, although there may be little evidence for the real causes of
cancer, or for the ability of individuals to control the course of their illness, those who
have suffered cancer wish to hold their own illusions about these factors (e.g. ‘I under-
stand what caused my cancer and believe that I can control whether it comes back’).
Taylor and her colleagues argued that these illusions are a necessary and essential
component of cognitive adaptation and that reality orientation (as suggested by other
coping models) may actually be detrimental to adjustment.
The need for illusions raises the problem of disconfirmation of the illusions (what
happens when the reoccurrence of cancer cannot be controlled?) Taylor argued that the
need for illusions is sufficient to enable individuals to shift the goals and foci of their
illusions so that the illusions can be maintained and adjustment persist.
Implications for the outcome of the coping process
According to this model of coping, the individual copes with illness by achieving cogni-
tive adaptation. This involves searching for meaning (‘I know what caused my illness’),
mastery (‘I can control my illness’) and developing self-esteem (‘I am better off than a lot
of people’). These beliefs may not be accurate but they are essential to maintaining
illusions that promote adjustment to the illness. Therefore, within this perspective
the desired outcome of the coping process is the developing of illusions, not reality
orientation.
THE POSITIVE INTERPRETATION OF ILLNESS
Most theories of coping emphasize a desire to re-establish equilibrium and a return to the
status quo. Therefore, effective coping would be seen as that which enables adjustment to
the illness and a return to normality. Some research however, indicates that some people
perceive benefits from being ill and see themselves as being better off because they have
been ill. This approach is in line with positive psychology and its emphasis on positive
rather than negative affect (see stress and positive psychology Chapters 10–11). For
example, Laerum et al. (1988) interviewed 84 men who had had a heart attack and
found that although the men reported some negative consequences for their lifestyle and
quality of life, 33 per cent of the men considered their life to be somewhat or consider-
ably improved. Similarly, Collins et al. (1990) interviewed 55 cancer patients and also
reported some positive shifts following illness. Sodergren and colleagues have explored
positivity following illness and have developed a structured questionnaire called the
Silver Lining Questionnaire (SLQ) (Sodergren and Hyland 2000; Sodergren et al. 2002).
They concluded from their studies that the positive consequences of illness are varied
and more common than often realized. They also suggest that positivity can be improved
by rehabilitation.
ILLNESS COGNITIONS 69