For example, a formal diagnosis may occur after symptoms have been perceived, the
individual has subsequently been motivated to go to the doctor and has been given a
diagnosis. However, screening and health checks may detect illness at an asymptomatic
stage of development and therefore attendance for such a test may not have been moti-
vated by symptom perception. Information about illness may also come from other lay
individuals who are not health professionals. Before (and after) consulting a health
professional, people often access their social network, which has been called their ‘lay
referral system’ by Freidson (1970). This can take the form of colleagues, friends or
family and involves seeking information and advice from multiple sources. For example,
coughing in front of one friend may result in the advice to speak to another friend who
had a similar cough, or a suggestion to take a favoured home remedy. Alternatively, it
may result in a lay diagnosis or a suggestion to seek professional help from the doctor. In
fact, Scambler et al. (1981) reported that three-quarters of those taking part in their
study of primary care attenders had sought advice from family or friends before seeking
professional help. Such social messages will influence how the individual interprets the
‘problem’ of illness.
STAGE 2: COPING
There is a vast literature on how people cope with a range of problems including stress,
pain and illness. Coping with stress and pain is covered in Chapters 11 and 12. This
section will examine three approaches to coping with illness: (1) coping with a diagnosis;
(2) coping with the crisis of illness; and (3) adjustment to physical illness and the theory
of cognitive adaptation. These different theoretical approaches have implications for
understanding the differences between adaptive and maladaptive coping, and the role of
reality and illusions in the coping process. They therefore have different implications for
understanding the outcome of the coping process.
Coping with a diagnosis
Shontz (1975) described the following stages of coping that individuals often go through
after a diagnosis of a chronic illness:
Shock: initially, according to Shontz most people go into a state of shock following a
diagnosis of a serious illness. Being in shock is characterized by being stunned and
bewildered, behaving in an automatic fashion and having feelings of detachment
from the situation.
Encounter reaction: following shock, Shontz argued that the next stage is an encounter
reaction. This is characterized by disorganized thinking and feelings of loss, grief,
helplessness and despair.
Retreat: retreat is the third stage in the process of coping with a diagnosis. Shontz
argued that this stage is characterized by denial of the problem and its implications
and a retreat into the self.
ILLNESS COGNITIONS 61