Redefining health: living with cancer.
The patients presented in this paper were being treated for cancer. None denied the diagnosis, and all were adhering to the medical regimen. Yet these patients also said that they were healthy in the face of the implications of their disease and the physical toll imposed by the treatments. The definition of health currently used by the American health care system is too restrictive to encompass the perception voiced by these individuals. This paper proposes to broaden the concept of health to help provide a legitimate place in society for individuals with chronic, life-threatening illnesses. A theoretical framework is proposed which might explain how these patients could still see themselves as healthy despite their disease. The core concept of health in this model is a sense of self-integrity, and the construct of health has two dimensions, Physical Status and Social Function. Individuals with chronic, life-threatening diseases like cancer use both of these dimensions simultaneously in order to negotiate and reestablish a sense of self-integrity based on their continued social functioning even in light of their acknowledged physical condition. Implications for restructuring our thinking about health, disease, and the mechanisms used to cope with cancer are outlined in order to develop a more realistic definition of health which is contextually based in the lives of the individuals with the disease. The criteria for assessment would not be biologic integrity alone, but a complex compromise between personal needs, social obligations, and physical abilities.
Kagawa-Singer
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School of Nursing, University of California Los Angeles 90024.
D000223:Adaptation, Psychological; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease / Q000523:psychology; D003431:Cross-Cultural Comparison; D005260:Female; D006801:Humans; D007564:Japan / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D014481:United States