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We have just described the psychological steps we have identified and observed in a patient's becoming ill. It's important to appreciate that many of these steps occur unconsciously, without the patient's awareness that he or she was even participating. The whole purpose of explaining the psychological steps in the spiral toward illness is to build a basis from which the patient can proceed to the steps in a spiral toward recovery.

By becoming aware of the spiral that occurred in the development of their own illness, many of our patients take the first step in altering its direction. Then, by changing attitudes and behavior, they can tip the scales in the direction of health.

We have observed four psychological steps that occur in the upward spiral of recovery:

  1. With the diagnosis of a life-threatening illness, the individual gains a new perspective on his or her problems. Many of the rules by which an individual lives suddenly seem petty and insignificant in the face of death. In effect, the threat gives the individual permission to act in ways that did not seem permissible before. Held-in anger and hostility can now be expressed; assertive behavior is now allowed. Illness permits the person to say no.
  2. The individual makes a decision to alter behavior, to be a different kind of person. Because the illness often suspends the rules, suddenly there are options. As behaviors change, apparently unresolvable conflicts may show signs of resolution. The individual begins to see that it is within his or her power to solve or cope with problems. He also discovers that life did not end when old rules were broken and that changes in behavior did not result in loss of identity. Thus, there is more freedom to act and more resources with which to live. Depression often lifts when repressed feelings have been released and increased psychological energy is available.

Based on these new experiences, the individual makes a decision to be a different kind of person; the disease serves as permission to change.

3. Physical processes in the body respond to the feelings of hope and the renewed desire to live, creating a reinforcing cycle with the new mental state. The renewed hope and desire to live initiate physical processes that result in improved health. Since mind, body, and emotions act as a system, changes in the psychological state result in changes in the physical state. This is a continuing cycle, with an improved physical state bringing renewed hope in life and with renewed hope bringing additional physical improvement.

In most cases, this process has its ups and downs. Patients may do very well physically until their renewed physical health brings them face to face with one of their areas of psychological conflict. If one of the conflicts has had to do with a job, for example, the physical disability associated with the illness may have temporarily removed the conflict because the individual was unable to work. With physical health restored, however, the patient may be facing again the stressful life situation. And even with renewed hope and a different perception of self and the problem, these are usually difficult times. There may be temporary physical setbacks until the patient again feels confident enough to cope with the situation.

4. The recovered patient is "weller than well." Karl Menninger, founder of the Menninger Clinic, describes patients who have recovered from bouts with mental illness as frequently being "weller than well," meaning that the state of emotional health to which they have been restored is in fact superior to what they had considered "well" before their illness. Much the same observation applies to patients who have actively participated in a recovery from cancer. They have a psychological strength, a positive self-concept, a sense of control over their lives that clearly represent an improved level of psychological development. Many patients who have been active in their recovery have a positively altered stance toward life. They expect that things will go well, and they are victims no longer.





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