• Written by Gill Hubbard, Reader in Cancer Care, University of Stirling
imageWe often hide behind a mask of wellness when we're really sick. Maybe it's time to be more open about our health.from

Why are we so shocked when we, or someone we know, becomes ill? Why are many people scared of illness and unable to support their loved ones when illness strikes? And why do so many people still think “it won’t happen to me”?

These questions strike at the heart of our relationship between sickness and health and our reluctance to confront illness as part of our everyday lives.

Many people do not talk openly about illness because they fear it will make them seem weak or self-indulgent.

People also keep illness a secret because they worry they will be blamed or judged for developing it, which is surprisingly common. For example, think about the stigma patients and their families experience if they are affected by lung cancer, obesity-related illness or mental illness.

This fear of being judged or blamed may also contribute to people hiding their symptoms, even from health professionals, delaying diagnosis and proper management.

Perhaps we don’t talk about illness because of the global multi-billion dollar health industry reinforcing a message that we must be healthy if we consume the right food and drinks.

Or perhaps we don’t talk about our illness because we believe modern medicine will cure us.

All of these factors mean remaining quiet about illness becomes normal, illness is often hidden and many people cope with illness alone. While it may be acceptable to talk about having a common cold, it seems that speaking about more serious illness is not. Sometimes we hide away our health troubles behind a mask of wellness.

About a quarter to a third of people with serious physical illnesses hide their illness from colleagues and even family and friends. The data is even more striking when considering mental health problems, with studies suggesting more than two-thirds of people would conceal a mental illness from their co-workers or classmates.

So, it is hardly surprising people are not prepared when they, or a loved one, become ill; they can find it hard to cope psychologically with, and adjust to, their and other people’s illness.

Serious and chronic disease is common

Society seems in a state of denial that illness is a fact of life for most families. It is part of the human condition.

Serious and chronic illness is becoming more common. At any one time, about half of us will be managing a serious health condition and around one in five of us will be experiencing two or more serious illnesses at once.

No family is immune: serious illness can affect people of all ages, wealth, professions and education levels. Celebrities also develop serious illnesses (although many likely keep their health problems private).

Look around you. Who in your family is ill? Who is off work because they are sick with something other than a common cold? Who has been diagnosed with a life-threatening condition (cancer, diabetes and heart disease spring to mind) or with a chronic condition such as inflammatory bowel disease, arthritis or depression?

Living with illness

We are now coming to understand that many life-threatening diseases are in reality long-term conditions rather than a death sentence. Many people are managing multiple serious illnesses at once, while others are told they are at risk of developing a serious illness in the future. If your family, friendship circle and workplace is anything like ours, then being ill is surprisingly common.

There are a number of different psychological approaches to help us cope with these long-term health problems.

So-called third wave psychological therapies promote the idea of accepting rather than avoiding illness, and the pain and suffering that often accompanies it. These types of therapies may help us to cope when illness strikes. They can help patients to clarify their values and make choices that align with them.

Other more traditional psychological approaches (such as cognitive behaviour therapy) may also help people who are struggling with their health to re-frame their illness as part of the normal experience and identify effective coping strategies. They may also help people to identify their needs and seek help to meet these needs.

For young people who are ill, more modern approaches, using internet-delivered support may meet their needs well, for instance this online intervention for young cancer survivors.

And when an illness becomes terminal, psychological therapies and bereavement counselling can help patients, families and friends to face the end of life.

These forms of support may help people thrive with illness rather than despite their illness. But society also needs a “therapy” to cope with people being ill.

For starters, we need to see people who are not 100% healthy represented in the government, workplace and media, in fact in all areas of social life. This should lead to greater acceptance of illness and position ill health as the new normal.

If this article has raised issues for you or if you’re concerned about someone you know, call Lifeline on 13 11 44.

Gill Hubbard currently receives research funding from Chief Scientist Office ( Scotland) and the charity, Melanoma Focus

Claire Wakefield receives funding from the National Health and Medical Research Council Australia. Her research is supported by a Harry McPaul Cancer Council NSW Program Grant (PG16-02), as well as other research grants from Cancer Australia, Children's Cancer Institute and The Kids Cancer Project. The Behavioural Sciences Unit is supported by the Kids with Cancer Foundation.

Authors: Gill Hubbard, Reader in Cancer Care, University of Stirling

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