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What helps some people diagnosed with cancer, heart disease or diabetes stay relatively happy and healthy, while others are devastated? The traits and mindsets that can make the difference.

People everywhere are living longer than ever. The average global life expectancy has more than doubled since 1900 and now exceeds 70 years. Vaccines and antibiotics have reined in scourges like polio, tuberculosis and pneumonia, which can strike young and old people alike. This helps explain why diseases that have long been more common in the elderly, such as cancer and cardiovascular ailments, are today leading causes of mortality, making up more than 35 percent of all deaths. In different part of the world, roughly half of all adults suffer from at least one sort of ongoing, incurable illness, including cancer, multiple sclerosis, rheumatoid arthritis and diabetes.

Considering how painful and disabling these conditions can be, it’s no surprise that people with chronic illnesses are two to three times more likely than the general population to suffer from depression. That risks a downward spiral in which a patient may stop keeping up with treatments and other self-care, such as diet and exercise, and sink further into despair as health inevitably declines. Yet people differ dramatically in the way they respond to being ill. While some surrender hope, others become determined to do all they can to maintain or improve their health, with some even finding silver linings in their diagnoses.

 

living with chronic disease

Why is there such a wide range of outcomes for people living with chronic illness?

How patients fare after being diagnosed with chronic illnesses depends a lot more on them than on their doctors. The patient has to be taking medication, monitoring diet, exercising and following up with medical appointments, all of which can make a big difference in how well he or she does, both psychologically and physically.

At the same time, having a chronic illness will mean different things to different people, and to different people at different stages of the disease. For some people, having a chronic illness completely changes the way they think about themselves; among people who are equally physically impaired, some will see themselves as much more altered than others. For instance, one study of men with prostate cancer showed that one-third said they felt less masculine. In a study comparing heterosexual women and lesbians with breast cancer, the lesbians reported less concern about their appearance.

In general, women who are chronically ill have a harder time with it emotionally than men.

We did find this to be the case, but it’s complicated. It’s true that when women are chronically ill, for instance with something like type 2 diabetes on average and compared with men, women report being more depressed and more physically limited due to the illness. (There are a few exceptions to this rule: One study showed that men with heart failure perceived their health as being worse than women with similar illness.)

The complication is that even when we’re physically healthy, women suffer more from emotional problems than do men. In the general population, women are twice as likely as men to be depressed. So I can’t say that women with chronic illnesses are more depressed than men due to the illness, specifically. The research just isn’t clear. What I can say is that the way we socialize males versus females can have a negative impact on how both men and women adjust to chronic illness. For women, the issue is that we may try to resume our role as caregivers. For men, the issue is they may try to appear strong and self-reliant and be unwilling to ask for help.

 

One particularly striking finding is that a woman will suffer more than a man whether she herself is ill or is caring for a man with a chronic illness.

This may be because, in general, women are socialized to be more other-focused than men, while men are socialized to be more self-focused. If you’re more other-focused, it may be more difficult for you to take care of yourself when you’re ill. You may also be more vulnerable to emotional contagion when your spouse is ill.

Wasn’t the feminist revolution supposed to have done away with all that self-sacrificing?

There have definitely been some changes. Women are socialized now to have more agency and be more assertive — but not at the expense of giving up that “other” orientation.

 

What about race as a factor in how people fare with chronic illness?

It clearly has an effect. Black people with diabetes, for instance, on average report greater distress related to their condition and greater interference with their daily activities than do whites with the same illness. Non-whites with heart disease on average have a greater decline in functioning over five years. But it’s hard to get clear explanations of what is happening here, since race and ethnicity may also be linked to lower incomes and the unhealthy environmental conditions that can come with them, from more pollution to poor-quality medical care.

Most surprising thing about people copin with chronic illness?

I’ve been struck by how important it is for someone facing a diagnosis to have some sense of control. People who have a high sense of control tend to believe that they can influence their health. So when faced with chronic illness, a person with a high sense of control is more likely to take actions that might actually influence the course of their disease — such as taking medication and exercising, and so on.

You can’t control everything of course, and you don’t really get to decide what you can control, but when you figure out what you can, it enhances your feelings of self-worth and reduces distress. It’s like the Serenity Prayer, about accepting what you can’t change while having the courage to change what you can and the wisdom to know the difference. And then you might ask, what happens if treatment fails and the disease comes back? Are you worse off having believed you had control? No, you’re not. It’s always better to figure out a way to have some control. If you have a high sense of control over what happens to you, you’ll try harder to take care of yourself and manage the disease.

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