“To try to deal with the difficulties I have reviewed, questions about cause and effects and effective ways of managing illness must arise. The answers to these questions come not only from the sick person but from anyone in the social network, the media, or the orthodox and alternative therapeutic systems. These explanatory accounts are essential for the more immediate tactics of tacking through the rough seas of chronic illness; moreover, the long-term strategies for assessing the deeper, more powerful currents that influence the chronic course of disorder also require continuous surveillance and information gathering. Thus, the chronically ill are somewhat like revisionist historians, refiguring past events in light of recent changes. (They are, unfortunately, also frequently condemned to repeat history even when they learn from it.) Interpreting what has happened and why and prognosticating what might happen make of the present a constant, self-reflective grappling with illness meanings. Does this event portend a break in the dike of therapeutic and preventive defenses? Did that experience mean I can no longer rely on this coping strategy? Will that upcoming circumstance provoke an exacerbation, as it did a year ago, or pass by unnoticed, as it did two years ago?
“The chronically ill become interpreters of good and bad omens. They are archivists researching a disorganized file of past experiences. They are diarists recording the minute ingredients of current difficulties and triumphs. They are cartographers mapping old and new territories. And they are critics of the artifacts of disease (color of sputum, softness of stool, intensity of knee pain, size and form of skin lesions). There is in this persistent reexamination the opportunity for considerable self-knowledge. But—as with all of us—denial and illusion are ready at hand to assure that life events are not so threatening and supports seem more durable. Myth making, a universal human quality, reassures us that resources conform to our desires rather than to actual descriptions. In short, self-deception makes chronic illness tolerable. Who can say that illusion and myth are not useful to maintain optimism, which itself may improve physiological performance (Hahn and Kleinman 1983; Tiger 1980)? The point I am making is that the meanings of chronic illness are created by the sick person and his or her circle to make over a wild, disordered natural occurrence into a more or less domesticated, mythologized, ritually controlled, therefore cultural experience.”
—The Illness Narratives, Arthur Kleinman
