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Illness For many of us, stressful or traumatic events never progress to chronic illness. A
childhood symptom may occur only once and then completely resolve, never to
reappear or develop into a chronic disease.
The same is seen with antibodies, which are proteins created by our immune systems to protect, def
end and help our bodies heal, such as in the presence of infections.
Specific types of antibodies can also form against body tissues, such as
insulin-producing cells in the pancreas, to precede and predict risk for the development of certain
chronic illnesses, such as type 1 diabetes. But antibodies
like these have also been found to resolve and disappear before we
ever develop symptoms (Milward, 1986; Yu, 2000).
This is because we are all designed to recover, to adapt, and to heal following painful or
overwhelming experiences. Just as we are designed to heal from cuts, wounds and broken bones.
Risk for symptoms and chronic illness occurs when the innate process of healing from trauma is
interrupted or prevented. This can occur when there is a need to speak with the police about the
details of an accident or other event rather than having the time to emerge more quietly from the
shock, the shaking or the terror that are common reactions to trauma.
The inability to integrate ALEs also occurs when danger persists - such as when a child lives in an e
nvironment where a family member is an ongoing source of threat.
When we are unable to recover from ALEs the effects begin to accumulate. For those of us with
chronic illnesses of all kinds - from type 1 diabetes to chronic fatigue to multiple sclerosis to
Parkinson’s disease to rheumatoid arthritis and more - the effects evolve like an undersea volcano.
Each traumatic event adds a little to the volcano’s evolution and development.
When there are too few ALEs, or when recovery occurs following traumatic events, the volcano
recedes back towards the ocean floor.
It is only when a sufficient frequency, intensity, or severity of unresolved ALE’s occur that a
tipping point is reached and a final stressor or trauma makes the
volcano grow past some critical point.
It is when the tip of this mountain crosses the water line and becomes visible that the effects of
trauma coalesce fully into a chronic illness or another group of symptoms.
This is what happens with the stressful or traumatic event that triggers the onset of a chronic illnes.
It is also why the onset of symptoms can occur so suddenly and unexpectedly following one
stressful event too many (Poser, 1986).
The kind of life events that add up to affect risk for chronic illness include subtle as
well as overt forms of trauma. Very often they are experiences that we have tended
to underestimate, overlook or to belittle.
I will introduce you to different types of ALEs in part 5 of this book. This will help you get a sense
of whether trauma may have affected your health, including the development of your chronic illnes.
This is not because chronic illness is psychosomatic. It is because the effects of ALEs go beyond
emotional and psychological symptoms and can have profound effects on our bodies, our brains,
and on our biologies.
The ideas I’ll be telling you about come from a diverse array of fields including embryology and
neuroscience, epigenetics, parent-child relationships and childhood trauma, influences of birth
events and parent-infant bonding, as well as stress and trauma.
These theories, along with my work as a trauma therapist, have enabled my clients with chronic illn
ess to begin to
I have also been testing and refining this theory through my own experience of living with a chronic
illness for nearly 20 years. My personal journey of healing has not been fast, but the patterns, the set
backs, and the progress have all helped me continue to hone and refine what I sometimes refer to as
“The Chronic Illness Model.”
While current medical perspectives hold that each disease is caused by a different risk factor that is
unique to that disease, our understanding of trauma suggests otherwise.
The Chronic Illness Model provides a different explanation for the causes and the process of evoluti
on of chronic illness, which I introduce in this book (see my blog post for a recap and descriptive
graphics like the one on this page).
The Model offers a context for understanding the patterns we see in so many different types of
chronic diseases. It also clarifies why and how stress and trauma affect so many of us and our
symptoms, regardless of which disease we have.
The model provides a framework for developing and using tools that can more effectively help us
reduce our symptoms of chronic illness. Based on the accumulating evidence, I suspect that it
may also enable us to begin to heal and sometimes even fully recover from these symptoms.
The research continues to evolve. The Amercian Academy of Pediatrics is updating its guidelines
to acknowledge the role of life experiences in shaping health. Studies are happening at Harvard and
Columbia. And some doctors are beginning to take notice.
Book1_ChronicIllness-Trauma-Series_Mead_2018_Sept21_CITS_Mead.pdf
Living a life with chronic illness
In 1900, the average life expectancy for an American was 50 years, and the death rate was 1,720 per
100,000. A high incidence of disease that was largely communicable and for which there was but
limited treatment meant illness and dying trajectories were relatively short. The focus of health care
was thus necessarily on comfort (End of-Life Nursing Education Consortium, 2001, p. m22).
The biomedical model, variously called the clinical or disease model, is the most prevalent
framework for understanding health and illness in contemporary Western culture. Often credited
with enhancing the quantity and quality of human life by advancing treatment of infectious disease
and acute bodily trauma, its efficacy is apparent in the fact that, by 1997, the average life
expectancy in the United States had increased to 76 years, and the death rate had dropped to 865 per
100,000. Not with standing its obvious utility, assumptions inherent in the biomedical model can
lead to a precariously narrow view of humans and health. Conceptualization of a person as a
biochemical system whose whole can be inferred from its parts, acceptance of the Cartesian
mind/body dichotomy, and a perception of health and illness as opposing poles on a linear
continuum conspire to obscure the interactive role social, mental, cultural, political, economic,
environmental, and spiritual factors play in health.
The reductionism characteristic of the Western world for the past 300 years is apparent in the
distinct disciplines and subjects that order knowledge, the analytic techniques developed that focus
on discrete factors, and even in the way we are taught to perceive different parts of ourselves
(Wheatley, 1999, p. 29). Over 25 years ago, Clinical Nursing: Pathophysiological & Psychosocial
Approaches, a book described as “The most comprehensive and authoritative text available in
professional clinical nursing” (Beland & Passos, 1975, book jacket), advocated the synthesis and
integration of biological, social, cultural, and behavioral knowledge, rather than simply viewing the
patient from a strict biomedical call model. Out of print for over a decade, this widely acclaimed
book reasserted an expectation promulgated by Nightingale that nursing practice should take into
consideration more than physical-care needs. The emergence of nursing diagnosis in the early 70s
helped set the stage for this restoration, in part by providing a vocabulary to describe what nursing
is and does. Nursing diagnoses delineate the discipline’s phenomenon of concern—that is, human
responses to actual and potential health threats. Nurses treat those human responses.
Like medicine, nursing seeks to help people reach, retain, and regain health, though an orientation
toward cure guides the former discipline, and care is a more primary compass for the later.
Paradoxically, progress measured as increased longevity and attributed to the biomedical model is
accompanied by an increased incidence of chronic illness. Nearly 50% of the 276 million
Americans in the year 2000 had some type of chronic condition (Partnership for Solutions, 2003).
Close to 60 million American snow suffer from multiple chronic conditions, with 3 million of these
having as many as 5 (Partnership for Solutions, 2003). Chronic medical conditions ranging from
paralysis, Alzheimer’s disease, mental disorders, and HIV/AIDS to allergies, asthma, diabetes, and
high blood pressure affect men, women, and children of all ages, ethnicities, and income levels and
are the leading reason why people seek medical attention (Anderson, 2003). Yet, national surveys
of 1,238 physicians, 1,663 Americans, and a convenience sample of 155 policy makers reflect a
prevalent attitude that the current health care system is not adequately addressing the needs of those
so afflicted (Anderson, 2003). Rantz, Marek, and Zwygart-Stauffacher suggest that due to “the stark
realities of the sheer numbers of aging persons in our society, their increased risk of chronic illness,
their economic power, and their demands as consumers, ”the future financial survival of health care
organizations is closely linked to providing effective and efficient care for this population (p. 51).
Many people with chronic conditions require assistance from family caregivers and a variety of
professional providers. Promoting health in the occurrence of chronic illness requires the efforts of
a collaborative multidisciplinary team providing a continuum of care extending way beyond the
confines of today’s restricted hospital stays. Intervening effectively necessitates exceeding
biomedical obsession with physical integrity and helping afflicted individuals to manage their
symptoms, obtain relief from suffering, cope with their related fears, and maintain their highest
level of functioning. It necessitates attention to spiritual concerns, as well as the psychosocial and
bodily needs that Beland and Passos insisted nursing address. Providing care in the occurrence of
chronic illness entails venturing beyond neat and tidy, but false dichotomies in contemporary
nursing texts still exist and are apparent in common binaries like mind and body, health and illness,
or acute and chronic. It necessitates being alert to a proclivity toward medicalization, which allows
thoughts, feelings, and behaviors that depart from accepted norms to be diagnosed and treated as
disease. In other words, it requires thinking and acting holistically.
With care as its foundation, nursing would seem ideally suited to meet the above noted
requirements, but long-standing hegemony of the biomedical model has led many nurses to
reflexively find acute care settings preferable. Though it would be very hard at any point in time to
find a nurse who saw only the physical aspects of care as relevant, opportunities to identify and cure
pathology often seem more attractive than helping one cope with its irreversible ravages. The
January 2002 issue of the American Journal of Nursing includes an editorial that asks, “Is nursing
adequately addressing the needs of the chronically ill?” (Mason, Leeman, & Funk, 2000, p. 7). The
authors posit that lack of time in the primary-care setting, coupled with care-delivery models
focused on acute care and cure, hinder the health care system’s ability to meet the needs of the
chronically ill. A primary contention is that current and future nursing research studying the lives of
individuals with chronic illness will help clinicians “identify ways to better support patients in their
efforts to live with illness” (Mason, Leeman, & Funk, 2000, p. 7). To promote that inquiry, the
American Journal of Nursing publishes a quarterly column entitled “Living with Illness.”
Clearly, Nursing, as represented in the journal of its professional organization, recognizes the vast
need for better information and teaching about caring for individuals living with chronic illness.
Ironically, however, the title of the editorial calling our attention to this need underscores a common
propensity to define the individual with a chronic illness as the illness. In other words, the
chronically ill takes the tenor of a proper noun, inadvertently implying all who occupy the category
are the same. In our experience, that perceived uniformity is often cast with a negative patina. Few
students come to the courses described in this book excited about doing chronic care, and even
fewer look forward to the possibility of doing it with the mentally ill, the elderly, or the persistently
infirmed and/ or dying. In general, students come to us with a plethora of negative stereotypes and a
desire to just get through the courses as quickly as possible. They would prefer to continue in acute
care settings, where they can learn to use the most current and sophisticated equipment so they can
“fix” people or “make them better” and send them home. In summary, the ever-escalating incidence
and prevalence of chronic illness, coupled with a current shortage of nurses interested in and
prepared to meet the complex needs of those experiencing it, motivated the development of
Edgewood’s theory and clinical courses in chronic illness. Our goal in teaching them is to create a
learning environment that fosters in our students the interest, curiosity, and empathy necessary for
providing compassionate, whole-person care, especially when the need for care is ambiguous,
amorphous, and/or all encompassing.
file:///E:/ASDOS/BUKU%20AJAR%20KRONIS/BUKU%20SUMBER/[Pamela_Minden_RN__Ph
D__CS,_Colleen_Gullickson_RN_(BookFi).pdf
Trauma dan Penyakit
Kronis Bagi banyak dari kita, peristiwa stres atau traumatis tidak
pernah berkembang menjadi penyakit kronis . Sebuah masa kanak-
kanak gejala mungkin terjadi hanya sekali dan kemudian benar-
benar menyelesaikan, tidak pernah muncul
kembali atau berkembang menjadi sebuah kronis penyakit.
Yang sama ini terlihat dengan antibodi, yang adalah protein yang
diciptakan oleh kami kekebalan
tubuh sistem untuk melindungi, membela dan membantu kami tubuh menyembuh
kan, seperti yang di dalam kehadiran dari infeksi.
Spesifik jenis dari antibodi dapat juga membentuk terhadap tubuh jaringan, seperti
sebagai
insulinproducing sel di t dia pankreas, untuk mendahului dan memprediksi risiko
untuk para pengembangan dari tertentu kronis penyakit, seperti sebagai tipe 1 diab
etes. Tapi antibodi
seperti ini telah juga telah ditemukan untuk tekad dan menghilang sebelum kita pe
rnah mengembangkan gejala-
gejala (Milward, 1986; Yu, 2000).
Ini adalah karena kita sedang semua dirancang untuk memulihkan, untuk beradapt
asi, dan untuk menyembuhkan berikut menyakitkan atau luar
biasa pengalaman. Hanya karena kita sedang dirancang untuk menyembuhkan dar
i luka, luka dan patah tulang.
Risiko untuk gejala dan kronis penyakit terjadi ketika para bawaan proses dari pen
yembuhan dari trauma yang terganggu atau dicegah. Hal
ini dapat terjadi ketika ada adalah sebuah kebutuhan untuk berbicara dengan para
polisi tentang para rincian dari sebuah kecelakaan atau lainnya acara bukan dari m
emiliki satu waktu untuk muncul lebih tenang dari yang shock, yang gemetar atau
yang teror yang yang umum reaksi untuk trauma.
The ketidakmampuan untuk mengintegrasikan Ales juga terjadi ketika bahaya teta
p seperti sebagai ketika seorang anak tinggal di sebuah lingkungan di
mana sebuah keluarga anggota adalah sebuah berkelanjutan sumber dari ancaman.
Ketika kami berada tidak untuk pulih dari Ales yang efek mulai untuk menumpuk.
Bagi orang-
orang dari kita dengan kronis penyakit dari semua jenis dari tipe 1 diabetes untuk
kronis kelelahan untuk beberapa sclerosis untuk Parkinson penyakit untuk arthritis
arthritis dan lebih dalam efek berevolusi seperti sebuah bawah gunung
berapi. Setiap traumatis acara menambahkan sebuah sedikit ke dalam gunung
berapi evolusi dan pengembangan.
Ketika ada yang terlalu sedikit Ales, atau ketika pemulihan terjadi berikut traumat
is peristiwa, yang berapi surut kembali ke arah yang laut lantai.
Ini adalah hanya ketika sebuah cukup frekuensi, intensitas, atau keparahan dari ya
ng belum terselesaikan ALE
ini terjadi bahwa sebuah tipping titik yang mencapai dan sebuah akhir stressor ata
u trauma membuat para berapi tumbuh melewati beberapa kritis titik.
Ini adalah saat yang ujung dari ini gunung melintasi satu air garis dan menjadi terl
ihat bahwa para efek dari trauma menyatu sepenuhnya menjadi sebuah kronis pen
yakit atau lain kelompok dari gejala.
Ini adalah apa
yang terjadi dengan yang stres atau trauma acara yang memicu para onset dari seb
uah kronis illnes. Hal ini juga mengapa para onset dari gejala dapat terjadi begitu t
iba-tiba dan tak
terduga berikut satu stressf u l event terlalu banyak (Poser, 1986).
Saya telah juga telah menguji dan menyempurnakan ini teori melalui saya sendiri
pengalaman dari hidup dengan sebuah chroni c penyakit selama hampir 20 tahun.
Saya pribadi perjalanan dari penyembuhan telah tidak pernah cepat, tapi itu pola,
yang kemunduran, dan para kemajuan telah semua membantu saya terus untuk me
ngasah dan suling apa yang saya kadang-
kadang merujuk ke sebagai “The kronis Penyakit Model.”
Penyakit kronis
Model Th e kronis Penyakit Model terintegrasi ilmu dari para lapangan dari traum
a penelitian untuk meneliti dan memahami temuan di banyak kronis penyakit, yan
g secara biasanya dipelajari di isolasi dari satu sama
lain. Aku digunakan untuk menyebut itu sebuah teori tapi yang ilmu ha s berkemb
ang ke dalam titik di mana para peran dari trauma, terutama di masa kanak-
kanak, yang menjadi diakui sebagai yang terbesar publik kesehatan krisis dari ka
mi waktu (Shonkoff, 2012; Naviaux , 2018).
B ook1_ChronicIllness-Trauma-Series_Mead_2018_Sept21_CITS_Mead.pdf
Original text
A childhood symptom may occur only once and then completely resolve, never to reappear or
develop into a chronic disease.
Contribute a better translation