Coping with the stress of illness.

How can we cope better, or help others to do so? The answer to this depends on knowing what an individual is coping with. This, in turn, depends on the appraisal, by the individual concerned, of the significance of what is happening for well-being--in effect, the source of harm, threat, challenge. Cases of myocardial infarction, cancer and chronic pain have some harms, threats, and challenges in common but there are also unique factors in each illness. The patient with a chronic illness is continually appraising his or her symptoms, pains, disease progression with respect to their significance for well-being and survival, and coping accordingly. The paper presents a microanalytic, contextual and process-centred approach to coping which is part of a broad system of thought, emphasizing cognitive appraisal and the person's ongoing relationships with the environment as factors of his or her emotional life. Implications for prevention and treatment of illness in a perspective of health promotion are discussed as well as the need for research to predict long-term outcome from stress and coping.