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Carolyn Weiner Report

The Theory of Illness Trajectory addresses how chronic illness exacerbates the inherent uncertainties of life. It views coping within a sociological perspective, emphasizing how illness disrupts life and influences responses through changing interactions and contexts. Living with illness involves four types of "work": illness-related work, everyday life work, biographical work interacting with others, and uncertainty abatement work to reduce impacts on temporal perceptions, body, and identity from illness uncertainties. The theory examines how these works shift dominance over the illness trajectory as perceptions and capacities change with the evolving body.

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243 views4 pages

Carolyn Weiner Report

The Theory of Illness Trajectory addresses how chronic illness exacerbates the inherent uncertainties of life. It views coping within a sociological perspective, emphasizing how illness disrupts life and influences responses through changing interactions and contexts. Living with illness involves four types of "work": illness-related work, everyday life work, biographical work interacting with others, and uncertainty abatement work to reduce impacts on temporal perceptions, body, and identity from illness uncertainties. The theory examines how these works shift dominance over the illness trajectory as perceptions and capacities change with the evolving body.

Uploaded by

Jerome Clark Cid
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THEORY OF ILLNESS TRAJECTORY

“The uncertainty surrounding a chronic illness like cancer is the uncertainty of life writ large.
By listening to those who are tolerating this exaggerated uncertainty, we can learn much about
the trajectory of living” - (Wiener & Dodd, 1993)

Theory of Illness Trajectory

- Addresses the theoretical pitfalls by framing the phenomenon within a sociological


perspective that emphasizes the experience of disruption related to illness within the
changing contexts of interactional and sociological processes that ultimately influence the
person’s response to such disruption. This theoretical approach defines this theory’s
contribution to nursing: coping is not a simple stimulus-response phenomenon that can be
isolated from the complex context of life. Life is centered in the living body, therefore
physiological disruptions of illness permeate other life contexts to create a new way of
being, a new sense of self. Responses to the disruptions caused by illness are interwoven
into the various contexts encountered in one’s life and the interactions with other players
in those life situations.

Within this sociological framework, Wiener and Dodd address serious concerns regarding
conceptual over attribution of the role of uncertainty for understanding responses to living with
the disruptions of illness (Wiener & Dodd, 1993). An old adage tells us that nothing in life is
certain, except death and taxes. Living is fraught with uncertainty, yet illness (especially chronic
illness) compounds uncertainty in profound ways. Being chronically ill exaggerates the
uncertainties of living for those who are compromised (i.e., by illness) in their capability to
respond to these uncertainties. The illness trajectory is driven by the illness experience lived
within contexts that are inherently uncertain and involve both the self and others. The dynamic
flow of life contexts (both biographical and sociological) creates a dynamic flow of uncertainties
that take on different forms, meanings, and combinations when living with chronic illness. Thus,
tolerating uncertainty is a critical theoretical strand in the Theory of Illness Trajectory.

MAJOR CONCEPTS & DEFINITIONS


Life is situated in a biographical context. Conceptions of self are rooted in the physical body and
are formulated based on the perceived capability to perform usual or expected activities to
accomplish the objectives of varied roles. Interactions with others are a major influence on the
establishment of the conception of self. As varied role behaviours are enacted, the person
monitors reactions of others and a sense of self in an integrated process of establishing meaning.
Identity, temporality, and body are key elements in the biographical context, as follows:
■ Identity: the conception of self at a given time that unifies multiple aspects of self and is situated
in the body
■ Temporality: biographical time reflected in the continuous flow of the life course events;
perceptions of the past, present, and possible future interwoven into the conception of self
■ Body: activities of life and derived perceptions based in the body
Illness, particularly cancer, disrupts the usual or everyday conception of self and is compounded
by the perceived actions and reactions of others in the sociological context of life. This disruption
permeates the interdependent elements of biography: identity, temporality, and body. This
disruption or sense of disequilibrium is marked by a sense of a loss of control, resulting in states
of uncertainty.
As life contexts continually unfold, dimensions of uncertainty are manifest, not in a linear
sequence of stages or phases, but in an unsettling intermingling of perceptions of the uncertain
body, uncertain temporality, and uncertain identity. The experience of illness always is placed
within the biographical context, that is, illness is experienced in the continual flow of the life. The
domains of illness-related uncertainty vary in dominance across the illness trajectory through a
dynamic flow of perceptions of self and interactions with others.
TABLE 30-1

Illness Trajectory: States of Uncertainty

Domain Sources of Uncertainty Dimensions of Uncertainty

UNCERTAIN TEMPORALITY Life is perceived to be in a Loss of temporal predictability


constant state of flux related prompts concerns
to illness and treatment. surrounding:

Taken-for-granted The self of the past is viewed • Duration: how long


expectations regarding the differently (e.g., the way it • Pace: how fast
flow of life events are used to be).Expectations of • Frequency: how often the
disrupted. A temporal the present self are distorted experience of time is
disjunction in the biography by illness and treatment. distorted (i.e., stretched
out, constrained, or
limitless)

Anticipation of the future self is


altered.

UNCERTAIN BODY Faith in the body is shaken Ambiguity in reading body


(body failure). signs. Concerns
surrounding:

Changes related to illness and The conception of the former • What is being done to the
treatment are centered in body (the way it used to be) body
one’s ability to perform comingles with the altered • Jeopardized body
usual activities involving state of the body at present resistance
appearance, physiological and the changed expectations • Efficacy and risks of
functions, and response to for how the body may treatment
treatment. perform in the future. • Disease recurrence

UNCERTAIN IDENTITY Body failure and difficulty Expected life course is


Interpretation of self is reading the new body upset shattered. Evidence gleaned
Domain Sources of Uncertainty Dimensions of Uncertainty

distorted as the body fails to the former conception of self. from reading the body is not
perform in usual ways, and Skewed temporality impairs interpretable within the
expectations related to the the expected life course. usual frame of
flow of events (temporality) understanding. Hope is
are altered by disease and sustained despite changing
treatment. circumstances.

The activities of life and of living with an illness are forms of work. The sphere of work includes
the person and all others with whom he or she interacts, including family and health care
providers. This network of players is called the total organization. The ill person (or patient) is the
central worker; however, all work takes place within and is influenced by the total organization.
Types of work are organized around the following four lines of trajectory work performed by
patients and families:
1. Illness-related work: diagnostics, symptom management, care regimen, and crisis
prevention
2. Everyday-life work: activities of daily living, keeping a household, maintaining an occupation,
sustaining relationships, and recreation
3. Biographical work: the exchange of information, emotional expressions, and the division of
tasks through interactions within the total organization
4. Uncertainty abatement work: activities enacted to lessen the impact of temporal, body, and
identity uncertainty
The balance of these types of work is dynamically responsive, fluctuating across time,
situations, perceptions, and varied players in the total organization in order to gain some sense
of equilibrium (i.e., control). This interplay among the types of work creates a tension that is
marked by shifts in the dominance of types of work across the trajectory. Recall, however, that
the biographical context is rooted in the body. As the body changes through the course of illness
and treatment, the capacity to perform certain types of work and, ultimately, one’s identity are
transformed.

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