The Department of Health estimates that 15.4 million (or 30 per cent of) people in England are living with a long-term condition (what used to be called chronic illness), accounting for 70 per cent of the total health and social care spend in England. These statistics demonstrate the astonishing success of biomedicine in keeping people alive but entirely fail to reflect the quality, or lived experience, of these many lives that have been saved. While physical suffering has never been better “controlled”, emotional distress remains at high levels. Clinical psychology works with both realist and phenomenological accounts of health and illness, and in this chapter I outline a biopsychosocial and phenomenological model of adjustment, illustrated with quotes from diaries kept by people with cancer and drawn from my clinical work in cancer care. This model accounts for both positive and negative responses to major life transitions such as illness and recovery, and poses questions about the nature of health care.

INTRODUCTION

Cancer is the archetype of protracted or chronic illness, being not only a “long-term condition” but also life-threatening. As old as the dinosaurs, it is a much-dreaded disease that historically has reaped truly abominable suffering. Illnesses like cancer exist within the social world of other people and taken-for-granted meanings. The very word seems to carry a potent existential reminder of our ultimate mortality.