bodily emissions (Donnely, 1995). Religious beliefs may influence
the meaning of an experience, changing the person’s perception of
the meaning of an event. Meanings may vary for both the individual
and for the clinician trying to make sense out of the illness. The
meanings assigned to an illness are unique to the individual and
these subjective illness meanings may be difficult to assess.
Kleinman (1988) introduced an explanatory model as a way of
understanding the meaning attached to an illness experience. The
explanatory model includes a lay view of the etiology, onset,
pathophysiology and desired or expected treatment. Liposki (1970)
defines meaning as the subjective significance of all disease-related
information that impinges upon the patient. He conceptualized
several categories of meanings assigned to illness, namely;
challenge, enemy, punishment, weakness, relief, strategy,
irreparable loss and value.
The most popular meanings assigned by women with breast
cancer to their illness were challenge and value (Luker, Beaver,
Leinster, Owens, 1996). These women went through a process of
reevaluating their lives in an attempt to determine what
contributed to continuing meaning in their lives and served as a
means of helping them to reestablish priorities. The illness was
perceived as contributing to the women’s renewed growth. As a
meaning, when value is attached to an illness the following
changed perception of the disease is possible:
“I have this sense of being alive and embracing life. The spirit is
the energy that drives the whole vehicle, it is the lust for life,
wanting to get there, that’s the energy, that’s the spirit, that drives
me, the zest of energy...I can live life to the fullest, even if I have
no physical ability. I can still live life to the fullest because where
I am living is from within”
Women who perceived their illness as an enemy experienced more
difficulty getting on with living, stating, “it’s like being on death row
waiting for your turn to die”.
An individual’s personal meanings and the context in which
the person lives affect the meaning that a serious illness will have
in their lives. Illness is always an interruption and the meaning or
significance of that interruption will depend on where that person
is in their own life journey (Benner, 1989). The following story
demonstrates the meaning derived from a cancer diagnosis for a
young, athletic man:
This young man with bone cancer, who raged throughout the early
days of his diagnosis and treatment, drew a picture depicting the
meaning of cancer in his life. He drew a crude sketch of a vase
with a crack running through it. Eventually this young man
redefined his purpose in life and began a kind of ministry of
helping other patients. As a result of this new-found meaning he
asked to complete his earlier drawing. He drew yellow lines
radiating from the crack to the very edges of the paper. and
pointing to the yellow coming out of the crack stated, “This is
where the light comes through” (Remen, 1996).
In contrast, a veteran railroad worker regarded his cancer solely
as an annoyance, as something not to be thought about but
eliminated (Ryder, 1993). In an effort to adapt to these
interruptions and changes, individuals reformulate their way of
being in the world (Carter, 1990) and attempt to develop a sense of
the meaning of the illness (Steeves, 1992; Barkwell,1991).
Searching for meaning
Persons with cancer search for ways of explaining their
sickness experiences in an attempt to make sense out of the
chaos. By giving meaning to their experiences, individuals
define and give purpose to their cancer experience and their lives
(O’Connor, Wicker, Germino, 1990). Frankl (1959) identified the
search for meaning as the primary force in life and believed that
each person’s meaning is unique and specific and must be
fulfilled by him alone. Only then does it achieve a significance
that satisfies his own “will to meaning”.
The person searching for meaning may enter an initial search
attempting to find an answer to their symptoms, the meaning of
tests and finally the meaning of life in light of the illness
(Barnard, 1995). It has been proposed (Thompson, 1991) that
the search for meaning could involve looking for: causal
attributions (Why do events happen?), selective incidence
attributions(Why did this happen to me as opposed to someone
else?), and responsibility attributes (questions of personal
responsibility for the event) . Unfortunately, self-blame may be
one of the potential outcomes of searching for meaning in
cancer.
Meanings might also evolve out of seeking an understanding
of the personal significance of the cancer diagnosis (O’Connor,
Wicker, Germino, 1990). Finding meaning in an illness
experience may require a change in values and priorities in life.
Many individuals are able to rework and redefine meaning in
their lives by embarking on a process of restructuring values
and their attitudes towards self, life and others. Women
experiencing uncertainty from breast cancer embarked on an
exploration to find meaning in their lives to help them live with
multiple possible outcomes in their uncertainty (Nelson, 1996).
These women struggled with what their lives had meant and
what their futures might hold and had to learn a new way of
being in the world. New meanings surfaced for these women
through helping others.
The human spirit searches for goals that have personal
meaning and enhance life (Frankl, 1959). Meaning can be found
in three categories: creative (accomplishments), experiential
(witnessing a sunset) and attitudinal (adopting a positive
attitude toward a fate that cannot be changed). Frankl (1959)
states, “when called upon to deal with life’s challenges, the
spirit’s defiant power is activated in tenacious determination; it
responds with irresistible stirrings including the urge to live, to
be free, to understand, to enjoy, to create, to connect and to
transcend”. Those who are able to attribute meaning to their
cancer experience can be led to a creative, self-actualizing
experience (Granstrom, 1985).
Finding meaning in suffering
Illness has been described as both a soul and body experience
and it is within the soul where meanings may surface. “Meaning
is one of the most powerful of all intrinsic rewards and it sings
to the soul” (Frankl, 1959). Secretan (1997) states, “a person’s
mind and emotions are windows to the soul and the soul is the
spirit, inner self or the essence of the person, which is tied to a
greater sense of self-awareness, a higher degree of
consciousness, an inner strength and a power than can expand
human capacities and allow a person to transcend his or her
usual self”. The soul has been described as our essence and the
immortal or spiritual part of us that transcends our temporary
existence (Secretan, 1997). Psyche is the Greek word for soul.
Hippocrates believed that the person’s mind and soul should be
inspired before illness could be treated.
Suffering may be a possible outcome of not being able to find
meaning in an illness experience or patients may find a way
through suffering by finding new sources of meaning. Illness has
been described as a manifestation of soul suffering but what is
meaningless suffering can be transformed into soul making
(Woodman, 1990). Our minds are limited to dealing in
possibilities, but our souls are capable of reaching beyond the
traditional, to the magical and the richly elaborated dream.
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CONJ: 8/1/98 RCSIO: 8/1/98