What Exactly Is A Chronic Illness And Who Defines It?

by Lisa Copen

If you were to walk up to a person on the street and ask him what he believed the difference was between illness and health, chances are that you would likely receive a fast reply about how health is when the body works correctly and illness is when it does not.

When one starts to live with daily symptoms that resemble a chronic condition, however, the necessity of needing to understand the difference between a healthy body and a chronically ill body becomes much more important. It comes as a surprise to many people who are diagnosed with illnesses such as chronic fatigue syndrome, that many diseases are still surrounded with great mystery, even from the medical community. Long-term symptoms are not fully known.

This does not negate the need, however, for one to seek answers. When the definitions of health and illness significantly impact your life, it obviously becomes a more personal issue. And the validation to have your pain recognized by both friends, as well as medical professionals, can become quite important. One needs someone to listen and diagnose symptoms of his or her illness.

The definition of chronic illness seems like it would be a simple answer even though there are thousands of types of chronic illness: Health is feeling good; illness is the lack of health or appearing overweight or out of breath. But consider the fact that there are many people who actually are quite ill, but who appear to be in great health. How many times have we heard of a perfectly healthy forty-year-old man having a heart attack? Or a young woman having a stroke that is completely unexpected since she runs marathons annually?

So if one’s appearance or “feel good” measurement doesn’t work accurately to decipher the difference between health and illness what do we use to determine it?

Those who cope with daily chronic pain due to a chronic illness may be surprised to hear the physician ask, “Do you think you can be a healthy chronically ill person?”

According to Derek Yach, who presented on the topic of “Health and Illness: The Definition of the World Health Organization,” both societies and individuals have a variety of definitions of what is regarded as health. These definitions have all undergone scrutiny and criticisms.

How can health be determined after all? For example, does life expectancy or infant mortality rate statistics determine a society’s health? While we serve up lunches for our children full of sugar and poor carbohydrates, other groups turn away from that cause and instead pressure McDonald’s to remove toys from Happy Meals and have a McDonalds calorie list. While the toys may be nice perks, not every mother is Googling the McDonalds Happy Meal toy schedule. Moms are still saying, “Eat your food and then you can play.”

Are we setting unrealistic expectations on people to believe that everyone can obtain some level of “health”? Defining health and illness will always be a vague science because it is often the sociological definition and each country will have difference measurements to determine their level of health and illness, oftentimes emphasizing health (or illness) with certain intentions for international purposes.

And so this brings us once again to the question of “What is a chronic illness?”

Medically speaking, a “chronic” condition can be defined as any medical state of pain or symptoms that last 3 months or longer. This definition is provided by the U.S. National Center for Health Statistics. Chronic conditions typically have symptoms or pain that persists, regardless of treatment, such as the autoimmune illness chronic fatigue syndrome, multiple sclerosis, lyme disease, Alzheimer’s disease, migraines, or back pain from an event like a car accident.

Despite the fact that America may be well known for their well-being, nearly 1 in 2 American live with a kind of chronic pain, condition, or illness. This can include anything from chronic migraines to disabling back pain. This is according to the report “Chronic Care in America: A 21st Century Challenge” completed by the Robert Wood Johnson Foundation.

Our society has firmly held the opinion that the commonly advertised medications will cure our illness or at least make all symptoms soon disappear. And we are told this is true: that we just need to follow the advice of the pharmaceutical companies and soon we will be as good as we used to be!

It is not unusual for us to believe that pain management is not the “management” of any pain but the complete and total removal of the pain. And curing one from that pain indefinitely. If a medication does not give us back our life as it was before illness, we assume the medication simply did not work; not that it worked to the best of its ability.

The World Health Organization (WHO) was established in the year 1948 and at that time the word health was given the definition as “being a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” According to the online encyclopedia, Wikipedia, it defines the word illness as “a state of poor health.” In fact, this source states that “Illness is sometimes considered a synonym for disease.”

Many people would claim that true health is more about having a peaceful state of mind; an attitude about life that includes joy. They would say that health is not defined what your lab test results may expose about your body and its ability to function.

This can be a sensitive issue. There are healthy people who live with extreme chronic illnesses, but they stay as fit as possible in spite of their conditions. Other people may have wonderful genetics and be very healthy according to lab tests, and yet they put their body under great physical stress. And then if they get an illness, was it caused by the stress or was it an illness they likely would have gotten eventually anyway?

This starts to get into the area of the definition of social health, trying to understand which comes first, the stress or the illness? There are a variety of social factors that determine health.

To wrap up the topic, it can be difficult in our society to find a solid definition for chronic illness, because, depending on who you ask, the odds are that a variety of terms will be given. It’s true that chronic illness has a long list of frustrations and burdens; I know this because I have lived with illness for nearly two decades. But I also try to understand that joy is a choice I can decide to focus on. And while lab tests can determine if I have an illness or not, and its severity, no one has the power to take away my joy or how I find it each day.

Here is a 2-minute video where I, Lisa Copen, share some surprising news about who believes they don’t know anyone who lives with illness!

Lisa Copen is the founder of Rest Ministries and National Invisible Chronic illness Awareness Week, as well as the author of Why Can’t I Make People Understand? Chronic illness doesn’t have to be depressing! Subscribe to receive daily emailed encouragement from the largest Christian outreach for people with illness. Don’t miss Rest Ministries great books and gifts we’ve selected for people coping with illness.

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Statistics – Chronic Illness

• Nearly 1 in 2 Americans (133 million) has a chronic condition
  Chronic Care in America: A 21st Century Challenge, a study of the Robert Wood Johnson Foundation & Partnership for Solutions: Johns Hopkins University, Baltimore, MD for the Robert Wood Johnson Foundation (September 2004 Update). “Chronic Conditions: Making the Case for Ongoing Care”.

• By 2020, about 157 million Americans will be afflicted by chronic illnesses, according to the U.S. Department of Health and Human Services. Chronic Care in America

• That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million. Chronic Care in America

• 96% of them live with an illness that is invisible. These people do no use a cane or any assistive device and may look perfectly healthy. 2002 US Census Bureau
• Sixty percent of the chronically ill are between the ages of 18 and 64.
  Chronic Care in America

• 90% of seniors have at least one chronic disease and 77% have two or more chronic diseases
  The Growing Burden of Chronic Disease in American, Public Heal Reports / May–June 2004 / Volume 119, Gerard Anderson, PhD

• 9 million people are cancer survivors with various side effects from treatment
  American Cancer Society

• The divorce rate among the chronically ill is over 75 percent
  National Health Interview Survey

• Depression is 15-20% higher for the chronically ill than for the average person
  Rifkin, A. “Depression in Physically Ill Patients,” Postgraduate Medicine (9-92) 147-154.

• However, the significance of one’s faith has shown to lower one’s risk of depressive symptoms and aid one in better handling a stressful medical event.
  Pressman P., Lyons J.S., Larson D.B., Strain, J.J. “Religious belief, depression, and ambulation status in elderly women with broken hips.” American Journal of Psychiatry 1990; 147(6): 758-760.

• Various studies have reported that physical illness or uncontrollable physical pain are major factors in up to 70% of suicides Mackenzie TB, Popkin MK: “Suicide in the medical patient.”. Intl J Psych in Med 17:3-22, 1987

• and more than 50% of these suicidal patients were under 35 years of age
  Michalon M: La psychiatrie de consultation-liaison: une etude prospective en milieu hospitalier general. Can J Psychiatry (In French) 38:168-174,1993

• About one in four adults suffer from a diagnosable mental disorder in a given year;
  Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

• and more than 90 percent of people who kill themselves have a diagnosable mental disorder
  Conwell Y, Brent D. Suicide and aging I: patterns of psychiatric diagnosis. International Psychogeriatrics, 1995; 7(2): 149-64.

• Four in five health care dollars (78%) are spent on behalf of people with chronic conditions
  The Growing Burden of Chronic Disease in American, Public Health Reports, MayJune 2004 Volume 119 Gerard Anderson, PhD

• Those who use their religious faith to cope are significantly less depressed, even when taking into account the severity of their physical illness. In fact, the clinical effects of religious coping showed the strongest benefit among those with severe physical disability. Some 87 patients hospitalized with serious illness who also then suffered depression were followed over time in another study. The patients with a deep, internalized faith recovered faster from the depression, even when their physical condition wasn’t improving.
  Kendler, K.S., Gardner, C. O., and Prescott, C.A. “Religion, Psychopathology, and Substance Use and Abuse: A Multimeasure, Genetic-Epidemiologic Study,” American Journal of Psychiatry 1997; 154: 322-329. Koenig, Harold G., Larson, David B., and Weaver, Andrew J. “Research on Religion and Serious Mental Illness,” in Spirituality and Religion in Recovery from Mental Illness, ed., Roger Fallott. New Directions for Mental Health Services 1998; (80).

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