Terminal illness means any illness which ends in death. There is no possibility of recovery. It is defined by the American Cancer Society as an irreversible illness that, without life-sustaining procedures, will result in death in the near future or a state of permanent unconsciousness from which recovery is unlikely. Some examples, of terminal illnesses may include advanced cancer, some types of head injury, and multiple organ failure syndromes.
Diagnosis with a terminal illness can be a traumatic event for a patient and his or her family, and is usually accompanied by offers of psychological counseling and similar assistance. Once a patient is diagnosed with a terminal illness, treatment efforts are withdrawn.
Often, the treatment for a serious disease can be ineffective. All treatment given at this stage is to manage their condition. It will aim to keep them as independent, pain free and mobile as possible. It is important to recognise that some people may function well during a terminal illness. They may be able to walk about, cook meals and care for themselves. Disability may only prevent them from carrying out these activities in the final few weeks or days of their illness.

Psychological response to terminal illness:
Kῢbler-Ross five stage theory:

Denial:
Denial is the initial stage, when the patient learns about diagnosis; he is in state of shock. Denial is a strategy used by patient to avoid the consequences of the illness.

Anger:
Patient usually ask questions 'Why me?’ feelings of resentment, envy, rage, etc. arouse at this stage. Anger is displaced in all directions, the hospital staffs, family members often feel that they are blamed by the patient. Sometimes indirectly anger is displaced on friends and family.

Bargaining:
Patient tries to negotiate openly with hospital staff and secretly with God to postpone death for a promise of good behavior. They try to engage in good work, avoid selfish behavior, get involve in charitable activity.

Depression:
In this fourth stage patient has lack of control. The patient acknowledges that little can now be done to stay the course of illness. Patient’s symptoms and depressed feelings often co-exist. Patient grows weaker and become depressed.

Acceptance:
At this stage, patient is too weak to be angry and depressed. He prefers peace and calmness. Some patients use this time to make preparations, deciding how to divide up their last personal possessions and saying goodbye to old friends and family members.

Coping strategy for terminal illness patient:

• Accept the fact
• Take the help of care takers
• Talk to your loved ones, share your feelings
• Recollect your good memories and cherish your achievement
• Try to change your negative attitudes towards other and think positive about them
• Do not think much about your illness learn to live with peace
• Get involve in spiritual activity
• Practice meditation
• Resolve your unfinished business
• Engage in positive talk
• Eat your favorite dish.

Coping strategy for care takers:
Significant changes:
Often, the individual with the terminal illness undergoes significant physical, emotional, and perhaps behavioral changes as the illness progresses. Loss of hair, weight loss, irritability, depression, and other manifestations may be observed. Family members should be encouraged to provide as much factual information about the illness as possible to the patient.

Listen, to the patient.
Individuals who are gravely ill consider that their loved ones are a blank canvas on which they can share their fears, hopes and other emotions. They require someone with whom they can share emotions but at the same time they do not want any interference. They expect that family member does not play the role of counselor. Rather than providing potential solutions or suggestions, it is more than enough that the individual knows you are there with them – and not going anywhere.

Respect their position in the family.
If the dying loved one is a parent, then it is important to allow them to continue to live with dignity in their final days. Care for them, but don’t treat them like a child. They will be much more content knowing that they maintained the role of parent until the very end.

Share responsibility.
A better strategy is to share and delegate care responsibilities with siblings or other family members. Sometimes only one family member takes the entire responsibility and it adds to stress or depression. Sharing the responsibility will help to reduce burden on one person and patient also get the opportunity to talk with other members as well.

Encourage them to talk.
Giving a terminally ill individual a chance to talk about their life provides two benefits: it takes their mind off of the pain associated with their illness, and helps them find peace and satisfaction with everything they have enjoyed and accomplished throughout their lives.
Seek professional help.
The individual who is caring for a terminally ill relative will likely to be burdened with a great deal of mental stress. They may also show symptoms of anxiety or depression. Family therapy or support group or psychological counseling can help the care taker to cope up.

Chronic Illness
A chronic illness is basically any disease that has a long term effect on the body. The name Chronic comes from the Latin word ‘Chronos’ meaning time. Some chronic illnesses, or the tendency to contract them are hereditary, and some are environmental. People can be born with a chronic disease or fall ill later in life with a long term illness.

Being diagnosed with a chronic illness does not necessarily mean you will be forever trapped with the disease. Some chronic illnesses can eventually be cured. In some cases the symptoms fade over time, in others they abruptly cease. There is no tried and true method of calculating if and when you will overcome a chronic illness.

The best method of dealing with such a disease is to effectively alleviate the symptoms while attempting to avoid the situations that created the problem in the first place. Chronic conditions range from relatively mild ones such as partial hearing losses, to severe and life threatening disorders, such as cancer, coronary artery disease, diabetes, etc. Mild chronic illness can be managed but when life threatening disorders are in advance stage they can cause terminal illness or death.

Psychological responses to chronic illness:

1.Denial:
Denial is a strategy used by patient to avoid the consequences of the illness.
Denial may be useful in helping patients control their emotional reactions to illness, but it may interfere with their ability to manage their conditions, to take initiative in seeking treatment.

2.Anxiety:
Anxiety is common after the diagnosis of chronic illness. E.g. A person with cancer will worry about minor ache or pain in the body. He may have fear that his condition is getting severe. Anxiety is high when people are waiting for test results, receiving diagnoses and experiencing side effects of treatment.

3.Depression:
Depression is one of the most common complications of chronic illness. It is estimated that up to one-third of individuals with a serious medical condition experience symptoms of depression. Depression can increase the risk and course of the chronic illness. When depression is present, it is extremely important to treat both the depression and the chronic medical illness at the same time.

4.Effect on individual:
Chronic illness can produce drastic changes in self-concept, which includes body image, social functioning and the private self.
Person with chronic illness negatively evaluate the affected body part.
They get feelings of being neglected by social groups.
Their illness makes them dependent on others this threatens their independent identity.

Coping strategy for chronic illness patient:

• Accept your illness
• Keep positive focus
• Take help of social support group
• Involve in healthy life style like eating nutritious food, engage in exercise, take proper sleep, this will help you to manage your illness
• Go for regular medical check-up and take proper medicines, regularly
• Take proper care of your health, do not get involve in health risk behavior
• When you feel distress visit a counselor
• Talk to your loved ones and share your emotions
• Handle your anger and irritability
• Keep realistic expectations
• Keep positive hopes
• Pray to GOD
• Live in present

What relatives of the chronically ill patient can do?
Honestly tell the family member and the patient about the illness. Hiding a person's serious illness from the rest of the family can backfire. Communicate directly and be open with family members. Support the person who is suffering from chronic illness. Sometimes we all need a shoulder to cry on, so this is the time when the patient needs your shoulder. Learn about the disease, help out with daily chores, and give emotional support to him.

Care takers should understand that after hearing the news of illness patient may develop some psychological symptoms like anxiety, depression, irritability, denial, etc. Relatives can take some time to interact with patient and give proper care to the patient.
Not attending the patient, replying rudely or shouting on the patient can worsen the condition. Care taker or relatives should show some sympathy towards patient and act politely with them. Encourage the patient to cope up with illness.

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Basil Wellness

Thank you so much for your very helpful post and the really useful information there about people and how they are affected by terminal illness on a psychological level. It has to be one of the most difficult things for a family to deal with, who could ever be prepared for losing someone in such way, watching them get weaker until they died. You post will help a lot of people.