Introduction

Not everybody who is bereaved or develops a serious physical illness will have psychiatric problems as a consequence. To understand why, it is useful to have a model of the normal process of adjustment to stress; psychiatric disorder can then be seen as arising when that process, often called coping, is either maladaptive or is adaptive but only partially successful. This chapter will start with an outline of one theory of stress and coping as it applies to physical illness, followed by a review of disorders of adjustment to illness. A distinction will be drawn between recent-onset illness, which provokes an acute response, and long-standing illness, where the challenge is more often to adjust to chronic disability. Bereavement and grief are then discussed. As with responses to illness, there is a difference between the immediate response to loss, which is what we normally mean by grief, and adjustment to long-term life without a loved one.

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