Crisis Phase

The crisis phase is the period immediately prior to and following the diagnosis of an illness. Medical activities are directed toward controlling symptoms and illness progression. This phase is characterized by shock and bewilderment, closely followed by feelings of grief regarding the loss of the healthy child. This is a time when there may be an oscillation between denial of the illness and acceptance of permanent change. The crisis phase represents a time during which a family may search for meaning in an effort to obtain a sense of mastery. This can be a time when families may turn to religious and spiritual support. Families may respond to their "need for meaning" in different ways, including 1) resigna tion (assuming a passive role in the search for meaning by resigning themselves to circumstances); 2) reconciliation (a more active approach in which patients or families may believe that there is a reason for the illness which they are not aware of but which they are able to accept); and 3) remonstration (in which there is a continued search for meaning throughout the course of the illness) (Taylor 1995).

The family coping tasks during the crisis phase may include 1) obtaining and retaining information about the illness; 2) explaining the illness to healthy siblings and family members; 3) mobilizing support from friends and extended family; 4) managing the emotional reactions to the illness (e.g., anxiety and/ or depression); and/or 5) temporarily reallocating family resources (Jacobs 2000). Additional tasks may include learning how to live with pain and disability and adapting to repeated visits and/or hospi-talizations in the pediatric setting.

Pediatric physical illness and its treatment often necessitate other family problems being temporarily placed on hold. If these issues have previously been problematic or difficult to negotiate, the centrality of the physical illness may serve the role of helping the family avoid dealing with other important issues. This appears particularly true in parents who have unresolved marital issues. The illness may be used to regulate marital distance or parental conflict. Parenting can become an adversarial process should the illness polarize and fragment the family such that opposing sides are taken regarding illness-related issues. The opposite may also happen, in which the illness can lead to greater recognition of the strengths, co-hesiveness, and competency within a family.

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