Ways of Thinking about Illness Representations of Cancer

Ian Zachary Pervil, City University of New York, Graduate Center


For people who have illnesses with vague or diffuse symptoms, such as systemic cancers that lack solid masses or tumors (e.g. leukemia), the process of adjustment appears more difficult than for those with clearly-defined symptoms. Dual systems theory attempts to understand this phenomenon by contending that individuals rely upon two modes of cognitive processing when conceptualizing illnesses: implicit, System 1 processes and explicit, System 2 processes. Those with illnesses whose symptoms lack specificity may rely more heavily on System 1 processing and have greater difficulty adjusting.

This study tested whether illness representations mediate the relationship between cancer patients' tumor status (whether or not they have masses/tumors) or thinking style (levels of System 1 and System 2 processing) and psychological adjustment (depressive symptoms, cancer-related distress, body image, and post-traumatic growth). A national sample of 305 men and women diagnosed with cancer completed an online survey; a subsample of 99 individuals completed an optional measure asking them to draw their cancer at time of diagnosis and in the present.

The hypotheses were partially supported. Tumor status was unrelated to illness representations, thinking style, or psychological adjustment. The illness representations of (greater) identity, consequences, chronicity, cyclicality, and emotional representations were related to reporting more depressive symptoms and cancer-related distress, and worse body image. Attributing a locus of control to self or to treatment and greater illness coherence were related to less depression and distress, better body image, and more post-traumatic growth.

The relationship between System 1 thinking and post-traumatic growth was mediated by a combined factor of illness representations that captured locus of control and acuteness of illness. System 2 thinking was correlated with depressive symptoms, but no hypothesized factors were mediators. Drawings of participants with greater System 1 thinking were more likely to be rated abstract and contain fewer people.

Results suggest that, despite the range of illness representations of cancer, a shared understanding of 'cancer' underlies all representations. Having a solid cancer does not appear to be an essential component of survivors' ability to adapt; however, thinking style, particularly as it shapes illness representations, may be an important predictor of adjustment.