For Professionals
Caritas, Veritas, Fortitudo
My work includes a method for managing chronic illness that employs a Four-Phase Model to assess and treat patients. The effectiveness of the model lies in its ability to address the heterogeneity that characterizes chronic conditions and in its inclusion of the individual’s physical, psychological, and social-interactive systems. Although acute illnesses and traumas also involve the totality of an individual’s systems, it is rarely as important for the outcome whether they are all addressed or not. With chronic conditions, however, it is essential to consider all the individual’s systems. Failure to do so can skew assessment or treatment, rendering potentially useful therapies ineffective because clinicians have not considered the total picture.
Elements of this model came into focus gradually for me in the first 20 years (or more) of my clinical service experience. During my childhood, I experienced medical conditions that would now involve a much broader systems assessment than was used at the time. My experiences heightened my awareness of how medicine was practiced and how society regards people who are ill. Early in my career, I worked in hospice and, for the first time, I saw the kind of assessment and care that I believed all patients, not just the dying, deserved and required. Hospice workers were openly compassionate clinicians who spent time coming to understand and attending to the significant others in a patient’s life and coordinating their care with patient care.
In my practice with chronic patients, my colleagues and I saw a large number of clients with a broad range of conditions. By having an extensive population to reflect on, I began to identify distinct phases in the illness experience and the individual’s adaptation to it. It became clear clinically that practitioners needed to attend not only to the physical and psychological needs of clients, but also to their family, social, and work relations. Moreover, clinicians needed to coordinate their interventions in such a way that they reinforced each other rather than working at cross purposes. Objectively desirable therapies were not equally effective in certain phases. If clinicians attempted to employ therapies at the wrong time, not only did they fail to produce the expected results, but also clients would often reject the same therapy later, when they would have been able to sustain it and benefit from it. Furthermore, clinicians tended to experience predictable reactions to clients, depending on the phase the client was in, and needed to carry out a parallel process of personal evolution in the course of treating the chronic patient. It thus appeared that clinicians dealing with chronic illness also went through a phase process.
My experience with chronically ill patients stimulated an interest and engagement with research in the field. As my ideas took shape, I worked with colleagues to design empirical tests to begin validating what clinical practice had shown to be effective. Empirical testing occurred worldwide, and findings indicated that the Fennell Four Phase ModelTM is robust. Subsequently, for more than 25 years, I have been involved in research design – developing, executing, and/or collaborating in a variety of research initiatives addressing chronic syndromes, trauma, autoimmune disease, post-viral disease, clinical education and training. In this pursuit we have developed novel models for assessment and treatment with complimentary instrumentation and served as primary investigators.
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A paradigm shift is happening globally, and thus in patient care, from acute to chronic illness. The distinctive features of the Fennell Four-Phase ModelTM offer an umbrella framework that addresses the cyclic nature of chronic illness, overcomes common conceptual dichotomies, addresses the ongoing trauma of chronic illness patients, uses countertransference, and includes components concerned with the development of meaning. Public health, public policy and chronic illness are inextricably linked. Discussion of these elements, informed by peer approved research, is essential. This research, must be predicated on the heterogeneity that exists in chronic illness, including the multiple physical systems involved, the changing manifestations of symptoms over time, and the multiple domains in which changes occur: the physical, the psychological, and the social-interactive.
Some years ago, I saw the epigraph, “Caritas, Veritas, Fortitudo,” carved in marble on a building scheduled for demolition. I have never forgotten the words, because they sum up completely what is required of those with chronic illness and those who work with them.
Caritas means not only “love,” but also compassion. It is a quality absolutely essential for those treating chronic illness patients, but the patients must also have it for themselves. Only when they have compassion for their suffering selves can they move toward the integrated, meaningful life that will make chronic illness only one aspect of it.
Veritas refers not only to “truth,” but also to authenticity, which must be the goal of all chronic illness patients. When patients do not achieve authenticity, they must constantly defend structures they cannot support, thereby undermining what health they have. Clinicians treating the chronically ill must also strive for parallel authenticity if they wish to have the credibility necessary to help their patients.
Finally, fortitudo is not simply “strength,” but also moral courage. Chronic illness is not easy to endure. Achieving Phase 4 does not relieve patients of pain, suffering, or fear. Their lives require a constant exercise of bravery, rarely seen or celebrated by anyone. Clinicians, too, need courage, for it can be daunting to follow the phase process through with their patients.
It is my hope that my work gives clinicians the help they need to assist their patients in achieving “caritas, veritas, and fortitudo“ and, with them, better, more meaningful lives.