The older I get, the greater power I seem to have to help the world; I am like a snowball -- the further I am rolled the more I gain.
Susan B. Anthony

Coping is defined as "constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person."  More simply, coping is not mastering the stressful demands, but rather trying to manage stressful demands as best we can.  Often coping involves becoming content to accept, endure, minimize, or avoid stressful demands. I doubt if  there is a more stressful situation that a person having to face his/her own imminent death.

You hadn’t been feeling quite right so you went to the doctor to find out what was wrong. After a thorough exam and visits to various specialists, you were told that you have a terminal illness and you have only a limited amount of time left on this earth. Once the letters “ALS” spilled out of the doctor’s mouth, you hardly heard anything else he said. except he couldn’t tell you if you had a few months or a few years to live. However, you’ve read enough to know that this is a death sentence - there is no cure for amyotrophic lateral sclerosis (ALS or Lou Gehrig’s Disease). You think to yourself: “How can this be happening to me?” You always expected to live longer than this. There are so many things left you wanted to do and see. What do I do now? Panic begins to sink in as you realize you are suddenly faced with a myriad of things to do, decisions to make, and demands to be met. The stress of it all is overwhelming as you realize that there is no light at the end of this tunnel, at least not until you’re dead! You know you’ll have to figure out a way to manage, i.e., to cope, with this unbelievable situation. Of course, you are not the only one who has to cope with this, so does everyone else who is involved, including friends, family, and eventually, professional caregivers.

R.H. Moos and J.A. Schaefer have helped us better understand coping by dividing it into three categories, each with three skills.

Appraisal-focused Coping
These skills involve how we understand the stressful situation
  • Logical analysis and mental preparation - Breaking down an overwhelming problem down into manageable parts, taking advantage of past similar experiences, evaluating and rehearsing plausible "what-if" scenarios
  • Cognitive redefinition - Restructuring or re-framing the situation to find something favorable
  • Cognitive avoidance or denial - Denying or minimizing the severity of the situation
Problem-focused Coping
These skills involve doing something about the problem itself
  • Seeking information and support - Getting information about the situation and evaluating any possible courses of action
  • Taking problem-solving actions - Taking deliberate action to deal directly with the situation
  • Identifying alternative rewards - Trying to replace any losses or setbacks with new sources of satisfaction
Emotion-focused Coping
These skill involves what we do with our reactions to the situation
  • Affective regulation - Working to maintain hope and to control emotions
  • Emotional discharge - Expressing feelings and using humor to help reduce strain
  • Resigned acceptance - Accepting the situation for what it is, realizing the circumstances cannot be altered and submitting to fate
As you can probably gather from this list, we learn coping skills over the course of our lives, depending on what we have experienced. This means that no two people address the same stressful situation in exactly the same way. There are two basic reasons for this:

  1. different people have their own sets of skills and, of those skills, they are better at using certain ones at certain times; and
  2. each person perceives the same situation uniquely. Therefore, everyone's reaction to extreme stress must be considered according to what he/she is actually doing or thinking.
It is not useful to judge someone based on what that person might do, should do, or usually does; or on what people generally do in similar situations. Coping with a highly stressful event is an individualistic effort. If this sounds familiar, it should. When I was writing on bereavement, grief, and mourning, I wrote repeatedly that mourning (the processing associated with another extremely stressful time - being bereaved) is also a highly personal process.