Existential Concerns and Chronic Illness |
What Is a Chronic Illness?
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Chronic illness raises existential concerns.
Four major existential issues involve freedom, meaning, death and isolation.
Existential work requires working in the complexity of dialectics.
Existential work is highly personal and ongoing.
Chronic illness changes everything. At the beginning of many people’s chronic illness journey, they may feel as if illness is an annoying detour that will be forgotten as soon as they can heal and get back to business as usual. As it sinks in that illness has changed them irrevocably, they realize that their pre-illness self is gone forever. This painful reckoning with pain, fragility, mortality and identity leads to an existential crisis. In addressing this crisis, existential therapy can be extremely helpful.
Existential therapy “aims to illuminate the way in which each unique person comes to choose, create, and perpetuate his or her own way of being in the world (Akbari et al., 2023).” With its roots in philosophy, existential therapy provides a framework for looking at “the big questions”: Who am I? Why do we suffer? What does it mean to be alive? Can there be meaning in the midst of pain?
Major Themes in Existential Therapy
Irvin Yalom, a noted existential therapist, outlines four major concerns of existential therapy: freedom, meaninglessness, death and isolation (Akbari et al, 2023). Each of these themes is present in the chronic illness experience.
Freedom: Existential therapy involves thinking a lot about freedom, choice and responsibility. It asks us to contemplate the ways in which we have choices even in the face of immovable limits. This is not to say that we don’t have feelings about those limits. It is to say that we are encouraged to look for the ways that we continue to have agency. For example, we may not be able to change the fact of our illness, but we do have choices about how we respond to it.
Meaninglessness: Chronic illness breaks down meaning we carried in our pre-illness life. In pre-illness life, the meaning of being a self was anchored by a tacit belief that the body automatically would perform its functions in the background. When illness removes that anchor, we are thrown into a crisis of meaninglessness. Who am I if I cannot simply forget about my body and go on living as I did before? Who am I with different abilities than I had pre-illness? Who am I now that I have been through this experience that has changed me?
Philosopher Soren Kierkegaard called events that cause crises of meaning “strokes of fate.” According to Kierkegaard, a stroke of fate like illness forces people to consider their existential situation and try to make new meaning in their life in order to combat despair (Anderson et al., 2025).
Death: Illness brings to the forefront a keen awareness of the inevitability of death. With illness, being mortal becomes much less abstract (Missel et al, 2025). Pain and suffering create an experiential awareness of the fragility of the body.
Isolation: Chronic illness also brings into focus an awareness of our separateness from others (Akbari et al, 2023). Can we ever be fully understood by another person? Many people living with illness remark on the separation they feel between themselves and healthy others. The illness experience is so profound that they wonder if others can possibly understand. What does connection look like when there are large experiential gaps in interpersonal understanding?
Working in the Complexity of Dialectics
Each of the four themes outlined above involves a tension or a dialectic (Terao & Satoh, 2022). When we think about freedom, we contrast it with lack of choice. Our task is to sort out what we cannot change from what we can change, and to live in a space where both realities are acknowledged. Similarly, meaninglessness and meaning exist at opposite ends of a continuum that is very real. There are ways to make sense of things and there are things that cannot be made sense of. We must live in a space that accepts both of those truths. Death and life, of course, exist on a similar continuum. It is true that we will die, and it is true that we live; true acceptance of both is vital. Finally, isolation and its opposite — connection — also exist on a continuum. We are both isolated (in the sense that we can never totally be understood) and connected (in the sense that connection is vital to our well-being).
What Is a Chronic Illness?
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Find a therapist to help with chronic illness
What’s powerful about existential work is how personal it is. There is no “right” answer to how to make sense of these dialectics. Rather, each individual must use their own capabilities, sensibilities, and values to determine what a meaningful life looks like for them (Purc-Stephenson & Edwards, 2024).
Furthermore, the work is ongoing. We are always reassessing meaning as we have new experiences. The quest for meaning is a process rather than an end goal.
Finding an Existential Therapist
If this type of work appeals to you, ask a prospective therapist how they work with existential issues. You’ll get a sense from their response whether this is something they focus on and — importantly — whether their way of working with existential concerns feels resonant with your needs.
To find a therapist, visit the Psychology Today Therapy Directory.
Akbari, M., Rezaeian, M., Helm, P. J., & Becker, K. (2022). How existential therapy may help people who are suicidal. European Journal of Psychotherapy & Counselling, 24(4), 419-433.
Andersen, A. H., Assing Hvidt, E., Huniche, L., Hvidt, N. C., & Roessler, K. K. (2025). Why we suffer? Existential challenges of patients with chronic illness: A Kierkegaardian inspired interpretative phenomenological analysis. Journal of Humanistic Psychology, 65(5), 969-996.
Missel, M., Andersen, L. K., Corvinius, C., Mathiasen, M. C., Donsel, P. O., Schønau, M. N., ... & Piil, K. (2025). Understanding symptoms in the lives of adult patients with acute or chronic illness: a phenomenological study of patient experiences. International Journal of Qualitative Studies on Health and Well-Being, 20(1), 2534871.
Purc-Stephenson, R. J., & Edwards, R. (2024). Finding meaning in chronic illness and its relationship to psychological well-being: A mixed-methods study. PLOS Mental Health, 1(4), e0000121.
Terao, T., & Satoh, M. (2022). The present state of existential interventions within palliative care. Frontiers in Psychiatry, 12, 811612.