What is “Coping” in the Context of Illness and Dying?

BJ Miller, MD
2 min readAug 9, 2021

Coping implies that there’s something to cope with. Something about life is tricky. Something is difficult.

So let’s back ourselves into the subject a little bit.

If everything were just moving along, I think coping would be less important. Just to state the obvious. There would be nothing to cope with besides your joy, I suppose. When you realize there’s something you need to cope with, that’s where strength lies. For my money’s worth, strength is not the absence of fear. The lack of feeling might be getting in the realm of numbness nd forcing an absence of emotion can lead to a state that is less than fully human.

Within the context of illness and death, much of what I must say here is just based on observation and trial and error working with myself and patients. But my perspective is somewhat of a hypothesis.

And the hypothesis is that so many things that vex us can be traced back to existential fear. There may be different ways to set up the need to cope, but I believe the common origin is fear.

I love this quote from the Buddhist scholar, Pema Chödrön:

“Fear is a natural reaction to moving closer to the truth.”

It suggests that the truth can be a big, scary, unfathomable thing. Fear is organic and natural, and in a way, right.

I think that taking away the sting out of fear is a crucial set up. Not feeling fear can be a point of pride. On the other hand, fear can also be a wonderful situation, to have it and be fruitful even though you are afraid.

There is certainly judgement folded into the dialogue when we’re talking about illness, death, suffering, etc. mortality, you know, those are huge, huge truths tonight and for my money largely are much of it is unfathomable, and at seems to be so much the scary part. The fact that Pema children’s quote here I think one of the things I want to put this helps us do here is this is normal,

Fear is not weakness. Fear is normal.

This is an important way to take the sting out of fear.

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BJ Miller, MD

BJ is a hospice & palliative medicine physician who sees people at mettlehealth.com and speaks on topics of illness and palliative care around the world.