Many factors affect the course of a chronic illness, but an extremely important one is the developmental moment in life when sickness strikes or when exacerbations and crises occur.  The disease has its own relentless chronology, but the ill person has a time line, too--a life story apart from the illness.   Inevitably the disease and the person are going to in some sense collide, and the "when" factor is going to be significant in how a patient copes.

In After the Diagnosis, in a chapter called "The Growing Point," the story of Anne, a young woman who became insulin-dependent at age ten, illustrates the kind of serial adjustments people make as the double narrative of the life and the disease unfold in time.   As a child Anne was notably compliant, a classic "good girl," checking blood sugars, following a strict diet, regularly injecting insulin.  When puberty arrived and her body changed, she felt suddenly confused about her food intake and her insulin requirement; by the time she hit high school, she had developed anorexia, which seemed to take care of everything at once-less food, less need for insulin, better control.  But this adjustment failed her when she went to college and had a critical episode of hypoglycemia: a friend found her lying on the floor in a pool of blood-she'd fallen out of the upper bunk and cracked her head, having taken her insulin and then fallen asleep.  After this, Anne went completely the other way; terrified of low blood sugars she became obese, gaining 80 pounds.  It was only after several years in therapy that she was able to understand her eating disorder and return to a normal weight.   Testing the extremes-wobbling between starvation and bingeing-turned out to be a means of locating the right balance for herself as she moved from adolescence into young adulthood.