Chapter 3. Psychological Responses to Illness

Le résumé fourni par la source

A central task of psychiatrists working with the medically ill is to understand patients’ subjective experiences of illness to design therapeutic interventions that modulate the patients’ behavioral or emotional responses, decrease their distress, and improve their medical outcomes. Physicians witness a tremendous diversity of emotional and behavioral responses to illness. Some individuals face devastating illnesses for which no cure is currently available with courage and a sense of humor (Druss and Douglas 1988). Others, facing easily treatable illnesses, have difficulty overcoming intense emotions such as anger, fear, or hopelessness. Clinical experience and research indicate that illness variables such as severity, chronicity, or organ system involvement cannot predict an individual’s response to any given medical illness (Lloyd 1977; Sensky 1997). It is in the realm of the individual’s subjective experience of an illness that one can begin to understand his or her emotional and behavioral responses (Lipowski 1970). There has been considerable research investigating interindividual differences in responses to the stresses of illness (see, e.g., Ciechanowski et al. 2003; Druss 1995; Geringer and Stern 1986; Lazarus 1999; Strain and Grossman 1975). We provide a general overview of the stresses that accompany medical illness and hospitalization and review psychological, emotional, and behavioral responses that these stresses frequently elicit. Framework illustrating the complexity of an individual’s behavioral or emotional responses to illness. Source. Adapted from Lazarus 1999; Lazarus and Folkman 1984. The concepts of stress, personality types, coping strategies, and defense mechanisms can be integrated into a framework that illustrates the complexity of an individual’s behavioral or emotional responses to illness (Figure 3–1 ). This framework, adapted from the work of Lazarus and Folkman (Lazarus 1999; Lazarus and Folkman 1984), attempts to integrate the psychodynamic concepts of character style and intrapsychic defenses with other psychological concepts such as stress and coping. The importance of individual subjectivity is emphasized through the placement of coping styles, defense mechanisms, personality types, and the appraised meaning of illness as central mediators of the behavioral and emotional responses to the stresses of medical illness. It is important not to limit the discussion to maladaptive responses to illness or to psychopathology. A coping strategy or defense mechanism may be relatively maladaptive or ineffective in one context but adaptive and effective in another (Penley et al. 2002). The maladaptive use of denial by a patient diagnosed with early breast cancer might lead to a long delay in seeking treatment (Fang et al. 2016; Zervas et al. 1993), while the adaptive use of denial by a man diagnosed with untreatable metastatic pancreatic cancer might enable him to maximize his quality of life in the final months of his life (Druss 1995). Psychiatrists do not see most people who become ill, nor will most patients’ responses to their illnesses concern their physicians (Patterson et al. 1993; Perry and Viederman 1981). That does not mean that there is no psychological response to the illness. An overt display of emotion may or may not be appropriate for a patient’s racial and cultural background. Patients may feel or be discouraged from expressing their thoughts and feelings about their illness to family members or physicians. The determination that a psychological response to illness is problematic must be based on the effect the response has on the patient, the patient’s adherence to treatment, and social functioning. There is no one correct way to characterize psychological responses to illness. Psychodynamic formulations, coping styles, and personality types offer different perspectives that may or may not be useful in understanding the response of a particular patient. Therefore we provide an overview of the following topics without subscribing exclusively to any single theoretical framework: 1) the stresses of medical illness and hospitalization; 2) the influences of personality types, attachment styles, coping styles, and defense mechanisms on patients’ subjective experiences of illness; 3) optimism and pessimism; 4) denial; 5) emotional responses to illness; and 6) behavioral responses to illness.

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