COPING WITH THE CRISIS OF PHYSICAL ILLNESS 3.

Illness-related factors
Vivienne S. Caguioa-Cleofas, MD,FPPA 4. Sociocultural and economic factors
Intrapersonal factors
Objectives 1. Personality
To recognize and understand the 2. Past experience
different psychological responses of
patients to illness 3. Emotional state of the patient at the time of illness

To understand what is coping and its Meaning of illness

effects on the patient, the illness Personality
and the doctor
enduring tendencies of an individual to react to and process stimuli
To understand the different factors that affect the reactions to medical and to act in characteristic ways
illness
individuals cognitive-perceptual style
psychodynamic configuration
Recognize and be attentive to the patients emotional needs and recognize
their potential influence on the symptoms and course of the illness Meaning of illness / Personality
American Board of Internal Medicine 1979
Patients cope with their medical illness based on their habitual
More appropriate question is not whether there is an emotional reaction, but defensive styles
what kind of psychological reaction is occurring and to what degree it may be These defensive patterns are hallmarks of a patients character style
affecting the patient
An understanding of this can help lead to a specific therapeutic
intervention designed to help deal more successfully with the
psychological ramifications of the illness

DEFENSE MECHANISMS
Automatic psychological responses by which the mind confronts a
psychological threat or conflict between a wish and the demands of
reality or the dictates of conscience
DEFENSE MECHANISMS vs COPING
Psychological concept of coping is more behavioral, involves action, is
a conscious experience
Defense mechanisms are intrapsychic processes that are largely out of
the individuals awareness

DEFENSE MECHANISMS
Hierarchy proposed by Valiant (1993)
Psychosocial reactions to illness Psychotic
Helps a doctor identify and understand a given patients reactions Immature
and to be better able to promote optimal recovery from or adaptation Neurotic
Mature

Psychosocial reactions to illness DEFENSE MECHANISMS

Key components of the psychosocial reaction to illness Denial
a. Meaning of illness
b. Emotional Response to illness Regression
c. Coping with illness Anxiety

Meaning of illness Anger

subjective significance for the patient of the illness related information Depression
that impinges on him or her
Specific Personality Types Related to the Reactions to Illness
Illness as a crisis that represents a turning point in an individuals life
- Drs. Rudolf Moos and Jeanne Schaefer 1986 Ralph Kahana
Grete Bibring
Four major categories of Meaning
1. Illness as a challenge or threat 7 Personality types
2. Illness as loss Individuals with rather fixed personality styles who react to the stress
3. Illness as Gain or relief of illness in the different fashions
4. Illness as Punishment
Specific Personality Types Related to the Reactions to Illness
Meaning of illness Kahana/ Bibring
Determinants of Meaning Delineate personality characteristics and conflicts that can occur in the
1. Intrapersonal factors context of the physician-patient relationship
2. Interpersonal factors

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 Provides a useful bridge between dynamic and descriptive psychiatry subjective importance for the patient of the body part or function
for the clinician affected
illness-related information influenced by
Doctors and nurses response somatic perceptions
COUNTERTRANSFERENCE patients own knowledge of and belief of
disease
*see table for personality types
messages patient receives from social environment and doctors
statements
Meaning of illness
Changes caused by physical illness
change in identity Somatic
perceptions
change in location
change in role Own know ledge
of beliefs abt ds

change in social support Message fr social

environment
change in the future

Meaning of illness
Meaning of illness
Factors that exacerbate the crisis of illness:
Determinants of Meaning
illness is often unpredicted 1. Intrapersonal factors
information about the illness is unclear 2. Interpersonal factors
a decision is needed quickly 3. Illness-related factors
4. Sociocultural and economic factors
ambiguous meaning
limited prior experience Meaning of illness
Sociocultural and economic factors
Meaning of illness influenced by education and cultural background
Illness Concepts by Lipowski (1970)
1. Illness as challenge Emotional response to illness
2. Illness as enemy inseparably linked to its meaning
3. Illness as punishment have an important effect on the patients manner of coping with the illness
and ultimately on its course and outcome
4. Illness as weakness
5. Illness as relief Coping with Illness
6. Illness as strategy a process by which people try to manage a discrepancy between the
7. Illness as irreparable loss or damage perceived demands of a situation (illness) and their available resources

8. Illness as value thoughts and behaviors that the person uses to manage or alter the
problem that is causing distress and regulate the emotional response
to the problem
Meaning of illness
Folkman et al 1993
Intrapersonal factors
1. Personality
A powerful mediator of how a patient responds emotionally to a given
stressor
2. Past experience Folkman and Lazarus 1988
3. Emotional state of the patient at the time of illness Lipowski 1970

Meaning of illness Why study coping?

Determinants of Meaning Coping has improved psychological well being among patients
1. Intrapersonal factors Coping has influenced outcomes of illness hormone levels and
2. Interpersonal factors immune function, improved wound healing and even hastened
3. Illness-related factors recovery
4. Sociocultural and economic factors
The way patients deal with their illness influence how physicians
Meaning of illness interpret their symptoms and the information they have to go on in
deciding treatment
Interpersonal factors
support from the family Coping is our response to illness
good doctor patient relationship
FACTORS
Meaning of illness 1. Stresses of Illness and hospitalization nature and severity of the illness
Determinants of Meaning stress of hospitalization
1. Intrapersonal factors 2. Meaning of Illness
2. Interpersonal factors
3. Illness-related factors 3. Characteristic personality traits, temperament, coping strategies,
4. Sociocultural and economic factors psychological defenses
4. Past experiences with illness
Meaning of illness Doctors, nurses, hospitalization
Illness-related factors

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 Experiences of friends and family Anger a demeaning offense against me and mine
5. Doctors and nurses response to the patient Anxiety feeling uncertain, existential threat
Fright an immediate, concrete, and overwhelming danger
Guilt having transgressed a moral imperative
Shame failing to live up to an ego ideal
Sadness having experienced an irrevocable loss
Happiness making reasonable progress toward the realization of a
goal
Envy wanting what someone else has
Relief a distressing goal-incongruent condition that has changed for
COPING STYLES the better or gone away
Individuals often prefer or habitually use certain strategies over others Hope fearing the worst but yearning for the better
Multiple strategies are used for complex stressful situation like Richard Lazarus 1991
medical illness or hospitalization
People employ trial and error in selection
Lazarus 1999
Coping strategies may change as the nature of the stressor changes
Heim et al 1993, 1997

Cognitive Responses
Illness related tasks
General tasks Behavioral Response to Illness
Maladaptive
Adaptive
ADAPTIVE TASKS
Illness Related Tasks Behavioral Response to Illness
1. Dealing with pain, incapacitation, discomfort and other symptoms Adaptive Responses
2. Dealing with the hospital environment and special treatment Altruism
procedures Support Seeking
3. Developing and maintaining adequate relationships with health Epiphany regarding Life Priorities
professionals Becoming an expert in ones illness
Maladaptive Responses
ADAPTIVE TASKS
General Tasks Nonadherence to Treatment Regimens

1. Preserving a reasonable emotional balance Signing out against medical advice

2. Preserving a satisfactory self-image and maintaining a sense of Conclusion

competence and mastery
An understanding of all these factors that affect a patients response
3. Sustaining relationships with family and friends to illness is needed by every physician in order to understand their
4. Planning for an uncertain future patients and provide the appropriate intervention.

Psychosocial reactions to illness Thank you.

are induced in every sick person by all the illness-related information
they receive

Emotional Response to Illness

vary in quality, intensity, duration

Emotional Response to Illness

Emotional Response to Illness

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