Biomedical subjects
Publications and source records attributed to A D Weisman.
Physicians have been known to procrastinate and deny problems about retirement and the inevitability of aging beyond employability. The transition from what they have devoted their life to practicing, coupled with anxiety about just getting old and older than most people is enough to precipitate sadness, if not sober bereavement.
Coping with cancer from the patient's or counselor's viewpoint means that strengths and resources depend on assessing predominant problems and acting appropriately to alleviate them. It does not always mean resolution of problems, but it does require understanding where the pressure points are that lead to more distress. Thus, counselors anticipate as well as understand actual distress; visualize various outcomes of different interventions, medical or otherwise; and narrow the gap between what is hoped for and what might be possible. Pastoral counseling needs a viewpoint that maintains morale in the utmost phase of terminal illness. Facing mortality is difficult for the counselor as well as significant others. Therefore, they must deal directly with bereavement and potential loss, if possible, indicating their willingness to confront ultimate questions, even without answers. Overall, the purpose of quality counseling is in the counselor: limitation is not futility. The job of counseling is not to figure out the universe or explain the unexplainable. Rather, the purpose of counseling is to help a suffering individual to come back within the range of normalized behavior and to become acceptable and credible. In this way, out of the web of vulnerability can come further strengths and resources.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
To study the effectiveness of preventive intervention in lowering emotional distress and improving coping, 381 newly diagnosed cancer patients were assessed shortly after the time of initial diagnosis. Subjects predicted by a screening instrument to be at risk for high levels of emotional distress and poor coping during the second through sixth months of their illness were randomly allocated to one of two short-term intervention programs (N = 59). Specific techniques to lower distress and improve coping were given during the four weeks following diagnosis. A control group (N = 58) received no intervention. All were followed at two-month to 6-month intervals by interview and testing. There was a significant lowering of emotional distress in the intervention group as compared to the control group (p less than 0.05). There was also a significant increase in the level of problem resolution in the intervention groups (p less than 0.01), although the numbers of problems experienced by both groups were no different.
Comprehensive cancer care is a combination of tumor treatment with understanding the special concerns and needs of cancer patients. To understand the psychosocial problems of cancer patients requires knowledge of protocol (treatment of the tumor), plight (nonmedical ramifications of cancer), and promise (the caregiver's view of the patient's predicament). Caregivers can sometimes be more distressed by the plight of their patients than are patients themselves. In extreme instances, their vulnerability leads to what is called "Caregiver's Plight," a set of responses which interfere with adequate understanding and may result in progressive vocational demoralization, change to another field, and drastic impairment of self-esteem. Therapeutic suggestions for identifying and correcting caregiver's plight are proposed, including knowing how to cope better and how much to promise, sharing concern with colleagues, attempting to make smaller contributions, and using an exercise called the "Absent Witness," an imaginary self-monitoring review.
Newly diagnosed cancer patients who were screened as being "at risk" for future psychosocial distress were offered a counseling program, covering the period from hospital discharge to resumption of regular activity. More than two-thirds of "at risk" patients accepted. Those who refused the program tended to be more antagonistic or apprehensive than those who accepted. Refusers denied difficulties, minimized problems, and in certain instances were truculent and suspicious. Some refusers did not wish to be interviewed, for fear that social and emotional equilibrium would be disturbed; they rejected counseling, which was felt to be either an immediate threat or an omen of disaster. Accepters, while as much "at risk," did not deny, but felt more hopeless. Differences in cancer site, stage, symptoms, treatment, availability of significant others, age, sex, social status, and so forth were not significant.
Explore the source record for details and available documents.
The way in which patients cope with cancer throughout the course of treatment and illness can be demonstrated by correlating levels and types of vulnerability with different psychosocial phases. The concept of psychosocial phasing is a hypothesis, the aim of which is to integrate typical problems, concerns, and distress with clinical staging, treatment, and disease progression. Expectations differ at each phase. Accordingly, different problems may arise which clinicians can anticipate and relieve through appropriate interventions.
Because most cancer patients seem to cope well with the stresses of their illness, including the psychosocial ramifications, it is important to understand what good copers manage to do, as opposed to those patients who simply defend themselves against persistent problems. This requires making a radical distinction between coping and defending, as well as between healthy adaptive resources and latent pathological dispositions. A case report is presented to illustrate how one "supercoper" solved problems by self-instruction. While cognitive self-instruction may not be applicable for every cancer patient and all problems, it is a working hypothesis deserving of further investigation, since self-control and personal responsibility are essential elements in rehabilitation on all levels. One intervention model for "high distress" cancer patients is outlined.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.