Some of the adaptive coping styles of children with craniofacial anomalies are discussed. Three cases of children with microtia are described to illustrate developmental pathways used in adapting to their deformities. The complexity of the chronic medical and psychological challenges these children face is illustrated and discussed. In contrast to previous frameworks dealing with the problems of deviance and stigmatization, we use a psychological historical framework, drawing an analogy to Handlin's work on immigration. These children are born into a world that considers them strange and abhorent. They can be considered aliens entering a society of normal, non-disfigured people. The craniofacial center is conceptualized as a "naturalization" office where highly valued health care professionals are counted upon to reconstruct facial appearance and function. An enduring attachment and bonding process to the staff takes place, and the center becomes of considerable importance to the craniofacial patient's identity. The craniofacial patient often has to carry the pain of social isolation and stigma. Physicians caring for these children should be cognizant of their coping styles; so that development can be directed to move away from deviance to successful "immigration into the country of normals" and adaptation to life.

Adaptation, Psychological↗

PubMed1980

The cost of medical education: the state's perspective.

Explore the source record for details and available documents.

Education, Medical↗

PubMed1979

Rehabilitating families with burned children.

A critical factor in the successful or unsuccessful life adjustment of the badly burned patient is his family's reaction to this chronic problem, its ability to support him, and to help him pursue the long course of treatment and its many associated problems, and to also help him navigate the social world into which he must go. The high incidence of emotional disturbance in families sustaining burn injuries makes it vital to deal effectively and in a sustained manner to assess the types of emotional disturbances which exist in these families and to see how they influence the responses to the injuries and to the long and arduous treatments that follow. Different patterns of adaptation occur, some much related to economic class and special types of psychiatric disorder in the family. Some reactions of chronic grief and intermittent helplessness and hopelessness may transcent all groups, but the ability to follow through in later care varies enormously, and is correlated with the overt depression of the mother. Several types of reaction are epitomized in the cases presented, along with directives for their management, and the interplay of social, somatic, and psychological factors which lead to these patterns will be delineated.

Burns↗

PubMed1979

Unreasonable expectations of reconstructive patients affecting rehabilitation.

Common difficult and recurring problems develop which make the demands of certain cosmetic surgical patients appear reasonable or not reasonable to the people operating upon them. In spite of careful preparation and repeated instruction, a number of patients continue to entertain fixed and elusive ideas about themselves, their body images, and the results they desire from surgery. These wishes are often not logical, and derive from personal experiences of the patients, and are not related to the actual degree of deformity or the objective reactions that other people have to these defects. while it is generally true that more gross deformities force a more realistic perspective upon the patients and their families in contrast to many normal-looking persons who seek cosmetic surgery, this is not always the case. The authors attempt to examine and describe several specific cases of these problems, along with the psychological mechanisms which underlie them, and present possible ways in which such behavior can be managed by the aesthetic surgeon. An attempt is also intended to be as practical as possible about the use of the busy surgeon's time in these situations.

Body Image↗

PubMed1979

Public and professional reactions to the facially disfigured which interfere with rehabilitation.

The rare appearance in public and the difficulty in obtaining follow-ups indicate the general tendency of facially disfigured people toward seclusion and restriction of their work lives and social functioning. Investigation of some of the reactions in the community, the underlying mental mechanisms, and the ways in which the nurses, doctors, and teachers they meet lead to the awareness of the ways in which professional and public attitudes may function synergistically against the rehabilitation and optimal functioning of these patients. The innate and biological mechanisms which cause observers of the disfigured to react with alarm, fear, rejection, and withdrawal are examined, as also are the ways in which professional attitudes differ, and how professional attitudes evolve. The variables of authoritarianism, friendliness, and the ways in which caretakers perceive and manage people in deviant roles in order to advance their rehabilitation will be explored and illustrated with case examples. Techniques for educating doctors and nurses about handling disfigurement in the complex matrix of modern medical care will be outlined, with emphasis upon comprehensive care and the emerging concepts of a case manager system of care in the handling of these chronic and tragic problems.

Esthetics↗

PubMed1972