Patient perspective and self-help.

Abstract

Effective adaptation to PD demands that patients and their caregivers elaborate coping strategies that empower them and promote a more salutary orientation to formidable psychosocial difficulties and thus, perhaps, blunt or prevent depressive responses. Patients and their loved ones should be encouraged to seize the initiative in terms of promoting an acceptable life-style: in short, "breaking through" rather than "breaking down." The notion of a "healthy" PD patient is not necessarily a contradiction in terms if the patient and family can be encouraged to view organic disease as a learning opportunity, continuing to find meaning in life despite the inevitable threats to identity posed by PD (e.g., loss of work). PD patients and their families may benefit by grieving (over a finite interval) or observing other rituals associated with universal life changes. These adaptive processes should be promoted in the context of a trusting physician-patient alliance that addresses both the biochemical foundations and adverse psychosocial consequences of PD; the latter problems require that the clinician or nurse furnish both education and emotional support. Three well-established phenomena from the depression literature must be combatted: a normal depression reaction associated with the failure to attain closely held life goals; outer locus of control, in which PD patients may perceive that the disease is dictating their existences; and learned helplessness, which may result when coping behaviors are not positively reinforced.