The person with a spinal cord injury: psychological care.
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Heart transplantation offers not only increased quantity but also highly improved quality of life. Nevertheless, it should not be seen as a panacea. Postoperatively the patients and their spouses face and have to overcome profound psychosocial problems. In this paper the five most important phases in the emotional adjustment to heart transplantation are discussed as to their significance for the patient, the patient's relationship to his/her partner and in view of the care by the medical team. These phases are a. the early postoperative period, b. rejection episodes, c. the postoperative inpatient phase, d. discharge and e. the first postoperative year. The paper highlights the difficulty of and the necessity for psychological care of heart transplant patients to reassure them emotionally and support them during phases of psychological instability.
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Social stress, psychological distress, and psychosocial support effect the adjustment of breast cancer patients, influence their experience of and adherence to medical treatment, and may effect the course of the disease. The literature indicates that levels of distress, depression, and anxiety are substantially elevated among patients with breast cancer. These problems persist in a sizable minority of patients even years after diagnosis. Coping styles are related to adjustment and, in some studies, survival time. The nature of the relationship with physicians affects adjustment to the illness, satisfaction with treatment outcome, and adherence to medical treatment protocols, which can influence relapse and survival. In many but not all studies, serious life stress adversely affects medical outcome. Social support in general and structured psychotherapy in particular have been shown to positively affect both adjustment and survival time. Clear and open communication, expression of appropriate emotion, and collaborative planning and problem-solving enhance adjustment and improve outcome. Conversely, influences that isolate breast cancer patients from others or undermine support can have adverse medical and psychological consequences.
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Hartmann's theories have experienced a remarkable rise and fall in popularity over the past fifty years. In this paper, an effort is made to arrive at a balanced view. The genetic and economic aspects of Hartmann's ego psychology are found to be problematic, but the dynamic aspect led to a sophisticated psychoanalytic concept of health as yet unsurpassed. Hartmann always called for the clinical application of his ideas. In this spirit, a vignette is offered from a clinical area in which questions of "health" and "illness" are particularly vexing at present.
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