Responses to Illness

Health is characterized by a state of well-being, enthusiasm, and energetic pursuit of life's goals. Illness is characterized by feelings of discomfort, helplessness, and a diminished interest in the future. Once patients recognize that they are ill and possibly face their own mortality, a series of emotional reactions occurs, including anxiety, fear, depression, denial, projection, regression, anger, frustration, withdrawal, and an exaggeration of symptoms. These psychological reactions are general and are not specific to any particular physical illness. Patients must learn to cope not only with the symptoms of the illness but also with life as it is altered by the illness.

Conflict is an important medical and psychological concept to understand. Patients live with conflict. What is conflict? Conflict exists when a patient has a symptom and wants to have it evaluated by a member of the health-care team, but the patient does not want to learn that it represents a ''bad'' disease process. Conflict is very widespread in medical practice. It is very common for patients to be seen by a physician and at the very end of the consultation, the patient may state, ''Oh doctor, there is one other thing that I wanted to tell you!'' That information is often the most important reason for that patient to have sought consultation. Patients with an acute myocardial infarction often suffer chest pain for several weeks before the actual event. They convince themselves that it is indigestion or musculoskeletal pain;they do not seek medical attention because they do not want to receive a diagnosis of coronary heart disease. The health-care provider must be able to identify conflict, which is often a precursor of denial, to facilitate care of the patient.

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