Psychological Assistance To The Terminally Ill And Their Loved Ones

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Although every person knows about the finiteness of his existence, but, as many psychological studies assert, a person himself often does not really believe in his own death, does not deeply realize the fact of its inevitability. The founder of psychoanalysis, Freud (who himself resorted to euthanasia after years of struggling with a painful disease) argued that a person is convinced of his own immortality. Faced with the death of other people or being in a mortal situation himself, a person experiences unaccountable fear and anxiety. At the same time, it has been proven that among the first thoughts of a person at the sight of the death of another person, there is an experience that “it’s not me yet”. The fear of death and unwillingness to die in everyone, at least in a mentally healthy person, is very great.

Psychological condition a person who first heard from medical workers that he may have a fatal incurable disease (for example, cancer), is described in the classic works of E. Kobler-Ross). She found that most patients go through five the main stages of psychological reaction:

1) Denial or shock. 2) Anger. 3) "Trade". 4) Depression. 5) Acceptance.

First stage very typical. The person does not believe that they have a potentially fatal disease. He begins to go from specialist to specialist, double-checking the data obtained, and makes analyzes in various clinics. Alternatively, he may experience a shock reaction and no longer go to the hospital.

Second stage characterized by a pronounced emotional reaction to doctors, society, relatives.

Third stage - these are attempts to "bargain" as many days of life as possible from various authorities.

At the fourth stage a person understands the gravity of his situation. He gives up, he stops fighting, avoids his usual friends, leaves his usual affairs, closes at home and mourns his fate.

Fifth stage - this is the most rational psychological reaction, but not everyone gets it. Patients mobilize their efforts in order to continue to live for the benefit of loved ones despite the disease.

It should be noted that the above stages do not always follow the established order. The patient may stop at some stage or even return to the previous one. However, knowledge of these stages is necessary for a correct understanding of what is going on in the soul of a person who is faced with a fatal illness and the corresponding psychological correction.

Such a strong fear of death lives in people that as soon as they learn that they have an incurable disease with a fatal outcome, their personality changes dramatically, very often this becomes the main characteristic of such people. A person can fulfill a huge number of roles in life: to be a parent, boss, lover, he can have any qualities - intelligence, charm, a sense of humor, but from that moment he becomes "terminally ill." All of his human essence is suddenly replaced by one - a fatal disease. All those around, often including the attending physician, notice only one thing - the physical fact of an incurable disease, and all treatment and support is addressed exclusively to the human body, but not to his inner personality.

Anxiety in the terminally ill

Anxiety is a common and normal response to a new or stressful situation. Every person experienced it in everyday life. For example, some people get nervous and anxious when interviewing for a job, when speaking in public, or just talking to people who matter to them. The psychological state of a person who learns that he has a fatal disease is characterized by a particularly high level of anxiety. In cases where the diagnosis is hidden from the patient, this condition can reach the level of severe neurosis. The most susceptible to this condition are women with breast cancer.

The state of anxiety is described by patients as:

• Nervousness
• Voltage
• Feeling of panic
• Fear
• Feeling that something dangerous is about to happen
• Feeling like "I'm losing control of myself"

When we are anxious, we experience the following symptoms:

• Sweaty, cold palms
• Upset gastrointestinal tract
• Feeling of tightness in the abdomen
• Tremors and tremors
• Difficulty breathing
• Accelerated pulse
• Feeling of heat in the face

The physiological effects of anxiety can be characterized by severe hyperventilation with the development of secondary respiratory alkalosis, followed by a pronounced increase in muscle tone and seizures.

Sometimes these sensations come and go quite quickly, but in the case of breast cancer, it can last for years. Anxiety can be very severe, disrupting the normal functioning of the body. In this case, qualified psychiatric care is required. However, with moderate severity of symptoms, the patient can learn to cope with this condition on his own.

Women with breast cancer are especially vulnerable and experience fear and anxiety in the following situations:

• Medical procedures
• Radiotherapy and chemotherapy
• Side effects of surgical, radiological and pharmacological treatments
• Anesthesia and surgery
• The crippling consequences of surgical treatment and a sense of female inferiority
• Possible tumor metastasis

Some of these fears are quite natural, but their pronounced manifestation interferes with the normal functioning of the body, which is already experiencing great overloads associated with the disease itself and its treatment.

Psychological preparation for death

Psychological preparation for death involves the study of some of its philosophical aspects. Awareness of the inevitability of death, in particular, makes a person decide whether to spend the remaining time allotted by nature in anticipation of the inevitable tragic ending, or to act in spite of everything, live a full life, maximally realizing himself in activities, in communication, investing his psychological potential in every moment of its existence.

A. V. Gnezdilov singles out 10 psychological (psychopathological) types of reactions at hopeless patients, which can be classified according to the following main syndromes: anxious-depressive, anxious-hypochondriac, asthenic-depressive, astheno-hypochondriac, obsessive-phobic, euphoric, dysphoric, apathetic, paranoid, depersonalization-derealization.

Most often observed anxiety-depressive syndrome, manifested by general anxiety, fear of a "hopeless" disease, depression, thoughts of hopelessness, near death, a painful end. In the clinical picture of stenic in premorbid personalities, anxiety more often prevails, in asthenic - depressive symptoms. Most of the patients show suicidal tendencies. Patients close to medicine can commit suicide.

Some patients, realizing their diagnosis, imagining the consequences of mutilating treatment or surgery, disability and the absence of guarantees of relapse, refuse treatment. This refusal of treatment can be interpreted as passive suicide.

As you know, the position of the patient, asked by the medical staff, is to "hold on with clenched teeth." And most patients do this, especially men. They keep themselves in control, not allowing emotional stress to splash out. As a result, in some patients who are taken for the operation, even before it begins, suddenly there is a cardiac arrest, or a violation of cerebral circulation, which is caused by nothing more than emotional overload. Timely diagnosis of psychogenic reactions, which are usually suppressed and hidden by patients, can significantly affect the outcome.

In second place in frequency is dysphoric syndrome with a dreary, maliciously gloomy coloring of experiences. Patients have irritability, dissatisfaction with others, searches for the causes that led to the disease, and, as one of them, accusations against medical workers of insufficient efficiency. Often these negative experiences are directed to relatives who allegedly "brought to illness", "did not pay enough attention", have already "buried the patient in their minds."

The peculiarity of the dysphoric reaction is that suppressed anxiety and fear are often hidden behind aggressiveness, which, to a certain extent, makes this reaction compensatory.

Dysphoric syndrome most often observed in persons with a predominance of traits of excitability, explosiveness, and epileptoidy in premorbid. Assessment of the severity of the dysphoric syndrome shows the presence of the strongest emotional tension.

Anxiety-hypochondriac syndrome consistently ranks third. With it, a lesser degree of tension is noted than with the first two. In contrast to the dysphoric reaction, introversion and self-directedness prevail here. The clinical picture reveals emotional tension with fixation of attention on one's health, fears of the operation, its consequences, complications, etc. The general background of the mood is reduced.

Obsessive-phobic syndrome manifests itself in the form of obsessions and fears and is observed in a group of patients with a predominance of anxious and suspicious, psychasthenic traits in the character. Patients experience disgust towards their roommates, obsessive fear of contamination, infection with "cancer microbes", painful ideas about death during or after surgery, anxiety about the possibility of "gas emission", feces, urinary incontinence, etc.

Apathetic syndrome indicates the depletion of the compensatory mechanisms of the emotional sphere. Patients have lethargy, some lethargy, indifference, lack of any interests, even in relation to further prospects of treatment and life. In the postoperative period, as a rule, there is an increase in the frequency of manifestation of this syndrome, reflecting the reaction to the overstrain of all mental forces in the previous stages. In asthenic personalities, a more frequent manifestation of apathetic syndrome is observed in comparison with sthenic ones.

In this case, I would also like to emphasize the importance of the doctor's orientation towards the patient. Each organism has its own reserve of time and its own rhythm of life. One should not rush to stimulate the patient's nervous system by prescribing obvious drugs, even if he is knocked out of the "time statistics" of the hospital bed.

Apathetic syndrome - a stage in the dynamics of reactions that expediently adapt the patient to changing conditions. And here it is necessary to give the body to gain strength and recover.

Astheno-depressive syndrome … In the clinical picture of patients, depression and melancholy appear with feelings of hopelessness of their disease, early or late, but doom. This symptomatology is accompanied by a noticeable depressive background. It should be noted the prevailing connection of this syndrome with a group of cycloid nature.

Astheno-hypochondriac syndrome … In the foreground are the fear of complications, anxiety about the healing of an operating wound, anxiety about the consequences of a mutilating operation. The syndrome predominates in the postoperative period.

Depersonalization-derealization syndrome … Patients complain that they have lost the sense of reality, they do not feel either the environment or even their body; require sleeping pills, although they fall asleep without them; note the disappearance of taste, appetite,and along with this, satisfaction from the performance of certain physiological acts in general. It is possible to note a certain connection between the frequency of this syndrome and the group of so-called hysteroid-stigmatized patients.

Paranoid syndrome is observed rarely and manifests itself in a certain delusional interpretation of the environment, accompanied by ideas of attitude, persecution and even single deceptions of perception. The connection of this syndrome with schizoid personality traits in premorbid is characteristic. Common with dysphoric syndrome is aggressiveness directed at others. However, in the case of the paranoid type, there is a "mental", schematization, consistency or paralogicality of the complaints presented. When "dysphoria" is characterized by emotional richness of the syndrome, brutality of experiences, chaotic complaints and accusations.

Euphoric syndrome … The mechanism of its occurrence is not difficult to imagine: as a reaction of "hope", "relief", "success", euphoria appears at the postoperative stage. Euphoric syndrome manifests itself in an elevated mood, an overestimation of one's condition and capabilities, and seemingly unmotivated joy. Its connection with the cycloid group is undoubted.

Concluding the review of the psychological (pathopsychological) reactions of patients, a peculiar syndrome of self-isolation at the follow-up stage should be especially noted. This is the fear of recurrence of the disease and metastases, social maladjustment caused by disability, thoughts about the infectiousness of the disease, etc. Patients become depressed, feel a sense of loneliness, hopelessness, lose their previous interests, stay away from others, and lose activity. An interesting connection with premorbid schizoid features among patients who have a syndrome of self-isolation. In its presence, the severity of the psychological state and the danger of suicide are undoubted.

Guidelines for psychological support when working with a terminally ill patient:

• Ask “open-ended” questions that stimulate the patient's self-disclosure.
• Use silence and “body language” as communication: look the person in the eye, leaning slightly forward, and occasionally touch his or her hand gently but confidently.
• Pay special attention to motives such as fear, loneliness, anger, self-blame, helplessness. Encourage them to unfold.
• Insist on clarifying these motives clearly and try to understand them yourself.
• Take practical action in response to what you hear.

1. "I feel bad when you do not touch me"

Friends and relatives of the patient may experience irrational fears, thinking that serious illnesses are contagious and transmitted by contact. These fears are present in people much more than the medical community is aware of. Psychologists have found that human touch is a powerful factor that changes almost all physiological constants, from heart rate and blood pressure to feelings of self-esteem and changes in the inner sense of body shape. “Touch is the first language we learn when we enter the World” (D. Miller, 1992).

2. "Ask me what I want right now"

Very often friends say to the patient: "Call me if you need something." As a rule, with this statement of the phrase, the patient does not seek help. Better to say, “I'll be free tonight and come over to you. Let's decide what we can do together with you and how else I can help you. " The most unusual things can help. One of the patients, due to a side effect of chemotherapy, had a cerebral circulation disorder with speech impairment. His friend regularly visited him in the evenings and sang his favorite songs, and the patient tried to pull her up as much as possible. The neurologist observing him noted that the restoration of speech was much faster than in normal cases.

3. "Don't forget that I have a sense of humor."

Kathleen Passanisi found that humor has a positive effect on the physiological and psychological parameters of a person, increasing blood circulation and respiration, reducing blood pressure and muscle tension, causing the secretion of hypothalamic hormones and lysozymes. Humor opens up communication channels, reduces anxiety and tension, enhances learning processes, stimulates creative processes, and enhances self-confidence. It has been established that in order to stay healthy, a person needs at least 15 humorous episodes throughout the day.

Emotional support for the patient's family

It is of great importance to involve relatives in the emotional support of the patient. The doctor must take into account the individual system of family and family relations. Too much informing of the family about the patient's condition should be avoided, while at the same time not providing such information to the patient himself. It is desirable that the patient and his relatives have approximately the same level of knowledge of this information. This contributes to greater consolidation of the family, mobilization of reserves, psychological resources of the family structure, promotion of psychological processing of the work of grief in the patient and his family members.

Very often, family members are too busy with the attention that is given to the patient. It is necessary to understand that relatives suffer just as hard. An incurable disease hits the whole family.

"Ask us how you are doing"

Very often, a medical worker, visiting a patient at home, is interested only in the condition of the patient himself. This greatly traumatizes his relatives, who do not sleep at night, listening to the patient's breathing, perform unpleasant but extremely necessary procedures and are constantly under stress. They also need attention and help.

"We are afraid too"

All people are aware of the genetic predisposition to disease. Therefore, it is necessary to raise this topic in a conversation with relatives and, perhaps, it makes sense to do a preventive examination at least in order to relieve fears.

"Let us have our tears"

There is an opinion that relatives should maintain external composure in order to psychologically support the patient. The patient understands the unnaturalness of this state, which blocks the free expression of his own emotions. A 10-year-old girl dying of cancer asked a nurse to bring her a “crying doll”. She said that her mom tries to be very strong and never cries, and she really needs someone to cry with.

“Forgive us for acting like crazy”

Relatives may experience hard-to-hide anger over feelings of powerlessness and lack of control over the situation. As a rule, underneath it lies a feeling of guilt and a feeling that they did something wrong in life. In such cases, the relatives themselves need the individual help of a psychotherapist or psychologist.

How the sick person can help himself

Controlling anxiety states is a complex process. However, with hard work, you can master the necessary psychotechnical skills to do this. Your goals are:

• Recognize that some degree of anxiety is normal and understandable
• Be prepared to seek professional help when you are struggling on your own
• Master relaxation techniques for self-relieving stress
• Make a plan of the daily routine, taking into account possible psycho-traumatic and stressful situations

You should immediately stipulate the situations in which you should contact professionals:

• Serious trouble sleeping for several days in a row
• Feeling threatened and panicky for several days
• Severe tremors and seizures
• Disorders of the gastrointestinal tract with nausea and diarrhea, which can lead to electrolyte and acid-base imbalances
• Accelerated heart rate and premature beats
• Sudden mood swings that you cannot control
• Breathing disorders

What can we do to manage anxiety-panic states:

• Find out through introspection exactly which thoughts cause us anxiety
• Talk to someone who has experienced similar stressful situations before
• Engage in pleasant, distracting activities from disturbing thoughts
• Be in the circle of friends and family
• Apply psychophysical relaxation techniques
• Ask a professional to assess our situation

Finding out which thoughts are causing the anxiety is key to controlling the situation. Anxiety has two components: cognitive (mental) and emotional. Anxious thoughts cause anxious feelings, and anxious feelings, in turn, intensify anxiety thoughts, which ultimately causes a vicious circle. We can break this circle only by influencing its cognitive component.

Obtaining adequate medical information is of particular importance. If you are afraid of a medical procedure, you should familiarize yourself in detail with all the technical aspects, possible side effects, complications, and ways to avoid them. Evaluate the possibilities of replacing this procedure with a less frightening one, but giving a similar result. If you are concerned about the side effects of radiation or chemotherapy, you should get the necessary information in advance to prevent and control them. Modern medicine has a wide range of chemotherapy drugs and treatment regimens and therefore there is always a possibility of replacement.

The opportunity to speak with someone who has previously experienced a similar situation provides information that has not gone through professional medical censorship. It is very important to feel that you are not alone in your fears and worries.

"INTERNAL TALK" for Depression

People who are prone to negative mental stereotypes very often "talk" themselves into depression. "Internal conversation" reflects the personality's reflection on the situation and forms a personalized judgment. This is an extremely subjective tendency without external objective guidelines. This "internal conversation" is recorded in the operative memory a person, emerging even in minimally significant situations. This subjective "internal conversation" is formed over the years and is cultivated in the form of negative mental stereotypes that violate the social adaptation of the individual. Thus, a stable low self-esteem of the individual is formed. A person begins to automatically filter the information coming into him. He may simply "not hear" the positive aspects of the situation. If you praise such a person, then he automatically “cuts off” any positive information about himself. Any praise is “not allowed” into the inner world, because it can cause significant emotional pain, as it contradicts the person’s inner image of himself. a person in depression to praise - the stereotype "Yes, but …". You say, “I really like your dress,” to which the depressed person replies, “Yes, it’s beautiful, BUT I don’t have shoes that fit it.” If you want to help a depressed person, you should immediately draw his attention to this blockage of positive information and show him that he only lets negative thoughts into himself. The feeling of a changed appearance is especially painful: crippling scars, hair loss and even complete baldness. Women who underwent mastectomy confessed that when they entered a room with strangers, they felt as if all eyes were on their missing or crippled breasts. Therefore, they sought solitude and fell into the deepest depression.

When we ourselves can cope with depression, and when we should see a specialist

You should immediately stipulate the cases in which you should seek professional help:

• If you had depression before being diagnosed with breast cancer and have at least two of the following symptoms: feeling bored throughout the day, loss of interest in nearly all daily activities, difficulty concentrating on what you are doing and difficulty in making decisions;
• You notice sudden mood swings from periods of depression to periods of high mood. These mood swings, as a rule, are not related to what is happening around the person and can be symptoms of Manic-Depressive Psychosis, for which breast cancer was a provoking factor;
• If everything you are trying to do on your own to relieve your own depression is ineffective

How to prevent or reduce depression:

• Take action before depression becomes evident. If you ignore the early signs of depression, you are more likely to enter a condition that seriously threatens your quality of life and requires professional help.
• Plan for positive feelings for yourself. If you feel overwhelmed by your emotions, give up everything and do the things that you have always enjoyed.
• Increase the amount of time you spend with other people who have a positive impact on you. Typically, these people fall into three categories: sensitive and understanding people; people who can give good advice and help solve problems; people who can distract you from problems and direct your attention to pleasant sensations