Health Psychology: Psychological Adjustment to the Disease, Disability and Loss

Copyright © 2019 by author(s) and International Journal of Trend in Scientific Research and Development Journal. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) (http://creativecommons.org/licenses/ by/4.0) ABSTRACT This article discusses the psychological adjustment of adults to severe or incurable diseases or other loss. The stress that results from a diagnosis of illness or loss depends on many factors, such as the beliefs of each individual and the social context. Considering the diversity of human perceptions, feelings and behaviors, it was considered important for the present study to include a theory of stress and treatment related to physical illness. At the center of attention are end-stage individuals, not their organic problems but mainly their psychological state and that of their families. Reference is then made to the loss of loved one and the period of mourning. As regards the disease response, there is a difference between the immediate reaction to loss, what we call mourning, and the adaptation to a new way of life without the loved one. Finally, the role of therapeutic communication between patients and their families and mental health professionals, as well as the need to maintain psychological balance, is also described.


INTRODUCTION
The person affected by an incurable disease faces a series of threats, such as the threat of identity and future plans, the threat to social roles, his physical and psychological independence, his physical image, for relations, social stigma, isolation" (Lugton , 1999, pp 216). However, any person who develops a serious physical illness or experiences the loss of a loved one does not always show psychopathology as a consequence. To understand why, we need to take into account a model of the physiological process of stress adaptation (Mitchell, Chan, Bhatti, Halton, Grassi, Johansen & Meader, 2011). Psychopathology may then be thought to occur when the normal process of coping either does not work properly or works successfully only in part (Wethington, Glanz & Schwartz, 2015).

Disease as stress
The word "stress" is used in a number of ways. It sometimes refers to as an environmental stimulus -a threat or demand from the outside world (Schonfeld & Chang, 2017). According to this view, experiences are characterized by specific attributes (such as losses, challenges or dilemmas).
A second concept of stress applies to a physical condition, such that events are considered stressful and psychopestical only if they cause changes in the individual. The most well-known example of the use of this concept comes from physiology. Stress in the normal sense is often used in everyday practice. When someone says he has intense stress, he usually means he is in a state of tension or excitation of the autonomic nervous system (McEwen, 2007).
A third way of understanding stress useful in the case of physical illness results from the interaction between the environmental requirements and the resources available to deal with them. This view finds structure in the Lazarus & Folkman transaction model. In fact, it is the most widely used theory (Lazarus & Folkman, 1991). It refers to the way the person understands and evaluates stressful stimuli. frequent interpretation of particular episodes in the same explains the resemblance of most human reactions to certain diseases. There is the possibility of a personalized interpretation leading to marked differences between people who seemingly have the same disorder. One's cognitive system guides their emotional and behavioral responses (Beck, 1995;McGinn & Young, 1996). Leventhal  . Adaptation to an end-stage disease has a lot in common with adaptation to other serious diseases and, therefore, it is not a specific field. This article discusses two issues: the diagnosis of depression and other adaptation disorders and the issue of suicide.
The person in an end-stage disease is expected to feel despair, while stress is a common symptom in such dying patients, but it is not necessarily pathological. As with depression, anxiety can be a result of physical disability and controlling the pain of pre-existing anxiety disorders (Corr, 1992 (Chochinov, 2001).
People expressing a desire to commit suicide are almost always ambivalent; even in patients with a terminal stage disease, the desire for death is not reasonable and should never be considered logical without searching for signs of latent external pressures and fear of symptoms in the termination phase. They might, however, have treatable depression.
The guiding principle of treating patients in the final stage of an illness is pain relief. Anxiolytic drugs can offer symptomatic relief from various conditions while the use of antidepressants in dying patients might be more problematic because of unwanted effects such as sleepiness and so on. Psychostimulant medications are also often used, which, for end-stage patients, can have beneficial stimulating properties such as increased energy, better concentration and increased appetite (Rosenstein, 2011).
Often, the terms "loss of laughter" and "mourning" are used identically. However, the Committee on the Effects of Loss on Health proposes the following clarification: loss is the deprivation of a loved one due to death (DSM-V) ( Modern writers stress that this approach should not imply that the person who is mourning has to go through certain stages in the process. Perhaps less well-know are the positive aspects of the loss experience, such as the feeling of being able to make the most of the remaining time, increased independence and improved flexibility (Park, 2010;Zautra, 2009).
A key concern and challenge is the recognition of pathological mourning and other mental disorders caused by the loss of a loved one (Horowitz , Bonanno , & Holen, 1993). In this regard, abnormal sadness has several meanings. can be defined as: Chronic mourning or the failure to resolve all the unpleasant symptoms associated with the loss within six months. Injured Mourning, the absence of the expected symptoms of grief Late Grief, avoiding painful symptoms within the first two weeks of the loss An unusually intense reaction to loss is sometimes described as pathological grief. There are indications that this form of grief may be a predisposing factor for psychiatric morbidity. An alternative way of defining pathological mourning is to examine whether it is accompanied by a major disruption of the person's functioning and, secondarily, to determine if it is unjustifiably resilient.
Depressive disorders are often caused by the loss of a loved one, but depressive symptoms are also part of the normal process of mourning. Symptoms are usually more frequent in the first four months and decrease rapidly over time. The DSM provides some guidance on the differential diagnosis of normal bereavement from depression. The following elements are rare in the loss of a loved one but are often found in major depression ( According to Beck (1995) and the cognitive model of psychotherapy, cognitive falsifications involving the world and the future, known as the Cognitive Trinity, are indicative of depression.
Although anxiety disorders have been studied less than depression, they can be observed after the loss of a loved one. it is necessary to consider the possibility of post-traumatic stress disorder after such loss, especially when deat Additional psychological complications due to the deprivation of a loved one include alcohol and substance abuse or even attempted suicide (Lawton, Gilbert & Turnbull, 2016). In social terms, complications of deprivation of a loved one include isolation and loss of social role, problems with work, loss of friends and financial difficulties. Medical complications are also common (Worden, 2018).
Variables involved in the development of psychopathology or medical co-morbidity as well as its intensity and duration for a child are low selfesteem, an amphithematic relation to the deceased, dependence on the dead and previous insecure relationships. In particular, an amphibious relationship between the survivor and the deceased is believed to predispose the sufferer to a pathological emotional response, based on the Freud 's psychoanalytic approach. But there are equally important factors not related to the survivor such as unexpected death, prematurity, suicide or murder. Among others factors are poor social support and social isolation, low socio-economic situation and the stressful events that follow death (Mitchell, et al., 2011).
The treatment of emotional reactions after loss is controversial. There are experts who do not want to alter what they see as a normal process, even arguing that any treatment can negatively affect the process of mourning. However, the morbidity associated with complicated mourning may be subject to interventions. The traditional psychological treatment for suffering a loss involves treating mourning such that an expression of emotions is encouraged in conjunction with a review of what relationships mean. The techniques used for this purpose are psychoanalytic, cognitivebehavioral psychotherapy, cognitive analytical, and group and supportive psychotherapy, a brief-focused psychotherapy (Mitchell, et al., 2011). Drug depression treatment due to loss seems to improve the symptoms within six weeks. The basic symptoms of mourning are not affected, but pharmacotherapy may be as effective as psychotherapy when a depressive disorder develops despite the apparent psychological significance of the effector (Mitchell, et al., 2011).
Communicating with health professionals The patient finds help in his own way, through his own people, and sets his own limits. He usually finds strength through religious beliefs, those closest to him such as the people in his environment. The patient can do it alone with a profound review of himself, but the focus is usually on the doctor and nursing staff responsible for alleviating pain. Therapeutic communication is one of the most important factors involved in the correct approach to the psychosocial side of the patient.
It is necessary for health professionals to treat the patient as the center of concern, in spite of prevailing unacceptable views of illness as offensive in the culture (Sheldon, 2009). The patient suffering from a serious illness is a major concern of the nursing staff, the physician and the health psychologist. Health professionals need to have the necessary training to cope with the gravity and leverage their therapeutic communication skills. The principles of palliative care include dialogue, understanding, courtesy and the acceptance of the patient's behavior, while also focusing on the patient's abilities and attitudes, particularly those that catalyze depression after diagnosis (Kozłowska & Doboszyńska, 2012;Sheldon, 2009).
Particularly in cases of patients suffering from lifethreatening diseases, a particular kind of sensitive handling is needed as the idea of death can overwhelm the patient who is diagnosed with a lifethreatening illness. Health professionals play a key role in making this life change less painful and helping patients prevail. Patients might prematurely assume future losses as well as unfinished plans (Khoshnazar, Rassouli, Akbari, Lotfi-Kashani, Momenzadeh, Rejeh & Mohseny, 2016).
Healthcare professionals and all those involved in the care of patients can provide holistic care only if they are able to recognize and cover the mental and emotional needs of their patients ( Searle, 2001). Parkes (1998). To help those who are dying, they have to be prepared to stand by them and share their fears and try to diminish their panic. This includes a deep level of communication, which can be a privilege and also a painful experience. In short, care of people in the final stage is difficult and demanding. Health professionals are asked to support both the sick and the person's relatives. At the same time, however, they have to cope with their own feelings of pain, loss and death. Yet many consider (wrongly) that the influence and personal mourning of the health professional indicates a kind of weakness or failure. Thus, it is important that health professionals know their personal and professional limits. Appropriate training is necessary around illness and pain relief.