Bernard J. Bergen

The Relationship to Death as a Source of Stress for Nurses on a Coronary Care Unit.

This paper attempts to understand one of the ways in which nurses on a coronary care unit may be subjected to stress around the problem of establishing a meaningful relationship to death. The themes that nurses expressed during the course of a support group which they had requested are analyzed and discussed. The paper focuses on the stress felt by the nurses over responsibility for controlling illness and death which indicated an unconscious confusion between the feeling of being responsible for the care of an ill or dying patient and the feeling of being responsible for the occurrence of the patients illness or death. The possible source of this stressful confusion in medicines and societys own relationship to death is discussed.

An attempt to examine the perception of self and hospital among chronically ill mental patients.

AS new programs are formulated emphasizing community rehabilitation of the mentally ill, increasing attention must be paid to the large numbers of &dquo;chronically ill&dquo; who make up part of our present in-patient population. One important question to be answered is: What characteristics of these patients must be taken into account as we seek to restore them to some level of community functioning? Some studies have already suggested that a marked deterioration of social skills,’ lack of motivation,9 and sense of alienation from societyg are some of the factors with which any new rehabilitation program must cope.

PSYCHIATRIC HOME TREATMENT: PROBLEMS OF INNOVATION IN COMMUNITY PSYCHIATRY.

P ROVIDING treatment for mental illness is a process notable for alterations JL and changes in tactics and strategies over a period of time. No treatment system -i.e. the structure and arrangements whereby services to the mentally ill are organized and distributed-is perfect. Such systems necessarily undergo constant alterations and variations in the nature of the treatment techniques and the kinds of ancillary services provided, and the manner in which such services are presented. The most recent emphasis in psychiatric programming centres upon revising the structure of the treatment system, not only within a single institutional arrangement, as in the case of the mental hospital, but also in terms of further extending psychiatric services to the community at large. This latter has become an issue of central concern and a number of innovating programmes are being formulated towards this end. (6.8) Just how vigorous and fruitful they will be is a question which will require continual and systematic evaluation. It cannot be assumed that a programme simply, upon introduction, will function maximally to meet perceived deficiencies in patient treatment, responsibility and management. What requires clarification, among other things, is that the structure and functioning of treatment systems are not subject solely to rational procedures and rational considerations. Research on the functions of mental hospitals and on the development of programmes for the treatment of juvenile delinquency, etc., is beginning to show that the innovation of treatment procedures, although perceived as undeniably valid, logical and necessary, may encounter irrational forces and factors ingrained in diverse elements of the socio-cultural context in which the innovation is instituted. These factors appear to operate not only as contingencies in achieving goals, but often unknowingly operate to alter the definition held by the agency of the goals themselves. <15> 21) >

Psychosomatic Knowledge and the Role of the Physician: A Sociological View

One of the important tasks for psychosomatic medicine is that of educating clinical specialties outside of Psychiatry to the way in which psychosocial factors are implicated in illness. There is reason to believe that this educative task is more complicated than it appears at first glance. One of the difficulties may lie in a resistance on the part of physicians to integrating psychosocial knowledge into their ongoing activities because of a threat which that information poses to the historical foundation of their role. Following Foucaults study of the origin of modern medicine, this foundation can be said to be grounded in the belief that the truth of the suffering patient is that which reveals itself in the space of the body to the informed gaze of the physician. Psychosocial knowledge confronts the physician with the need to accept coexistent realities of the suffering of illness. As disruptive as educating physicians to this idea of “coexistent realities of illness” may be, it is essentially a task, belonging to psychosomatic medicine, of bringing the physician into the circle of scientific modernity.

A look at social support patterns

The issue of how to provide support for patients with a life-threatening illness continues to be a problem for pastors and chaplains. The authors discuss the significance and reasons for looking at the present day social support patterns as an “unnatural” problem. Unless the “unnatural” nature of support in the modern medical setting is understood pastors and chaplains can miss the target on answering the question of how to provide support. The authors conclude the article by addressing this question from the position of reserving the “unnatural” nature of providing support.