ADJUSTMENT REACTION

Anyone facing loss or change has to adjust. The concept of an “adjustment reaction” is a helpful way of understanding the transient episodes of anxiety and depression in terminal illness, bereavement, or any major crisis. (see Crisis Theory)

The term “psychosocial transition” describes a sudden major change in lifestyle that permanently alters a person’s assumptive world (the set of assumptions we make about the world, based upon past experiences, and expectations of the future). The assumptive world not only contains a model of the world as it is, but also as it might be. Giving up hopes or dreams for the future can be more difficult than giving up objects which actually exist. (Psychotherapy can be described as a painful reviewing of prior assumptions.)

Changes can occur in:

• Familiar environment
• Physical or mental capacity
• Role or status
• Expectations of the future
• Personal relationships

Several changes often occur simultaneously, making adjustment all the harder.

Elderly persons can become very disturbed and even confused by changes in their physical environment. Loved possessions can become an extension of self – the tools by which we function in the world. Losing them can produce a profound sense of insecurity and loss of confidence.

Increasing dependence can be seen as “giving in” and can cause increasing frustration. Giving permission to “regress” to a more dependent state can bring satisfaction to both the patient and carers. Sometimes this need to regress in illness has to be explained (for example, when a mother-child relationship is re-established and pushes out a new husband or wife).

Changes in role are painful but they can be coped with. A man who is ill may feel threatened by further loss of role if his wife needs to learn to drive, but can be helped to see that he can assist in teaching her and take pride in her new achievement.

Unrealistic hopes about the future bring frustration. Unrealistic fears can bring crippling anxiety. Meeting a patient more seriously ill than oneself who is coping well and cheerfully can enable a person to look to the future in a more optimistic and realistic way. (see Day Hospice)

Illness often involves restructuring of a family unit. The amount of time spent with different family members may suddenly change. New bonds strengthen, others weaken. Helping family members communicate with each other about all the changes facilitates adjustment. (see Communication Problems, Talking with Families)

Good hospice and palliative care can largely be seen in terms of facilitating this process of psychosocial transition. Encouraging communication allows people to close the gaps between their internal assumptions and their real situation. (see Crisis Theory, Grief, Support)

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.