Chapter 26 - Demoralization in the medical setting

Summary

Subjective incompetence is an essential facet of demoralization. Subjective incompetence has roots in catastrophic thinking, as the patient compares past failures and current limitations, arriving at the conclusion that future failure is guaranteed. Adjustment disorders, the most frequent psychiatric diagnosis, may have the most in common with demoralization in the medical setting. When patients are overwhelmed by the disease state, they may express a spectrum of anxiety. Treatment of demoralization syndromes depends on multiple factors. The factors include: the issue that is fostering the dysphoria; the way the issue impacts upon the individual's life trajectory; patient's personality temperament; and available social supports. For helpless patients who are giving up, environmental and social support can often remit the demoralized state, while those who have given up require more intensive pharmacotherapy plus psychotherapy. Thus, the clinician utilizes both psychotherapeutic interventions and pharmacotherapy depending upon the unique situation of the patient.