L'appropriation d'une maladie chronique

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The medical advances now make it possible to stabilize the health of patients and reduce symptoms. These diseases become chronic. The goal for patients is not to establish a short-term project “death” but life projects, projects to improve maximize their health and quality of life. Psychological work on oneself is essential to be able to live as well as possible with a chronic illness, it is the process of appropriation. It is “an active strategy that will be a prerequisite to behavior change on living with the disease” (Ninot and Roche, 2009).

The combined ownership of chronic disease

Ownership of a chronic disease has 6 phases. They vary in duration and intensity depending on the person.

Stage 1: Denial

The denial phase symptoms is a defensive strategy to minimize the impact of the signs of the disease on daily life. Unable to bear their appearance, the person, his entourage and / or caregivers are not out to understand their true meaning and implication in the future. Each clings to the idea of a total recovery of health after each symptomatic event. Minimizes patient discomfort punctual. “I’m sure it will pass.” The entourage puts the severity of signs. “My friends think I add, they must be right.” Not knowing, or can not, control the onset of symptoms, avoidance strategies are activated.

Phase 2: anxiety-related symptoms

The anxiety-related symptoms phase is the fear of triggering the symptoms become more intense, frequent and / or sustainable. Anxiety is caused by its most disabling situations in everyday life in the early events. Specifically, the environment can be seen emotional overreactions. The uncertainty caused by the situation will be a key driver of medical consultation.

Phase 3: The shock

The shock phase following the diagnosis. It has a suddenness, quantified by a battery of tests of unspeakable evil. Is often reinforced by the memory of a recent exacerbation and / or emergency hospitalization. The patient and family are not able to integrate spontaneously diagnosis, let alone the complexity of which is to determine prognosis due to multiple risk factors and protective game. Way to advertise the disease and its implications by the physician will determine the kinetics of the following steps. The patient will feel more detached from the situation, placing the viewer in what happens to him, the more the next phase will be long. Another factor extension of this phase will be the poor quality of the ad with vague or simplistic terms.

Phase 4: Denial of illness

The denial stage of chronic disease is a defensive strategy to avoid the anxiety caused by the non-reversibility of the situation and the required changes in lifestyle. The person minimizes disease yet objectified by physiological measures. She refuses voluntarily to understand the consequences for his future life thinking that being really sick at times. She is not ready to hear all about the irreversibility of the situation and the family and professional consequences. She clings to the idea of a possible cure. She accuses other officers responsible for his illness. Social isolation, withdrawal, denial of care and aggression (verbal or nonverbal) are current modes of expression.

Phase 5: The anxiety associated with the disease

The anxiety associated with the disease stage is devoted to the consequences of disease and adjustment conditions facilitating welfare. The patient is aware of the systemic repercussions of the disease. The repetition of exacerbations and activity restriction providing fun lead to a real awareness of the situation. The patient wants to change best by working out with health professionals of a program of care. This attitude brings hope of new life plans. Conditions are ripe to begin behavioral change and switch to ownership.

Phase 6: Minor depression associated with the disease

The phase of minor depression associated with the disease represents a transient period of abandonment, renunciation. This is a stage of questioning and despair, which is characterized by a significant pessimism, feelings of sadness and low self-esteem. The person asks why all efforts face a disease that is gaining ground. She no longer feels belong to the world of “valid”. This impression is accentuated by the eyes of others, difficulties in assimilating total invalid. The status of “sick” takes precedence over the individual.

Appropriation or resignation

Once Phase 3, the patient can switch in ownership or resignation. This flip-flop can be done at each subsequent stage without being definitive. The appropriation phase is a deep psychic reorganization has taken realization that there must cope with the disease and its constraints, however, trying to limit the impact on daily life. The irreversible loss, partial or complete, structure and / or function – if unsustainable when the diagnosis – is now raised with less suffering. The person with less emotion addresses the true causes of his illness. She jokes, refuses to complain about your life, learn to live with the disease, concurred. A new identity begins to build, which will come to life as the person thrives in different projects and / or she highlights her body by strengthening motor skills, control of symptoms (routine situation or emergency). Some gains in his situation appear (parking …). This new hierarchy of values demonstrates that life “takes over”. This process changes the relationship with others. Having approached death so closely during exacerbation and for having the courage to overcome this test makes it worthy, more attentive to the slightest signs of life, humble, generous, tolerant and more sensitive to human suffering . This process transforms the way of understanding life. The person can better appreciate his inner life and open up to others. The “carpe diem” becomes a leitmotif. Appropriating the disease, it is also love. Metaphorically, ownership allows floating, emerged to stay, regardless of the sea conditions Chronic disease is then placed in a kind of exchange. Received a gift you need to know go by enhancing the remaining life . It is then the process of metamorphosis and a new life. She asked about lifestyle, relationships, recreation, relaxation, eating habits, physical practices, sexuality, spiritual interest. This appropriation will thus improve adherence to the continued rehabilitation and patient compliance.

Conversely, resignation is a fear of an abandonment of self, a fatalism. It engenders compensation behaviors such as smoking or alcoholism. These patients without project no longer tolerate their incapacity and disability and waive psychologically to live. They indulge in morbid lines aggravating their health, as a kind of provocation to death, sometimes even entails suicide. Metaphorically, the patient feels overwhelmed by the elements.

Never finished

Ownership and resignation are not final. Periods of doubt, crises, medical complications, exacerbation may lead a patient to return to the stage where he was before, or phase directly lower in the process. Family or business circumstances such as rupture with spouse or forced occupational retirement may jeopardize the fragile balance and contribute to psychological reshuffle.

What it means for Patients

Speaking of “mourning” about a chronic illness is the result of an amalgamation with acute disease in the Health Blog © want to report. The concept of ownership, active approach to change, should be preferred. The quality of life may be an indirect measurement. A good quality of life mean how the patient has learned to live with chronic illness, how it is appropriated by such person. He will understand the need for adherence to care, created the conditions for a relationship of trust with the therapeutic team, able to initiate its own responsibility in controlling his condition.

What it means for Healthcare Professionals

One theory widely used in clinical practice to describe the psychological process of acceptance of the disease is that of Kubler-Ross (1976). It distinguishes six consecutive phases supposed characterize the grieving process of a patient with a chronic disease. According to this derivative Freudian work on loss, grief and melancholy theory, the patient successively through a period of shock, denial, rebellion, bargaining, depression and finally acceptance of the disease. This theory was established in oncology in the 1970s which was mostly palliative care, as announced in the title of the work of Kubler-Ross, “The last moments of life.” Lack of therapeutic solution to limit the rapid evolution of the disease, the goal of the patient was in the short term to accept death rather than allow the patient to develop a life plan in the medium term. The Kubler-Ross model (1976) therefore does not apply to most chronic diseases in adults. It can serve as a model for clinical rehabilitation considering the topic as a whole, its unique projects, living arrangements and chronicity of illness. The model of ownership is best for chronic diseases.

What it means for Researchers

Understanding the determinants of ownership of a chronic disease is essential in order to choose the appropriate treatment if they have to take the long term.

What it means for Policymakers

The concept of ownership of chronic illness is better than accepting that suggests too much passivity.


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