Descriptive Psychopathology: The Signs and Symptoms of ...

345 Chapter 14: Personalityill, also have concerns about family, friends, their body image, pain, finances,and how they will die. They may express guilt about a low mood and sadness,their anxiety and being slowed down and being unable to work and earn. 64 Theymay appear depressed, but demoralization is most likely, followed by depressivelikesyndromes due to paraneoplastic disease and malnutrition. Consultantpsychiatrists are often asked to see such patients to prescribe antidepressantsand anxiolytics as if the behaviors were always signs of pathology. Patient 8.1,the Scottish woman who awoke weeks after her surgery to find her life dramaticallyaltered, only needed “cheering up”. Another example of demoralizationfollows.Patient 14.3A 49-year-old woman with incapacitating COPD was hospitalized for feverand a possible lung tumor. At baseline she was mildly anxious and demoralized.A bronchoscopy was advised, but in the discussion of potential problemsfrom the procedure, the patient was told that her pulmonary status was sopoor that the procedure might precipitate the need for intubation and thatshould that occur she might never be off a respirator. That possibility led toher refusal, even after being told that she might die in her present state.A psychiatry consultant was asked to evaluate her capacity. 65The patient, in bed and receiving nasal oxygen, was found to be alert,anxious, and tearful. She denied depression or being suicidal, but declaredher life was already too restricted and the risk of permanently being on arespirator to be overwhelming: “The only thing left to me is talking to mychildren.” Although she had some cognitive problems (e.g. poor animal namingand delayed recall), she understood the procedure, why it was recommended,her present state of health, and the possible consequences if the bronchoscopywas not done and no further treatments prescribed. The psychiatry consultantconsidered her to have the capacity to make the decision and recommendedcounseling, which the patient readily accepted.DivorceIn societies in which divorce is highly stigmatized, more shame and guilt isexperienced by divorcing couples. In male-dominated cultures the consequencesare greater for women. Societies where divorce is more accepted, persons experiencerelief or anger depending on the conditions under which the divorce istaking place.Divorced couples experience signs and symptoms similar to bereavement. Theconflict between parents, loss of daily contact with one parent, and disruption ofroutines and place of residence associated with divorce affect children, who also