Religion and Spirituality in Psychiatry

192 Harold G. Koenigresentful over their extra burdens, and then communicatethis resentment directly or indirectly tothe dependent person. Is there any wonder whylevel of disability is one of the strongest predictorsof depression in medical patients?2.5. Change of Roles in Familyand SocietyWhen patients are no longer able to work, generatean income, or contribute to family responsibilities,their importance and leadership positionsin family and community are affected. The sick ordependent person often loses value and respectin the eyes of family members and society. Thisloss of “position” can be very distressing, especiallyfor those who derived a great deal of satisfactionin being independent and able to providefor themselves and others.2.6. Loss of Social RelationshipsPatients with chronic and/or serious medical illnesshave a difficult time both maintaining socialrelationships and making new ones. Hearing difficultiesmay interfere with communication, andchronic disability may impair mobility necessary toattend social events. Medical symptoms, especiallyloss of energy, can keep patients in their homes orrooms and may reduce motivation to get out forsocial interactions. Social isolation, then, becomesa huge problem for those with chronic illness andmay lead to depression, which may increase socialwithdrawal and increase loneliness. A vicious cyclequickly develops with increasing social isolation andincreasing depression, which feed on each other.2.7. Loss of Ability to WorkWork not only structures how people spend theirtime during the day, but also is a major sourceof identity and self-esteem for many. Not beingable to work or contribute meaningfully becauseof medical illness or disability can be devastating.Loss of work can also mean loss of ability togenerate income and provide support for self andothers. If depression is to be successfully treatedover time, then issues related to loss of work mustbe addressed.2.8. Loss of Opportunities to MeetLife GoalsMedical illness may portend permanent changesin physical functioning or may limit cognitiveabilities, which can result in the realization thatlifetime goals in work, career, or family maynever be achieved. These patients need to identifynew goals that are within their remainingabilities given their physical limitations. Patientsmay need counseling to develop their abilitiesso that worthwhile life goals can be successfullypursued despite limitations. Keeping motivation,hope, and vision alive become crucial.2.9. Loss of the Ability to Makea DifferenceUntil becoming sick, many patients may have takenpride in making a positive difference in people’slives. Providing for family, raising children, contributingto church or community, helping a neighbor,contributing to goals in the workplace, and soforth may have been important and meaningful.Illness can interfere with all that, particularly whenillness is chronic. Inability to make a positive difference,or its opposite, seeing oneself as making anegative difference in family or friends’ lives, canbe devastating to self-esteem and self-image.2.10. Loss of Purpose and Meaningin LifeAny one or a combination of the above lossescan leave patients feeling as if their lives have lostmeaning and purpose, and that they no longerhave a reason for living. Such feelings lead tohopelessness, discouragement, loss of motivationfor self-care, and can ultimately lead to the convictionthat life is not worth living and that deathis the only way out. Although antidepressants,anti-anxiety drugs, and other biological treatmentscan be extremely helpful in relieving painfulsymptoms, they do not address the core issues