PubMed · 14669375
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Liz Main. 2003. This life.. https://pubmed.ncbi.nlm.nih.gov/14669375/
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Despair as a phenomenon has not received much attention from psychopathologists, which is difficult to grasp in the clinical context. This paper is an attempt to elaborate upon despair as a key concept and thus open up a new field in psychopathology. The historical approach leads to a twofold view on despair, namely as an affect and as a cognitive structure. The paper therefore follows both the affect theories developed since the onset of the modern era and the cognitive theories on doubt at risk of progressing into despair. Using current approaches of cognitive emotional psychology, despair is defined as an oscillating, affective-cognitive process: the oscillation of doubt is reflected in the alternation of various single affects such as hope, fear, anxiety, anger, shame, guilt, and sadness and then moves towards the negative pole of increasing affect diffusion, loss of object relation, hopelessness, and suicidality. On the basis of this model it is possible to elaborate specific types of despair in individual psychiatric disorders, assessments of the stage of the process, and possible therapeutic strategies.
BACKGROUND: Emotional distress and psychiatric syndromes are prevalent in the breast cancer population at large. However, to date there is a paucity of literature specifically concerning presurgical breast cancer patients. METHODS: The authors assessed 236 newly diagnosed patients at the time of their presurgical consultation at the Comprehensive Breast Cancer Program of Dartmouth-Hitchcock Medical Center in Lebanon, NH. RESULTS: Of patients in this study, 41% rated their distress in the clinically significant range on the Distress Thermometer (ie, >5, 0-10 scale). Nearly one-half (47%) of patients met established thresholds for positivity on 1 or more screens for distress or psychiatric disorders. Prevalence rates were 11% for major depression (60% of these patients were moderately severe to severely depressed) and were 10% for posttraumatic stress disorder (PTSD). Emotional symptoms markedly interfered with daily function in both groups. Of depressed patients, 56% were already taking a psychotropic medication, yet they still met screening criteria for major depression. CONCLUSIONS: Emotional distress and psychiatric syndromes (major depression and PTSD) were prevalent in this population. Markedly impaired function was evident for both depressed and PTSD patients. Future research should refine current screening procedures and develop interventions to better address emotional distress and psychiatric disorders in newly diagnosed breast cancer patients.
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